When an individual has sexual desire he departs from the normal state and enters into the ‘sexual state’ and is deemed to have undergone ‘sexual grounding’. ‘Sexual grounding’ or the ‘Sexual state’ is a state in which the subject becomes receptive to the perception of stimuli inputs as sexual. Once this occurs, psychobiological stimuli arouse the sex center in the brain which starts sending out impulses, which are usually pleasurable. When such impulses reach the genitalia they lead to congestion of blood which is usually manifested as erection in the male and lubrication in the female. Further stimuli further arouse the individual and eventually lead to orgasm.

How can one know that once has reached an orgasm?

An orgasm is like a sneeze - it is difficult to describe but once you have had one you know what it feels like. Orgasms may differ. Usually one experiences a heightened sexual ecstasy accompanied by rhythmic vaginal contractions in females and ejaculation in males, followed by a fooling of relaxation.

Multi-orgasm is experiencing of multiple orgasms one after another, without an intermediate refractory period.

Usually after orgasmic experience, in a male, a refractory period ensues (during which sexual stimuli fail to arouse) following which arouse ability is regained. Therefore, for multi-orgasmic experience the male has to train himself.

Multi-orgasmic capacity is a natural physioanatomical female asset for which no training is required. After experiencing orgasm, females maintain sexual arouse ability and therefore can experience multiple orgasms in succession. In short, for a female multi-orgasmic capacity is a natural potential and for a male it is an acquired art.

There is no ‘normal standard time’ for an intercourse. It depends upon the partners. Intercourse may be continued till it is mutually satisfying. A prolonged intercourse does not necessarily give more pleasure. This is a myth. What is important is not how long, but how satisfying?

Sexual intercourse is the means to an end, the end being pleasure. Therefore, a couple can have intercourse as often as it pleases them. It is a pleasure to be shared between the partners and there is no need to keep a tally. ‘Frequent’ or ‘normal’ depends upon the individual couple. The best thing to do is to forget the number’s game and indulge as often as it is mutually pleasurable and satisfying. What is- important is the quality and not the quantity.

Frequent Intercourse Harmfulness

Present medical knowledge acknowledges the fact that as long as intercourse occurs among accepting partners and is not associated with physical trauma or irritation, the act itself is not harmful, irrespective of its frequency.

Interplay implies the whole spectrum of interaction, that is the entire gamut of motions and emotions, between individuals indulging in ‘play’.

Foreplay is extremely important. It kindles desire and marks the beginning of the interplay. An adequate foreplay ensures adequate arousal and promotes sexual compatibility.

No. The diaphragm fits into the deep portion of the vagina where there are hardly any nerve endings. Real stimulation is in the outer aspect i.e. clitoris and the surrounding area and the outer one-third of the vagina. The diaphragm in no way inhibits a woman’s orgasm.

It is not necessary that a woman should reach orgasm during intercourse. She may achieve orgasm during foreplay or after play by any method including clitoral stimulation. What is important is satisfaction, no matter how one derives it.

Some women report an increase while others report a decrease in sexual desire at menopause. Increase in sexual desire may be because of relative freedom from pregnancy and hence one may respond and perform with greater abandon and enthusiasm. Some women harbor the misconception that menopause marks the end of their sexual career and this fear (about their waning sexuality) increases their sex drive so that they may reaffirm their femininity. A decline in sexual desire could be because of physical reasons.

During menopause (or even a few years earlier), a reduction in the secretion of the ovarian hormones may cause atrophy of the vaginal epithelium which leads to reduction in lubrication and hence pain at the time of sexual intercourse (which can be remedied by estrogen replacement therapy). This causes a decline in sexual desire and a woman avoids sexual overtures. Depression and anxiety are common features and they also tend to reduce the sexual desire.

When one reaches orgasm, one usually has gasping uncontrolled movements, or a sense of suspension which are nonverbal communications to the partner that one has had an orgasm. It is usually accompanied by vaginal contractions in female and the visible associate of ejaculation in males. Later, after completion of the sex act, one appears calm and physically satisfied. The signs of having had an orgasm are quite fleeting. The best way is to ask the partner.

It is absolutely normal to reach orgasm by Clitoral Stimulation. There are women who are unable to reach climax by vaginal intercourse alone. Climaxing by clitoral stimulation is in no way inferior.

Different erogenous zones are important. One need not reach orgasm by genital stimulation alone. One may stimulate any erogenous zone to the point of orgasm. What is important is the end and not the means to the end’.

After play is important as foreplay. Though penovaginal sex is regarded as the most intimate and satisfying form of sexual activity, this is not always true. There are many women who report “I am not worried about orgasm but I would very much appreciate a bit of love play after he is through”.

Vatsyayana in the Kamasutra, has given a lot of emphasis to afterplay and he has mentioned that afterplay is equally, if not more, important as foreplay. Most people enjoy being held, cuddled, talked to, and partners need to communicate with each other as to what they prefer. Many-a-time, a woman in her fifties or so would come and report “Doctor, sex is now far more satisfying despite the fact that my husband is unable to achieve erection.”

Perhaps he is forced to learn or devote more time to foreplay and afterplay which takes away the feeling of mechanical sex and at times when he is unable to perform, there is enough warmth and affection in all forms of sexual activity, the foreplay, the interplay and the afterplay.

Can a very active sex life in the early years affect one’s sexual life later?

A very active sexual life in youth does not precipitate an early termination of the sex drive or capacity. On the contrary, persons having a strong sexual interest and capacity in the early years are more likely to retain the same in the later years. This was confirmed by a longitudinal study on sexual behavior and old age.

What are the most common conditions which could decrease sex drive in later years?

The common reasons for a reduced sex drive in later years are

1. Monotony and loss of interest
2. Changes in physical appearance
3. Misconceptions about one’s waning sexuality
4. Lack of communication
5. Depression

As a man grows older, erection takes a longer time to occur. Similarly, in women, lubrication takes a longer time to occur. A man may often require direct physical stimulation to achieve erection and the same is also true of a woman’s lubrication. The color of the semen changes from white to light yellow, the consistency gets thinner and the quantity decreases. When, people are not informed about these facts, anxiety can be generated, as there is a vast discrepancy between the unrealistic expectations and the real experience. This paralyses the sexual response leading to avoidance of sexual overtures.

Older persons tend to become obese because of sedentary lives, lack of exercise and changes in hormonal levels. Exercises for toning up the muscles and good functioning of the body, are essential. All these help in improving the self-image and making a better sex life.

What are the common sexual misconceptions prevalent among the middle aged men and women?

Men harbor the misconception that increasing age and excessive use may lead to weakening of the genitals and end in ‘seminal bankruptcy’. Because of this misguided belief, they observe sexual abstinence. One should remember that it is disuse which leads to atrophy and not the use. As a man grows older, he walks slow, he talks slow but he expects that his erection should not be slow! One needs to remember that this is a normal phenomenon. Some are under the impression that “one failure in making it means an end to sex life”. As a result, many men move from effective sexual functioning to various degrees of impotence. I always emphasize that occasional failures are common and failure does not mean an end. Women harbor the misconception that menopause marks the end of sex life. Menopause merely marks the end of a woman’s reproductive career and not the conjugal career which can continue up to the end of one’s biological life. In fact, the maturity of the partner’s end the relationship, along with guaranteed natural contraception may enhance the sex life. The misconception that “sex after 60 is not possible” needs to be changed. Men and women can continue to remain sexually active till the last day of their lives provided they are in sound physical and mental health.

A disease involving a defect in cell mediated immunity that has a long incubation period follows a protracted and debilitating course, is manifested by various opportunistic infections and has a poor prognosis.

The disorder is found primarily in homosexual men and intravenous drug users and to a lessor degree in female sex partners of bisexual men and children of those with the disease. The causative agent is believed to be retrovirus, identified as HTLV 3 (Human T cells lymphotropi virus transmitted through sexual contact or exposures to contaminated blood or possibly close personal contact Initial symptoms include extreme fatigue, intermittent fevers night sweats, chills, Lymphadenopathy, enlarged spleen, anorexia, consequent weight loss, severe diarrhea, apathy and depression.

As the disease progresses, there is a general failure to thrive, energy and any no. and kind of infections most commonly Pneunocystis, casim Pneumoia, menengitis or encephalitis caused by asperogillosis, candidia Cystococcosis, Cytomegalo virus, texoplasmosis or herpes simplex. Treatment consists primarily of combined chemotherapy to counteract the opportunistic disease.

Interferon and other immunomodelators have been used, with little success, to correct the underlying immune defect. The fatuity rate is 90% in those diagnosed more than 2 years.

An orgasm is like a sneeze - it is difficult to describe but once you have had one you know what it feels like. Orgasms may differ. Usually one experiences a heightened sexual ecstasy accompanied by rhythmic vaginal contractions in females and ejaculation in males, followed by a fooling of relaxation.

Is completion of the sexual response cycles always necessary for satisfactory sex?

Sex is a method for reaching a sensual objective, which, when achieved gives satisfaction. During sex what is important is to experience that sensual satisfaction, and it may not be necessary to go through every stage of the sexual response cycle.

Causes of Reduced Orgasmic Pleasures

Orgasmic pleasure is considerably reduced in drug abuse (brown sugar in particular), myopathy, alcoholics, neuropathy and anxiety disorders.

It is not necessary that a woman should reach orgasm during intercourse. She may achieve orgasm during foreplay or after play by any method including clitoral stimulation. What is important is satisfaction, no matter how one derives it.

Difference between ‘Clitoral Orgasm’ and ‘Vaginal Orgasm’

No, there is no difference. An orgasm may be more or less satisfying depending upon several Factors, but whatever be the means of stimulation, ultimately “All roads lead to Rome.”

Can the use of a diaphragm inhibits a woman’s orgasm

The diaphragm fits into the deep portion of the vagina where there are hardly any nerve endings. Real stimulation is in the outer aspect i.e. clitoris and the surrounding area and the outer one-third of the vagina. The diaphragm in no way inhibits a woman’s orgasm.