Hormonal birth control beyond oral contraceptives

Dear Thinking about trying a new method,
Good question! It's key to be in the know about a variety of birth control options, since new ones are being developed and may be a better "fit" for you than what you're currently using. You're correct in noting that the contraceptive patch and NuvaRing (the vaginal ring) work differently than Mirena, which is an intrauterine device (IUD). While they all use hormones, the primary difference is that IUDs are considered long-acting reversible contraception. This means after they're put in place by a health care provider, they require minimal maintenance and can last for years. The patch and vaginal ring require weekly or monthly maintenance to ensure effectiveness. This difference can contribute to a higher effectiveness rate, but it's key to note that one method isn't better than another. Each method has its pros and cons and the most appropriate one will be dependent on the needs and preferences of the person using it.
The contraceptive patch and the vaginal ring do work similarly. The contraceptive patch is essentially a sticker that is applied weekly to the surface of the skin that uses norelgestromin (a progestin) and ethinyl estradiol (an estrogen) to significantly decrease the chances of pregnancy. The vaginal ring is a small polymer ring that is inserted into the vagina for three weeks. It uses the same hormones as the patch to prevent pregnancy. The ring is then removed for one week, when a person experiences withdrawal bleeding (mimicking a period) — during that time, that individual is still protected from becoming pregnant. After their period has finished, a new ring can be inserted. For more specific information on these two methods, check out the related Q&As.
Mirena is a commercially-available, U.S. Food and Drug Administration (FDA)-approved IUD. IUDs are T-shaped contraceptive devices that are inserted by a health care provider that sit in a person's uterus, just past the cervix. Depending on which type a person uses, IUDs can prevent pregnancy from three to ten years and can be removed at any time by a health care provider. IUDs have proven to be as effective or even more effective than birth control pills (especially among those who have had a child or children), though specialists are still not certain as to precisely how they work. Hormone-releasing IUDs present various benefits, which include:
•High efficacy: Hormonal IUDs have a high effectiveness rate, bein
g over 99 percent effective. Because it's placed by a health care provider, there is little room for user error,
•Hormonal regulation: Hormonal IUDs release progestin into the uterus. A progestin hormone is also used in several progestin-only birth control pills, as well as in the Plan B emergency contraception method.
•Lighter periods: Hormonal IUDs can help to regulate periods, making them lighter and reducing cramping for some.
•Convenience: A single insertion of a hormonal IUD can be effective for up to six years without the necessity of strictly adhering to a daily, weekly, or monthly contraceptive method. This means not having to remember to frequently take a pill or replace a patch or a ring. Some folks find that this enhances their sexual experiences.
•Low cost: Although the initial medical exam, insertion, and follow-up appointments may be expensive, using an IUD may save you big bucks compared to the monthly cost of the pill, the patch, or the ring.
For more on the pros and cons of IUD use, see IUD (intrauterine devices): Another birth control option.
In the end, deciding between an IUD, the pill, the vaginal ring, the contraceptive patch, or any other method is a choice you can make with your health care provider and partner. Your provider can discuss with you the many options available for contraception and, dependent on your medical history, lifestyle, sexual activity, and any medication you might be taking, can recommend specific choices that would best suit you. Lastly, none of the methods of contraception mentioned above prevent against sexually transmitted infections (STIs). For this kind of protection, condoms (and other barrier methods) are still the most effective option.

Just can't orgasm

Dear Reader,
Regardless of your gender or genitalia, reaching orgasm isn’t necessarily a simple task. While concentration or fantasy might be the key to your orgasm, physiological, psychological, societal, and interpersonal factors may also get in your way of getting off. There’s no one-size-fits-all method for a person to experience pleasure and orgasm, so your personal journey might involve a fair amount of introspection, exploration, and information gathering.
Anorgasmia, which refers to difficulty achieving orgasm after sustained sexual stimulation, impacts individuals across the gender spectrum, and is particularly common in women. It may present itself as never having orgasmed, a change in ability to orgasm, or only being able to achieve orgasm in certain situations or contexts. Individuals may struggle to reach orgasm for a whole host of reasons, ranging from emotional to physical. Some of the physical reasons could include:
•Age: As an individual ages, they may have shifts in hormones, circulation, the neurological system, and anatomy that may influence their sexual desires, responses, and sensations.
•Alcohol and smoking: Alcohol can inhibit the body’s ability to climax and smoking can decrease blood flow to genitalia.
•Medications: Certain medications such as antidepressants and blood pressure medications can make it difficult to orgasm.
•Medical concerns with pelvic organs or nerves: Folks who experience vaginal pain during penetrative sex, hysterectomy, or other concerns with the vagina, vulva, or uterus might find that it affects their ability to orgasm. People with penises and prostates can find it difficult to ejaculate after prostate surgery or injury to the pelvic nerves.
•Medical conditions: Serious illnesses and infections could inhibit orgasm, along with hormonal conditions. Some examples include multiple sclerosis, hypothyroidism, and urinary tract infections.
•Conditioning to a sensation: For people who masturbate using a certain method, the body can become dependent on that method to reach climax.
Along with physical factors, whether or not someone orgasms can also be influenced by psychological factors or external pressures. Sex and sexuality can bring up shame, insecurities, and expectations, and these concerns may interfere in folks’ ability to experience pleasure fully. It might be good to take some time to explore your views on sex and sexuality to determine if that’s impacting your ability to orgasm. Some of the non-physical causes of anorgasmia could be:
•Mental health conditions
•Poor body image
•Past abuse or trauma
•Cultural or religious pressure and expectations
•Shame or guilt
•Difference between sexual expectations and reality
Lists adapted from Mayo Clinic.

Just as anorgasmia might look different for different people, so does the orgasm and the process of getting there. Preferences for speed and pressure of stimulation vary from person to person, as does the sensation and intensity of the orgasm. Some folks need lots of foreplay before direct stimulation of the clitoris, penis, prostate, or other erogenous zones and others don’t. The fantasies or sexual acts that turn one person on might not do the same for someone else.
It's also possible for some people to feel fully content with the intimacy and sensation that they experience without an orgasm. It might be worth exploring your body to see if you can discover some new spots or sensations that you enjoy, regardless of whether it leads to orgasm. Sometimes the pressure of seeking an orgasm can make it hard to relax into the moment. It may be helpful to have the goal of making yourself feel pleasure, rather than reaching climax. You might also try introducing a new toy, lubricant, sexy books or films, or touching areas of your body you hadn’t explored previously. There’s no one way to masturbate or experience pleasure. If you’re still frustrated by the absence of an orgasm, consulting with a health care professional may be helpful in finding the origins of your anorgasmia.

What's an STD?

Dear STD,
No need to apologize. Your question reflects your interest in learning, and there's nothing wrong with wanting to stay informed. Lots of people don't know what an STD is! STD is an abbreviation for sexually transmitted disease, and is a term that has replaced VD or venereal disease. Today, the more commonly used term is STI, which stands for sexually transmitted infection. A sexually transmitted infection is an infection that is passed on through sexual activity from a person who already has an STI.
The explanation for the shift in terms from STD to STI is simple, yet significant. The term infection means that a germ is present in a person's body, but the person may not have any signs or symptoms of the infection. The term disease means that the infection is causing obvious signs or symptoms in the person. Thus, a sexually transmitted germ — bacteria, virus, parasite, or fungi — causes an infection, which may or may not result in a disease. This distinction is critical because many sexually transmitted infections don't result in signs or symptoms, so a person may have an STI and not know it. Essentially, the term STI is a more encompassing term than STD. Some organizations or websites continue to use the term STD or use the terms STD and STI interchangeably.
When it comes to STIs, who all is at risk of contracting one? Every sexually active person is at risk for contracting an STI if a partner is infected. To help reduce your risk, you may want to follow safer sex guidelines. If you think you may have an STI, you could consider seeing your health care provider for a checkup. It's a good idea to regularly get checked for STIs if you're sexually active, even if you don't experience symptoms.

Safer sex means reducing skin-to-skin contact and contact with bodily fluids, including semen, vaginal floods, and blood, between partners. Safer sex includes ways of minimizing the risk of spreading HIV and other STIs. Some of these guidelines include:
•Using a condom correctly and consistently every time a person has vaginal, anal, or oral sex (and using a new condom if switching from one form of sex to another or switching partners)
•Using a latex barrier for cunnilingus (oral-vulva contact ) and anilingus (oral-anal contact) – such as a dental dam, a non-lubed condom (that has its ring removed, cut down the length, and opened up to form a rectangle), or non-microwaveable plastic wrap
•Mutual masturbation (masturbating together)
Sex without taking additional precautions can put an individual at risk for HIV and other STIs. This allows semen, vaginal lubrication, or blood (body fluids) to be passed from one person to another. These body fluids may then spread viruses or bacteria to the other partner. You may find the Sexually Transmitted Infections (STIs) category of the Go Ask Alice! Sexual & Reproductive Health archives to be helpful for learning more.

Difference between clitoral and vaginal orgasm

Dear Cumming,
Oh, oh, baby! There are many factors that contribute to how an orgasm feels. One variable is the type of physical stimulation, and to what body parts. A “vaginal orgasm” is the notion that women can have an orgasm through stimulation during intercourse or other vaginal penetration, entirely without clitoral stimulation. However, the vagina has few nerve endings, and therefore cannot create an orgasm on its own. Instead of thinking of the vagina and clitoris as separate entities, try thinking about them as a network of nerves and muscles.
In reality, total separation between the vagina and clitoris is mostly artificial, and often based on a misunderstanding of what, where, and how big the clitoris really is. The clitoral organ system actually surrounds the vagina, urethra and anus. Rather than thinking of an orgasm as "vaginal" or "clitoral", it makes more sense to think of orgasm in terms of the feelings that came along with it. In the end, an orgasm is an orgasm is an orgasm!
Here’s a little bit of history for you: Sigmund Freud made a pronouncement that the "mature" woman has orgasms only when her vagina, but not her clitoris, is stimulated — this is commonly referred to as the “vaginal orgasm”. The emphasis on stimulation from penetration made the man's penis central to a woman's sexual satisfaction. It is important to emphasize that Freud did not base his theory upon a study of woman's anatomy, but rather upon his assumptions of woman as inferior to men.
Back to the basics, stimulating the clitoris and (for some women) pressure in or around the vagina can cause pelvic fullness and body tension to build up to a peak. During sexual excitement, the clitoris swells and changes position. The blood vessels through the whole pelvic area also swell, causing engorgement and a feeling of fullness and sexual sensitivity. The inner vaginal lips swell and change shape, and the vagina balloons upward, causing the uterus to shift position. Orgasm is the point at which all the tension is suddenly released in a series of involuntary and pleasurable muscular contractions in the vagina, uterus, and/or rectum.

You or a partner can stimulate your clitoris in a number of different ways — by rubbing, sucking, body pressure,  or using a vibrator. Although some women touch the glans of the clitoris to become aroused, for others it can be so sensitive that direct touching hurts, even with lubrication. Also, focusing directly on the clitoris for a long time may cause the pleasurable sensations to disappear. Your clitoris can also be stimulated during sexual intercourse, most often with the woman on top — this happens when the clitoris is rubbed against the man's pubic bone. It can also be achieved when the man is on top if the man positions himself high enough so that his pubic bone presses against his partner's clitoral area. You or your partner can also stimulate your clitoris with fingers during intercourse to help bring you to orgasm.
Aside from clitoral stimulation, it is important to remember another major organ involved with orgasm — the brain! Emotions, perceptions, memories, and senses determine how we experience sex, rather than past experiences or physical appearance alone. Mental (cortical) stimulation, where the imagination stimulates the brain, can actually help set off an orgasm. Relaxing and concentrating on sensations (rather than worrying about how you’re doing) can help your brain process your pleasure.
Overall, orgasms are a very individualistic thing — there is no one correct pattern of sexual response. Whatever works, feels good, and makes you feel more alive and connected with your body (and partner if you have one) are what count!

What is Vyvanse hypersexuality?

Vyvanse is the brand name of a drug called lisdexamfetamine dimesylate, which doctors often prescribe to treat people with attention deficit hyperactivity disorder or severe binge eating disorder. Vyvanse belongs to a class of drugs called amphetamines, and some research links these drugs to hypersexuality.
Hypersexuality means abnormally increased sexual activity or sexual thoughts and urges.
It is perfectly normal to think about sex, and most people experience periods when they think about it more than usual. However, with hypersexuality, these thoughts or behaviors interfere with everyday life and relationships.
As with most amphetamines, changes in libido and sexual function are among the possible side effects of Vyvanse. All drugs have potential side effects, but it is important to remember that not everyone will experience them.

Symptoms of hypersexualityPeople commonly go through stages of feeling more or less sexual. However, the symptoms of hypersexuality, which is also called hypersexual disorder, tend to persist for longer periods.
The symptoms of hypersexuality may include recurrent and intense sexual fantasies, urges, or behavior that meets four or more of the following criteria:
spending excessive amounts of time being fully preoccupied with sexual thoughts or planning for and engaging in sexual behavior
repeatedly engaging in sexual fantasies, urges, or behavior in response to feeling anxious, depressed, bored, or irritable
frequently engaging in sexual thoughts and activities in response to stressful life events
being unsuccessful in attempting to control or reduce the frequency of sexual fantasies, urges, and behavior
engaging in sexual behavior with no regard for the risk of causing physical or emotional harm either to themselves or to others around them
Sexual behaviors may include:
having sex
masturbating
watching pornography
taking part in telephone sex or cyber sex
going to strip clubs
Research has linked hypersexuality to the use of amphetamines, particularly in males.
In a study of 1,159 males who were using the drugs illicitly, half of the participants said that the drugs had affected their sex life. They reported reduced sexual satisfaction and more intense orgasms. Some said that the drugs had increased their sexual desire, but others felt that this had decreased.
Uses of Vyvanse
Doctors may prescribe Vyvanse to treat people with attention deficit hyperactivity disorder (ADHD) and those with binge eating disorder (BED).
Some doctors prescribe Vyvanse to treat the symptoms of ADHD, which include:
difficulty paying attention
hyperactivity

acting without thinking
According to the National Institute of Mental Health, the warning signs of ADHD can include:
overlooking or missing details and making careless mistakes
problems sustaining attention while listening, having conversations, or reading
inability to listen to direct communication
not being able to follow instructions
losing focus or becoming easily sidetracked
problems organizing tasks and activities
A growing body of evidence suggests that ADHD also has an effect on sexual activity. In one study from 2006, researchers found that people who had ADHD from childhood tended to start having sex earlier and have more sexual partners and more casual sex than people without ADHD.
Binge eating disorder
Doctors may also prescribe Vyvanse to help treat BED. People with this condition typically have binge eating episodes that last about 2 hours and involve at least three of the following behaviors:
eating much more quickly than usual
eating to the point of feeling uncomfortably full
eating large amounts despite not feeling hungry
eating alone to hide feelings of embarrassment relating to eating
feeling disgusted, distressed, depressed, or guilty after the binge
Such binge eating tends to happen at least once a week for a minimum of 3 months. The person does not usually purge, or make themselves sick, afterward.
Females living with eating disorders are more likely to suffer from sexual dysfunction. A review of current research reported that women with anorexia, bulimia, or BED had fewer sexual partners and fewer sexual relationships than women without any of these conditions.
Eating disorders can cause sexual dysfunction and decreased libido. A person who has an eating disorder may also avoid sex because they feel anxious or self-conscious
According to the American Psychiatric Association, hypersexuality is not a formal diagnosis because there is a lack of evidence to show that it is a health condition rather than a set of symptoms.
It is normal for both males and females to go through periods of increased sexual interest or activity.
When hypersexual thoughts are interfering with a person’s everyday life or relationships, however, it is a good idea for them to see a doctor.

Yawning: An unsolved mystery

Yawning: An unsolved mystery


Despite the fact that virtually every human yawns on a daily basis, its function is still largely a mystery. In this Spotlight feature, we delve into the baffling world of yawn science, touching on topics as diverse as schizophrenia, empathy, chimpanzees, and sexual arousal.
Not a great deal of research has gone into studying yawning; it has not necessarily captured scientists’ imagination en masse. But, once you start to peel back the layers, there is much to talk about.
The process of yawning seems relatively simple: the mouth opens, there is a swift intake of air, a brief pause in breathing, a longer expiration, and sometimes an accompanying stretch.
But that is far from the full list of events. A yawn is a relatively complicated behavior, spread over an average of 6 seconds.
Facial muscles stretch and the head tilts back. The eyes narrow or close and can often water. Saliva is produced, and the Eustachian tubes of the middle ear are opened. Beyond this, there are probably cardiovascular, neuromuscular, and respiratory changes that we are yet to define.
It is common knowledge that we yawn when we are bored or tired, and studies have demonstrated this to be scientific fact. However, there are also reports of paratroopers yawning before a skydive, musicians yawning before hitting the stage, and dogs yawning before they attack – all of which mean that there is obviously more to the yawn than sleepiness.
The sexuality of a yawn
Interestingly, the yawn shares a number of components with other behaviors. For instance, there are some similarities between the “yawn face” and the “orgasm face.” Some researchers believe that there may be common origins, and although at first glance that may seem a little absurd, there is some evidence of a link. For a start, yawning is triggered by androgens (male sex hormones) and oxytocin. Furthermore, most drugs that produce stretching and yawning in rats also cause penile erection.

Another intriguing link between sex and yawning concerns antidepressants. Drugs including clomipramine and fluoxetine tend to depress sexual desire, and in some people, they also produce an odd side effect: their yawns trigger orgasm.
We have all been yawning since we were in the womb, and a whole host of animals – from flies to snakes, and from bears to badgers – all indulge. It is clearly an ancient behavior, and the fact that it has been conserved throughout evolution means that it must do something useful.
The program that controls yawning appears to rest in an ancient part of the brain, too. As an example, patients with amyotrophic lateral sclerosis who are “locked in” and who have virtually no control over their muscles can yawn normally. Neurologists believe that this means the yawn coordinates are kept in the brainstem, an evolutionarily old part of the brain, along with the centers responsible for controlling breathing and vascular tone.
One of the most interesting things about yawns are their contagious prowess. As you read this article, many of you will be yawning as a result of simply thinking about it.
According to Robert R. Provine, the most prolific yawn researcher, he himself has become a “yawn stimuli.” Because his friends are all aware of his work, he simply has to enter a room and people begin to yawn.
Human-to-human yawn infection is well documented. However, it is not contagious in children until they reach around 5 years of age.
Catching yawns in non-human animals is much less common, but it has been observed in chimpanzees and some other primates.
A study looking at yawning in gelada baboons found that yawns were more contagious among individuals that shared a closer relationship, as measured by levels of grooming. A similar observational study on bonobos also found that a yawn is more likely to be contagious when it is spread between individuals that are more closely bonded.
Aside from primates, it has been demonstrated that dogs more easily catch yawns from their owner than from a stranger, which provides more evidence that being close knit enhances the yawn bond.
To some researchers, these findings mean that yawning might offer an intriguing insight into the human mind – specifically, an insight into primal empathy.
Researcher Steven Platek and his colleagues conducted a study in which participants received MRI scans while watching other people yawning. Activity was measured in the posterior cingulate and precuneus brain regions. These areas are involved in self-referencing, theory of mind, and autobiographical memory. The authors conclude:
This potential measure of empathy could prove useful in relation to certain mental conditions. For instance, in disorders such as autism and schizophrenia, an individual’s ability to assess other people’s emotions and motivations are substantially reduced.
As an example, one study published in 2009 found that individuals with schizophrenia were less susceptible to both yawn and laughter contagion.
Not everyone believes that yawning is linked with empathy, however. An experiment published in PLOS One found only one significant predictor of yawn contagion: age. Older people were significantly less likely to yawn when watching a video of people yawning than younger people were. The researchers also found that an individual’s level of empathy (as assessed by questionnaires), time of day, and intelligence were not significant predictors of one’s likelihood to catch a yawn.
Either way, there certainly is a social aspect to yawns – but that fails to answer the question of why we yawn, specifically. It could just as easily be sneezing or hiccups that are contagious, so why is it this long, deep breath?

What is an orgasm headache?

An orgasm headache is intense and it starts suddenly, just before or during an orgasm. These headaches are usually harmless, and a person can often treat them with over-the-counter pain medications.
However, headaches during sex can sometimes signal a more serious condition.
In this article, we describe what orgasm headaches are, what they feel like, and what causes them. We also explore risk factors, prevention, treatment, and when to see a doctor.
An orgasm headache is a primary headache that some people get during sexual activity. A primary headache is a condition itself, not a symptom of another health issue.
A person may experience an orgasm headache just before or during sexual climax. These headaches can happen during masturbation or partnered sex.
Orgasm headaches are one of two types of primary sex headache. The other type is a sexual benign headache, which doctors also call a pre-orgasm headache.

What do they feel like?
People typically experience orgasm headaches just before or during an orgasm.
The pain may feel:
intense
explosive

like a clap of thunder
An orgasm headache may be most painful behind or around the eye area.
Around 75 percent of people who experience these headaches report feeling pain on both sides of their head. Moving around may make the pain worse.
A common feature of primary sex headaches is intense pain for 5–15 minutes that gradually eases.
The pain occurs abruptly, and after it diminishes, a person may feel a throbbing in their head, which can sometimes last for several hours or even days.
Unlike migraine headaches, orgasm headaches do not usually occur with nausea or sensitivity to light or sound.
In contrast, a sexual benign headache feels like a dull background headache. This type of pain builds slowly, rather than starting suddenly, and it may feel similar to a tension headache.
Some people experience both pre-orgasm and orgasm headaches.
Causes
Doctors do not know what causes orgasm headaches, but they may be a type of vascular headache. These result from blood vessels swelling in the brain.
When a person has an orgasm, their blood pressure increases rapidly. This surge in pressure causes blood vessels in the head to dilate quickly, which can trigger sudden, intense headaches in some people.
A sexual benign headache, on the other hand, results from increased muscle tension. As a person becomes sexually excited, muscles in their neck and head can contract, which may trigger a tension headache.
Risk factors
Anyone can experience orgasm headaches. However, a 2010 review reports that males are four times more likely to experience primary sex headaches than females.
According to a case report from 2013, the average age of onset for these headaches is between 40 and 49 years.
People with a history of migraine headaches, exertional headaches, or cough headaches may be more likely to get orgasm headaches.

Is it ok to masturbate during pregnancy?

Most doctors agree that masturbating during pregnancy is safe and that it can even provide health benefits, such as lowering stress and promoting blood flow.
For some pregnant women, morning sickness, nausea, and fatigue remove any interest in sexual activity, including masturbation. Others notice an increase in their sex drive — libido — due to increases in progesterone and estrogen levels.
Women often wonder whether masturbating while pregnant is safe or if there are any risks. The good news is that, in most cases, it is totally safe.
In this article, we answer some common questions about masturbating while pregnant.
In most low-risk pregnancies, masturbation is a perfectly safe way to relieve stress and manage an elevated libido. That said, women should always defer to the advice of their doctors.
It is safe to use sex toys, such as vibrators or dildos, as long as they are clean.
Before using any toy in or around the genitals, wash it with soap water to prevent bacteria from entering the vagina. This applies to the hands as well. Keep the fingernails trimmed short to prevent scratches.
Masturbation will not harm the baby, and the baby will not understand what is happening. In fact, some doctors believe that babies may be soothed or comforted by the rhythmic uterine contractions that happen during an orgasm.


Are there benefits?
Masturbation, including during pregnancy, can be good for the body. Some women even report stronger or more intense orgasms while pregnant.
Some benefits of masturbation during pregnancy include:
lowering stress levels
improving sleep
easing pregnancy-related discomfort and pain
increasing the release of endorphins
In addition, masturbation is the safest form of sexual activity. There is no risk of sexually transmitted infections (STIs) unless a person is sharing a sex toy with someone else.

Are there side effects?
Later on in pregnancy, a woman may notice increased Braxton-Hicks contractions following an orgasm. These contractions, though sometimes uncomfortable, are nothing to worry about.
Some women also have cramps, similar to period cramping, after an orgasm. These cramps are normal and may feel like Braxton-Hicks contractions.



What are the risks?
There are no risks associated with masturbation for a woman having a low-risk pregnancy who has no complications or other medical issues.
When preterm labor is a risk, however, vaginal penetration — or even having an orgasm — can trigger labor. In these cases, the doctor may recommend avoiding intercourse or orgasms to lower the chances of premature delivery.
Masturbation can cause small tears in the internal or external genitalia, especially if a woman has long nails. Breaks in the skin can introduce bacteria into the body and cause infection, which can be more serious when pregnant.
To reduce this risk, keep the nails short and make sure that the hands and any sex toys are clean. Placing cotton balls in the fingertips of a latex or nitrile glove and wearing it while masturbating can provide extra protection.
It is important to recognize the risk of contracting STIs from sharing sex toys. Covering a sex toy in a condom will minimize any risk of infection. Make sure to change the condom between each use of the toy.
When women experience certain complications, doctors may recommend avoiding orgasms and sexual activity — including masturbation — during pregnancy. The restriction may be temporary or apply to the entire pregnancy.
Conditions and complications that may make some sexual activity risky include:
placenta previa, in which the placenta covers the cervix
a weakened cervix
premature rupture of membranes
a history of premature labor
vaginal bleeding
uterine infections
intrauterine growth restrictions
It is extremely important to ask a doctor about specific risks. They may advise that a woman avoid having orgasms altogether or only refrain from vaginal penetration, for example.
Having an orgasm causes the muscles in the uterus to contract. In some situations, this can trigger early labor, premature delivery, or other serious complications.
If a doctor advises against vaginal penetration, masturbation or mutual masturbation with a partner can be a good alternative. If an orgasm is off-limits, avoid masturbation and all other sexual activity.
Couples yearning to connect may consider engaging in sensate focus exercises. The aim of these exercises is to build intimacy and increase physical awareness through mindful touching and enhanced communication.
If the water has broken or if there is any vaginal bleeding, refrain from masturbation and other sexual activity and consult a doctor.


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Sex and the Peak Experience

Name: Fabrienne Serignese
Location: New York City
Profession: Tantric yoga instructor (templeofoshun.com)
Fab coaches people in the art ofmaximizing pleasure. "There is this whole esoteric aspect to tantra," she says, "but it has some practical techniques that will—in a couple of minutes—make you more able to feel sensation and more orgasmic." Focus on breathing. Make eye contact. The biggest challenge to sensuality her clients face: turning off their thoughts. "If you're thinking about anything during sex—including how good it is—you're not present."
Dive In
Perhaps the importance of warm-up exercises has been overrated. According to a recent study, the consistency with which women have orgasms with partners is correlated with their reported average duration of intercourse, but not with time spent on foreplay. Of course, there's something to be said for the fun of a leisurely buildup.
Playing Keep-away
People who avoid personal attachment are more likely than others to sleep around and have one-night stands. But because they're uncomfortable with true intimacy, they also find less satisfaction in their trysts. As a result, women with high attachment avoidance report less frequent orgasms with partners.
Hurts So Good

Your O-face looks a lot like your ouch-face, a result of a common brain area activated by both orgasm and pain. But people are slightly better at recognizing photographed expressions of pain than those of heightened sexual pleasure, perhaps because we have more exposure to others' oh-nos than to their oh-yeses.
What She's Having
If a woman suspects that making a little noise during sex will heighten the experience for her man, there's suggestive evidence from the primate world to back her up. In a study of macaques, males ejaculated 59 percent of the time when their partners vocalized, but almost never with their mates on mute.
Booster Shot
In one case study, a man's inability to have an orgasm was treated by his using oxytocin nasal spray during sex. Oxytocin is known to induce both bonding and pelvic muscle contractions. Hold tight.
Hope and Glory
Many women give up on serotonin reuptake inhibitors because of delayed orgasms, but a clinical trial found Viagra reduced this side effect in frustrated females. Talk to your doc...

14 Crazy Amazing Facts About Female Sexuality

Right now, at the Leslie Lohman Museum in Soho, New York, there is an art exhibition about the clitoris, called CLITERACY. Now, the clitoris doesn't usually get a lot of press. It's usually upstaged by the vagina which is usually left in the dust by the attention that the penis gets.
The artist, Sophia Wallace, in her ongoing mixed media project "exposes the irony of society’s obsession with and ignorance of female sexuality. CLITERACY, 100 Natural Laws (2012) includes a monumental wall of texts that challenge phallocentric biases in science, law, philosophy, politics and the art world. Wallace’s focus on the clitoris and female pleasure serves to question and counteract the history of misinformation regarding women’s bodies and the concomitant oppression therein." I was completely drawn in. It's a "must go see".

And I left with a lot of clitoral facts and then went off to do even more research. Brace yourself for some facts and thoughts about the clitoris. As artist Sophia Wallace states: "The clitoris is not a button, it's an iceberg."
1. If you want to address the clitoris, labia, and vagina together, the vulva is the all-encompassing term.

2. Fifty to 75 percent of women who have climaxes (orgasms) need to have their clitoris touched (clitoral stimulation). Most women are unable to have an orgasm through intercourse alone.
3. The clitoris is only partially visible to the naked eye. The clitoris is actually close to four inches in length (the average non-erect penis) but three-fourths of it is hidden from view within a female’s body. It's buried treasure. Think of all that pleasure potential in the entire region. Have you explored it?

4. The clitoris grows throughout a woman's life. After menopause, the clitoris can become 2.5 times larger than it was when the same woman was a teenager. No wonder that some women have stronger orgasms in mid-life and into their fifties and beyond. And maybe size doesn't matter at all.
I don't think that women have a size thing about their clitoris, the way men do around penis size. I have never ever met a woman who has measured her clitoris, but I have met men who have measured their penis. Another interesting fun fact is that women who have given birth tend to have a larger clitoris, the longest ever measured was 12 inches long.

5. The clitoris contains 8,000 sensitive nerve endings, double the nerve endings in the glans of a penis.
6. Most of us don't know that all babies have the exact same genital tissue when they are conceived. At about 12 weeks, each baby’s genitalia begins to differentiate into a penis or labia. We are more alike than we are different. The clitoris and penis are the same materials assembled in a different way. The clitoris has glans, a foreskin, erectile tissue, and a very small shaft; all the parts that a penis has. It even swells when it's aroused.

7. Back to being an "inny" and an "outy." Only one-quarter of the clitoris is visible. The rest of it is inside the woman's body. Besides the clitoris being made up the clitoral head, the hood the clitoral shaft, it is also composed of the urethral sponge, erectile tissue, glands, vestibular bulbs, and the clitoral legs. Only the clitoral head and the hood are located outside the body. Some sex experts believe that the G Spot is actually a part of the clitoris.

8. The clitoris is designed to bring a woman pleasure. That is its sole purpose. Not reproduction.
9. Yes, there are all kinds of orgasms. Vaginal, Cervical, and G Spot Orgasms do exist, but they are much harder for most women to achieve than a clitoral orgasm. Very few women are able to achieve an orgasm without any kind of clitoral involvement. There is nothing immature about women having orgasms through their clitoris.

10. The clitoris varies in size and shape on different women. Some are hidden under the hood, and some stick out. Some like to be touched softly and others like a lot of pressure. It takes time to get to know a woman's clitoris. Don't assume that you know what it likes. Take your time and get to know each unique clitoris, just like you would take the time to get to know the woman it is attached to.

11. People have all kinds of nicknames for the clitoris. You may have heard a few: man in the canoe, rosebud, joy buzzer, cherry pit, love button, bald man in a boat. I have also heard, chickpea, and lentils.
12: A clitoral orgasm can bring about anywhere between 3-16 contractions and can last from 10-30 seconds. But that doesn't exclude the fact that many women have multiple orgasms that can include pelvic contractions.

13. Male and female orgasm have been compared and even the most average clitoral orgasm lasts longer than even the best ever most fantastic male orgasm. Woman have more nerve endings in the clitoris.
14. Did you know that the word "Clitoris" is from the Greek word for "key"? Understanding and getting to know the clitoris may unlock your sex life forever. I invite you not to dismiss the clitoris and realize how deeply wired this gland is into the female body.

Why wouldn't we take a cue from the ancient Greeks, and recognize fully that this amazing female pleasure source is indeed a key to unlocking a female's pleasure possibilities and perhaps so much more. When we turn a key, doors open.

Why Are Men Mad About Mammaries?

Why do men love breasts?
Let me count the theories:
1. Freudian (breasts remind men of their moms and the nurturing of childhood)
2. Evolutionary (breasts resemble buttocks, and prehuman ancestors always mounted from behind)
3. Reproductive (breasts are an indicator of age, and big breasts, in particular, are a marker of high estrogen levels, associated with fertility).
Do these reasons sufficiently explain why breasts are beloved, even in cultures that don't eroticize them any more than the face?
If not, here's another:
Breasts facilitate "pair-bonding" between couples. Men evolved to love breasts because women are likelier to have sex with, and/or become attached to, lovers who handle their breasts.
This idea came up in New York Times journalist John Tierney's interview with Larry Young, a neuroscientist famous for his research on monogamy. According to Young, "[M]ore attention to breasts could help build long-term bonds through a 'cocktail of ancient neuropeptides,' like the oxytocin released during foreplay or orgasm."

The same oxytocin circuit, he notes, is activated when a woman nurses her infant.
When women's breasts are suckled, as they are during breastfeeding, the hormone oxytocin is released. Oxytocin helps the mother bond with her baby. She feels loving and attached. The same reaction might happen if a man sucks and fondles a woman's breasts during foreplay. Therefore, the logic goes, men pay attention to breasts because doing so may help them attract and retain mates. In our ancestral past, most titillated men may have been more likely to pass on their genes.
The "boobs-help-bonding" theory may not be the strongest explanation of why men have evolved to love breasts, but it's worth introducing to the debate. That said, there are many ladies out there for whom a lover's suckling does nothing, and there are many breast-ogling boobs who know nothing of foreplay.

Women in Bed: What's All the Noise About? (Part II)

[Apologies to readers who have been asking for more on female libido. I've been dealing with book galleys, but appreciate your interest.]
Women aren’t the only female primates who make a lot of noise in the throes of passion. British primatologist Stuart Semple found that, “In a wide variety of species, females vocalize just before, during or immediately after they mate. These vocalizations,” Semple says, “are particularly common among the primates and evidence is now accumulating that by calling, a female incites males in her group….” Precisely. There’s a good reason the sound of a woman enjoying a sexual encounter entices a heterosexual man. Her “copulation call” is a potential invitation to come hither, thus provoking sperm competition.

Semple recorded more than 550 copulation calls from seven different female baboons and analyzed their acoustic structure. He found that these complex vocalizations contained information related both to the female’s reproductive state (the vocalizations were more complex when females were closer to ovulation) and to the status of the male “inspiring” any given vocalization (calls were longer and contained more distinct sonic units during matings with higher-ranked males). Thus, in these baboons at least, listening males could presumably gain information as to their likelihood of impregnating a calling female, as well as some sense of the rank of the male they’d find with her if they approached.

Primatologist Meredith Small agrees that the copulation calls of female primates are easily identifiable: “Even the uninitiated can identify female nonhuman primate orgasm, or sexual pleasure," she says. "Females,” Small tells us, “make noises not heard in any other context but mating.” Female lion-tailed macaques use copulation calls to invite male attention even when not ovulating. Small reports that among these primates, ovulating females most often directed their invitations at males outside their own troop, thus bringing new blood into the mating mix.


Female copulatory vocalization is highly associated with promiscuous mating, but not with monogamy. Alan Dixson has noted that the females of promiscuous primate species emit more complex mating calls than females of monogamous and polygynous species. Complexity aside, Gauri Pradhan and his colleagues conducted a survey of copulation calls in a variety of primates and found that “variation in females’ promiscuity predicts their tendency to use copulation calls in conjunction with mating.” Their data show that higher levels of promiscuity predict more frequent copulation calls.

William J. Hamilton and Patricia C. Arrowood analyzed the copulatory vocalizations of various primates, including three human couples going at it. They noticed that “female sounds gradually intensified as orgasm approached and at orgasm assumed a rapid, regular (equal note lengths and inter-note intervals) rhythm absent in the males’ calls at orgasm.” Still, the authors can’t help sounding a tad let down when they note, “Neither sex [of human] … showed the complexity of note structure characteristic of baboon copulatory vocalizations.” But that’s probably a good thing, because elsewhere in their article we learn that female baboons’ copulation calls are clearly audible to even human ears from three hundred meters away.

Before you conclude that female copulatory vocalization is just a fancy phrase for a little excitement, think about the predators possibly alerted by this primate passion. Chimps and bonobos may be out of reach up in the branches, but baboons (like our ground-dwelling ancestors) live among leopards and other predators who would be quite interested in a two-for-one special on fresh primate—especially given a mating pair’s distracted, vulnerable state.

As Hamilton and Arrowood put it: “In spite of the risk of exposure of individuals and the troop to predators these baboons habitually call during copulation, [so] the calls must have some adaptive value.” What could that be? The authors (writing in Science) offered several hypotheses, including the notion that the calls may be a stratagem to help activate the male’s ejaculatory reflex, an analysis with which many prostitutes would presumably agree. Perhaps there is something to this idea, but even so, male primates are not known for needing a great deal of assistance in activating their ejaculatory reflex. If anything, the human male ejaculatory reflex tends to be too easily activated—at least from the perspective of women not being paid to activate it as quickly as possible. Especially given all the other convergent evidence, it seems far more likely that in humans, female copulatory vocalization would serve to attract males to the ovulating, sexually receptive female, thus promoting sperm competition, with all its attendant benefits—both reproductive and social.

Yet despite all the loud carrying on by women the world over, “The credo of the coy female persists,” writes Natalie Angier. “It is garlanded with qualifications and is admitted to be an imperfect portrayal of female mating strategies but then, that little matter of etiquette attended to, the credo is stated once again.”

Ecstatic, Sexy, Orgasmic Mid-Life Sexuality: Anyone?

There is this study making the rounds - it's popping up on blogs all over the internet. It's the latest poll on sex with the famous Dr. Ruth Westheimer bringing some celebrity to the findings—you can read all about it on LifeGoesStrong. The big take away is that if you are between the ages of 45 and 65 years old - chances are you are giving a thumbs down to your sex life (24%). So what else is new? I don't mean to be glib—but franky this is not news to me—or perhaps you.

I am not shy—I will admit it. I not only lived it—I wrote about my own mid life sexual dissatisfaction, and confusion that led to my own wonky journey to personal rediscovery in my soon to be released memoir Shameless: How I Ditched The Diet, Got Naked, Found True Pleasure and Somehow Got Home in Time to Cook Dinner.  While my path of re-awakening and relighting my own fire—may not be yours—the desire to get there may be. I was 43 when I could no longer hide from the fact that my sexuality was on hold. A little younger that the 45 year olds in the study—but I have always been ahead of myself!

I guess what got me about the poll is that people both younger and older than mid lifers are doing better than mid-lifers! Only 12 percent of 18-29 year olds say they are frustrated with their sex lives and just 17 percent of the 66-plus  seniors are complaining.
Perhaps mid life is our second adolescence—that time of uncertainty and un-named hunger. I don't know if it is the shifting of hormones, kids leaving the nest, job changes, or sexual boredom in either long term monogamy or recent divorces that is creating the sexual blues  But mid lifers seem more often than they are not - disconnected when it comes their sex. lives. I think it is time to let go of the woulda's, shoulda's and coulda's- and start living fully again.

Dr. Ruth Westheimer says that the poll's under lying message is that mid-lifers are not communicating enough about sex. That may be true—but as a woman in has been in trenches—I think that we are not helping both men and women to reconnect first to their own bodies. Get rid of the awful messages in our heads that we are not enough.

Perhaps we need to re-learn sexual pleasure again our own bodies—and we can do that with our partners by learning to give and receive pleasure—perhaps in a different way—by showing up as our partner's sexual healer for lack of better language.
Imagine asking your partner to simply receive pleasure one night—and don't do anything back. Make that night all about them—what would that do to your sex life? And then on a different night—trade.

What if you spent time giving and receiving sensual massage with your partner—have you done that lately? Played with sexual fantasies? Bought some new sex toys—and even watched some sexy videos together?  Let's face it—if we are in mid-life and in a long term relationship—our hearts may be totally committed to each other. But sometimes our bodies get bored. Reach for whatever could perk things up—I wrote about my "Zestra Experience" —about how reaching for something new to bring into my bedroom really enlivened the experience for not only me—but for my husband.

Let's face it lots of things change over time—our bodies—and our desires. We live in a world that tells us that sexuality should be spontaneous—and "natural." Yet we watch cooking shows to learn new recipes - get personal trainers—and sit on a sofa talking about our troubles. What if we put just a little bit of that attention onto our sex lives? Do something different—shake it up and go on a little sexual exploration either with your partner or if you don't have one—by yourself.  There is so much out there - seminars, workshops and even get a ways! And what is so cool is that where ever I travel on my own sexual journey—I am met by other mid lifers—just like me.

So what about it? How are you going to create the kind of sex life you want to have?

Can Animals Have Wives, Husbands, Children, and Orgasms?

In response to an interview with the Canadian Broadcast Corporation (CBC) called "Science is revealing more about animals' rich, complex inner lives" that's available online, I received a good number of motivated emails containing extremely interesting observations and, in some instances, even more interesting and "deep" questions about nonhuman animals (animals). The fifth question I received from Ann-Marie was, "Can animals have wives, husbands, children, and dare I ask, orgasms?" Hence, the title of my brief essay.

The interview began, "Some people like to draw some kind of taxonomic line. They'll say, 'Well, mammals have it all, but not birds or fishes or reptiles, amphibians or invertebrates,' I told The Sunday Edition's host Michael Enright. "But I don't think that anybody who looks at available data and also just uses common sense would debate that the number of animals in that cognitive, emotional consciousness arena seems to grow every day, actually." Numerous references can be found here, here, and here.

I begin with Ann-Marie's question because it raises a number of questions about the words we use to describe what animals do and feel. Simply put, words matter. My answer to Ann-Marie was, "Yes they can. Many animals form relationships for the purposes of making children, often referred to as 'offspring' or 'young' in scientific literature, but there's no reason not to call them 'children,' because that's who they are. And there's a lot of research on various mating systems that have been observed in other animals and they're often referred to as being monogamous, polygamous, or polyandrous. If we can use those words we surely can use wives, husbands, and children. In fact, right now, I've been observing a House Finch near my home I named Mabel who is waiting to have children and whose husband seems to have gone missing. And yes, there are many observations and ample data suggesting that some nonhumans experience orgasms. Thanks for asking." One person who read this essay before I posted it jokingly asked, "Maybe animals don't fake them?" I feel safe in saying that no one really knows. When I talk about Mabel with neighbors and friends, not a single one flinched when I used the words "children" and "husband."

Another email I received from Celeste read, "I listened to your interview with Michael Enright on The Sunday Edition this morning with great delight. I thought you might be interested to hear another real-life skill of a raven. It was 18 years ago that I rescued a baby raven, that had fallen out of the nest before fledging, and broken its leg. Living on tiny Pender Island I sent it to a wildlife rescue centre, where it recovered and also learned to fly. I released it right where I'd found it a month later and it flew away with its apparent family.  In the years ever since, this same raven — I think a female — whose voice I recognize, has been building a nest and raising some babies in the forest right behind our house. Last year, in the middle of the night, our neighbour (a doctor of ornithology) was wakened by the distressing "shouts" of ravens, went outside and discovered a raccoon had grabbed one of the fledglings. She scared it off, and we buried the dead baby in the forest just behind our place. I put a cement flagstone on top and painted a raven feather to identify it.
A couple of days later, this is what I found — a moulted raven feather lying just as it still is (now wet) a year later.  My partner rolls his eyes at this, but my neighbour and I both 'get the message'." I quote it in full because it shows just how important "citizen science" can be and how interested many non-scientists are in the behavior of diverse nonhumans.

I thanked Celeste for writing to me and for sharing her very interesting observations and referred her to an essay called "Grieving Animals: Saying Goodbye to Friends and Family" I wrote about a wonderful book by John Marzluff and Tony Angell's called Gifts of the Crow in which they discuss grieving behavior and many other fascinating aspects of bird behavior.

Here are a few other questions and observations I received. David asked, "Why is it that so many people are afraid to pay attention to 'the science' of what we know about how smart and emotional other animals are?" I wrote that while I really don't know, it's likely they believe humans are superior and radically different from other animals, but human exceptionalism really doesn't work in numerous situations. Or it's possible they deny what we know because it enables them or us to use animals for in ways that cause pain, suffering, and death. (See "Animal Emotions: What Must We Do With What We Know?," "The Rich and Deep Emotional Lives of Dogs in 226 Seconds," and "Stripping Animals of Emotions is 'Anti-Scientific & Dumb.'") How some deal with the cognitive dissonance they feel also is mysterious to me.

Jean's email also was very interesting. She asked, "Why don't people who live with dogs use what they know about them and extend this to other animals?" Once again, I couldn't really answer her question other than to say that I hope that people would look toward dogs and other companion animals as "gateway species" who could help them bridge the "empathy gap" and apply what they know to a broad spectrum of species. (See "'Everyone Wants a Lost Dog Found,' Bridging the Empathy Gap," Canine Confidential, and Unleashing Your Dog.)

Three more notes are worth mentioning and I hope they and the other emails I received get you thinking more about all that we know about the cognitive and emotional lives of animals. Jim wrote, "My dog, Gus, did something very interesting a few days ago. He was running around in our yard and got a yellow flower petal stuck on his head. We don't think he knew it was there and he paid it no attention until he walked into the house, passed by a mirror that's been there for years, stopped, looked into the mirror, and swatted at it with a front paw. My wife and I were shocked. After I heard your interview I figured I'd ask if you had any idea what he was doing?" I wrote back, "Among the many interesting questions in which people who study animal minds are interested is what do they know about themselves." I went on to explain what the "mirror test" is and how it's used to study self-awareness in animals, and also referred him to an essay called "Dogs, Mirrors, and Purple Fuzz: Did Honey Know That's Honey?" and references therein in which I wrote about the mirror test, a similar observation of a dog named Honey, and covered some of what we know about self-awareness in nonhumans. I really wish I knew for sure what Gus and Honey were thinking and knew.

Alisa wrote, "What about fish?" I wrote that there is a lot of data about the cognitive and emotional lives of fishes and that there is no reason to exclude them from the cognitive, emotional, or consciousness arenas. I also mentioned what we also know about other vertebrates and insects and other invertebrates that should give us pause in writing them off as unthinking or unfeeling beings.

Lastly, Maria wrote, "I've always felt animals have feelings, are smarter, and are better 'people' than most people I know. I give the example of my cat, Mika, who found my cancer months before the doctors found it. Note - I am fine, no worries, healthy now.  When I came home from the first surgery, the cat hopped up on the bed and sniffed the area, and hasn’t bothered with it again. Thankfully my doctors are animal people too and said if my cat ever gets obsessive about any other part of my body, call and they’ll get me in for an MRI immediately. Would he have been as obsessive over this tumour had it been on someone else?  But at least he caught it for me." Lucky Maria. There are many observations of dogs and cats being good at detecting various medical conditions and illnesses.

As I'm writing this essay a few other emails came in with very interesting observations and questions. These included a number of observations of Jon's dogs using tools to get what he thought was inaccessible food (I suggested he read "Can Dogs Make and Use Tools?" and do a web search), fishes who seem to recognize the humans with whom they live (there's evidence fishes can recognize human faces), and a question from Erwin whose cats seems to be able to count food items. He wanted to know if cats can count and I wrote it's possible they can.

There's no reason for humans to be anthropocentrically possessive about certain traits or the use of certain words
Stay tuned for further discussions of the fascinating cognitive and emotional lives of other animals. I hope these questions and observations get you to think more about what we know about animal minds from scientific research and what you observe and what you know about your companion or other animals. I hope you're motivated to write down your observations and questions and share them with researchers and with people who simply are interested in what animals think, know, and feel.

All of this information is important in helping us to learn more about the other animals with whom we share our magnificent planet. And, there still is much to learn and we should keep the door open to possibilities that seem unlikely or that some people write off as being "impossible." Much of what we've learned in the past two or so decades was previously written off by a good number of researchers in the past who were anthropocentrically possessive of traits we now know are widespread among diverse nonhumans or who were anthropocentrically possessive and had strong reservations about the use of certain words that truly explain what other animals are doing, thinking, and feeling. Anna-Marie's question is right on the mark.

We should all be very glad that narrow views about animal cognition, emotions, and sentience didn't predominate and a cadre of researchers and other people didn't submit to some very strong personalities who said, with great authority, something like, "This or that is impossible and uniquely human" or "It's a waste of time to pursue certain questions about the minds of other animals."

Clearly, these humancentric views, often made despite what we already knew, were incorrect and are rapidly disappearing as more and more data clearly show that numerous nonhumans are capable of amazing feats of mind and heart. What an exciting time it is to study the lives of other animals.

Mating Motives: Hook Up Orgasms and Relationship Mercy Sex

A new sex study has been receiving much media attention recently, including mentions in the New York Times and on network TV. According to findings presented by the evolutionary biologist Justin Garcia of Indiana University, women have fewer orgasms during hook ups than during sexual encounters in the context of a relationship. The study results converged with those from previous studies, notably an oft-quoted online questionnaire survey recently published by researcher Paula England, a sociologist at New York University. England’s work, which included thousands of students from multiple universities, found that only forty percent of women experience orgasm in their last 'hook up' encounter compared to seventy-five percent who experienced an orgasm in their last relationship sex episode. Taken together, these findings appear to suggest that despite well publicized changes in sexual mores among young women and their increasing tendency to accept and even initiate hook up sex, at the end of the day (or night) the sex they are having is still not equal, at least in the context of orgasm.
Beyond the technical discussion about how the fluid, blurry definition of the term ‘hook up’ limits scientists’ ability to collect reliable and valid ‘hook up’ data, much of the debate surrounding these findings has focused on the question of how to interpret them.
On one side is the claim, which often carries moralistic undertones, that the root problem resides in women’s inherent difficulty to really enjoy sex without commitment, outside the stable, safe and intimate confines of a (traditional, monogamous) relationship. Indeed, feelings of security and emotional closeness are important to many women in facilitating the processes of turning on and letting go that lead to orgasm.
On the opposing side stands the argument that the problem resides not so much in the nature of women, but rather in the etiquette of men, and in their failure to provide their female partners with the level of physiological stimulation necessary for orgasm. Indeed, according to the data, men in 'hook up' encounters engage in less foreplay with their partner, feel less committed to bring her to orgasm, are less likely to perform oral sex, and are less communicative and aware of the woman’s sexual needs and preferences.

A third argument holds that, on a deeper level, maybe there is not really a problem at all. After all, an orgasm may not be the only (or main) reason to have sex. In fact, orgasm is easier, safer, faster, and cheaper to experience alone via masturbation. Researchers Cindy Meston and David Buss of the University of Texas in Austin showed several years ago that there are hundreds of reasons for the decision to initiate or agree to sex, including (but not limited to) feelings of compassion, boredom, or the desire for revenge. Moreover, women generally report satisfaction in sex even without orgasm (and those who experience one orgasm in a sexual encounter usually leave many additional possible orgasms on the table, given that all women are potentially multi-orgasmic). Perhaps the assumption that sex must always end in orgasm to be considered good or healthy is in itself at fault.
Researcher Debby Herbenick of Indiana University, in a Slate magazine interview, suggested in this vein that those who rush to see problems in the ‘orgasm gap' may themselves be the problem. Why pressure women to orgasm? Why blame men for a lack of skill? According to Herbenick, the human need for touch and connection is not embodied in orgasm alone.
It is a point well taken. The tendency to apply one simplistic standard to the evaluation of complex phenomena and of entire populations is problematic, and not only with regards to sex. The tendency to measure success by wealth alone, for example, is equally problematic. By this measure, Albert Einstein was less successful in his life than Al Capone. Maybe it's better to let people decide for themselves how they wish to measure, evaluate and experience their relationships and their sexual lives, rather than make the sexual encounter a tournament for the orgasm championship. One size does not fit all, and one reason—even a good one such as an orgasm—does not motivate or interest all of us all the time.
Either way, the heated discussion of the motives of hook up partners, though fascinating, is not proportional to the size of the phenomenon itself. Young people’s casual sex is indeed a more titillating topic than married sex; it sells more magazines, gets more eyeballs on the TV screen, and lights up the imagination. But most of the sex that happens at any given moment around the world happens between partners in steady, intimate, long-term relations. Married people have more sex than singles. Thus, questions about what motivates sex in relationships are as, if not more, important than questions about the motives of hook up partners.
Relationship research, it turns out, has begun to shed light on these questions. Well-regarded theories in the psychology of motivation posit that human behavior in general can be divided helpfully into two categories: approach motivated behavior and avoidance motivated behavior. Approach motivation is expressed in action that seeks a positive consequence. Avoidance motivation seeks to prevent a negative outcome. This basic distinction has been applied to the study of relationship sex. In this context, approach sex seeks to achieve a positive result such as physical pleasure or intimacy with a partner. Avoidance sex aims to neutralize relationship conflict or eliminate bad feelings, like guilt—“mercy sex” in the bedroom vernacular. According to studies in recent years, individuals who frequently engage in approach sex report more positive emotions and satisfaction in their relationships; those who rely on avoidance sex experience more negative emotions and conflicts in their relationships. Studies to date, however, have been limited by their narrow self-focus, examining the experiences of the participants themselves, without examining the impact their sexual motives may have on their partners.
An interesting article published this year by the researcher (and fellow Psychology Today blogger) Amy Muise at the University of Toronto and her colleagues sought to address this point. Muise and her coauthors have followed over 150 married or cohabiting couples and asked them, in two separate studies each spanning several weeks, to complete daily diaries about their relationship, the level of passion and sexual satisfaction, and their reasons for having sex. Analysis of the findings showed that approach sex positively affects not only the initiator but also the partner. Avoidance sex, conversely, adversely affects the feelings of the partner, even though the partner 'got sex' and could ostensibly be expected to feel good about it.
The researchers also found that the days where the couple had sex, regardless of motive, were better than days without sex. From these findings they concluded that while approach sex is better than avoidance sex, the latter is better than no sex, at least in the short run. The long term may be a different story. At follow-up four months later, couples that depended mainly on avoidance sex experienced a decline in the quality of their relationship and their satisfaction. Avoidance sex, it appears, may work as a tactic, but fails as strategy.
In addition, the researchers found that sexual desire mediates the link between sex motives and relationship satisfaction. In other words, the main reason that approach sex leads to improved relations and avoidance sex leads to satisfaction decline is that sexual motives affect feelings of desire, which in turn influence satisfaction. People participating in approach sex experience greater sexual desire, which in turn enhances relationship satisfaction. Sexual desire is the active ingredient in the mix, love cocktail's alcohol.
This model suggests that couples may be able to increase their satisfaction in the relationship by managing their sexual motives. Those who concentrate on maximizing the amount of approach sex while minimizing avoidance sex will experience more passionate sex, and more satisfaction in their relationship over time.
Whether the same approach-avoidance dynamics and consequences that characterize relationship sex hold for hook up sex is a question that, to my knowledge, still awaits further research.

No One "Gives" Anyone an Orgasm

Just about everyone can enjoy orgasms by themselves, but many people encounter difficulty having them with others. A great deal of research shows that only 25 percent of women are consistently orgasmic during intercourse, and an estimated 5 to 10 percent of men have trouble ejaculating and/or experiencing orgasm with partners. Meanwhile, many people consider it their responsibility to "give" their lovers fabulous orgasms--and wonder how to do that.

On the one hand, the wish to "give" great orgasms is laudable, especially for men who hope to give them to women. In the Western world, until well into the 20th century, sex was something for men to enjoy, and for women to endure. Men "took" sex from women, who were considered merely fleshy receptacles for male lust. Many people believed that women were unable to experience sexual pleasure, so men had no responsibility to provide it.

Today, we know that men and women are equally capable of sexual pleasure, and that satisfying lovemaking involves both lovers taking turns giving and receiving sensual caresses. Compared with how men felt a century ago, the wish to "give" women orgasms represents progress. But no one "gives" anyone else an orgasm.

Orgasms Are Like Laughter
Orgasms emerge from deep inside us when conditions feel right. Comedians can tickle our funny bones, but they don't "make" us laugh. They allow us to. They create the conditions that encourage us to produce laughter from deep within ourselves.
Orgasms are similar. They, too, emerge from deep within when conditions are favorable. For most people, those conditions include: trust, comfort, relaxation, love, understanding, and whole-body massage that eventually focuses on tender genital caresses.

Lovers create the physical and emotional context the allow orgasms to happen. A lover can be trustworthy and help you deeply relax. A lover can caress you the way(s) you enjoy, the way(s) that allow you to dive deep enough into your own pleasure and sexual fantasies to produce your own orgasms.
A lover can also destroy the conditions that allow orgasm by being untrustworthy and causing grief instead of relaxation and comfort. But lovers don't "give" each other orgasms. Each of us is responsible for our own orgasms. We produce them ourselves.

That's why it's so important for lovers to tell one another what they enjoy, what turns them on. Of course, this can be a challenge. Here are some suggestions:
No one can read minds. Forget all the romantic Hollywood nonsense about knowing instinctively which erotic moves your lover wants. Being in love doesn't confer magical powers that allow the two of you to read each other's sensual minds. Unless you signal your likes and dislikes, your lover doesn't know what turns you on--and what turns you off.

No need to be didactic. You don't have to provide an instruction manual with detailed explanations of what you enjoy. Instead, when your lover does something you like (or close it), just say "yes" or "ahhh." When your lover's moves don't thrill you, remain silent. Most lovers quickly provide more of what elicits an "ahhh" and less of what greets them with silence. Over time--usually a month or two--you can get a lot more of what you want, and less of what you don't, simply by saying "yes" and "ahhh.

Review things afterwards. Even when you say, "yes" and "ahh," it still might be difficult to direct a lover's moves while you're in the middle of things. But afterwards, when you feel content and close, it's often easier to comment. Begin with compliments. Highlight what you enjoyed, and ask for more of it. For example: "Remember when you were giving me oral and you circled my clit with your tongue? That was great. I'd love that every time."

Be positive about negatives. If a lover does anything you really can't stand, feel free to say so, but give it a loving spin. List a few moves you enjoy, then criticize the one you don't. For example: "I really love the way you stroke my penis and suck me, but when you suck on my balls, it kinda hurts. Can we leave that out from now on?"

Cultivate experimentation. As marvelous as sex can be, after a while, the same old moves become boring. You might try new accouterments--candles, music, sex toys, lingerie, etc. Or a different time of day. Or a different room of the house or a romantic weekend getaway. Use your imagination.
Be patient. It takes some people--both men and women--quite a while to work up to orgasm. Sometimes, it's situational. If you're under the weather, it may take longer than usual. But some people always take quite a while. That's just who they are--and that's fine. If your lover takes what you consider a long time, or if you've ever received apologies for "taking so long," reassure the person that you're there for their pleasure, no matter how long it takes. Invite them to relax and focus on their own erotic feelings, not on how impatient they imagine you to be. The anxiety people feel about thinking that they take too long actually interferes with orgasm. So be patient, and tell your lover you're happy to be patient. That should help them relax enough to have orgasms. Or consider a vibrator. Vibrators often help women have orgasms more quickly, and vibrating penis sleeves often help men.

If you implement these suggestions, your lover should feel comfortable, relaxed, trusting, accepted, and loved enough to have orgasms. But remember, you don't "give" them. You're the catalyst. You help create the conditions that allow your lover to release them.
The question is not: How can lovers give each other wonderful orgasms? The question is: What can lovers do to help each other relax and feel accepted, trusting, and loved enough to reach deep inside themselves to release their own orgasms?