Development of palliative medicine in the United Kingdom and Ireland
Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita in Textbook of Palliative Medicine and Supportive Care, 2015
Often, the partner becomes the caregiver, changing dressings and managing drains and wounds, and intimate touching decreases and becomes treatment related. Sexual intercourse is not the defining characteristic of a person's sexuality; a sexual relationship includes the need to be touched and held along with closeness and tenderness [10,11]. Masters and Johnson [12] describe the human sexual response cycle that begins with libido or the desire for sexual activity. Gregorie reports that men are more attracted to visual sexual stimuli, whereas women are more attracted to auditory and written material, particularly stimuli associated within the context of a loving and positive relationship [13]. Women aren't linear in their sexual response but more circular and may experience sexual excitement before they have a desire for sexual activity [14]. Sexuality is a broad term including social, emotional, and physical components [15]. It is not just genitals or gender but includes body image, love of self and others, relating to others, and pleasure. It is genetically endowed, phenotypically embodied, and hormonally nurtured, is not age related, but is matured by experience, and can't be destroyed despite what is done to a person. Sexuality includes affection, sexual orientation, sexual activity, eroticism, reproduction, intimacy, and gender roles and encompasses feelings of trust [16,17]. Sexual excitement is the phase where the penis becomes rigid enough to use (erection), and in the female, the vagina lubricates and enlarges in depth and width, and the clitoris enlarges [18,19]. Orgasm is the height of sexual pleasure and the release of sexual tension. The penis emits semen through muscular spasms and there are rhythmic contractions of the vagina and the cervix lifts up out of the vaginal vault. The last phase of the cycle is the resolution phase where the genitals return to their normal, nonexcited state. During this phase, there is an evaluation of the sexual experience as well as relaxation and contentment [20]. The refractory period, where the genitals are resistant to sexual stimulation, happens during this stage. In males, this period can be a matter of minutes in youth but take days in older men or with certain medications or with medical conditions like cancer. Expressions of sexuality include style of dress, values and attitudes, as well as hugging, touching, kissing, acting out scenarios/fantasies, sex toys, masturbation, sexual intercourse, and oral genital stimulation, either alone or with others [9,17,21]. Sexual behaviors may involve oral, vaginal, and/or anal penetration [30]. Sexual behavior is influenced by religious beliefs, age, education, level of comfort with one's body and physical functioning, experiences of sexual abuse and trauma, their partner's wishes, and comfort level with one's own sexual orientation and gender identity [22,23]. SEXUAL DYSFUNCTIONSexual dysfunction is failure of any aspect of the sexual response cycle to function properly.
Anatomy and physiology
Suzanne Everett in Handbook of Contraception and Sexual Health, 2020
Both men and women experience during sexual intercourse the sexual response cycle. This follows four phases: desire, excitement, plateau, orgasm and resolution. Desire is influenced through stimuli that can be from many different areas such as environmental and cultural, and causes the initiation or receptiveness of sexual activity. Excitement develops through stimulation. Plateau is a consolidation period in which intense stimulation will be intensified. Orgasm is where there are involuntary contractions causing the peaking of sexual pleasure and the release in sexual tension. Resolution is where the body returns to its pre-excitement state which can be seen in loss of erection or the decrease in the clitoris’s size, and vasocongestion is relieved. If orgasm does not occur, then discomfort in the genital area may be experienced as vasocongestion has not been relieved. The sexual response cycle can be influenced by cultural, religious and personal experiences. Communication between sexual partners is a vital aspect of satisfying sexual intercourse; however, this is not always an area that people feel confident enough to discuss with their sexual partners and so can lead to loss of libido, or failure to achieve orgasm, or premature ejaculation, for example. Psychosexual counselling of the individual or couple can address psychological causes and is available through referral in most sexual health services.
Psychosexual medicine
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
The physiological sexual response depends not only on intact vascular, endocrine and neurological pathways, but also on sensory input. Bancroft describes this as the ‘Psychosomatic Circle of Sex', the fundamental concept of mind-body interaction, on which the discipline of psychosexual medicine is based. Female responsiveness is a result of sensory input through the peripheral nerves of the somatic and autonomous nervous systems, as well as through the cranial nerves and psychogenic stimulation. The frontal and temporal lobes all have a role to play in mediating the sexual response. The precise details of the processing of afferent information within the spinal cord and brain still remain unclear. Genital motor responses include vasocongestion and vaginal lubrication. During sexual penetration the vagina lengthens, the labia increase in fullness, the uterus draws back and the clitoris retracts. At orgasm there is also contraction of the uterine and pelvic muscles.
The Gender Gap in Orgasms: Survey Data from a Mid-Sized Canadian City
Published in International Journal of Sexual Health, 2019
Objective: Previous research has established a gap in orgasm frequency between men and women. This study investigates explanations for the gender gap in orgasm. Methods: Crosstab analysis and logistic regression are used to examine the gender gap in orgasms from one Canadian city: Hamilton, Ontario (N = 194). Results: We find a strong association between women’s orgasms and the type of sexual behavior in which partners engage. Women who receive oral sex are more likely to reach orgasm. Conclusion: Sexual practices focused on clitoral stimulation are important to reducing the gender gap in orgasms.
Not All Orgasms Were Created Equal: Differences in Frequency and Satisfaction of Orgasm Experiences by Sexual Activity in Same-Sex Versus Mixed-Sex Relationships
Published in The Journal of Sex Research, 2018
Karen L. Blair, Jaclyn Cappell, Caroline F. Pukall
Which sexual activities result in the most frequent and most satisfying orgasms for men and women in same- and mixed-sex relationships? The current study utilized a convenience sample of 806 participants who completed an online survey concerning the types of sexual activities through which they experience orgasms. Participants indicated how frequently they reached orgasm, how satisfied they were from orgasms resulting from 14 sexual activities, and whether they desired a frequency change for each sexual activity. We present the overall levels of satisfaction, frequency, and desired frequency change for the whole sample and also compare responses across four groups of participants: men and women in same-sex relationships and men and women in mixed-sex relationships. While all participants reported engaging in a wide variety of activities that either could, or often did, lead to the experience of orgasm, there were differences in the levels of satisfaction derived from different types of orgasms for different types of participants, who also engaged in such activities with varying degrees of frequency. We discuss group differences within the context of sexual scripts for same- and mixed-sex couples and question the potential explanations for gender differences in the ability to experience orgasm during partnered sexual activity.
Body Movement Is Associated With Orgasm During Vaginal Intercourse in Women
Published in The Journal of Sex Research, 2019
Annette Bischof-Campbell, Peter Hilpert, Andrea Burri, Karoline Bischof
Very few studies have investigated the relationship between women’s ability to experience an orgasm during vaginal intercourse and specific stimulation techniques. We examined two common techniques during vaginal intercourse both with and without simultaneous external clitoral stimulation: (1) body movement, in particular back-and-forth swinging movements of the pelvis and trunk; and (2) precise rubbing of the clitoris with an immobilized body. Structural equation modeling was used to compare the effects of the two stimulation techniques on women’s orgasm frequency (N = 1,239). As hypothesized, the frequency of orgasm during vaginal intercourse with simultaneous clitoral stimulation was positively associated with a preference for body movement during arousal. Body movement, as opposed to body immobilization, was also associated with a higher frequency of orgasm during vaginal intercourse without simultaneous clitoral stimulation. We conclude that body movement is associated with more orgasms during vaginal intercourse, whereas precise rubbing of the clitoris with an immobilized body is not associated with more orgasms. Teaching women to move their pelvis and trunk in a swinging back-and-forth movement during vaginal intercourse might therefore facilitate reaching an orgasm, whereas encouraging them to self-stimulate the clitoris might be less helpful if done with an immobilized body.
Related Knowledge Centers
- Autonomic Nervous System
- Muscle Contraction
- Pelvis
- Sexual Behavior
- Reproductive Physiological Phenomena
- Reproduction
- Spasm