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The Pathophysiology of Male Infertility
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Premature ejaculation (PE) is a common ejaculatory dysfunction that deteriorates the quality of sex life and may affect effective deposition of semen into female genital tract in severe cases. The definition of PE varies from intravaginal ejaculatory time within 1 minute [58], 2 minutes [59], 3 minutes [60], or 7 minutes of penetration [61]. PE can also be defined in terms of the number of penile thrusts, in which, 8–15 thrusts have been postulated as criterion for PE [62]. More recent definitions suggest PE as consistent or recurrent failure to voluntarily postpone ejaculation on or soon following the penetration or with less sexual stimulation [63]. On the other hand “deficient ejaculation” (DE) refers to delay in or impossibility to ejaculate or to reach orgasm. An “orgasm” may be defined as “subjective, perceptual-cognitive event of pleasure” [57] and reportedly occurs at the same time as the ejaculation. However, it may occur even without ejaculation. Anorgasmia, with or without ejaculation, is a frustrating sexual disorder characterized by absence of orgasm in a sexual act. On the contrary, orgasm without ejaculation, even in men who are sexually mature, may occur and is termed as “coitus reservatus”. Because ejaculation is androgen mediated, it declines with age, and so does the experience of orgasm. Orgasm may also modulate central neurotransmission, thereby inducing a postejaculatory pain syndrome with generalized myalgia [64].
Problems with Female Orgasm
Published in Philipa A Brough, Margaret Denman, Introduction to Psychosexual Medicine, 2019
Orgasms can occur from an early age with recognition of pleasurable feelings when the genital area is stimulated, for instance while riding a horse or bicycle. Later in adolescence there is the desire for self-exploration of the genitalia with experimentation of rubbing and different levels of pressure over the clitoris to provide pleasure. Masturbation may become a normal behaviour. The stimulus to orgasm differs between individuals and so in order to have satisfying foreplay and sex, communication is essential between the couple. A number of relationship and psychological factors can however contribute to a difficulty in reaching orgasm. The media and pornography often portray an unrealistic view on what men and women should perceive as ‘normal’. The patient and her partner may have very differing, unexpressed views on this. Women may feel under pressure to achieve a purely ‘vaginal’ orgasm without clitoral stimulation or to reach orgasm successfully to avoid her partner feeling a ‘failure’. Anorgasmia is the medical term for regular difficulty reaching orgasm after ample sexual stimulation, causing personal distress. Primary anorgasmia where the woman has never experienced an orgasm is not uncommon. Secondary anorgasmia occurs in an individual who has previously been orgasmic but now has significant difficulties and an inability to orgasm. Patients can present with primary and secondary anorgasmia when the actual problem is that there is no libido and sex is unwanted or not enjoyable. Although it is useful to differentiate, this is less important than exploring and interpreting the patient's feelings.
Pathophysiology of male sexual dysfunction after spinal cord injury
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Pierre Denys, Clément Chéhensse
Few therapeutic options exist to induce or enhance orgasm after SCI. The first step is to apply appropriate stimulation to induce ejaculation, even if ejaculation and orgasm can be dissociated in SCI men. As specified before, PVS is an efficient and simple tool to elicit ejaculation thus sexual climax. Associated to PVS, midodrine, an α1 agonist prescribed to prevent orthostatic hypotension,41,42 increases ejaculation rate43 and orgasm occurrence.44 Some results about midodrine and orgasm are conflicting30,44 but none of these studies were designed to assess, in a same series of patients, the occurrence and intensity of orgasm during PVS with or without midodrine. However, the studies by Soler et al. and Courtois et al. provide new insights about anorgasmia management in SCI men.
Women’s Experiences of Different Types of Orgasms—A Call for Pleasure Literacy?
Published in International Journal of Sexual Health, 2023
Katharina Weitkamp, Fabienne Seline Verena Wehrli
In our sample, the number of women who have never experienced an orgasm was quite low when compared to other studies. A Danish study reported 6% of women meeting diagnostic criteria for anorgasmia (Christensen et al., 2011) and an earlier review, reported 16–25% of anorgasmia in Western samples (Lewis et al., 2010). It is important to keep in mind that anorgasmia is defined as a reduced intensity, delay, infrequency, or absence of orgasm for at least six months and be experienced as distressing (APA, 2013) which is quite different from never having experienced an orgasm. The low number of reported difficulties with orgasm in the current sample could also be due to a potential selection bias, where women refrained from participating in a study on their sexuality when they felt lacking in terms of orgasmic experiences. Nevertheless, it is highly relevant to map the large variety of women’s experiences including those who do not experience orgasms, who nonetheless may have satisfying sex lives anyway regardless.
Sexual dysfunction with major depressive disorder and antidepressant treatments: impact, assessment, and management
Published in Expert Opinion on Drug Safety, 2022
Joan Winter, Kimberly Curtis, Bo Hu, Anita H. Clayton
Some studies have demonstrated that psychotherapy may help with sexual dysfunction. Most of the therapy modalities evaluated have been cognitive behavioral therapy (CBT) or mindfulness-based therapy. A study investigating the effects of mindfulness on sexual function in women with low sexual desire and arousal utilized four 90-minute group sessions that included mindfulness training, psychotherapy and education. Women were put in 2 groups, those that began therapy immediately or after a 3-month waiting period. Compared to the delayed treatment group, the immediate treatment group showed significantly improved sexual desire, sexual arousal, lubrication, sexual satisfaction, and overall sexual functioning[162]. Limitations of the study include lack of a true control group (used a wait-list control), in addition to not using a validated assessment tool for sexual function. A single session of autogenic training (a form of mindfulness) was found to increase subjective female genital arousal and genital sensation in a small study[163]. Cognitive behavioral therapy has also been studied for anorgasmia in women, however similar to the mindfulness therapy study, these studies do not have adequate control groups[164]. Further systematic, controlled research is warranted, using validated questionnaires.
Sexual function and quality of life in Chinese couples undergoing assisted reproductive treatment: a prospective cohort study
Published in Human Fertility, 2022
Sue Seen-tsing Lo, Raymond Hang-wun Li, Wai-ming Kok, Grace Ching-yin Wong, Ernest Hung-yu Ng, Celia Hoi-yan Chan
The proportion of female sexual dysfunction in this cohort (IUI: 24%; IVF: 21.9%) was much lower than that reported in a study of same design among infertile women presenting for initial infertility evaluation (32.5%) (Lo & Kok, 2016). A lower proportion of sexual function (30%) was also reported in Italian women before their first cycle of oocyte retrieval for IVF than other infertile women (Facchin et al., 2019). A confirmed treatment plan that provided hope for motherhood might explain why sex was better in women embarking on ART (Monga et al., 2004; Piva et al., 2014). Desire-arousal disorder was the major cause of sexual difficulty reported in other studies (Marci et al., 2012; Smith et al., 2015) but orgasmic disorder was the major problem in our cohort. Studies with similar design in local reproductive age women (Lo & Kok, 2014) and infertile women (Lo & Kok, 2016) also reported anorgasmia as the major female sexual problem.