Breast implants

Dear Alice,
I always had small breasts until I became overweight. I am now going on a medically supervised diet. I know that I am ready to really lose the weight and keep it off. The only trouble is that I am only a size "B" cup now. When I lose the weight, I am sure to be an "A," or even an "AA." So, I have been considering the possibility of breast implants. Can you tell me some of the repercussions of breast implants? Can you breast-feed later? What happens during pregnancy? What are the health risks? Well, any information you have about the topic would be helpful. Thanks!
— Flatty but not a Fatty!

Dear Flatty but not a Fatty!,
It's a good idea to ask questions and do a bit of research as you consider the possibility of getting this surgery. There are a number of possible health risks involved with breast enhancement surgery. You also asked what, if any, effect the procedure might have on your ability to breastfeed and what might occur during pregnancy. The short answer to those questions is that it’s difficult to say for certain (more on that later). And, though your line of questioning specifically asks about health risks, there may be other relevant considerations before you decide on your optimal breast size.
In terms of the procedure itself, a consultation with a surgeon would typically entail a discussion about your general health, medical history, lifestyle, hopes, and expectations for the procedure’s outcome (check out the U.S. Food and Drug Administration’s (FDA) helpful list of questions you might want to ask during an appointment). The surgeon would also explain various options such as outpatient versus overnight stay, sedation versus general anesthesia, type of implant, location of implant, and type of incision.
There are two different kinds of implants approved by the FDA: saline and silicone. Implant type and size is generally based on skin elasticity, desired size increase, breast anatomy, and body type. Saline implants are filled with sterile salt water. Silicone implants are filled with gel that feels much like actual breast tissue. Manufacturers occasionally introduce new types of implants, so there may be additional options available.
Health risks of the surgery and of the implants can include (but are not limited to):
•Infection
•Pain, bleeding, swelling, and bruising
•Implant leakage or rupture
•Undesired cosmetic changes, such as wrinkling, dimpling, and puckering
•Improper healing around the implant or incision site
•Changes in nipple and breast sensation (temporary or permanent)
•Capsular contracture, or hardening of tissue around the breast
•The need for additional procedures/surgeries — implants often don't last a lifetime. Up to 20 percent of people with breast implants need to have them removed or replaced due to complications.
List adapted from the U.S. FDA.

In regards to the impact on pregnancy, baby, and the ability to breastfeed: there are some unknowns in this area. There have been a few studies that found no higher rates of birth defects in babies born to mothers with breast implants. Additionally, how breast milk supply develops during pregnancy and while breastfeeding will be dependent on a number of factors relating to augmentation. The placement of implants doesn't generally affect the mammary glands and breast ducts, which still allow for the production of milk. However, some breast tissue is removed during the surgery, so it may have the potential to interfere with how well milk is produced. It can also be dependent on the types of incisions that are used, as some may sever nerves in the breast necessary to breastfeeding. Due to this, some mothers with implants have the ability, while others don't. In addition to the production of milk, the appearance may also change as implants won't prevent any sagging that's associated with pregnancy or other life changes. A breast lift procedure would help to prevent sagging. Further, because there’s no established way to detect silicone in breast milk, it isn’t known whether silicone can pass through the implant shell and into breast milk (and be passed to the baby). Although you're thinking about pregnancy and breastfeeding now, it's also key to know that breast implants can affect mammograms. When the time comes, you may need more specialized tests to make sure health care providers can adequately see the breast tissue. 
A surgeon will have a better sense of which concerns will be most relevant for you. Talking with others who have had the surgery can also be immensely helpful, not only in helping to identify a quality surgeon but also in providing a sense of what to expect. Considerations about the cost of getting breast implants and the possibility that implants may need to be replaced after a certain number of years may also factor into your decision.
Knowledge of health risks can certainly inform whether or not to go ahead with the procedure, but have you thought about factors beyond weight loss that might be influencing your decision? What are the benefits, as you see them, of having larger breasts? Are there any potential non-health related drawbacks for you? What would be your ideal size? And what was your process in deciding that this size would be better for you? People are bombarded by messages about how breasts "should" look. Family, friends, lovers, advertising, movies, and many other influences shape people's views on this. It may be a useful exercise to think back about your own influences as you work through a decision that feels right to you.
For more information about the procedure, associated health risks, and additional recommendations to consider, check out the FDA website.
Breast of luck to you!

Missed period, not pregnant

Dear Missing monthlies,
Waiting for Aunt Flo to show up can be frustrating or worrisome (Where is she? Why hasn't she called to say she’d be late?), especially if she's typically known for being punctual. Amenorrhea, or the absence of menstruation, isn’t considered to be a health condition on its own. Rather, it’s usually due to an underlying cause such as contraceptive use or high stress. While the conditions that cause amenorrhea are rarely serious, it’s a good idea to talk with a health care provider, particularly if you’ve missed more than three consecutive periods. They can recommend the appropriate plan for regulating your menstrual cycle.
There are two types of amenorrhea: primary and secondary. Primary amenorrhea is characterized by not having menstruated by age 14 to 16, and secondary amenorrhea is characterized by missing at least three consecutive periods, not including those who are pregnant. Secondary amenorrhea, which is sometimes accompanied by other symptoms such as headache, changes in vision, increased facial hair, hair loss, changes in breast size, and milky discharge from the nipple, may be due to some of the following:
•Contraceptive use
•Breastfeeding
•Pregnancy
•Too much physical activity
•Menopause or family history of early menopause
•Stress or anxiety
•Some medications
•Having a low body weight
•Underactive or overactive thyroid
•Pituitary tumor
•Uterine scarring
•Polycystic ovary syndrome (PCOS)

Even though you haven't had sexual intercourse, it’s worth thinking about any other sexual contact you’ve had. Depending on the activity, it’s still possible for semen to enter the vagina, so you may want to take a pregnancy test as a precautionary measure. Another factor to consider is whether you have a family history of amenorrhea by asking close female family members and relatives whether they've ever experienced something similar. In addition, keeping a menstrual chart is often useful for determining the length of your menstrual cycle as well as tracking any changes that may occur. This could be done using pen, paper, and a calendar, or for those who prefer to use electronic methods, there are a number of tech-based tools  that can also be used.
If you’re worried that your missed period could be due to something more serious or you’ve noticed a pattern with your missed periods, it may be helpful to discuss it with a health care provider. Once they have a better idea of your pattern and symptoms, they might help determine the cause of the missing periods and be able to recommend a variety of strategies to regulate your menstrual cycle. These could include starting on contraceptive pills, maintaining a healthy body weight, or adopting positive coping mechanisms for stress. If you aren't doing so already, consider incorporating some of the following into your routine — regular moderate physical activity, meditation, tai-chi, yoga, aromatherapy, balanced eating habits, getting enough sleep, and reaching out for support during stressful times. Practicing some or all of these strategies may help with stress management and maintain balance in your life.
While it can be frustrating to keep waiting for Aunt Flo to arrive, understanding the reasons behind the delay may be helpful in predicting future visits.

Tubal ligation

Dear Reader,

Getting your tubes tied (the popular expression) and tubal ligation (the medical term) actually refer to the same process! Tubal ligation is generally considered a permanent form of pregnancy prevention, or sterilization, for people assigned female at birth. The tubes in question refer to the fallopian tubes, which are a set of thin tubes that transport eggs from the ovaries to the uterus during ovulation. If an egg and a sperm meet in the fallopian tube, fertilization can occur. A fertilized egg then travels to the uterus, where it imbeds itself on the uterine wall and may develop as a pregnancy. Tubal ligation is a procedure that cuts, ties off, or blocks the fallopian tubes in order to prevent an egg and sperm from meeting. To your question about hormonal imbalance as a result of the procedure, recent research suggests that tubal ligations don’t have a significant impact on reproductive hormones (more on that later).

So what can be expected during the procedure? Some types of tubal ligation involve small incisions near the belly button to cut or block the fallopian tubes. Anesthesia is generally used, and the type of anesthesia depends on how the procedure is done, which is a decision that can navigated with a health care provider. With this procedure, the results are considered permanent. While surgery can be performed to attempt a reversal, it tends to be quite complicated and there’s no assurance that it’ll be successful.

Tying tubes can also come with a host of benefits. The procedure won’t affect the body’s hormones — that means no changes to menstrual periods or initiation of early menopause. It’s a great option for those who know they never want to become pregnant and are hoping to avoid hormonal contraception methods. It may also be of interest to know that some people who undergo tubal ligation find that they’re better able to relax and enjoy sex even more because they aren’t worried about becoming pregnant.

As with any type of medical procedure, there are potential risks. With tubal ligation, risks include adverse reactions to anesthesia or medications, infection, pain, and (in rare cases) accidental damage to nearby organs and tissues. Although tubal ligation is 99 percent effective at preventing pregnancy, if pregnancy does occur, there is a greater risk of having an ectopic pregnancy. This type of pregnancy occurs when a fertilized egg grows and develops in the fallopian tube. It’s considered to be life-threatening and requires immediate medical attention. Note that tubal ligations don’t protect against sexually transmitted infections (STIs), so condoms may be used to reduce the risk of STI transmission.

Tying it all together, Reader, tubal ligation is considered a low risk and reliable form of permanent birth control. For people who don’t wish to become pregnant, who’d like to limit the size of their family, or who haven’t been satisfied with other birth control methods, tubal ligation may be an appropriate option to discuss with a health care provider.

How soon after a miscarriage can you have sex?

Dear Reader,
While a miscarriage is a physical process that a person might experience, some may also go through an emotional component as well. Both of these factors may determine when someone feels ready to have sex after a miscarriage. The bottom line about having sex after a miscarriage is that it's a good idea to speak with a health care provider before engaging in any sexual activity to avoid any possible physical complications. If someone has sex after a miscarriage before doing so, it’s wise to follow-up with them to ensure that there are no infections.
Typically, the longer the pregnancy lasted before the miscarriage, the longer the recommended waiting period before inserting anything into the vagina — this includes a penis, finger, tampon, or sex toy. After a miscarriage, a person is more susceptible to infection because the uterus and cervix remain partially dilated, allowing bacteria to more easily reach the internal structures in the reproductive system. If a person is exposed to bacteria before the healing process is complete, the fallopian tubes, ovaries, uterus, cervix, and vagina could potentially become infected. It's also possible that bleeding may reoccur. If someone already had vaginal sex without consulting a health care provider, it’s highly recommended to make an appointment as soon as possible to ensure that the body is healthy and not experiencing any complications.

Peoples' experiences with miscarriage may vary. For some, a miscarriage may occur within the first three to four months of pregnancy. If there are no complications — such as heavy bleeding, pelvic pain, vaginal odor, fever, or even continued pregnancy symptoms — a health care provider many indicate that sexual activity may resume after two to three weeks. For others, a miscarriage may take place in the last five months of pregnancy. If this is the case, a person typically is often advised to wait at least six weeks, sometimes longer. However, regardless of when the miscarriage occurs, people are advised to see their health care provider for a pelvic exam before having sex again. This is because ovulation may resume and pregnancy may possibly occur as early as two weeks after having a miscarriage.
While there is no absolute as far as returning to the bedroom, everyone has their own timeline, both physically and mentally. That being said, most people experience a mix of emotions after a miscarriage that's different for each individual. Some people have a quick turnaround time and are ready to plan another pregnancy, while others may experience a wide range of emotions that cause them to wait a bit longer before trying to conceive again (if that is their goal). These feelings are normal and, for some people, may cause anxiety around being intimate with a partner. While the body may be physically ready, not everyone is emotionally ready at the same time. Some may find support from a mental health professional to be beneficial to help process the emotions and to enhance their coping skills. At the end of the day, it's about what feels right for each person, including what will reduce risk to their health and well-being.
Hope this helps!

Everything you need to know about orgasms

The orgasm is widely regarded as the peak of sexual excitement. It is a powerful feeling of physical pleasure and sensation, which includes a discharge of accumulated erotic tension.
Overall though, not a great deal is known about the orgasm, and over the past century, theories about the orgasm and its nature have shifted dramatically. For instance, healthcare experts have only relatively recently come round to the idea of the female orgasm, with many doctors as recently as the 1970s claiming that it was normal for women not to experience them.
In this article, we will explain what an orgasm is in men and women, why it happens, and explain some common misconceptions.
What is an orgasm?
Orgasms can be defined in different ways using different criteria. Medical professionals have used physiological changes to the body as a basis for a definition, whereas psychologists and mental health professionals have used emotional and cognitive changes. A single, overarching explanation of the orgasm does not currently exist.

Alfred Kinsey’s Sexual Behavior in the Human Male(1948) and Sexual Behavior in the Human Female (1953) sought to build “an objectively determined body of fact and sex,” through the use of in-depth interviews, challenging currently held views about sex.
The spirit of this work was taken forward by William H. Masters and Virginia Johnson in their work, Human Sexual Response (1986) – a real-time observational study of the physiological effects of various sexual acts. This research led to the establishment of sexology as a scientific discipline and is still an important part of today’s theories on orgasms.
Orgasm models
Sex researchers have defined orgasms within staged models of sexual response. Although the orgasm process can differ greatly between individuals, several basic physiological changes have been identified that tend to occur in the majority of incidences.
The following models are patterns that have been found to occur in all forms of sexual response and are not limited solely to penile-vaginal intercourse.response and are not limited solely to penile-vaginal intercourse.
Master and Johnson’s Four-Phase Model:
excitement
plateau
orgasm
resolution
Kaplan’s Three-Stage Model:

Kaplan’s model differs from most other sexual response models as it includes desire – most models tend to avoid including non-genital changes. It is also important to note that not all sexual activity is preceded by desire.
A cohort study published in 1997 suggested that the risk of mortality was considerably lower in men with a high frequency of orgasm than men with a low frequency of orgasm.
This is counter to the view in many cultures worldwide that the pleasure of the orgasm is “secured at the cost of vigor and wellbeing.”
There is some evidence that frequent ejaculation might reduce the risk of prostate cancer. A team of researchers found that the risk for prostate cancer was 20 percent lower in men who ejaculated at least 21 times a month compared with men who ejaculated just 4 to 7 times a month.
Several hormones that are released during orgasm have been identified, such as oxytocin and DHEA; some studies suggest that these hormones could have protective qualities against cancers and heart disease. Oxytocin and other endorphins released during male and female orgasm have also been found to work as relaxants.
Unsurprisingly, given that experts are yet to come to a consensus regarding the definition of an orgasm, there are multiple different forms of categorization for orgasms.
The psychoanalyst Sigmund Freud distinguished female orgasms as clitoral in the young and immature, and vaginal in those with a healthy sexual response. In contrast, the sex researcher Betty Dodson has defined at least nine different forms of orgasm, biased toward genital stimulation, based on her research. Here is a selection of them:
Combination or blended orgasms: a variety of different orgasmic experiences blended together.
Multiple orgasms: a series of orgasms over a short period rather than a singular one.
Pressure orgasms: orgasms that arise from the indirect stimulation of applied pressure. A form of self-stimulation that is more common in children.
Relaxation orgasms: orgasm deriving from deep relaxation during sexual stimulation.
Tension orgasms: a common form of orgasm, from direct stimulation often when the body and muscles are tense.
There are other forms of orgasm that Freud and Dodson largely discount, but many others have described them. For instance:
Fantasy orgasms: orgasms resulting from mental stimulation alone.
G-spot orgasms: orgasms resulting from the stimulation of an erotic zone during penetrative intercourse, feeling markedly different to orgasms from other kinds of stimulation.
The female orgasm
The following description of the physiological process of female orgasm in the genitals will use the Masters and Johnson four-phase model.
Excitement
When a woman is stimulated physically or psychologically, the blood vessels within her genitals dilate. Increased blood supply causes the vulva to swell, and fluid to pass through the vaginal walls, making the vulva swollen and wet. Internally, the top of the vagina expands.
Heart rate and breathing quicken and blood pressure increases. Blood vessel dilation can lead to the woman appearing flushed, particularly on the neck and chest.
As blood flow to the introitus – the lower area of the vagina – reaches its limit, it becomes firm. Breasts can increase in size by as much as 25 percent and increased blood flow to the areola – the area surrounding the nipple – causes the nipples to appear less erect. The clitoris pulls back against the pubic bone, seemingly disappearing.
Orgasm
The genital muscles, including the uterus and introitus, experience rhythmic contractions around 0.8 seconds apart. The female orgasm typically lasts longer than the male at an average of around 13-51 seconds.
Unlike men, most women do not have a refractory (recovery) period and so can have further orgasms if they are stimulated again.

Orgasmic dysfunction: Everything you need to know

Orgasmic dysfunction is when a person has trouble reaching an orgasm despite sexual arousal and stimulation.
In this article, learn about the causes and symptoms of orgasmic dysfunction and how to treat it.
Orgasmic dysfunction is the medical term for difficulty reaching an orgasm despite sexual arousal and stimulation.
Orgasms are the intensely pleasurable feelings of release and involuntary pelvic floor contractions that occur at the height of sexual arousal. Orgasmic dysfunction is also known as anorgasmia.
There are several different types of orgasmic dysfunction, including:
Primary orgasmic dysfunction, when a person has never had an orgasm.
Secondary orgasmic dysfunction, when a person has had an orgasm but then has difficulty experiencing one.
General orgasmic dysfunction, when a person cannot reach orgasm in any situation despite adequate arousal and stimulation.
Situational orgasmic dysfunction, when a person cannot orgasm in certain situations or with certain kinds of stimulation. This type of orgasmic dysfunction is the most common.
Orgasmic dysfunction can affect both males and females but is more common in females. Researchers estimate that female orgasmic disorder, which is recurrent orgasmic dysfunction, may affect between 11 to 41 percent of women.
The North American Menopause Society report that 5 percent of all women have difficulty achieving orgasm.
Research from 2018 found that 18.4 percent of women could reach an orgasm through intercourse alone. However, the same study indicated another 36.6 percent of women needed clitoral stimulation to reach orgasm during intercourse.
In men, experts often categorize orgasmic dysfunction and delayed ejaculation together.
Available studies suggest that delayed ejaculation is very uncommon in men, with one 2010 overview noting that it was rarely prevalent in more than 3 percent of men, although other estimates have the figure between 5 and 10 percent.
Orgasmic dysfunction can affect the quality of people’s relationships, as well as a person’s self-esteem and mental health.
Orgasmic dysfunction is when someone has difficulty or the inability to reach an orgasm. For some people, reaching a climax can take longer than normal or be unsatisfying.
The way an orgasm feels or how long it takes to have an orgasm can vary widely. When someone has orgasmic dysfunction, climax can take a long time to reach, be unsatisfying, or be unattainable.
Scientists are not sure what causes orgasmic dysfunction, but believe the following factors may contribute to the problem:

relationship issues
certain medical conditions, such as diabetes
a history of gynecological surgeries
some medications, including antidepressants
a history of sexual abuse
religious and cultural beliefs about sex and sexuality
depression
anxiety
stress
low self-esteem
Also, women over 45 years of age are more likely to have trouble orgasming than women under this age. This may be due to menopause-related hormonal shifts and vaginal changes.
Men are more likely to have trouble orgasming following a radical prostatectomy. They are also more likely to experience delayed ejaculation as they get older, as the ejaculatory function tends to reduce with age.
Once someone experiences difficulty reaching an orgasm, they may experience increased stress in sexual situations. Stress and anxiety during sex can make it even more difficult to reach an orgasm.
Before diagnosing orgasmic dysfunction, a doctor will likely ask about a person’s symptoms and how long they have existed.
The doctor will also note any factors that could contribute to orgasmic dysfunction, such as underlying health conditions or the medications a person is taking.
A doctor may do a physical examination as well. In some cases, they may refer a person to a sexual medicine specialist or a gynecologist.

Women's Sexuality Close Up

As a result of the second and third waves of the feminist movement, many women have felt freer to examine and express their sexuality. Before this time, it was simply assumed that heterosexuality centered on the experience of the male partner. If you asked a heterosexual couple how many times per week they had sex, they counted by times of intercourse and male orgasm. This definition was used as recently as the studies of Masters and Johnson, who, in their own way, helped disabuse the public and professionals of this antiquated notion and even discovered that women were capable of multiple orgasms, given the right stimulation. [1] The definition of sex had to change.
The role of the clitoris and its anatomy were virtually ignored and often unknown until the second wave of the women’s movement, which coincided with the sexual revolution in the United States.  Feminist clinicians and researchers took up the issue of women and sexual pleasure. Wasn’t that sex also?
It was soon discovered that women had a sexual organ that was homologous to the male penis and it was named the clitoris. Various forms of stimulation would bring a woman to orgasm. To begin with, Betty Dodson[2] and others began to run what they called pre-orgasmic groups to teach women how to self-stimulate to orgasm. Initially this involved the use of vibrators and was conducted in Pre-Orgasmic groups. The term pre-orgasmic replaced the previously common one "frigidity." Once the woman learned her own body, she could teach the ins and outs to her partner for a more satisfying sex life.[3]
This kind of study became an area of research and treatment in psychotherapy. Research on female sexuality has continued and so have clinical observations. I offer here my clinical observations, which are being supported by the research of many young scientists, as Western culture passes once again through a sexual revolution, perhaps smaller than the earlier one, but just as significant. It concerns orientation and fluidity.

Many girls and women, the majority in fact, grow up being attracted only to males. They are cisgender and heterosexual by definition. Then somewhere around the age when reproduction is no longer an option, many of these women find themselves surprisingly attracted to other women. Apparently women’s sexuality is also fluid in a way that men’s does not seem to be even when they are younger. Many women have gone on to form lifelong romantic relations with other women, after having considered themselves strictly heterosexual.[4]
It is too soon to know if this phenomenon is hormonal, psychological or cultural. I would add to this list that it may have an evolutionary aspect, in that women did not need men after their reproductive years. However, this idea does not explain the greater fluidity found by researchers in earlier years and I myself have seen it in my practice with women from 20 to 80 or more. An alternative hypothesis is that women are a bit more advanced on the evolutionary scale than are men as a group. These are still only hypotheses.
There is still much to be learned about women’s sexuality in a society that has suppressed it all these years. We are no longer in the Victorian times of Freud. Cultural context always affects individual psychology in different ways.
In my next post, I will discuss what we have learned about the sexuality of men in these years since the 1960’s, when feminist revolution made this research possible.

A Touchy Subject: The Health Benefits of Masturbation

by Jason Hannay
A recent Gallup Poll reported that half of Americans regularly take a vitamin or nutritional supplement. It appears that adults in the U.S are becoming steadily more health-conscious and taking steps to improve their own health.
There is one healthy activity, however, that is often considered a taboo topic in our culture and even a source of shame for many individuals. That activity is masturbation. Information provided by Planned Parenthood tells us that “Negative feelings about masturbation can threaten our health and well-being. Only you can decide what is healthy and right for you. But if you feel ashamed or guilty about masturbating, talking with a trusted friend, sexuality educator, counselor, and/or clergy member may help.”

The organization's website also lists the varied health benefits of masturbation, including creating a sense of well-being; enhancing sex with partners both physically and emotionally; increasing the ability to have orgasms; improving relationship and sexual satisfaction; improving sleep; increasing self-esteem; improving body image; reducing stress; releasing sexual tension; relieving menstrual cramps; strengthening muscle tone in the pelvic and anal areas; and reducing women’s chances of involuntary urine leakage and uterine prolapse. Another recent study suggests that men could reduce their risk of developing prostate cancer through regular masturbation, and another notes that for women, masturbating can flush old bacteria from the cervix, decreasing the chances of developing a urinary tract infection.

Masturbation is also a cornerstone of modern sex therapy. Those who seek professional counseling for sexual difficulties, including inability to orgasm, are typically instructed to masturbate to learn about their bodies and then encouraged to communicate what they discover to their partners. Many outstanding self-help books, such as Becoming Orgasmic and The Elusive Orgasm, suggest masturbation as a core strategy, and sex educators including Betty Dodson and Corey Silverberg, tout the benefits of the practice and provide how-to guides.

There is a biochemical basis for the positive effects of masturbation. It "releases feel-good neurochemicals like dopamine and oxytocin that lift your spirits, boost your satisfaction, and activate the reward circuits in your brain," reports Gloria Brame, Ph.D. "An orgasm is the biggest non-drug blast of dopamine available.” In short, a masturbation-induced orgasm creates feelings of euphoria: It’s a safe, free, and natural high.

Considering all the benefits, why aren’t more people—especially women—masturbating regularly? Societal taboos and the resultant shame they cause are partly to blame. For women, there may also be another reason: Stated simply, female masturbation presents more of a logistical challenge than does male masturbation, and reaching arousal takes longer for women than for men. Finding sufficient private time to reach arousal and/or orgasm may be difficult for women who share a bed with a partner or who have children.

Masturbation certainly requires more time and effort than taking a multivitamin. Yet the research on vitamin and supplement benefits is riddled with conflicting results, whereas the findings on masturbation are unequivocal. What Woody Allen called "sex with someone you love" and what Betty Dodson called "selfloving" is beneficial for one’s physical, emotional, and relational health.

In my Human Sexuality class at the University of Florida, students can choose to complete a Psychology Today-style blog for a class project. I then choose the top five submissions, and the students vote on their favorite, with the winner given the option of having me edit their post and publish it here. Above is the edited version of the winning post from my Fall 2013 class, submitted by junior Jason Hannay.

Mixed marriages

A couple of news stories this week deal with "mixed marriages."  I don't mean Jewish/Christian or Black/White marriages, but marriages where the sexual drive of one partner is fundamentally different than the sexual drive of another. In the first set of stories, it is about women who "marry gay."  In the other, it is about women who just don't want to have sex as often as their male partners.

Kiri Blakeley's Can't Even Think Straight: A Memoir of Mixed-up Love tells the story of her ten year relationship with a man who decides, in the end, that he's gay.  Apparently Ms. Blakeley finds not just the fact that her partner of ten years would dump her memoir worthy, but feels particularly betrayed that the reason he left her was because of his sexuality.   She describes the scene of his coming out as her trotting into the living room like the family dog, expecting a belly rub, but getting a bullet in the head instead.  A bit dramatic, but then again, betrayal always leads to self-pity, at least at first. 

On a particularly alarmist segment about Blakeley's book on the Today Show , the viewer is told that "experts" say that "for a woman to find that the man she's in love with is gay is happening more and more often."  Really?  How are we measuring that number?  Then a psycho-therapist is trotted out to tell us that when women cheat with other women it's for emotional connections, and therefore easier to forgive, but when men cheat with men it's purely sexual.   

Sigh.  There is so much wrong with this story that I don't know where to begin. But let's stick with the most obvious problem: men are sexual; women are victims.  Men want sex; women want emotional connection.  And the experts are here to help us figure out what to do with our "mixed marriages."  Ms. Blakeley may not realize it yet, but she's set off a whole cottage industry now where the media plants fear and panic in the listeners who then rush to experts because they fear they "married gay."

This widespread assumption that we need experts in love and desire is also what drives large pharmaceutical companies for a cure to "female sexual dysfunction."  A new documentary,  Orgasm,Inc., makes the danger of corporate love experts clear.  The "pink viagra"- which has yet to be approved for human use- attempts to put a chemical end  to something that the vast majority of women seem to feel at some point in their lives:  difficulty orgasming and decreased sexual desire. In Orgasm, Inc. filmmaker Liz Canner realizes that the purpose of big pharma is not "pleasure" but "profit" and that in pursuit of that profit they are willing to put women's health at risk. 

Of course,  these stories of mixed marriages are not really newsworthy. After all, what's the news?  That people break up even after seemingly perfect relationships?  That sometimes people leave other people for unfulfilled sexual and emotional desires, including the desire to be with someone of the same sex?  That sometimes one partner wants sex more or less than the other? Or that there are "experts" and the corporations that employ them out there trying to convince us that the love we have is not the love we want?

Instead of getting sucked into believing that there is something wrong with us and only experts can fix it, we might be better off taking a deep breath.  Let's relieve both sex and the experts of some of their significance.  So your fiance is gay?  That may or may not mean the end of your coupling, but it surely doesn't have to end your friendship in the bonfire that is a tell-all memoir.  So you just don't want to have sex anymore?  That too need not be seen as a problem.  Instead of rushing into the arms of "experts" and others who will sell us "true love," we'd be better off listening to the words of the 20th century's two greatest philosphers:

Why Older Women (Cougars) Seek Sex With Younger Men (Cubs)

There have always been couples comprised of older women (cougars) and significantly younger men (cubs), but these relationships went mainstream in 2009 with the premiere of the TV show “Cougar Town.” Then in 2017 Emmanuel Macron was elected president of France, and the media feasted on the fact that his wife, his former high school Latin teacher, was 24 years older. Not surprisingly, sexologists have recently delved into the cougar-cub phenomenon.

"Script-Defying" Sex
A French researcher conducted in-depth interviews with 55 women, age 30 to 60, who'd been involved with significantly younger men. Their choice of mates involved several factors independent of their age differences: appearance, intelligence, kindness, family background, and sense of humor. But the younger men also gave their older partners a welcome gift—“script-defying” sex.

“Script” refers to sexual scripts, the sexological term for culturally accepted generalizations about lovemaking, what most people consider conventional and normal. Prevalent sexual scripts include:
•Men lust. Women want to feel desired.
•“Sex” equals fellatio and intercourse, with perhaps a bit of cunnilingus.
•Men should orchestrate sex. Women should follow their lead.
•Women come during intercourse.

These scripts may be widely accepted, but they are seriously mistaken:
•Yes, the large majority of women want to feel desired. In addition, some—an estimated 5 to 10 percent—also experience lifelong male-style lust. Many cougars said they’d been denigrated by friends and previous close-in-age lovers for having lusty libidos.
•Sex equals fellatio and intercourse with a little cunnilingus in one key realm—pornography. Porn shows almost constant penis worship, but comparatively little (if any) cunnilingus. This seriously deludes men about women and lovemaking. Gentle, extended clitoral caressing—particularly cunnilingus—is key to most women’s orgasms and erotic satisfaction. Many cougars said they’d tried unsuccessfully to persuade similar-aged lovers to provide oral. They found cubs more open to instruction and much less resistant to providing extended cunnilingus every time. As a result, the women were more consistently orgasmic than many had been with age-matched lovers, and reported greater sexual satisfaction.
•When men orchestrate partner sex, they work up to orgasms around 95 percent of the time. But depending on the study, women’s rate of partner-sex orgasms is only 50 to 70 percent, no matter how long it lasts or how large the erection. As just mentioned, in cougar-cub relationships, the women insist on extended cunnilingus, which helps them climax. And most cubs appreciate having experienced teachers who clue them into the fine points of pleasuring women and helping them come.
•When TV and movies depict intercourse, after a few thrusts, both lovers come. Actually, only around 25 percent of women are consistently orgasmic from intercourse alone. The other 75 percent need kissing, cuddling, whole-body massage, genital hand massage, and especially cunnilingus. Compared with men their own age or older, cougars say cubs are more teachable, and therefore, preferable partners.


Finally, in the study, the cougars appreciated their young bucks’ sexual energy and stamina, including their ability to raise new erections soon after ejaculating so the couple could go second and sometimes even third rounds.
While the cougars in the study placed great value on cunnilingus, they did not reject intercourse. On the contrary, they wanted it every time. But they also wanted generous cunnilingus—and made sure their cubs provided it.

Cougar-Cub Sex When the Men Are Minors: Is It Child Abuse?
Many cubs are legal adults—say, 55 year-old women with 30-year-old men. But some cubs are barely teenagers. If a 30-year-old man has sex with a 12-year-old girl, she’s a victim, he’s a pedophile, and most Americans would support locking him up. But if a 30-year-old woman has sex with a 12-year-old boy, is she a pedophile?

In the case of Mary Kay Letourneau, the court thought so. In 1996, Letourneau was a married, 34-year-old elementary schoolteacher in Burien, Washington, when she began a consensual sexual relationship with her then-12-year-old student, Vili Fualaau. The following year, she gave birth to their daughter.

When Letourneau’s husband discovered their affair, he divorced her. Then a relative of his took additional action. He called the police. In a plea bargain, Letourneau was sentenced to six months in jail on the condition that she never see Fualaau again. A month after her release, police caught the two together and she was sentenced to seven years in prison.         

In 2004 when Letourneau was released, Fualaau was 20, an adult who could legally consent to sex. He petitioned the court to rescind the no-contact order. His request was granted. The couple married in 2005 and had another child. “I always wanted the relationship,” Fualaau said, “I was never a victim. I’m fine.”

Until the late 1970s, the legal system typically ignored sexual relationships involving cougars and underage boys based on the belief that they caused no harm. Since then, cultural sentiments have changed. If cougars bed underage boys, the courts treat them as sex offenders. But when cougars get busted for sex with minors, they’re much less likely than comparable men to go to prison, and if imprisoned, they serve shorter sentences.

Meanwhile, the vast majority of men with histories of cougar-cub relationships believe there’s nothing wrong with them. In one study, almost two-thirds of adult men who, as minors, had sex with adult women felt fine about it. Many expressed gratitude for their sexual initiation and the erotic instruction they’d received. Of those who felt less than positive, 33 percent felt neutral. Only 5 percent said they’d been abused.

How do you feel about cougar-cub relationships? If adult women have sex with male minors, do you think it’s child sex abuse?

Friend No More?

My closest friend of the last five years has recently developed two new close friends and shuts me out so that our conversation remains impersonal. I feel all my loyalty has been in vain. I don't know whether to confront her or just let her go. She makes me feel bad when she directly excludes me. I know I have my faults but a friend can depend on me. The worst part is she doesn't seem to notice how she's treating me.
What a limited set of options you give yourself! Why do you think that confrontation is the only kind of conversation two people can engage in over an uncomfortable situation? The assumption that a disagreement means that talk must be adversarial in itself leads people into hostile stances and that almost guarantees negative outcomes. Instead -- and this holds true for any conversation with anyone about anything, and in any kind of relationship -- when you have a complaint or seek change of some kind, request setting aside time for a conversation. You would be wisest to begin it in a way that is most likely to bring about the result you want, while preserving your own dignity. That means not beginning with criticism. If you launch into an attack, your friend will feel defensive and that will render her unable to hear your request for more closeness. Besides, she won't be in any frame of mind to want it at that point. You don't need to distort your very legitimate feelings. You might begin by saying that you miss the closeness you two used to have and you want to know whether you've done something specific to put her off. At the very least, you'll get valuable feedback you can use to correct course in the future. Your role is to listen nondefensively. If the door is open at all, then ask what steps you both can take to resolidify the friendship. At the same time you're approaching the problem nonconfrontationally, you are making yourself more likeable. It's a very winning combination. Still, don't expect success 100 percent of the time; some people are too glued to their grievances.
Love Is a Weighty Matter
My wife and I have been married for 15 years and have five kids. Until two years ago, we had a good sex life -- sex about twice a week. Then she lost interest, citing 10 to 15 pounds of weight gain as the culprit ("I'm fat and unattractive"). I have assured her that the weight can be lost, that she is still attractive. I have also tried physical contact without expectations of sex. We also talk to each other about what is going on with our lives. Bottom line: We now have sex once or twice a month, when she urges me to just "get it over with."
Perhaps you are the one who needs to lighten up. Ten to 15 pounds is not a dramatic gain, but weight is a loaded issue for most American women. Telling your wife that the gained weight can be lost is tantamount to declaring you dislike the way she looks now. Even if she doesn't understand how she picks up the signals, your unspoken feelings could be making her so uncomfortable that she can't wait to get any exposure over with. She may read your interest in lovemaking as desire not so much to be with her as to satisfy your own sexual needs. Depending how much real power in the relationship she does or doesn't have, she may find it hard to tell you directly what's bothering her -- and the weight can even be a convenient scapegoat for lack of power. On the other hand, women's heads are so wacked on weight matters that it may take outsize demonstrations of affection to persuade her she is lovable as is, even if she wants to lose weight. Either way, the best path to getting your sex life back is to forget about both sex and weight for now. Focus on doing fun things together and surprising your wife often with unambiguous demonstrations of affection.
My Boyfriend Doesn't Have Orgasms

My boyfriend and I have taken our relationship to the physical level. But I am the only one having orgasms. When I question him, he tells me he has a problem reaching orgasm and only reaches it once in a while, and that I shouldn't take it personally. I work in the medical field and know male physiology. I told him he should have this checked. He is a thoughtful lover, always making sure I'm pleased. I don't want to be a nag. He's 47 and appears to have no other health problems.
Take your cue from your boyfriend -- don't get hung up on his orgasms unless he makes them an issue. Having a beau who is a good person and a thoughtful lover is like hitting the jackpot. Far more important than any particular variation from the norm, sexual or not, is how you two handle it. You need to be able to communicate freely and to "read" each other's reactions accurately. I suggest that you take the emphasis off his performance and not club him over the head with your medical knowledge or intuition -- that could be a big deterrent to open communication. Male anorgasmia is not as uncommon as you may think. Most often, it is a side effect of antidepressant use. It's possible that your boyfriend is taking Prozac or a similar drug and feels the need to conceal that fact. Perhaps your real concern with his anorgasmia is that it keeps you from knowing whether he is sexually satisfied. If so, you might tell him that you would like to be sure you are satisfying him as much as he is satisfying you, and without this pretty obvious signal you don't know whether that is the case. Ask what signs the two of you might use. By taking the emphasis off his failure (anorgasmia) and putting it on his success (satisfying you), you just may find him relaxing and opening up to you. That emotional intimacy is by far the sexiest part of any relationship.
What Happened to His Sex Drive?
For the past year or so, my partner and I have had completely mismatched sex drives -- I want it, he doesn't. It's not that I want to be pinned against the wall every night (or even every week) but I also don't want to have to twist his arm to make love. I know he's not getting it anywhere else; his libido just seems to be lacking. I'm getting impatient.
We like to think that sexual desire has a life of its own, especially in men; you don't have to do anything to it, it's just there. But that's not how it works. Low libido has much to do with general mental state, desire for you as a partner and the state of your relationship. More and more, men are less and less interested in sex because they're angry at their partner, usually for being critical and complaining. When asking for something different or new, women often criticize rather than express appreciation of their partner ("You never want to do anything anymore" usually prevails over "I like spending time with you and miss the fun we used to have together"). Resentment can stifle desire as thoroughly as a toothache. Good sex starts with a good emotional connection. That's where you're likely to find your partner's missing sex drive. Make him feel wanted, and spend time sharing your inner worlds with each other. Talk in a loving, nonconfrontational way. Ask what his needs and preferences are. Desire will come from his wanting to share something with you. You might also jump-start desire by taking unilateral action. A little seduction may just make your partner feel much more wanted and more interested in the relationship.
Married With... Attractions
I have a wonderful marriage of 30 years and have never been unfaithful. The past two years I also have had a very special relationship with a woman I met through work. We can talk about common interests, understand each other, but also know boundaries. My wife knows and likes her as well. There is some attraction between us, which is kept in check. "Experts" insist such a relationship means something is missing in the marriage. Isn't it natural to be attracted to others and develop more than one relationship, as long as sex is limited to your spouse?
The question is not whether attraction to others happens but how it's handled. Sexual attraction need not lead only to the bedroom. If you are a living, breathing human being, you are likely to encounter many people in many settings who are attractive to you and vice versa. Work definitely provides opportunities for intimate interaction, as men and women spend time sharing professional challenges and the intense emotions of accomplishment, frustration and failure. Two people can acknowledge the frisson and agree to channel the sexual energy into work, sparking creativity and productivity. But there are emotional boundaries to be heeded, too -- like not sharing inside information about your marriage. Once you cross that line, your primary relationship becomes secondary. Your wife would rightly feel violated -- and as pained as if there were sexual infidelity.

PT Bookshelf: From Parenting to Perceptions

Crawling: A Father's First Year
By Elisha Cooper (Pantheon Books)
"There's a head sticking out of my best friend. This is insane." The opening lines set the pace for a wry, frank, and uniquely paternal perspective on initiation into a parent's life. Cooper, a children's book author and illustrator, admits early on that he never liked children, and liked parents even less (except his own). But this young father and husband grows quickly. Much about raising a baby is universal, so Cooper uses tales, details, and reflections economically, sparing us both gushes of emotion and a deluge of the mundane. We witness the suctioning of snot from a tiny nose and the softening of a skeptical heart, but both are inlaid with humor and insight. As Cooper sobs in the final scene, filled with love for his daughter and doubts about himself, you realize that the one learning to crawl is not the baby but the dad.

—Matthew Hutson
The Science of Orgasm
By Barry R. Komisaruk, Carlos Beyer-Flores, and Beverly Whipple (The Johns Hopkins University Press)
Disclaimer: Don't expect this book to contain diagrams detailing the art of giving your partner multiple orgasms. Rather, it covers the "multiorgasm" by highlighting the role of the pubococcygeus muscle and citing studies speculating on the function of mindset. More of a reference manual than a how-to guide, The Science of Orgasm takes a brainy perspective on the big O. Approach the book with any question you can conjure about the whys and wherefores of orgasm and you'll receive a minutely detailed answer that incorporates findings from the latest sex research. Do orgasms serve a biological function? How are they influenced by aging? How do drugs, from cocaine to alcohol to Zoloft, affect them? After tackling the answers to these questions and many more, the authors admit that the brain regions responsible are still under debate: Orgasm research has not yet peaked.

—Katie Gilbert
Strange and Dangerous Dreams: The Fine Line Between Adventure and Madness
By Geoff Powter (The Mountaineers Books)
An explorer's fiercely competitive nature drives him to the North Pole. On his return, he meets a chilly end just miles from salvation. A woman, unhinged by heartbreak, boards a sailboat alone, convinced that circumnavigating the globe will allow her to shed her psychic baggage. She is never seen again. Clinical psychologist Powter dissects the personal odysseys of adventurers, including Meriwether Lewis and Aleister Crowley, in an attempt to determine when healthy risk taking gives way to madness. Powter's postmortem diagnoses of his subjects deliver no clear answers, but readers will likely find themselves swept up in these tales of emotional strife and physical hardship.

—Orli Van Mourik
A Mind of Its Own: How Your Brain Distorts and Deceives
By Cordelia Fine (W.W. Norton)
We convince ourselves that we're all whipsmart valedictorian manques (had we just cared a bit more back then...), we guard against self-critical information with the zeal of a star DA, we display not the slightest aptitude for basic statistics—especially when the need to justify our own choices arises—and we generally sail through life blanketed in a consciousness that both insulates and smothers. Fine, a young Oxbridge-trained psychologist and philosopher, catalogs this mental scramble in wry, spirited prose. While readers may occasionally balk at the detailed study descriptions, Fine is ever entertaining on the bigotry and pigheadedness of those nearest and dearest to her: her husband's abject delight on encountering evidence of Scottish thrift; her two-year-old's glee in chastising a naughty playmate. Fine succeeds marvelously at a tricky task—exposing the psychological hijinks and hijacks that propel us forward.

Closing the Orgasm Gap: Tips for Personal and Culture Change

Today is International Women’s Day. This day is a global celebration of women’s achievements across many domains—social, economic, cultural, and political.  It’s also a day where women are called to action to focus on equality.  This year’s theme is #PressforProgress.
Here’s what the organizers say about the theme this year:
Individually, we're one drop but together we're an ocean. Commit to a "gender parity mindset" via progressive action.
The organizers recommend that individuals commit to pressing for gender parity in their own sphere of influence
As a sex educator with a specialization in women’s pleasure, for me this means continuing to press for gender parity in the bedroom. It means pushing for gender equality in our most personal, intimate encounters.
Research shows we don’t yet have such gender parity.  Instead, we have an orgasm gap between women and men. Here are some telling statistics:
One study of university students found that 91 percent of men vs. 39 percent of women report always or usually experiencing an orgasm with a partner.
While this study didn’t ask the context of the sexual encounter (e.g., hookup or relationship), when I poll my students (using anonymous classroom technology), across five years and over 500 students, I’ve found that:
55 percent of men versus 4 percent of the women say they always orgasm during first-time hookup sex.
Clearly, the orgasm gap is massive in casual sexual encounters. And, while it narrows, it doesn’t disappear in relationship sex. In one study, 85 percent of men vs. 68 percent of women said they’d orgasmed during their last sexual encounter that occurred in the context of a committed relationship.
It’s time to push for progress in terms of closing this gender orgasm gap. If you are a woman who has sex with men, here are a five steps that you can take, at a personal and a cultural level.Know your own anatomy. One study showed that over a quarter of women couldn’t locate the clitoris—their most essential orgasmic organ—on a diagram. My experience as a sex educator is that even more women don’t know that their inner lips are chock-full of nerve endings (they’re analogous to the head of the penis). If you don’t know what you’ve got “down there,” you won’t know how to please yourself or to tell a partner how to do so. So, grab that hand mirror and a diagram of a vulva, and take a look at yourself. And, while you are taking a look, pleasure yourself too. Every woman’s genital nerves are positioned a bit differently, so before you can tell a partner what feels good, you will need to learn this by yourself.

​Call your anatomy by the correct name. Perhaps you noticed that I used the word vulva in a prior sentence. This is the correct name for women’s external genital anatomy. Yet, in our culture we call everything down there a vagina. By doing so, we are erasing our most erotic parts and calling our genitals by the part that is most useful to men rather than to women themselves. Words convey the importance we place on something. Use words that show you consider your pleasure important.
Stop thinking of sex as synonymous with intercourse. Speaking of words, in our culture, we use the words sex and intercourse synonymously and relegate everything that comes before as “just foreplay.” This language privileges men’s most reliable route to orgasm (penetration) as the only one that counts as sex and relegates women’s most reliable route to orgasm (clitoral stimulation) as a warm-up for the real act. Only about 5 percent of women say they most reliably orgasm from intercourse alone. About 95 percent of women need clitoral stimulation to orgasm—either alone (e.g., oral sex) or paired with intercourse (e.g., using a vibrator on yourself during intercourse). Start considering your pleasure just as much sex—in other words, just as important—as his pleasure.
Get the stimulation you need during partner sex. To put the attitude that your pleasure is as important as his into action, you will need to get the stimulation you need to orgasm during partner sex. A survey by Cosmopolitan magazine found that during heterosexual encounters that involve intercourse, 78 percent of women’s orgasm problems were due to not getting enough clitoral stimulation. In other words, when a penis is part of the sexual encounter, we forgo the stimulation we need in favor of his stimulation. Don’t skip over your pleasure. Instead of relying on the standard cultural script of 1) foreplay; 2) intercourse; 3) male orgasm, and 4) sex over, use sexual scripts where your orgasm is as central as his. While you can find details of these sexual scripts here, the summary is that you can employ a turn-taking model where you come first (e.g., oral sex during which you orgasm followed by intercourse) or you come second (e.g., enough stimulation to get you ready for intercourse, intercourse, and then have him or you use a vibrator on yourself after). Alternatively, you can both come during the same sexual act (e.g., touch your clitoris during intercourse, or use a couple’s vibrator, such as a cock ring with a clitoral vibrator). When enacting these new sexual scripts, keep in mind that the key to getting the stimulation you need is getting the same type of stimulation you use with yourself when with a partner.  We know how to pleasure ourselves when alone (94 percent of women orgasm when pleasuring ourselves), but we too rarely transfer this to sex with a partner.Start talking about women’s pleasure, and your own pleasure, loudly and proudly. To implement the tips above, you’re going to have to learn and use good sexual communication skills. Say what you like and what you don’t like loudly and clearly.  Research shows that clear, enthusiastic consent and female pleasure are highly related.  And, it’s not just in our own bedrooms that we need to talk—it’s publicly. Push for progress by talking about the orgasm gap and by educating others about how to close it. As one example, the next time you are watching a movie with friends and there is a scene where after two minutes of foreplay, the couple has intercourse and they both have screaming, simultaneous orgasms, call this out. Similarly, call out penis size jokes, as they perpetuate the lie that penetration is the route to female pleasure, as well as perpetuate male insecurities. In both cases, call out the lie and then share the truth—that is, that women’s and men’s easiest and most reliable routes to pleasure (penile and clitoral stimulation, respectively) need to be equally attended to and valued.I hope this blog inspires you to push for progress, today and every day.  When it comes to orgasm equality, pushing for progress can be quite pleasurable!

Polyamory and Women's Orgasms

Scientists once claimed that female orgasm was unique to humans and explained that its function was to “sustain the long-term pair bond at the heart of the nuclear family” according Psychology Today blogger and author Christopher Ryan. This theory is problematic partly because more astute observations have revealed that human females are not the only ones to have orgasms. As Ryan so cleverly put it, “Your problem gets worse if the most orgasmic species happen to be among the most promiscuous as well, which appears to be the case.” The fact that the nuclear family is a twentieth century invention also casts doubt on the evolutionary relevance of this theory on the function of women’s orgasm.
Scientific researchers have long been aware of the bias introduced by the expectations, personality and belief systems of the observer. The “self-fulfilling prophecy” has a powerful and demonstrable effect. Selective attention also skews results. This phenomenon became apparent to me as an undergraduate psychology student at UC Berkeley in a lab course where we were instructed to observe and record the mating behavior of the golden hamster while electrodes measured their brain waves. As I watched these hamsters I noticed that in addition to their attempts to mate with females, the males engaged in both self stimulation and homoerotic activity. When I mentioned this to the other students, none of the guys had noticed the hamsters masturbating or interacting with other males, but all of the women had seen both behaviors. Coincidence? I doubt it.

In the case of women’s orgasms, we are up against a number of prejudices which obscure the truth of the matter. First is the idea that women are sexually weaker than men. As ancient Taoist sexual teachings put it, the woman, whose sexual nature is like water, is slower to heat up than the man, who sexual nature is like fire. But like fire, he quickly burns out while she is just coming to a boil. A man who has not learned to delay his ejaculation, or to orgasm without ejaculating, is no match for a woman whose sexual endurance is essentially infinite. Just in terms of our physiology, the average man has difficulty engaging in intercourse with more than one woman in the course of an evening, whereas the woman is much more likely to become orgasmic if she has access to multiple partners who can provide the quantity and variety of stimulation she may need to reach orgasm.
In other words, one of the most common sexual problems for men is premature ejaculation. While many men fantasize about how wonderful it would be to have two women in bed, many become too excited or too confused to take full advantage of the opportunity in real life.
One of the most common problems for women is difficulty reaching orgasm. Women who manage to overcome the conditioning which tells them they are sluts or whores if they don’t adhere to monogamous standards, often report very satisfying experiences.
Of course there are exceptions to the rule, but given this equation, one would expect that in the interest of promoting sustainable relationships, polyandry would be the norm (one woman mated with multiple men). But historically, in most cultures the norm has been polygyny (one man mated to multiple women). Clearly factors other than sexual satisfaction are at play. One of these factors is which gender controls the economic resources and has the political and religious power to make the rules. Another is emotional intelligence. Both of these are addressed in my forthcoming book, Polyamory in the 21st Century (Rowman & Littlefield, June, 2010).