The ins and outs of menstrual cups — How do they differ from tampons and pads?

A menstrual cup is a flexible cup worn inside the vagina during menstruation to collect menstrual fluid, rather than absorb it like tampons or pads. While insertion and removal may take some time to get used to (more on techniques in a bit!), many people consider menstrual cups to be an innovative and safe alternative to tampons. Whether they're more difficult to use than tampons can be a personal opinion and varies based on each user. The menstrual cup differs from a diaphragm as it's a menstrual product intended for use during menstruation, while the diaphragm is a form of contraception. While both are inserted into the vagina, they have primarily different functions. Menstrual cups are considered low risk for people of all ages, regardless of sexual experience. They provide a number of benefits, some of which are unique to the menstrual cup.
Some of the benefits the menstrual cup include:
•Reduced risk of toxic shock: The fibers that are used in tampons have been associated with the rare toxic shock syndrome. Because menstrual cups are made with medical grade (non-latex) silicone or hypoallergenic rubber, the risk of toxic shock is reduced.
•Longer wear time: Menstrual cups can be worn for up to twelve hours, while tampons and pads generally need to be changed every four to six hours. Additionally, extra materials won’t need to be carried as the menstrual cup can be reinserted.
•Environmentally friendly: Pads and tampons end up in landfills. Since most menstrual cups are reusable, this drastically decreases the amount of waste being put into landfills.
•Budget friendly: Because they're reusable, the costs associated with menstrual cups are generally lower than purchasing pads and tampons each month. They can be worn during vigorous physical activity, such as swimming, aerobics, and dance.
While there are a number of benefits, there are some people for whom a menstrual cup may not be the right fit. Consult a health care provider before using a menstrual cup if you have an intrauterine device (IUD) inserted, have had toxic shock syndrome, just had a baby, a miscarriage or an abortion, you have a tilted uterus, if you've been advised to avoid tampons after a surgical procedure, or have other medical conditions you feel may interfere with wearing the cup. Additionally, some people may find that it doesn't quite fit their body how they'd like or find that it can be a bit messy. They also require more upkeep than tampons or pads do in order to keep them clean and in good condition each month.

If you feel like this method might be your cup of tea, it's good to know that there are a few different varieties of menstrual cups on the market. If you choose to try one out, make sure to read the manufacturer's directions and recommendations, as each product differs. Most are washable and reusable, but there are disposable menstrual cups, too. The cups look similar to a cervical cap with small flexible rods connected to the base to aid in their removal (kind of like a tiny plunger). Depending on the product, it could last up to ten years.
Insertion and removal of menstrual cups typically takes practice, just as tampons and diaphragms do. The more knowledgeable and comfortable a person is with their body, and the more they practice insertion, the easier it will be. To insert the cup, squeeze and fold the sides of the cup, then push it into the vagina. As it opens up inside, it creates a very gentle seal with the vaginal wall. The cup is held in by the muscles of the vagina, and if put in properly, typically it won’t be felt after it's been in for a few minutes. To remove the cup, pull on the stem, and gently squeeze the base of the cup. This releases the seal. Gently remove it, empty it out, then rinse it out or wipe it. With practice, privacy, and persistence, spills can be minimized.
All types of menstrual cups are safe for people who haven’t had penetrative sex to use, although insertion can lead to hymen (the thin tissue at the opening of the vagina) stretching. Remember, the hymen can stretch for reasons other than vaginal penetration — sometimes just from bicycle or horseback riding, gymnastics, or dancing. If you are considering using menstrual cups but are worried about hymen stretching, it may be helpful to consider what you feel comfortable with, your priorities, and your cultural values. Now that you're more informed, feel free to give this method a try!
Alice!

Extended-cycle birth control pills: Putting periods on hold

Dear Reader,
You bet your buttons there are more period-pausing (or eliminating) options out there, including but not limited to birth control pills! As you mention, Seasonale is one brand name for the “combination pill” which is a formulation of estrogen and progestin — the same hormones used in many of the 21-day or 28-day cycle birth control pills. However, unlike those monthly cycle pill packs, you would take “active pills” (containing the hormones) every day for twelve weeks (84 days) followed by a week of “inactive pills” (placebo) that contain no hormones. Long story short: Seasonale is one of several pill options that allow you to get your period once every three months. If you find that the pill options aren't the right fit for you, there are a number of other contraceptive options that can also lighten or stop periods (more on these in a bit).
When taking hormonal contraceptives, people get what is referred to as withdrawal bleeding rather than true menstruation. This occurs due to not having the same level of hormones from the contraceptives when inactive pills are taken, rather than due to the body’s actual menstrual cycle. That being said, despite not being actual menstruation, this withdrawal bleeding is still often referred to by health professionals as a period. Pills that give you a period every three months come in a variety of hormone doses including some with lower or fluctuating levels of estrogen throughout the pill pack. If three periods a year sounds like your jam, ask your health care provider about different brands and dosing in this category to find the right fit. If a period every three months is still more frequent than you’d like, you may be able to stop your periods altogether. If you’re interested in officially parting ways with Aunt Flo, talk to your health care provider about combination birth control pills that can be taken continuously with no placebos, ever. No breaks in the hormones means there’s no period, period!

Although the withdrawal bleeding isn't medically necessary, to some, a monthly period is a welcomed reassurance that their body is working properly and that they're not pregnant. But, having fewer (or no) periods may appeal to those who don't want to have their period or those who have:
•Heavy menstrual bleeding
•Long or painful periods
•Bloating, breast tenderness, or mood swings in the ten days prior to menstruating
•Difficulty using sanitary napkins or tampons
•A health condition worsened by menstruation, such as endometriosis or anemia
•An upcoming event during which menstruation would be inconvenient or undesirable (e.g., vacation, a honeymoon, the first week of a new job, or final exams)
Curious about any downsides of using pills to skip periods? Breakthrough bleeding (bleeding or spotting between periods) is common, but typically improves after the first few months. The chances of breakthrough bleeding increase if you miss taking a daily pill or if you smoke. It’s worth noting that there aren’t adverse health risks associated with period skipping or your ability to get pregnant in the future. On the other hand, there are some people for whom combination pills aren't recommended. If you have a history of heart problems or stroke, breast, uterine, or liver cancer, diabetes, a clotting disorder, high blood pressure, migraines with aura, or if you smoke and are over 35, your health care provider may not recommend the combination pill.
If the pill isn’t a great fit for you, not to worry! There are plenty of other period-modifying options out there to consider. Several types of hormonal IUDs and the contraceptive implant have been shown to lighten or eliminate periods altogether after a year of continuous use. The birth control patch and the vaginal ring can also be used to skip periods. For example, if you want to skip your period using the birth control patch, it's possible continue to put new patches on each week, skipping the patch-free week when you'd typically get your period. To use the ring to eliminate periods, leave the ring in place for four weeks, skipping the week that it's generally removed. Switching it on a routine schedule every four weeks for continuous coverage. It's wise to discuss these different options with your health care provider as you navigate your personal and sexual needs.
Here’s to punctuating your calendar a little less frequently, if that’s what you’re after!

Anal sex — Pregnant?

Dear Worried Boy,
Strictly speaking, sperm entering the anus can't lead to pregnancy. The only way someone might possibly become pregnant from anal play is if ejaculated semen is near the vulva or vaginal opening and that semen happens to work its way upwards into vagina. Otherwise, there is no chance of conception with anal sex. Is there more to learn more about the anatomy involved? Butt of course!
The anal opening leads to the rectum (the storage area for feces prior to defecation), which is one segment of the large intestine. The large intestine is an organ that is part of the exclusive and fully-enclosed gastrointestinal (GI) tract, which is essentially a long tube from the mouth to the anus. The ovaries, vaginal canal, cervix, uterus, and fallopian tubes (where fertilization can occur) are part of a physically divided set of organs that comprise the female reproductive system. Also — note that while the medical establishment typically refers to these organs as the female reproductive system, not everyone who has these organs identifies as female.

The GI tract isn't directly connected with the reproductive tract; therefore, sperm entering the anus cannot swim through the GI tract to reach the egg in the reproductive tract. Similarly, sperm entering the mouth can't cause pregnancy.
While pregnancy might not be a top concern, if you or your partner are ever unsure of your sexually transmitted infection (STI) status, it's wise to use safer sex techniques (such as a condom) during anal sex or any other sexual activity. If you're worried about semen accidentally coming in contact with the vulva or vagina, a condom can help reduce that risk (and hopefully some of your worries as well!).

Mammogram

Dear Reader,
Mammograms are a type of low-dose X-ray that helps detect breast cancer at its earliest and most treatable stage. The test allows for clinicians to screen for breast lumps that may be too small to be felt during a manual exam. Many individuals with breast tissue start getting yearly mammograms when they turn 40, although experts have differing opinions for when to begin screening. The American Cancer Society (ACS) recommends that individuals assigned female at birth age 45 and older get mammograms every year until age 54, whereas those age 55 and older may choose to continue their yearly appointments, or start getting them every other year. On the other hand, the United States Preventive Services Task Force recommends that people assigned female at birth start at begin getting mammograms every other year from the ages of 50 to 74. They recommend that those who are 40 to 49 may find it to be helpful to start the screening earlier based on their own personal risk. All that being said, despite the variations in when to start for those with average risk, if someone has a family history of breast cancer or genes known to increase the risk of breast cancer (such as the BRCA gene), it’s recommended that they discuss the possibility of starting mammography at an earlier age with their health care provider.
Now to get into more specifics: mammography is used for two purposes. The first is for screening in order to identify any possible breast abnormalities, and the second is to diagnose any breast changes that have already been noticed. The first time someone gets a mammogram, it's usually used to get a baseline reading of what a person’s breast tissue typically looks like. This first image will be compared to later mammograms to help detect any changes. Mammogram images then help providers determine if further diagnostic testing or treatment is needed.
Before booking a mammogram, it’s good to look for a certified facility. The good news is that the United States Food and Drug Administration (FDA) provides a list of certified facilities across the country. If cost or lack of health insurance coverage is an issue, check out the Center for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) website to determine if you’re eligible for free or low-cost mammograms and to search for such screenings in your area. For those with a regular period, when scheduling the test, consider planning it for the week or two after your period, as these are times when the breasts are less likely to be bloated or tender. This will not only help reduce discomfort during the procedure but also help with the picture quality.

On the day of screening, it’s recommended to avoid wearing deodorant, powders, lotions, or creams under the arms, as particles from these substances may show up on mammogram images. If there have been any recent breast changes, medical history that may impact the risk of breast cancer, and if breastfeeding or possibly pregnant, it’s best to let the technician know before starting the procedure. For folks who are new to a mammogram facility, it’s also recommended to provide the facility with any past mammogram records so that they can compare this year’s results with past images and information.
When arriving for a mammogram, clothing from the waist up needs to be removed, and the facility will provide some sort of wrap to wear. The mammogram technician will place one breast on a platform of the X-ray machine. During the test, the breast will be compressed between the platform and a clear plastic cover. They may ask for minimal movement and held breath during the X-ray. This compression helps spread the breast tissue out so the X-rays can get a clear picture. However, this does often cause discomfort, and individuals with sensitive breasts may want to take an over-the-counter pain reliever before their appointment. After both breasts have been compressed and X-rayed, the technician will check the clarity of the X-rays, and do retakes if necessary. It’s worth noting that additional X-rays don’t necessarily mean that there was something abnormal — it may just be that there was movement at the moment the X-ray was taken. Once that’s done, the mammogram is over! The entire procedure typically takes about a half hour.
After the procedure, federal law requires that all mammography facilities contact people with their results within 30 days. If the facility or ordering health care provider hasn't provided results within that time, it could be helpful to follow up. Depending on the results, individuals may be asked to undergo additional screening or follow-up diagnostic mammograms to further investigate an abnormality that was found on the first mammogram. Most of these abnormal findings are benign and may indicate the presence of calcium deposits, cysts, or spots of dense tissue.
Although it’s recommended to start mammography in their forties, individuals assigned female at birth are encouraged to conduct breast self-exams (BSE). Even though current research doesn’t indicate that BSEs help with early detection of breast cancer when individuals are also getting regular screenings, performing BSEs may prompt someone to become more familiar with their breasts and thus better identify any future changes. If you notice breast changes or have additional questions about breast cancer screenings, you may consider making an appointment with your health care provider to discuss your concerns.

Cramps after sex: Possible causes in men and women

Both men and women can experience cramps after sex. The medical term for pain before, during, or after sex is dyspareunia.
Cramps may occur after sex for many reasons, ranging from mild muscle strain to underlying conditions that may require treatment.
Read on for more information about the potential causes of cramping or pain after sex.

Causes of cramps in both sexes
There are many potential causes of cramps after sex in both men and women.
Muscle strains
Similar to during exercise, straining the pelvic and abdominal muscles during sex can sometimes lead to cramping.
Tight muscles, dehydration, or working the muscle in an awkward position can all cause cramps. These cramps usually dissipate after a few seconds to minutes.
Orgasm
An orgasm can also cause cramps. An orgasm involves the involuntary contraction of the muscles in the pelvis and pelvic floor.
If these muscles continue to contract intensely, they may cause temporary cramps after sex.
Bowel issues
Issues with the digestive system can cause abdominal cramping. Constipation and gas are two common causes of stomach pain after sex.
Other bowel problems, such as irritable bowel syndrome
, can also cause cramping.
Urinary problems

Likewise, problems with the bladder or urinary system can also cause pain after sex. The bladder sits right in front of the uterus, and intercourse can sometimes irritate it.
This is particularly true if someone has a urinary tract infection or a condition called interstitial cystitis, which causes pain and pressure in the pelvis and urinary system.
Sexually transmitted infections
Some sexually transmitted infections (STIs), particularly chlamydia and gonorrhea, can cause abdominal cramping, including after intercourse.
Many STIs do not cause any symptoms, so it is best to get tested regularly. Some STIs can also cause discharge from the penis or vagina, as well as pain during urination.
Emotional trauma
Sometimes, past trauma or an emotional issue surrounding sex can manifest as physical discomfort or pain during or after intercourse.
Even everyday stressors and anxiety
can build up and cause muscle tension or cramping.
Deep penetration
Deep penetration, especially against the cervix, can cause irritation and cramping. Injury or infection of the cervix can make it more susceptible to cramping or pain.
Ovarian cysts
The ovaries are two small organs located on either side of the uterus. Sometimes, a cyst grows on or in the ovary.
While these cysts are not usually dangerous, they can cause pain or discomfort after sex.
Ovulation
Each month, one of the ovaries grows a follicle that contains a maturing egg. About 2 weeks before a woman’s period, that follicle ruptures, releasing the egg for potential fertilization and conception.
Having sex around this time can cause abdominal cramping in some people.
Fibroids
Fibroids are growths that occur in the wall of the uterus. They are usually benign, or noncancerous.

The refractory period: What to know, and can you shorten it?

The refractory period is the span of time after having an orgasm during which a person is not sexually responsive. The refractory period can have both mental and physiological effects.
During the refractory period, a person might lose interest in sex, or they might not be able to have sex. It may not be possible for a person to get an erection, ejaculate, or orgasm.
Scientists have thoroughly documented the refractory period in males. In females, the refractory period is more controversial.

What happens in the refractory period?
Doctors define the resolution stage of sex as when a person feels satisfied, usually following orgasm or, in the case of males, ejaculation.
The refractory period occurs after the resolution stage.
During the refractory period, a male cannot get an erection. This type of response is a physiological refractory period, meaning a person is physically unable to have sex again.
Unlike males, many females can have multiple orgasms, suggesting they do not usually experience a physiological refractory period. Additionally, a female’s genitals may remain lubricated after sexual activity even if she no longer feels aroused, making sexual intercourse easier.
However, both males and females can experience a psychological refractory period.
This psychological type happens when a person does not want to have sex again. They may feel satisfied and prefer to avoid immediate sexual contact. Some people also feel tired during this period.
Brain imaging studies suggest that the cycle of a sexual response follows a similar pattern to other pleasurable activities. It begins with intensifying desire, culminates in satisfying that desire, and concludes with decreased desire.

Refractory period for males
During the refractory period, a male is unable to get an erection or ejaculate again. This physiological response usually accompanies a psychological refractory period, during which the person feels uninterested in sex.
The length of the refractory period varies greatly from person to person, from a few minutes to 24 hours, or longer.
Researchers do not fully understand what causes the refractory period or why it varies so much in duration from person to person. Additionally, not all males have a refractory period.
An older 2002 report on a 25-year-old male who did not experience any refractory period found that he did not secrete the hormone prolactin after ejaculating, as most males do.
This finding suggests that prolactin may play a role in determining whether a male can have multiple orgasms. However, as this was a small study, and females also produce more prolactin after orgasm, researchers need to continue investigating.
Similarly, some males find that they can orgasm without ejaculating, allowing them to have multiple “dry” orgasms and no refractory period.
While some females lose interest in sexual activity after an orgasm, they are usually physically able to engage in sexual activity again.
However, some women do report a physiological refractory period. One study from 2009 showed that after orgasm, a female’s clitoris can become too sensitive to continue sexual activity. Out of 174 females, 96% reported this symptom, and many did not want to have sex again as a result.
Most of the research into refractory periods to date has focused on males, so scientists know much less about the female response. Scientists will need to conduct more research to understand a greater variety of perspectives.
Changes with age
Sexual function tends to decline with age. People may need longer to get both physically and psychologically aroused as they grow older. They may also need longer to recover from sex, which may mean a more extended refractory period.
The refractory period a person has when they are young will also determine how it changes as they age. Someone with a long refractory period as a teenager may find it continues to get longer over time.

Are Sexual Lubricants Safe?

Previously, I’ve extolled commercial sexual lubricants as the slippery secret of sensational sex. Why the endorsement? In both women and men, lube enhances skin sensitivity to erotic touch. Many women of all ages don’t self-lubricate sufficiently for comfortable intercourse. And many post-menopausal women suffer chronic vaginal dryness. As a result, many sexologists encourage couples of all ages to use lube every time.

But now I must temper my enthusiasm. Recent research suggests that, in frequent users, sexual lubricants damage genital skin cells and may increase risk of sexually transmitted infections (STIs). I hasten to add that, for many lovers, lube benefits outweigh any risks. But the risks appear real and couples should understand them—and use lube with not just legs, but also eyes open.

Risk in High Osmolality?
Over the past 30 years, sexual lubricants have become quite popular. In the U.S. alone, they are a $200 million a year industry. A majority of couples have tried them. One-quarter of couples have used lube in the past month. And a broad consensus of women say they make intercourse more comfortable and enjoyable.

The most popular sexual lubricants—among them, Astroglide and K-Y Warming Jelly— are water-based, meaning that water is their main ingredient. In addition, these lubes contain glycerin and propylene glycol that slow the water’s evaporation and make the products slipperier than saliva.
But those other constituents also increase “osmolality,” a measure of the molecular concentration of ingredients. Most sexual lubricants have osmolalites substantially greater than the cells to which they are applied (hyperosmolality). When high-osmolality products come in contact with lower-osmolality genital or rectal cells, the cells lose water and shrivel up like grapes turning into raisins. And that may cause problems:


• Portuguese researchers exposed vaginal cells to either commercial high-osmolality lubricants or to a lubricant they formulated that had the same osmolality (iso-osmolality) as the cells. The high-osmolality lubes caused cell damage that might increase risk of STIs.
• The vagina contains a broad array of micro-organisms that help keep it healthy. University of Pittsburgh researchers found that high-osmolality lubricants kill some of these micro-organisms, possibly make the vagina more susceptible to STIs.

• Johns Hopkins researchers replicated the Portuguese study using rectal cells. The commercial lube caused greater cell damage, prompting the researchers to conclude that they might increase risk of HIV transmission.
• As part of an ongoing study, UCLA researchers surveyed adults about receptive anal intercourse (RAI) and lubricant use. Recalling the month before being surveyed, one-third of the participants reported frequent RAI and consistent use of lube.  Compared with couples who used lube infrequently or not at all, the frequent RAI-frequent lube users had three times the risk of a sexually transmitted infection—3 percent vs. 10 percent.

One of the Johns Hopkins researchers, biophysicist Richard Cone, Ph.D., advocates reducing the high-osmolality of lubricants, “Virtually all sex lubricants need to be reformulated.”
On the Other Hand
The problem with the studies just cited is that most studied cells in the laboratory, not people in the real world. Laboratory findings may be statistically significant, and therefore qualify for publication, but not really mean anything beyond the test tubes.

The one real-word study focused on couples who engaged in frequent anal intercourse, but that group represents only a small minority of the general population of lovers.
Meanwhile, Indiana University researchers gave 2,453 women one of several lubricants and asked them to keep a daily sex diary for five weeks. Compared with controls who did not use any lube, those who did reported substantially greater sexual pleasure and satisfaction with fewer genital complaints and no increased risk of STIs.

The Case for Saliva
The research to date raises questions about lube safety, but the only real-world study pointing to an increased risk of STIs involves couples who have frequent anal intercourse. For everyone else, there is no documentation of any increased risk, and some evidence of less risk. A confusing situation.

One reasonable response to the uncertainty would be to use the lube that’s closest in osmolality to genital cells. That product is Good Clean Love, available at Wallgreens and Target, or on their Web sites.
Another would be to use saliva, Nature’s own sex lubricant. Saliva is always available and it’s free. But saliva is not as slippery as commercial lubes and it dries quickly.

Meanwhile, a growing literature shows that in couple lovemaking, the key to women’s orgasms is not vaginal intercourse, but gentle, extended, cunnilingus—men providing oral sex for women. Intercourse can feel wonderful and many couples revel in its special closeness. But no matter how long intercourse lasts or how large the penis, the old in-out doesn’t provide much clitoral stimulations. As a result, among couples who equate “sex” and “intercourse,” men have orgasms around 95 percent of the time, but women’s rate is only around 50 percent.  But when men provide gentle, extended oral, women’s rates of orgasm increase to around 90 percent.

Cunnilingus automatically lubricates the vagina with saliva. So what if it isn’t as slippery as a commercial lube? During cunnlingus the man’s erection doesn’t enter the woman’s vagina, so friction and irritation are not issues. And so what if saliva dries faster than lubes? If the man provides extended cunnilingus, he’s constantly refreshing the saliva on the vulva and clitoris, so drying isn’t an issue.

Lubes may or may not do more harm than good. But lovers can easily skirt this controversy—and increase women’s likelihood of orgasm—by incorporating more cunnilingus into lovemaking.

The Odd Psychology of GoosebumpsThe Odd Psychology of Goosebumps

“Skin Orgasm” might be a great name for a punk band or a body lotion, but it’s also another term for goosebumps.
Physiologically speaking, your hair stands on end when your arrectores pilorum muscles contract after your nervous system detects a stimulus like cold or fright.  For most mammals, it’s an adaptation that modifies body temperature by providing more insulation. Chimpanzees, dogs, and cats have evolved a secondary “social warning” function where the raised hair means danger is at hand (Chaplin, et al., 2014). My chocolate Lab sports mohawk hair along his spine even when the neighbor’s dainty little Bichon strolls by. Go figure.

Approximately two thirds of us regularly experience “the shivers” with art—this is the feeling that's been dubbed skin orgasm. You might be in this group if you’ve ever felt the chills while watching a dramatic movie scene or listening to an awe-inspiring piece of music. A fan of classical music might feel a tingle down his back from the opening flute lines of Mussorgsky’s Night on Bald Mountain. My personal favorite is the haunting and commanding chorus in Carmina Burana. Speaking of power, how about the brass section blasting the very first notes in the Rocky theme song? Or the hairs on the back of your neck might rise in a piloerection (from Latin pilo meaning “hair”) brought about by John Cusack’s boombox playing Peter Gabriel’s "In Your Eyes" in Cameron Crowe’s classic teen flick Say Anything.

An “aesthetic chill” can happen whenever there is a quick change in volume, key, melody, or anything else that affects the atmosphere of a song. Part of the responsibility of an artist is to create music that moves the soul and takes you on an emotional journey. There are certainly go-to tricks and intensely emotional chords employed by filmmakers and musicians, but there is no set way to manufacture this sensation on command.


However, personality plays a role. The five factors most widely used to classify personalities are conscientiousness, agreeableness, neuroticism, openness, and extroversion. Collectively, these “Big Five” factors do a nice job of capturing many of the important dimensions that make us who we are. It is not a diagnostic tool that assesses abnormality or mental illness (Obsessive-Compulsive Disorder, depression, schizophrenia, etc.), but it is able to capture many of our interesting nuances.

For example, individuals who score high on the Openness factor are prone to piloerections from emotional and dramatic events. They enjoy the frisson that comes from watching YouTube videos of hockey player Mario Lemieux taking the ice for the first time after overcoming Hodgkin’s Lymphoma. It’s similar to the shudder of emotion one gets from listening to unedited footage of Martin Luther King Jr.’s "I Have a Dream" speech.

The element of surprise is what connects the psychology of openness and the physiology of goosebumps. The first time I heard John Bonham’s bombastic drums fall from the sky on "Stairway to Heaven," I wasn’t expecting it. Aesthetic chills usually include a violation of expectations with a rapid change—in tone, volume, melody—that wasn’t anticipated. People high on the Openness factor intentionally seek out and enjoy new experiences that break from normal patterns; it’s just what they do.

Did Cavemen and Women Have Better Sex?

No one said it was easy to find the right person. But it helps the dating process if you know how to gracefully exit from the wrong ones.

Survival of the fittest means carefully cherry-picking the right significant other for you. Thank you, Mr. Darwin, for your lessons in this. (Apparently there was an actual online dating site called Darwin Dating, which only allowed hotties to join, but it's no longer operative. Sorry, beautiful people.)

Psychologist Christopher Ryan, who wrote Sex at Dawn: The Prehistoric Dawn of Modern Sexuality said women probably had more control in the bedroom. In fact, he says:

       ...human males are in important ways sexually incompatible with human females, who are capable of multiple orgasms.

According to Ryan, women were "extraordinarily promiscuous" because of their ability to have multiple orgasms. Men usually had to wait their turn (and were equally promiscuous, of course).

Why was this part of our heredity? Humans have a very low rate of conception, so it was more successful if women just kept having sex. And orgasms are the cherry on the whipped cream.

So to feel like a cavewoman in bed, pretend he's just one of many, and enjoy your multiple orgasms. After you've made him wait his turn, of course.

You might also enjoy this cartoon on how to tell what your man is actually thinking. Next up: How can you compliment a beautiful person?

All Rights Reserved. Content including cartoon © Donna Barstow Cartoons 2019.  I upload new cartoons on Facebook, so please follow! Please contact me for usage rights and fees for cartoons in any of your projects or books.

Come Along with Me

The magical mutual, simultaneous orgasm. Is it all it's cracked up to be? How exactly did this event come to be so sensationalized, and take on such a powerful symbolic role in human sexuality?
The pressure on the male to sexually satisfy his wife is nothing new. In fact, many cultures (including Western culture, at various times) have actually believed that the female orgasm was as essential to conception as was the male climax. Some cultures even suggest that multiple female orgasms are necessary to create a healthy baby. In the Jewish tradition, it is considered a "mitzvah," or a sacred and encouraged act of kindness, for the husband to give the wife an orgasm during sex.

Physician Max Huhner argued in the early 1900s that if a man did not give his wife orgasms during sex, the poor wife might fall prey to the ills and evils of masturbation, condemning herself and her children and family to that sin's negative effects, and it would all be the fault of her inconsiderate, unskilled, and selfish husband.

Russell Trall was a physician in the 1800s who was actually an instructor of the young physician John Kellogg. Trall argued that unless a sex act was pleasurable to both parties, was generous and harmonious, and involved love, as opposed to lust, any children that might result would be flawed. The child of a lustful mating would show the weaknesses they inherited from their parents' corrupt union.

Men are under incredible internal and external pressure to give their female lovers an orgasm. A man rates his sexual self-esteem based upon his partners' response to his technique. When a man and a woman go to bed, the woman may worry about her body and appearance, while the man worries about his skills and his ability to sexually satisfy her. This is the main reason women fake orgasms. Women have told me, "Well, I knew I just was never going to come that way, but I didn't want to him feel bad." Or worse, "I knew he wasn't going to stop until I came, so I finally just faked it, so I could go to sleep already."


The pressure doesn't stop there. It's not enough for the man to give the woman an orgasm, but if it's a truly wonderful experience, both partners, theoretically, will magically orgasm at the exact same instant. So, simultaneous orgasm is an expression of a couples' communication, connection, bond, commitment, respect and sexual compatibility? Really? Granted, when it happens, it sure is nice. But does it really mean anything? I can't find any real research looking at it, other than some suggestions that mutual, simultaneous orgasms are not as common as people believe.

There is such incredible individual variation in people's bodies and sexual responses that mutual simultaneous orgasms are as likely to involve a lot of accidental timing and synchronicity as they are to reflect any mystical physical or spiritual bond. If anything, they may more often be driven by a man's sexual arousal and excitement at a woman's approaching climax.

This issue has been on my mind of late because of some clients I've seen in my practice. In the sexuality counseling I do, I often spend time with both individuals and couples, helping people realize that sexuality is a lot more than just an orgasm. That's a cherry on top of the experience, to be sure, but there is so much more to intimacy than worrying about whether someone climaxes. Does the timing of the end of the encounter — not that a sexual encounter necessarily ends with climax; there can be a lot more after that such as cuddling, talking, etc. — really have much to do with determining the value of the experience overall? It's like going to an amusement park, riding rides all day, and having a great time. And then, the last ride of the day ends up not being all that much fun. Does that last ride lead you to devalue the entire day, and regard it as a waste and a letdown? I often see people who approach sexuality that way: "It's all in the finish." For them, if the ending isn't just right, the whole thing loses value.

Sex and intimacy are complicated enough as it is. Can people just enjoy it for what it is, and stop putting so much pressure and heavy expectation on it?

Seventy Percent: A Statistic to Enhance Your Sex Life

I just finished teaching an undergraduate Psychology of Human Sexuality course, filled with well over 100 interesting and interested college students. The vast majority of these students entered the course with a vast amount of misinformation about sex. In fact, a goal of my course is to help students evaluate the images and messages they have learned through the media (e.g., television, movies, and internet) against scientific information about sexuality. 

Nowhere is the gap between media images and reality greater than in the realm of women’s orgasms. Media images (including porn images and mainstream movies) portray women as reaching orgasm through the stimulation provided by a penis in a vagina. It is thus no wonder that one study found that 75% of college women believe that most women orgasm during intercourse. The reality is just the opposite: About 70 to 75% of women have never had this experience.

The first researcher to report this statistic was Shere Hite. The 1974 Hite Report told us that 26% of over 3,000 women said that they experienced orgasm during intercourse when there was no accompanying clitoral stimulation. A more recent study, conducted by Glamour magazine in 2000, found strikingly similar results: Only 28% of women said they could orgasm from intercourse alone. In an anonymous survey of the women in my class who were having intercourse, 26% said they could reach orgasm during intercourse and 74% said they could not reach orgasm in this manner.

But, even this 26% - 28% is inflated. Most women answer yes if they have ever had an orgasm during intercourse. Significantly fewer women consistently have this experience. In line with research reporting that 3 – 10% of women consistently orgasm from penetration alone, when the women in my class were anonymously asked about their most reliable route to orgasm, a mere 3% answered “intercourse alone.”

Instead, the women in my class reported their most reliable route to orgasm was as follows:
7%: Manual Clitoral Stimulation
11%: Oral Sex
56%: Sexual Intercourse Coupled with Direct Clitoral Stimulation
While the actual percentages from my class are a little different than the Glamour study (in which 38% said they needed manual stimulation of the clitoris to orgasm and 21% said they needed oral sex), the take-home message is the same: Women reaching orgasm via the stimulation of a penis in a vagina alone is a myth.

The VAST majority of women require clitoral stimulation to reach orgasm.
However, this scientific fact was novel information to my students. As a woman growing up in the feminist era of Betty Dodson and OurBodies OurSelves, I asked my students, “How could you NOT know this?” 

"Movies" they said. Look at any movie—mainstream or porn—and you see women reaching orgasm through penetration. They aptly point out that even the movie “Kinsey” that I show in my class features Alfred Kinsey’s wife reaching instant orgasm via penetration.

The women and men in my class tell me that eradicating the myth of easily attainable vaginal orgasms and learning the reality of orgasms achieved through clitoral stimulation is life-altering. My women student say that before learning this, they had been feeling secretly and shamefully abnormal—leading many of them (almost 60%) to fake orgasms during intercourse. The male students tell me it is a huge relief to know their female partner’s orgasm is not dependent on their penis. They resonate with the words of Ian Kerner (author of She Comes First) who says that:

When we know how to recognize and navigate the process of female sexual response, when we understand the role of the clitoris in stimulating that process, then sex becomes easier, simpler, and more rewarding, and we’re impelled to create pleasure with our hands and mouths, bodies and minds. In letting go of intercourse, we open ourselves up to new creative ways of experiencing pleasure, ways that may not strike us as inherently masculine, but ultimately allow us to be more of a man. Sex is no longer penis-dependent, and we can let go of the usual anxieties about size, stamina, and performance. We are free to love with more of ourselves, with our entire self.

Clearly, both women and men benefit from letting go of the myth that women’s orgasms are penis dependent. Both women and men benefit from understanding the importance of clitoral stimulation.Too often we seek statistics to see if we are normal—fueling what writer Marty Klein dubs “normality anxiety.”

But, this statistic -- this 70 - 75% -- this one is different. It has the power to help many women stop wondering if they are normal and instead embrace their most reliable route to orgasm.

A Letter to Sexually Active Young Women

Dear Sexually Active Young Women,
About a year and a half ago, I wrote you a letter that went viral. This letter provided
advice to help make sex pleasurable that, sadly, too few of you had been taught. I’m sorry it’s been so long since I’ve written, but it isn’t because I haven‘t had you on my mind. In fact, just the opposite is true: You’ve been on my mind almost constantly, as I’ve been working on a book written to close the orgasm gap and empower you to orgasm. I’ve learned a lot writing this book—and I’ve become even more passionate about helping you become sexually comfortable and confident. I’m writing to share some of that with you now. Let’s start with the orgasm gap—what it is, why we have it, and what we need to do to close it.

Source: albund/depositphotos.com
First, men are having way more orgasms than women are. As just two examples, in one very recent survey of over 50,000 women and men, 65 percent of heterosexual women vs. 95 percent of men said they always or usually orgasm during a sexual encounter. This orgasm gap gets even bigger during hookup sex. In anonymous polls taken over several years in my own classes, 55 percent of men versus 4 percent of women say they usually reach orgasm during first-time hookup sex.
Second, there's also a gap among women based on their self-identified sexual orientation. In this same study mentioned earlier, lesbian women had significantly more orgasms than heterosexual women. In fact, an earlier study that found the same thing is the reason I wrote my last letter just to heterosexual women. But, in retrospect, this was a mistake for two reasons. First, in both of these studies, bisexual women were also having significantly fewer orgasms than were lesbian women. And, second and most important: ALL women can use information to enhance their sexual pleasure. In fact, as many as 50 percent of 18 to 35-year-old women say they have trouble reaching orgasm with a partner.
All of this tells me that rather than there being something wrong with women struggling to orgasm, something is wrong with our culture. Here’s what’s wrong—or in other words, here’s why your orgasm problem is a cultural problem:
We’re bombarded with media images of “sexy” women whose role is to attract and please men. Research shows that these images lead girls and women to constantly assess how they appear to others. Many women’s focus becomes on being sexually desirable to others rather than on their own sexual desires. Even worse, among women who have sex with men, some come to believe that a woman’s main role is to please men sexually, rather than to equally give and receive pleasure.
There’s way too much emphasis on penetration—the way men reach orgasm. Most movies (mainstream and porn) show women having amazing orgasms from penetration alone. As I say in my upcoming book, Becoming Cliterate, the false idea that women should orgasm from male thrusting alone is the number 1 reason for the orgasm gap. Instead, as I will tell you about in more detail in future letters, in order to orgasm, the vast majority of women (up to 95 percent) need some kind of clitoral stimulation, either alone or coupled with penetration. Yet, when with men, women often forgo this need and focus on penetration instead. In fact, during sexual encounters that involve intercourse, 78 percent of women's orgasm problems are caused by not enough or not the right kind of clitoral stimulation. Still, like I said earlier, it's not only when women have sex with men that they have orgasm problems, and the rest of the cultural issues below can affect any of you, regardless of who you have sex with.

Media images of sexy, beautiful, thin women lead many of us to dislike our bodies. If you dislike yourself naked, you’re not going to feel open and free during a sexual encounter. It’s impossible to have an orgasm while holding your stomach in.
Women are judged more harshly than men for having casual sex. This sexual double standard leaves many of you feeling conflicted about the sex you’re having. And, sort of obvious, it’s hard to have an orgasm when you’re guilt-ridden or ashamed.
Sex education focuses almost exclusively on the dangers of sex, and it’s difficult to enjoy something that you’ve learned is dangerous, rather than a pleasurable part of life.
Most of us have little to no training in sexual communication. Good communication is especially critical when it comes (pun intended!) to female orgasms, because what every woman needs is different.
Can you relate to anything on this list? If you identify as heterosexual or have sex with men, have you thought you were "supposed to" orgasm during intercourse? Or, regardless of how you identify or who you have sex with, have you ever felt ashamed of your body during sex? Have you ever wanted to tell a partner what you needed to orgasm, but didn’t know how?
Well, to close the orgasm gap, we have to attack all of these problems one-by-one. We have to change our culture, so women and men’s most reliable routes to orgasm—clitoral and penile stimulation, respectively—are viewed as equal. We have to give individual women (including you), the attitudes and skills needed to orgasm, including feeling like you deserve pleasure, knowledge of your body, and the skills to tell partners what you need. I can’t do all that in one blog, but I promise I will write again soon.
With Care for You and Your Pleasure,
Laurie Mintz

Helping Women Learn How to Have an Orgasm

As a sex therapist in private practice, I have come to understand that for many women, orgasm is a satisfying aspect of both sexuality as well as personal growth.
Often women come to see a sex therapist wanting to learn how to have an orgasm while simultaneously feeling like failures because the sexual techniques they have tried haven't resulted in having the Big O.

Learning to achieve orgasm involves your attitudes, thoughts, and feelings both about yourself and your body.
Currently, about 15-20% of women have never achieved orgasm. Many factors play into why women experience difficulty achieving orgasm including sexual values and attitudes including upbringing, religion, negative feelings about being sexual, experienced sexual trauma, negative body image, your feelings about your partner or your feelings about yourself. Also, many medications can interfere with the body's natural ability to orgasm. Have a talk with your doctor if you are on any medications and having trouble achieving orgasm.

The following is a four-step program I use with women to help them learn how to achieve orgasm and have a happy and healthy sex life.
Step 1.  Understanding Your Sexual Self
•Learn about feelings and attitudes regarding sex.
•Understand how your childhood shaped your beliefs about sex.
•Connect what your religious beliefs taught you about being sexual.
•Discuss what is normal and healthy for a sexual relationship while dating and during marriage.
•Understand birth control, STDs, and sex for pleasure vs. sex for conception.
•Use a hand mirror to look at your genitals.
•Review visual aids of women’s genitalia and the DVD “Becoming Orgasmic” to begin to normalize female sexuality.

Step One helps connect women with their thoughts and feelings about the role of orgasm in their lives.
Step 2.  Exploring Yourself Through Touch
•Set aside 30-60 minutes to begin the touching exercise.
•You may want to begin by taking a bath or shower, remaining nude, and proceeding to an area that is private. You may include oil, lubricant, or lotion.
•Begin by touching your body all over, maybe while applying lotion. Focus on how the touch feels and the areas you are concentrating on. Move into touching the outside of your vagina and then the inside of your vagina. Try and think about which areas feel good when you touch them verses which areas just feel the touch.
•After you finish, exhale a few breaths and think about how touching yourself made you feel and what may have come up for you as a result of doing this exercise.
•Repeat this 5-15 times before proceeding to the next step. Repetition is the key and desensitizing to touching yourself is important. We want to normalize this behavior so it is coded as being relaxing and stress reducing, not stress producing.

Step Two is all about exploring how your genitals feel when you touch yourself. Learning how to touch yourself just to see where it feels good is a very important aspect of eventually learning how to connect with having an orgasm.
Step 3. Touching for Pleasure
•Since masturbation is a good way to experience frequent orgasms, it gives the orgasmic response a way to become well-established. Practicing touching and masturbating will also help increase blood flow to your genitals and make it easier to achieve orgasm.
•This is a good time to mention that masturbation won’t decrease the desire to be sexual with your partner. Instead, it will help you desire to be sexual, because it is a pleasurable experience for you!
•Work on Cognitive Restructuring Techniques if needed during this step, such as making statements such as: “As a grown woman I deserve to experience natural pleasure” or “Being sexual is a healthy part of being an adult.”
•During your sexual sessions, try and be attentive to your position and the timing of your session. Using a lubricant and distraction techniques such as reading erotic stories or watching romantic or sexual movies can help with arousal.

Step Three is all about learning where it feels good to touch and beginning to physically touch yourself through masturbation. Its important to know that almost all of the time, women will experience their first orgasm alone verses with a partner. This is because women generally can be more relaxed when their partner isn't present, and they can have as much time as they need to touch themselves until it feels good without focusing on pleasing a partner.

While many women orgasm with a partner for the first time, I am specifically addressing women who have never orgasmed with a partner and want to learn to have an orgasm. Anxiety is often a part of the problem, so taking a partner out of the mix is helpful for creating a first orgasmic response.
Step 4. Touching for Pleasure, Focusing
•Begin touching yourself for the purpose of seeing if orgasm can be achieved.
•Understand that it may take 15, 30, or 45 minutes to achieve an orgasm. Don’t focus on watching the clock.
•Listen to your self-talk and what you are saying aloud to yourself.
•Introduce vibrators or sexual stimulation aids if that would be helpful.
•Think about the use of fantasy, relaxation, and erotic movies or literature to include in this step, as you become orgasmic.

Step Four is all about the finale. By now you have worked through your thoughts and attitudes about orgasm, accepted it as a wonderful part of the sexual pleasure process, and began to learn how to touch yourself to hopefully achieve orgasm.
The final piece of advice is to see a qualified sex therapist if you need or want more support with this process. Sex therapists will work with women individually or with a partner to learn how to incorporate orgasm into the relationship.

Have a Nice (Orgasm) Day

Source:
However, on International Orgasm Day I do want, appropriately enough, to discuss orgasms—female ones rather than male—and to celebrate the work of some people who did more than anyone in the modern age to bring forward discussion of orgasms and their importance. What did they find out about them and what did they leave the rest of us to complete?

Standing on the Shoulders of Giants—And Peering into Some Funny Places
Every field has giants upon whose shoulders the rest of us stand. In the field of sex research, one set of those shoulders belonged to Virginia Johnson, who—sad to say—died just last week, aged 88. She is most famous for her work with William Masters. More than anyone else, these two are synonymous with sex research in the twentieth century. They helped thousands of couples to happier sex lives and opened up the possibility of sorely needed discussion and research. Prior to them, no one had subjected human sexual response to such systematic lab-based study. As unromantic as laboratories tend to be—this level of control is an important component to any behavioural understanding.

A key contribution of Masters and Johnson was their analysis of the human sexual response cycle. They divided sexual response into excitement, plateau, orgasm, resolution (the EPOR model). With some minor revisions this is still in use to this day and it provides a framework for modern therapeutic intervention and research (1,2) .

As noted in my previous blog the existence of the clitoris comes and goes—pun intended—throughout human history. When Masters and Johnson were writing the clitoris was in one of its periods of abeyance. They hardly discovered it—but it’s a sign of the ignorance of those times that the first mention of the clitoris in Playboy Magazine (3) was in an interview with Masters and Johnson in 1968.

Masters was apparently baffled that women would ever fake orgasms and the story goes that he hired Johnson to help explain women to him. By happy coincidence she was also gifted at explaining him to them. Her people skills turned out to be a key factor in their success. It turns out that there are actually perfectly good biological reasons for women faking orgasms—but this will have to be a subject for a later post. Masters and Johnson’s focus was rather different. They were primarily concerned with couples’ happiness and therefore they were concerned with the most efficient ways of generating female orgasms—so no one would have to fake them ever again.

Just as in males, the most efficient forms of generating orgasms is--hands down--manual  stimulation. Oral stimulation comes in at a close second in terms of efficiency. Masters & Johnson (4) noted that penetrative sex might stimulate the glans of the clitoris through pulling on the clitoral hood. See my previous post “The Case of the Vanishing Clitoris” for details about why this is not the whole story.

Absence of Evidence, not Evidence of Absence
Be that as it may, Masters and Johnson helped many thousands in their clinic and, as a consequence, some folk are of the opinion that they explored the nature of female orgasm during sex in exhaustive detail. Thankfully, this is not the case—they left the rest of us with things to do. Orgasms are pleasurable—and pleasure is an end in itself for sex therapists. Nature, however rarely gives free rides. Are there any other functions that female orgasm might perform?

What, if anything, female orgasms might do was not a key issue for the Masters and Johnson team. Previous research with other animals had suggested that components of female sexual response—perhaps detectable as orgasm in humans—might speed sperm transport through the reproductive tract—assisting reproduction. Possible functionality was not a priority for these sex researchers, however. Of the thousands of sexual response cycles they measured, Masters and Johnson (4) tried to simulate sperm transport in only six experimental participants, but they could not find it. Close reading of their text reveals that Masters might have slipped up here—by placing his measuring device over the mouth of the cervix he unfortunately stopped any possible movement of sperm-like substances  that might have occurred. This is not to criticise them unduly. For therapists interested in couples’ happiness, pleasure is an end itself.

Let Them Eat Cake

However, the focus of a pure scientist is subtly different from that of a therapist. Think of it this way.  What is sweetness? A researcher who is interested in how the sense of sweetness developed in humans might want to know about how sweet foods figured in human ancestry and modern foraging ecologies. She might be interested in how humans interacted with bees or grew sugar cane. She might compare humans with other animals in terms of diet and preferences. She might investigate the problems (if any) experienced by humans who lacked a sweet tooth. On the other hand, a researcher who wants you to enjoy the sweet sensation in the most efficient way might just hand you some cake. At the time of Masters and Johnson’s work a world denied the female side of sexual pleasure was in dire need of some cake.

Work in Progress
What did Masters and Johnson leave us still to discover about female orgasm?
1)      Functionality
Masters and Johnson’s focus was on pleasure—not function. As noted above, this leaves the rest of the field with plenty to do. For sex therapists, partner pleasure is an end itself. Rightly so. Masters and Johnson did not find female orgasms doing anything, but other lines of research have suggested that they might. This is a topic worthy of more detail than I can go into here.

2)      Variability of female sexual response
When you ask women to describe their orgasms a lot of them say “That’s kind of a dumb question, which ones do you mean?” Women report variation in sensation, location, intensity, and all sorts of other things about their orgasms. Perhaps this variation matters? It certainly seems to matter to women (5, 6).

New techniques, unavailable to Masters and Johnson suggest a plurality in female orgasmic response during actual sex (1). This fits with the reports of women themselves (5, 6). Once again—I am going to have to leave readers who want more details about this teased and unsatisfied until a later date.
3)      Replication

Alas, the detailed records collected by Masters and Johnson were mostly destroyed. What remains is viewable here (7). This gives the rest of is the task of replicating some of their key findings in the light of newly acquired knowledge.
Resolution
Did Masters and Johnson get everything right? No pioneer ever does. Columbus went to his deathbed denying that he had discovered America. However, he still gets, and deserves, the credit due to pioneers.  Nothing gets to the heart of human nature faster than looking at our sexuality. Recognition of our deepest needs and desires can upset as well as excite.  Masters and Johnson had to stand firm in the face of many threats, although of course, one would like to believe that puritanism about sex could never again occur in our enlightened age.  Pioneers in this field had to be bold, ingenious, and resilient. We all owe them a debt.