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SEX PHARMACOTHERAPY A. PDE 5 inhibiters(PDE 5 inhibiter prevents the breakdown of cGMP causing enhanced relaxation of cavernosal smooth muscles, increased arterial flow into corpora cavernosa, compression of subtunical veins and finally penile erection. It helps in maintaining the erection and not the initiation. Erotic literature, fantasy or foreplay helps in initiation of erection.Contraindications: Nitrates, cardiac diseases, Hypotension, Optic neuropathy, Erythromycin, Rifampicin)1. Sildenafil (Viagra, Penegra) : 25, 50, 100mg tab. 30 min after dinner.2. Vardenafil (Levitra) : 5, 10, 20 mg tab 30 min after dinner. Onset of action after 30 min2. Tadalafil (Forzest, Megalis) 10, 20 mg tab after dinnerOnset of action after 30 min.3. Intracevernosal ing. Papaverine: 3 to 80 mgB. Alpha BlockersAlpha adrenergic receptor blocker dilates the arteries and reduces the venous return. (Beta adrenergic Blocking agents are contraindicated since they may cause sexual dysfunction).Contraindication: Hypotension1. Prazosin (prazopress): 0.25, 0.5mg. tab H.S.2. Terazosin (Hytrin): 1, 2, 5, mg tab. H.S.3. Indoramine (Doralese) : 20 mg tab H. S.4. Tolazoline (priscoline) 25 mg tab .5. Yohimbine: 2mg: 1 to 2 tab T.D.S.6. Dihydroergotamine: 1 mg tab T.D.S7. I.C. Ing. Chlorpromazine: 0.06 to 0.6 mg8. I.C. Ing . Phentolamine mesylate : 0.05to 1mgC. Dopamine Agonists(These drugs stimulate the Dopamine receptors. Dopamine is aneurotransmitter . It causes vasodilatation and has effects on motor, behavioral and endocrine system)1. Bromergocriptine2. fenfluramine3. Inj. ApomorphineD. Antidepressants(These are selective serotonin reuptake inhibitors . It takes 3 to 6 weeks of continuous treatment for suppression of symptoms. They delay the orgasm. This effects is made use of in the treatment of Premature Ejaculation for which the drug is given 2 to 4 hours before the coitus)1. Fluoxetine : 10 , 20, 30 mg in the morning2. Paraxetine : 10, 30, 40, mg tab in the morning3. Trazodone : 25, 50 mg tab after meal4. Dapoxetine : 30, 60 mg tab o.d. 3 hours before coitusE. Peripheral Vasodilators ( Vasodilators dilate the blood vessels and cause erection. They are also used in Hypertension) 1. Hydrallazine sulphate ( Nepresol): 25 mg tab B.D.2.Nifedipine ( Nifelat) : 5, 10, 20 mg tab T.D.S.3. Amlodipine (Amlodac) 2, 5, 5, 10 mg tab O.D.4. Pentoxifylline( Trental) 400 mg tab T.D.S.after meals5. Cyclandelate ( Cyclasyn) : 200 , 400 mg. tab T.D.S.6. Xanthinol nicotinate(Complamina)150, 500 mg tab TDS with meals 7. L- Arginine (Arginitric) 500 mg capF. Local Vasodilators( For local application. Drug should be washed off before coitus)1. Nitroglycerin Ointment 2. Minoxidil (Mintop): 2%, 5% Solution. Apply <2mlG. Nitrates(Nitrates are converted to Nitric oxide that relaxes smooth muscles and causes vasodilatation. Nitrates are used for Angina. Sildenafil/ Tadalafil should NOT be given to the person who are on Nitrates)1. Pentaerythritol Tetranitrate (Peritrate) : 10 mg tab2. Isorbide Dinitrate(Sorbitrate): 5, 10mg tab H. Prostaglandin(Prostaglandin E1 causes smooth muscle relaxation and vasodilatation. Not effective orally in Sexual dysfunctions.) 1. I.C. INJ. PGE1(Prostin VR): 2.5 to 40 mcg2.PGE1 Pallet (alprostadil): 125 to 500 mcg by muse (medicated Urethral system for erection) I. Hormones (testosterone increases the life span and fertilizing power of spermatozoa. It helps in final maturation of spermatozoa during spermatogenesis. In hypogonadism it stimulates libido and improves E.D. serum P.S.A. should be estimated and digital PR should be done prior to giving testosterone . in normal individuals, it does not improve libido or erection.)1. testosterone ( nuvir) : 40 mg cap, T.D.S. with fatty meals for 3 weeks2. Inj. Testosterone enanthate (testoviron depot) : 100, 250 mg, deep intramuscular, 1ml every 2 weeks3. Inj. Human chorionic gonadotropin ( profasi): 5000, 10000, 20000 I.U. Powder with diluent. Uses for ovulation, spermatogenesis & for undescended testis.4. Levonorgestrel (Ecee2, Norlevo, I pill) : 750 mcg tab . two tabs taken together, preferably within 12 hours (no longer than 72 hours) after unprotected sex. 5. Tibolone ( livial , tibomax ): 2.5 mg tab O.D. for 3 months for menopause.6. clomiphene citrate (clomid, fertyl): 25, 50mg tab.Female: for ovulation. 50mg O.D. For 5 days (from 5th to 9th day of menstrual cycle. For 3 menstrual cycles only.7. Male: for Oligospermia : 25mgO.D. For 3 months only estrogen (evalon , Dienoestrol) cream for intravaginal use in senile atrophic vaginitis, once daily, for not more than 2 weeks. J. Antioxidents(antioxydents are substances that protect the cells against the effects of free radicals. These include vit . A, C, E, Coenzyme Q 10, Zinc , selenium, lycopene and L- Carnitine . they improve the sperm count and / motility and hence proved be effective in oligo – asthenospermia that leads to male infertility . antioxidants are also available in vegetables, fruits , tomato, papaya, water melon, fish & egg)1. lycopene, zinc, selenium (Lycored) Cap . 2B.D.for months (lycotin) cap.1B.D. for 3 months .2. L-Carnitine (Carnivit , L-tine ) Tab. 2 T.D.S. for 3 months 3. Coenzyme Q 10 (CoQ10, Zyme Q10 ) Cap .1 T.D.S. For 3 months 4. Vit. A, C, E, Zinc , Selenium (Cytovit, Oxyvit) Cap . 1 T.D.S. For 3 months K. AntimicrobialsFor mixed Vaginal infection Fluconazole + Ornidazole+ Azithromycin ( Medikit, Zocon –AS) 4 tabs. Given orally for vaginal candidiasis, Trichomoniasis & Bacterial vaginitis For male genital tract infection / Chlamidial infectionDoxycycline (Doxt, Doxy1) : 100mg O.D. For 15 days. Both are treated. L. Ayurvedic Adjuvants(Empirical)1. Chyavan prash: Tonic2. Vigomax Forte: 1B.D. With milk. for ED3. Confido : 1T.D.S. For Oligo- asthenospermia 4. Vivadona : 1B.D. For female libidoDrugs causing Sexual Dysfunction1.Anticholinergic -Atropine, Propantheline2.Antihypertensive-Beta blockers, Methyldopa, 3.Antimicrobials -Ethionamide, Vidarabine4. Antipsychotics -Tranquilizers5.C.N.S. Depressants -Barbiturates, Opiates6.Diuretics-Thiazides, Spironolactone7.H2 receptor antagonists-Cimetidine8.Hormones -Estrogen9.Recreational drugs -Alcohol, Tobacco
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MALE ERECTILE DISORDER (IMPOTENCE)DefinitionPersistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate erection.This is also known as ‘Erectile Dysfunction’. The disorder may cause marked distress or interpersonal difficulty. There are different patterns. Some individuals report inability to obtain erection from the beginning of sexual experience, while others reports being able to experience erection only during masturbation or on awakening, but not during the coitus. Some experience adequate erection, but lose it when attempting penetration. Still others report that they have an erection that is sufficiently firm for penetration, but they lose erection before or during thrusting.Male Erectile disorder is frequently associated with anxiety, fear of failure, pressure of sexual performance, and decreased sexual excitement and pleasure. This can disrupt marital relationship and may be the cause of unconsummated marriage and infertility.EtiologyAging: With advancing age, The orgasm is less intensive, The ejaculate is reducedThe interval between the two-successive act is increased.Psychological factors:FatigueDepression, Stress, Mental disorders, Guilt, Fear of failure, Low self esteemReligious restrictionsHomosexualityLong/ serious illnessTraumatic initial experienceNegative feeling towards the partnerResentment Hostility Lack of interestVascular causes:Use of tobacco/alcoholAtherosclerosisPeyronie’s diseaseDiabetesHypertensionVenous leak or occlusionTraumaSurgeryRadiationHormonal causes:HypogonadismHyperprolactinemia DiabetesThyroid diseaseAndrogen deficiencyEstrogen excessAdrenal, pituitary or hypothalamic diseaseNeurogenic causes:Peripheral neuritisAutomatic neuropathy (in diabetes)Multiple sclerosisSpinal cord diseaseDrug related causes:Antiandrogens (cyproterone acetate, flutamide, estrogen)H2 receptor antagonists (cimetidince, famotidine)Diuretics (spironolactone, thiazides)Antihypertensive (beta blockers, ace inhibitors, ganglion blockers)Anticholinergics (atropine, probanthine, dicyclomine)Antidepressants (M. A. O., Tricyclic)Antipsychotics (tranquilizers)CNS Depressants(barbiturates)Substance abuse (heroin, marijuana, alcohol, tobacco)MiscellaneousRenal failureProstatectomyPitfallsA detailed history is essential before arriving at the diagnosis of impotence. Many times, sexual stimulation is not adequate in duration and intensity. Morning erection while awakening is suggestive of psychological origin of impotence. Psychological aspects of erectile problem should always be evaluated in all the cases of erectile difficulty even when the cause is organic. Performance anxiety, fear of failure, over concern with pleasing the partner, ignorance about sexual anatomy and physiology are major causes of erectile problem. The degree of penile erection required for successful vaginal penetration should be enquired. There are individuals who feel that they need a steel hard erection for penetration. This is not necessary. Nature has designed vagina in such a way that the male gets maximum erection followed by ejaculation in the vagina. The male needs to be convinced that if the alignment of vagina and penis is perfect, and the women is stimulated enough, the male will be successful in penetration even if he gets partial erection. Fur there he gets the rigidity during penile thrusting.Sometimes premature ejaculation is associated with impotence. At times, anejaculation is misinterpreted as impotence. Many times, vaginismus in female is the root cause of impotence in the male. He tries at the right site and in the right direction, but since the vaginal opening does not relax, the penis gets tried and he loses the erection. In unconsummated marriage, he may try at a wrong site and lose the erection. Some individuals try penetration at the right site and in the right direction, but since the vaginal opening does not relax, the penis gets tried and he loses the erection.In unconsummated marriage, he may try at a wrong site and lose the erection. Some individuals try penetration at the right site but in a wrong direction, and so they may lose the erection. Some are not aware that they have to make to-and-fro pelvic movements. Such individuals remain quiet after penetration, and ultimately lose the erection. Man is the only animal doing coitus in a face to face position. Coitus is the only act that is performed in the dark and the individual has no opportunity to learn from others. InvestigationsBlood Sugar estimation: Fasting and P.P.Lipid ProfileF.S.H., L.H., Prolactin & TestosteroneT3, T4, T.S.H.Diagnostic testsStamp Test: A long strip of postal stamps is wound around the base of the penis at night before going to bed. Next morning if the perforations of the strip are found to be torn off, impotence is supposed to be of psychological in origin.Peno- brachial index: The ratio of penile systolic blood pressure to that of brachial systolic blood pressure is normally 0.6. If found to be low impotence is vascular in origin.Papaverine Injection Test: Papaverine is a vasoactive drug. Using a 26 gauge needle, 30 mg Papaverine is injected at the mid-shaft of Corpus cavernosum of penis. He is isolated, asked to stoke the penis and exposed to erotic literature (or erotic fantasy). Erection will occur in 10 to 15 minutes. If the erection is short-lived or partial, then impotence is considered as vasculogenic. If the erection is full, then impotence is considered to be neurogenic or psychogenic in origin. Caution: This test should be performed in a hospital setting or where the facilities for detumescence are available. The patient should be observed for next few hours till the erection subsides.Rigiscan Test:This is a gold standard for evaluation of Nocturnal Penile Tumescence and rigidity(NPTR). This test is based on the physiological principle that a male gets erections 3 to 5 times during REM sleep. At night before going to sleep one ring of Rigiscan is slid over the base of the penis and the other over the tip. Next morning, the tracing obtained are studied. This test can quantify erectile tumescence and rigidity. Rigiscan tracing indicates whether the impotence is organic or psychological in origin.Arterial insufficiency and venous leaks can also be suspected on the basis of Rigiscan graphs. Patients with purely artery disease have low levels of rigidity but of adequate duration (20 minutes or more). Patients with venous leak will have varying rigidity levels with shortened duration.Penile Ultrasound: This test is for evaluation of the functioning of the penile arteries. A simple acoustic Doppler emits auditory signals or a color Doppler can help visualization of arteries. Cavernosometry & Canvernosography: This hemodynamic test is useful for diagnosing Veno-occlusive Dysfunction of the corpora. Biothesiometry, electromyography (EMG), nerve conduction studies: these tests are for evaluation of impotence. TreatmentCounselingSexual dysfunction is a marital unit problem and therefore both, husband and wife, should attend. Counseling is towards strengthening marital relationship. Wife is requested to co-operate. Client is requested to quit smoking and alcohol. He is advised relaxation exercises, yoga. The couple is educated about anatomy, physiology of sexual organs and about sexual response. Their myths and misconceptions about sexuality are countered. They are also explained that he does not have to do anything to have an erection. Erection is a physiological response to effective stimuli.Sex therapyNo sexual activity is permitted till specific instruction are given. To remove his performance fears he must stop mentally watching himself during the sexual activity. The couple is advised sensate focus exercise (mutual pleasuring) without any goal. Basic to the sensate focus is the recognition that touch is a vital part human communication that gives meaning to sexual responsiveness for both men and women. They are advised to touch each other in a communicative way. Tenderness, affection, solace, understanding desire, warmth, comfort- almost any feeling can be conveyed to the partner by touching. Though the problem is of one partner, both are involved. There is nothing like uninvolved partner. One partner is advised to trace, massage or fondle the other, using the information from verbal and nonverbal directions from the other getting partners about preferences for locations and intensity of touching. Partners are forbidden to touch breasts, genital organs or to have intercourse.After three or four days the partners are asked again to pleasure each other, but this time, caressing other part of the body, they are specifically instructed to touch the genitals and breasts but not to have intercourse. If erection occurs, as it does during the pleasuring sessions, the couple is not permitted to rush to complete the performance. They are encouraged to develop the ability to communicate with each other during the pleasuring sessions until erection regularly, but not proceeding to intercourse. After next three to four days the wife is instructed to tease the man’s genitals. When the erection is firm she stops teasing and they lie in each other’s arms until the erection goes away. She then repeats the process several times during the next half an hour. By use of teasing technique for the next three to four days, the man gradually overcomes the fear of losing his erection and getting it back.During the next step, after the preliminary sex play, the wife is instructed to straddle her husband and sit on his thighs. She Is asked to stimulate his penis to full erection and to insert it in her vagina. The therapist asks the wife to insert the penis because she knows exactly where the entrance is.After the entry has been accomplished, the wife moves forward and backward slowly on the penis (female superior coital position). If the erection is lost, the wife needs to withdraw and manipulate the penis to erection again. The couple has been told not to move demandingly. There is no pressure to perform. The therapist never instructs the couple to proceed to climax.If orgasm does occur, it should not be by plan, but allowed to be a natural involuntary happening.Once this is accomplished, the couple is instructed to resume intercourse in the man superior coital positionPharmacotherapyPharmacotherapy alone may not be effective unless it is associated with education, counselling, reassurance, countering myths & misconceptions, behavior modification, relaxation and supportive psychotherapy. 1. PDE5 inhibitors are found to be most effective for impotence of no known cause. These drugs maintain the erection and do not initiate the erection or increase the libido. Therefore, sexual stimulation is must. The side effects are headache, facial flushing, nasal congestion, visual disturbance and dyspepsia. Visual disturbances can occur with Sildenafil.Backache or muscle pain has been reported with Tadalafil. Special precaution is to be taken in persons having cardiovascular disease or renal impairment. PDE5 inhibitor must never be given to patients taking nitrates(e.g. Sorbitrate, Angised). Erythromycin, Cimetidine, ketaconizole, grapefruit juice or alcohol should not be taken concurrently. Generally priapism is not observed. PDE5 inhibitors should be prescribed along with alpha blockers (e.g.Prazopress), since this may cause hypotension.Sildenafil (Viagra, Caverta): Dose 25 mg to 100 mg given ½ hour after food and 1 hour before the sexual activity. Not more than once a day. Duration of action is 12 hours.Tadalafil ( Forzest, Zydalis) : Dose 10mg to 20mg. No relation to food. Given ½ hour before sexual activity. Duration of action is 12 hours.Vardenafil (Levitra) : Dose 5 mg to 20 mg. given ½ hour after food and 1 hour before sexual activity. Only once a day. Duration of action is 12 hours.The action of these drugs is dose related. To start with, minimum dose is prescribed.
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PSYCHO SEXUAL COUNSELING Many people think of counselling as giving or offering solutions to the problem. However, counselling is neither of these. When the client comes for help with a problem he has to change something in himself to solve it. This may be a change of attitude, of perception of self or of others, of habit or a change of behavior. Counselling is teaching the client ‘life-coping skills’.Goals :To help reduce the level of anxiety when confronted with a stressful situationTo help bring about a meaningful change in the client and function more successfullyTo facilitate client’s decision-making processTo help client to plan his solution for his problem using his value systemEssentials:Listen actively, and question effectivelyAccept the client , respect him, his ideas and feelingsShow empathy ( recongnition of another’s feelings)and warmthBe honest and non-judgmentalCounter the myths and misconceptionsMaintain confidentialityCounselling can never be hurried (average time: 30 min)Hold the counselling session in a private place. PLISSIT Model: Sexual problem, where there is no organic cause, can be effectively tackled by the use of PLISSIT model of sexual counseling. This is behavior treatment for sexual problems. This is based on the belief that human behavior is a learned process. Maladaptive behavior can be unlearned and positive behavior can be substituted. PLISSIT Model was formulated john anon in 1976 .this model suggests therapeutic interventions 4 levels:Treatment level I P: Permission:The counsellor asks questions about client sexuality e.g. sexual thoughts, fantasies, dreams, feeling, sexual arousal, masturbation, nocturnal emission etc. The counsellor assures the client that he is O.K. and to continue doing what has been doing. Level II : LI: limited information ;At this level the counsellor explains why the client is O.K. the counselor counters myths and misconceptions related to his sexual problem and provides scientific information on the concerned topic e.g. masturbation, oral sex, breast and genital size during menstruation/ pregnancy etc.Level III : SS : Specific Suggestion:At this level the counsellor provides alternative explanation for the problem (learning & conditioning) and offers specific suggestions to the client to manage the sexual situation e.g. specific coital position during pregnancy; sensate focus; Kegel exercise.Level IV: IT: Intensive therapy:At this level analysis and treatment of attitude, reinforcing and discriminative function of stimuli that elicit inappropriate emotional responses are required. Paraphilia, marital discord, substance abuse required this level of therapeutic intervention.Additional instruction to the client :1. Tobacco : To stop smoking or any other use of tobacco. Nicotine in tobacco causes vasoconstriction and enhances atherosclerosis.2. Balance diet : To avoid excessive consumption of fats, sugars and salts and to take plenty of proteins ( egg white, pulses, fish, skimmed milk) , green vegetables and fruits. Udid contains natural testosterone and soyabean contains natural estrogen. Idli made from udid and rice is a nutritious food item. Vegetarian and non-vegetarian diet are equally good provided extra milk is consumed by vegetarians. Balance diet provides enough energy for sexual activity.3. Exercise : The aim is to achieve physical fitness and not the body building. Exercise should be done on empty stomach. It should be gradual. If pain occurs in the chest during the exercise, it should be discontinued immediately and seek physician’s advice.The four components of physical fitness are:(a) Cardio-respiratory efficiency : Running, swimming, fast walking, cycling or spot running, , minimum for 20 min and at least for 5 days in a week. The pulse rate should be 220- age *4/5(b) Flexibility : Yogasnas. Each asana should be done for 2 min. Difficult and painful asanas need not be done. (c) Endurance : sit ups, push ups(d) Strength: Wait lifting, bulwarker.4. Body weight: Excessive body weight may cause difficulties in the sexual activities. Optimum body weight is calculated by the formula of body mass Index (BMI)B.M.I. – Body weight in kg/ ( Height in meters) 2The resultant Should be 25.Both, Dieting and exercise are necessary for the weight reduction.
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MAN –WOMEN SIMILARITIES & DIFFERENCESMan and women are not ‘opposite’ sexes but complementary sexes.Man & women form one unit of the Homo-sapiens species.Though both can survive & function Independently, involment of both is essential for reproduction and thus propagation of the species. To understand the similarities and differences of two on has to start from embryology .EmbryologyThe external genital are similar in male and Female embryos till 3months of Pregnancy, External genital are developed from 3 bodies1. Genital Tubercle2. Genital folds3. Genital swellingDuring 7th month of pregnancy1. In male, Genital Tubercle develops into Penis enveloping the urethra, and in female it develops into Clitoris.2. In males, the two Genital Folds unite from anus to the glans of penis. This union can be seen as a median raphe in the new born, In Female embryo, the two folds partly unite and partly remain open and develop into labia minora. Urethral and vaginal opening are developed in the space between the twofolds 3. In males, the Genital Swellings of two sides unite to form scrotum. The Gonads(Testes) descend into the scrotal sac during 7th month of pregnancy. In females, the Genital swelling remain separate and develop into Labia Majora. The gonads (ovaries) remain in the abdomen. These changes in the male embryo about by foetal testosterone. As a result of these changes, in the male the organ of procreation and pleasure remain the same while, in the female, they remain separate. There is a distance of about 1.5 inches between clitoris and vagina. Therefore, when women engages in vaginal intercourse, she may not get the pleasure and when she wants erotic pleasure she need not engage in vaginal intercourse. Perhaps this is one the reasons for paucity of male sex workers. The other reasons could be scarcity of testosterone, a desire stimulating hormone, in the female vagina is developed from endoderm and therefore, like esophagus , the touch sensation, expert in outer one inch, is absent.Glans of clitoris is erotically as sensitive as the glans of penis and is the seat of orgasm. During intercourse clitoris is not stimulated since the women is pinned down. Women can get orgasm only when clitoris is stimulated manually during the foreplay or when the women is on the top during the intercourse.If women gets lubricated by clitoral stimulation, then man gets better stimulation of penis and faster orgasm. Therefore women should have clitoral stimulation/ orgasm prior to penetrative sex. Man: sex chromosomes xyHair on face, Hair on pubic region: up to umbilicusMuscular body, nocturnal emissionBreasts: rudimentaryPenis: organ for coitus, erotic micturition & ejaculationGonads (testes)are outside theLubrication produced by bulbo – urethral glandsSexual hormone: Testosterone Sexual response: MonotonousSexual Response is essential for fertilityOrgasm: Possible every timeAssociated with ejaculation & followed by refractory Period .Explosive –mid or explosiveErotic stimulation is through five sense organs stimulated by nudity, blue film , seeing female genital and beauty Most of the male MasturbateAim: Sexual pleasureOral Sex – Most of them are interested.Deep interest in coitusAny women would do for coitusAttraction of extramarital relationAs the age advance, the Sexual Attraction decreased Total Sexual outlet are moreSatyriasis is not uncommonInterested in sexual postureInterested in sex tonicCoitus: How often , when and how long is decided by manAndropause is gradual and does not pose a problemParaphilia is commonSexual dysfunction is common Man is more interested in sexMan gives loves to get sexMan is dependent upon women for sexual PleasureMan is rational, steady & dashing Man seek any women for short term relationship Man want a Virgin & younger by ageMan’s sexual pleasure is genital orientedWomenSex chromosomes XXNo hair on faceHair in triangular regionDelicate body, Menstruation, broad waistBreast ProminentSensitive to erotic stimulation Produces milk after deliveryClitoris for erotic sensation: urethra for micturition & Vagina for coitusGonads (ovaries) are inside the bodyProduces one ovum per monthsLubrication produced by vestibular glands & vaginal wallSex hormones are Estrogen, Progesterone, ProlactinSexual response is variesFertility is possible in absence of sexual responseOrgasm: may or may not or Multiple orgasms. No refractory period.no ejaculation.Love, romance & touch are essential for erotic stimulationStimulated by romanticism & personality.Not stimulated by seeing male genital.Most of them do not masturbate.Aim: to relieve vascular congestionOral sex: most if them are not interestedInterested in partner’s company, his close contact& motherhood.Not much interested in coitusMeticulous selection of partner.Emotional involvement necessary for coitus. Any man would not doNo attraction of extramarital relationSexual attraction is the same throughout.No change according to age.Total sexual outlets are less.Nymphomania is very rare.Neither interested in sexual postures, Not interested in sex tonicWoman is passive. She does not take a lead.Menopause is sudden and poses a problem in some women.Paraphilia is very rareSexual dysfunctions : less commonWomen is more interested in love & motherhoodWoman gives sex to love Women is not dependent upon man For sexual pleasure ;but for love, romance & motherhood.Women is creative, instinctual, & affectionateWomen seeks a man for permanent Women wants a sincere man who would offer stability , & is senior by ageWoman sexual pleasure is entire body – oriented.
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Female MasturbationMasturbation is one activity in which the second largest number of female engages both before and after Marriage. In coitus a female may be delayed or completely prevented from reaching orgasm however, the techniques of masturbation usually offer the female the most specific and quickest means of achieving orgasm. Masturbation has not been as frequent and as regular a source of sexual outlet for female as it has been for the male. Many male are inclined to overestimate the incidence and frequencies of masturbation among female.in female masturbation is erotic satisfaction and some release from erotic tension are its objectiveMost of the female discover how to masturbate as a result of the exploration of their own genitalia. Females do not discuss their sexual experience in the open way as males do. Many females do not begin masturbation till the age of thirty, While most of males begin masturbation after the onset of adolescence. About 94 percent of males masturbate, while only 62 percent of females masturbate at some time in the course of their lives.There is a higher incidence of masturbation among the older females since there is an actual increase in erotic responsiveness at the older ages, reduced coital activities at the age, reduction of inhibition and they might have learnt by experience of obtaining their peak incidence in teenage. In elderly females as the estrogen level falls, the sex stimulating testosterone hormone level increases.
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BEST SEXOLOGIST DR. RAMESH MAHESHWARI PUNEHaving Sex - 9 Health Benefits ------------------------------------------ People who have healthy sex life are not only happier but also healthier than those who don't. Here are 9 health benefits you never knew sex can provide - 1) Rocking Immune System: Regular sex ensures higher levels of what defends your body against germs, viruses, and other intruders. 2) Lowers Blood Pressure: One landmark study found that sexual intercourse specifically (not masturbation) lowered systolic blood pressure. 3) Great Exercise: Sex is a really great form of exercise. It is a muscular exercise that burns calories and increases your heart rate. 4) Lowers Heart Attack Risk: Great sex life is good for your heart. It not just raises your heart rate, sex helps keep your estrogen and testosterone levels in balance. 5) Reduces Pain: Getting an orgasm can block pain. Vaginal stimulation can block chronic back and leg pain, and can reduce menstrual cramps, arthritic pain, and in some cases even headache. 6) Improves Sleep: People usually dose of quickly after sex and tend to get a sound sleep. 7) Relieves Stress: Sexual arousal releases a brain chemical that revs up your brain's pleasure and reward system. Sex and intimacy relieve you of stress and boost your self-esteem and happiness too. 8) Reduces Risk Of Prostate Cancer: A study, published in the Journal of the American Medical Association revealed that men who ejaculated frequently (at least 21 times a month) were less likely to get prostate cancer. 9) Helps Women's Bladder Control: Incontinence, a problem that affects about 30% of women at some point in their lives is helped with a regular sex. Good sex is like a workout for their pelvic floor muscles. Contact Us- 9359863878
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