Simultaneous Orgasms

In some people's vision of idealized sex, they strive for simultaneous orgasms, where both partners come at the same time. Perhaps it's an attempt at a shared experience. Perhaps it is seen as the culmination of one's sexual activities coming to it's logical climax. For others, it may be their goal in a very performance-based view of sex. Still for others, it may be their definition of what sex should be. It's true that at different points in history, having simultaneous orgasms was seen as the highest sexual goal, some believing that women could only conceive if this was the case. As a matter of fact, some "marriage manuals" actually recommended married couples strive for simultaneous orgasms, and spoke of how to best achieve such. We know now that women can conceive without having an orgasm, and that most women cannot achieve orgasm just by penetrative intercourse alone.

Oftentimes, simultaneous orgasms will be achieved because of the increased arousal of seeing and feeling your partner reaching orgasm, thereby pushing you over the edge. But I would like to offer some thoughts regarding simultaneous orgasm, especially for those people in which the female partner does not reach orgasm with penetration alone, or for those couples who seem to very agenda-oriented in their sex life.

If you find yourself attempting to have simultaneous orgasms during most or all of the sexual contact that you have with your partner, you are, in effect, limiting yourself to the entirety of sexual possibilities. I have seen that for some couples, they also set the stage for disappointment in their sex lives because of the expectations they have for themselves. When I work with couples that have a very rigid idea of what their sex life should be, I encourage them to look beyond their old definitions so that they can be open to a larger range of sexual adventures with their partner.

At different times, our sexual appetite varies, as does our energy level and our level of relaxation and arousal. Because of this, it is natural that we would want different things sexually at different times as well. Part of keeping our sex life fresh is having variety and being open to exploration. Sometimes, we may desire to have a very linear type of sexual encounter, with a predictable beginning, middle, and end. At other times, however, we may crave a variety of experiences that include periods of more or less intensity, periods of faster or slower movement, or periods of multiple orgasms or no orgasms at all. We are more open to such experiences if we do not impose strict and predictable rules for ourselves in what sex should or shouldn't be.

Lastly to consider is the understanding of what it means to get lost in the moment. Because our sexual pleasure is heightened when we truly let ourselves go, our experiences become more intense when we give ourselves up to them. At times when this happens, we can become so engrossed in our experience, that everything else around us seems to fade away - time, sounds, even our surroundings. We may be so focused on our own pleasure and physical sensations that it becomes difficult to sense what is happening with our partner. Having our own orgasm makes it difficult, if not impossible, to fully feel our partner's body as they have their orgasm if it happens at the same time. You can actually feel your partner's orgasm more fully if you each orgasm at different times. This also can increase your connection and intimacy with your partner because you can be fully present as their reach their climax. This is preferable rather than missing their orgasm because you are lost in yours, or worse - not focusing on your orgasm because you are too busy focusing on theirs.

The Benefits of Orgasm

Modern medicine still does not understand exactly the hows and whys of orgasm. But we do know that for humans, our psychological state is the major determining factor as to whether we can have an orgasm, or have difficulty acheiving one. We are, however, starting to understand more about what happens in the brain as a result of orgasm. But there is so much more to be studied and explored.

First, we know that at orgasm, both men and women release an increased amount of oxytocin. We know that oxytocin promotes feelings of comfort, closeness, relaxation, and feeling tingly all over. In women, it also causes contractions of the uterus, and may contribute to stronger orgasms. Along with this is the release of prolactin, another hormone that helps us feel satisfied and calm. There are studies demonstrating that at the point of orgasm, there is a protection against feeling pain without decreasing other sensations. Some people find that it helps relieve migraines, and others find it useful for body pain. Even though the effects of pain relief are immediate and last only a few minutes, those people regularly having orgasms experience lower levels of pain overall because of the increase in the body's natural opiods. We know that people having several orgasms per week have less chance for heart disease and stroke. I would also venture to guess that they smile more often.

Perhaps the most enjoyable benefit of orgasm is the feeling of being alive and charged sexually. When you orgasm, you feel powerful. It increases your blood flow throughout your body, but most importantly, to your genitals for increased support of those tissues and muscles. This is the best way to keep these tissues healthy, because blood flow promotes more blood flow in a positive feedback cycle. It's the flip side of 'use it or lose it.'

Even if you don't have a partner, bringing yourself to orgasm helps you gain some of these benefits. Although not all will admit it, most men will continue to actively masturbate even if they don't have a partner. I am still suprised, however, that there are several women who do not 'take matters into their own hands' when they find themselves without a partner. For some it is guilt, for some it seems inappropriate, for some it brings many negative automatic thoughts as to why they do not have a partner. Regardless, all of these cause a women to relinquish control of her sexuality and abandon an activity that her body thrives on.

I propose that we all masturbate frequently and happily. Just imagine if everyone woke up just a few minutes earlier and was able to have a little orgasm before leaving for work? I wonder if we would have a lot less road rage?

Master of Your Domain

Today I got into a very lively conversation on the topic of orgasm and masturbation. A friend of mine stated that she has never, and will never, masturbate. Instead, she wants her sexual satisfaction to come from a partner (in her case, a man). Trouble is, she doesn't have a partner, hasn't had one for some time, and isn't actively looking. So in the meantime, no orgasms for her.

Although she seemed to want to talk about sexual topics was in the pre-contemplation stage of checking out internet dating sites, she quickly dismissed any talk of masturbation. I went through my usual list of the benefits of orgasm: it increases your blood flow to your genitals, it feels good, it promotes relaxation, it feels good, it can be done without dependence on a partner or worries about catching a disease, it feels good, you can't get pregnant, it feels good. Still, she wouldn't hear of it.

Despite her objection to masturbation, I am a true believer and proponent of masturbation. I believe that it is natural and an excellent way to get to know yourself. How else will you know where to ask your partner to give extra-special attention to? Remember, everyone is different. What someone else learned with a different partner may not necessarily apply to you. You may need to give some directions. And if you've never figured out what you like and what gets you off, you could be waiting awhile for your partner to figure it out! Not that I'm against experimenting with a partner, but knowing yourself could cut down on the frustration. Plus, touching yourself helps you feel sexy as you realize that you can have such pleasure and enjoyment from different kinds of touch. And it's empowering to realize that you can do it by yourself!

This conversation with her reminded me that there are still so many myths and anxieties about masturbation, particularly for women. Here are some of the most common myths and the truth about masturbation:

Myth: It's a sin/dirty
Truth: Masturbation is a natural activity that can be found occurring as early as infancy. In fact, the clitoris only has one purpose, to feel good. It does not play any part in reproduction, except maybe increasing your desire to grind against your partner. I refuse to believe that it was meant to be ignored. And since such a large percentage of women can't come without touching this little button, I think it was meant to be touched.

Myth: You'll get hooked and you won't be able to come without it
Truth: Masturbation helps you learn about yourself and what physically turns you on. Some women can only come if they learn how to masturbate. You may find that you always have a preference for a certain angle, or a certain speed, or a certain amount of pressure, but it does not limit you to that activity alone. Once you start having orgasms with masturbation, you will discover the incredible variation and possibilities there are for women in having orgasms. You will learn that orgasms can vary from day to day, with your cycle, with your mood, with the stimulation, etc. And you can also learn that you can have orgasms on the inside, orgasms on the outside, or a combination of both. It's not altogether unpleasant either to give yourself multiple orgasms, you know!

Myth: It takes away from our sexual relationship with our partner.
Truth: For all the reason already listed above, masturbation serves to enhance our sexual relationship with our partner. It not only keeps our genitals healthy, but it encourages us to exercise our sexual fantasies as well - essential for mind-blowing sex. Women have the advantage of being able to have multiple orgasms, and some even find that subsequent orgasms are more intense than the first. And just in case you feel you're not getting enough foreplay, masturbating just before intercourse (perhaps with your partner watching as part of the foreplay!) gets you wet quick like a bunny.

So for all you Seinfeld fans, I propose that we redefine 'Master of Your Domain' as a person who actively masturbates - taking matters into their own hands. No more anxiety or shame! Just good, clean fun.

Sweet Wet Dreams

How many of you have had dreams about sex and end up having an orgasm in your sleep? And how many of you have orgasms in your sleep on a regular basis?

Most people know that men start having wet dreams (nocturnal emissions) at puberty. Orgasms (or ejaculations) during sleep are a natural and common occurrence. For men, the terms wet dreams, nocturnal emissions, or spontaneous orgasms are all the same thing. Some men are woken up by their orgasm/ejaculation, while others wake up to find that they have already come and may not remember having had a sex dream. And just because a man masturbates or has regular sexual activity, doesn't mean that he won't necessarily have wet dreams. It depends on the man.

What I find very interesting and not often discussed, is that women also have sex dreams that may or may not end in orgasm. As with other aspects of sexual arousal, there may be no obvious, tangible signs (like ejaculation), but she may be woken up by a strong orgasm. In fact, some women report they can have stronger orgasms in their sleep compared to the orgasms they have when they are awake. Some women can even have multiple orgasms in their sleep. Because women usually don't have 'emissions' with their sex dreams, terms like nocturnal orgasms, spontaneous orgasms, and sleep-related orgasms are used to describe these instead. Even though Kinsey reported that about 37% of women admitted to a sleep-related orgasm by age 45, and more recent surveys place that percentage much higher, it still seems that many people are not aware of this occurrence, and therefore have a some misunderstandings or guilt about it.

It is important to understand that sleep-related orgasms are a natural occurrence for both men and women that can start around the time of puberty. Some studies suggest that the occurrence of sleep-related orgasms may correspond to relative testosterone levels, both for men and women. Some cultures have been more open in talking about it than others. In fact, there is historical documentation of sleep-related orgasms for women dating back to ancient Greece about women having and enjoying sex dreams. (Gotta love the Greeks!) Despite it being such a common occurrence, it is not really taught in sex education classes, or by parents (especially not for girls). Consequently, many people develop bad feelings or guilt related to having sex dreams and sleep-related orgasms because they think they are not normal, or they are disturbed by the content of their dream.

As a psychiatrist, let me tell you that sex dreams, like most other dreams, are usually symbolic in nature. What this means is that what you are dreaming about usually stands for something or someone else and should not always be interpreted at face value. Many times people become alarmed if they are dreaming about someone other than their partner, or situations that they would usually find offensive or unacceptable. But dreams are tricky like that. They are the unconscious mind's way of working things out that doesn't always make sense to our conscious mind. Just because you become extremely excited dreaming about group sex, or some random person you met on the street, it doesn't mean that is your actual wish. Women may have dreams about sex with other women, for example, as a way for the mind to experiment without real-life consequences. Sex dreams should not necessarily be seen as a reflection of what a person wants when they are awake. Nor should they be seen as a sign of infidelity or desire to be unfaithful. It's just the way the unconscious mind works.

Sleep-related orgasms are found to occur most often in REM sleep when most other dream activity happens. They can also happen during a REM cycle during a daytime nap. The interesting part about sex dreams and sleep-related orgasms is that for many people, especially women, they can be more intense than what they experience in their sex life. This is because while you are asleep, there is less inhibition and less conscious restraint. Studies of brain scans have shown that there is actually a 'turning off' of certain areas in the brain that process outside information, motor activity, and emotion at the time of orgasm. This is very similar to a sleep state, and may help explain why there are less barriers to intense sexual excitation (especially for women) during sleep than when they are awake. Also, during sleep and dreaming, there is the ability to paint an optimal scenario where you get exactly the stimulation you want when and where you want it, which may not happen precisely in real life.

So we see that sex dreams and sleep-related orgasms are natural, healthy, and common. They should not be considered wrong, immoral, abnormal, or perverted. Just take them as they come. Sweet dreams.

Kegels for Men and Women

I'm always telling people that exercise will do them good and give them a better quality of life. Perhaps none is more applicable to your sex life than Kegel exercises. These exercises are simple, can be done anytime anywhere, and are guaranteed to improve your sex life.

Kegel exercises were originally created in the 1940's by a gynecologist, Dr. Arnold Kegel, who wanted to give women a way to increase the muscle tone of their PC muscles (pubococcygeal muscles), and thereby cure their urinary incontinence. This was especially important for women after childbirth and after menopause - the two main causes of weakening of these muscles. So while women were squeezing away, they found that not only could they control their urine better when they coughed or laughed really hard - they also found they were having stronger and more pleasurable orgasms. Of course when something improves your sex life, people take notice! The most interesting recent finding is that Kegel exercises have been found to be helpful for both men and women.

Kegel exercises involve the PC muscles, which is a network of muscles that extend from the pubic bone (found under your pubic hair below the level of your bladder) down and around between the legs, around the anus and to the coccyx (tailbone). These muscles contract to help stop urine flow and squeeze the anal sphincter closed, but also are the muscles that rhythmically contract when someone has an orgasm. By strengthening these muscles, women have better control of holding their urine, and also have stronger and more pleasurable orgasms. Men who do Kegels also have better control of their urine and experience stronger and more pleasurable orgasms, but also can have better control of the timing of their ejaculations and even better quality of their erections.

So who's up for a little Kegelcising? Here's how it's done, and it's basically the same for both men and women. First, locate your PC muscles. This can be done by trying to stop your urine stream while you are urinating. The muscle that you squeeze to get that done is your PC muscle. Another good way to locate the PC muscle is to squeeze your anal sphincter tight and then extend this squeeze all the way forward. You should locate these muscles and learn to isolate them from other muscle groups in the area. So make sure that your legs, buttocks, and abs are relaxed and are not moving while you're squeezing your PC muscles. Once you locate them, don't use them to stop your urine any more. Now you will just do the Kegel exercises by themselves.

As I mentioned before, Kegel exercises can be done anytime, anywhere. When you perform them, no one can tell that you're doing it - so you can squeeze on the way to work, during a business meeting, while you're waiting in line, while you're at the movies - you get the picture. Start off slow as you would any new exercise, doing 3 sets of 10 repetitions. Squeeze and hold for 5 seconds, then release and repeat again. Try to do the Kegels at least once a day, but shoot for three times a day if you can. Don't be dismayed if you get tired or feel the muscle losing the squeeze. As you get stronger, you will have more and more control of that squeeze.

Once you have been doing sets of 5-second squeezes faithfully for about 3-4 weeks and you can keep the squeeze consistently for the whole 5 seconds, you can try to extend the squeeze time to 8-10 seconds. You just squeeze, hold it for 10 seconds, and release. Then repeat this for 3 sets of 10 repetitions one to three times a day. The next level after this would be to practice the squeeze while you are masturbating or during penetration with your partner. It takes about 1-2 months of Kegels to really have solid results, but it's worth it.

Just remember, the body operates on the principle of 'use it or lose it.' As we age, keeping the PC muscles toned and strong gives us increased urinary and ejaculatory control, as well as maximizes the intensity of our orgasms and our sexual pleasure. It's a little exercise that goes a long way.

Give Yourself a Hand

"Masturbate? Who me?" "No, I don't do that anymore." "I don't need to do that now." Or better yet: "I never did that!"

I am here to say that it doesn't matter if you are in a relationship or not, masturbation is not only pleasurable, but it's healthy and it's part of a balanced sex life. First of all, your sexuality belongs to you. So even if you have a partner, you should never give up control of your sexuality. Ultimately, you are responsible for your own pleasure and your own happiness. The sooner you know that, the sooner you can share that happiness with somebody else. When you have a partner, you won't always be on the same page as them, or won't always be in the same mood as them, or you won't always have the same energy as them. But if you are in charge of your own sexuality, masturbation can help bridge those gaps. And masturbation doesn't have to be something you do by yourself. Maybe your partner can watch? Maybe they'll get so turned on watching you, they'll want to join in? Or maybe they can just get pleasure from knowing that you're getting off without any pressure on them. All of you who have been in long term relationships know that it is impossible to always be in sync with our partners all the time.

If you have never spoken to your partner about masturbation, that's the first step. Once you have open communication about different ways to have pleasure, you can bring up the topic of masturbation. Remember, doing it on your own is ok too. The main word here is balance. If it is not used to avoid your partner, or done compulsively, it is a natural part of your sex life that can actually enhance your sex life.

For those individuals without a partner, masturbation might make up the entirety of your sex life. Don't rationalize to yourself that you don't need it or that you don't want it. Both our body and our brain run on the principle of 'use it or lose it.' Masturbation not only gives us pleasure, but it also makes us feel alive. Orgasms release chemicals in our brain that help us feel more relaxed, happier, and more secure. Besides that, masturbation increases blood flow to our genitals which is important in maintaining sexual functioning over time. And every time you have an orgasm, it helps maintain tone in your PC muscles that help women keep continent after menopause or childbirth, and help men have stronger erections and ejaculation. So don't forget to give yourself a hand now and then!

Feel at home with the O.

Women are complicated - there's no denying that. Even we can't figure ourselves out sometimes. And physically, we're more complicated too. We have all that extra indoor plumbing and our bodies are much more sensitive and full of surprises.

And orgasms are no exception to this bundle of complexity. Not only can we have orgasms on the inside and orgasms on the outside, but we can also have a combination orgasm - or "blended" as some people like to call it. Not to mention those orgasms some of us can have without even getting close to our genitals!

So what are the different types of orgasms women have? Well, first let's start with the most well known orgasm - the clitoral orgasm. This type of orgasm is a result of repeated stimulation of the clitoris, which is located at the top of the labia, just below the level of the pubic bone. The clitoris is special because it has the most amount of nerve endings per surface area than anywhere else on a woman's body (or anywhere on a man's body for that matter). The nerve responsible for the sensation in this area is the Pudendal nerve, which experiences all range of sensation - light touch, pressure, pain and temperature, vibration, etc. This opens up the multitude of ways that a woman can get pleasure in this area - oral sex, masturbation with fingers, vibrators, rubbing against the arm of the couch, stream of water from a pool jet or a shower-massager, just to name a few.

Next we have the orgasm that's produced when the anterior (front) part of the vagina is stimulated. This is also known as the G spot and has been found to have the highest concentration of sensory nerve endings in the vagina. This type of orgasm is transmitted via the Hypogastric and pelvic nerves and gives a sensation of orgasm that spreads over the entire body. Many times referred to as a "blended" orgasm because of its overlap in sensation with the Pudendal nerve (that innervates the lower 1/3 of the vagina also), it's technically an "internal" orgasm and can be one of the ways that a woman comes through penetration. And many vibrators and dildoes have been designed specifically with a curvature to stimulate this area for powerful vaginal orgasms.

There is yet, another type of "internal" orgasm that comes with stimulation of the cervix during penetration. This produces pleasurable contractions of the uterus and is transmitted via the Vagus nerve, sometimes in combination with the Hypogastric nerve. Of course, since there is some overlap of nerves (as I'm sure some of you have already experienced) there is often a combination of pathways involved in an orgasm so that more than one pathway is activated at the same time. Women can also have a combination of stimulation on the inside and on the outside simultaneously from certain positions with their partners or manual stimulation of the clitoris while being penetrated. This can give "blended" orgasms as well that you feel on the inside and the outside at the same time. There are also other areas of the body that can be stimulated to bring a woman to orgasm that doesn't involve her genitals, but let's leave that for another post.

So our complexity is also our key to pleasure! Women have different ways to mix and match for a healthy variety of activity. This gives us more choices to keep things interesting. So boys, do your homework, and girls, get your hands-on training. This way, we can all feel at home with the O.

What is sex anyway?

I like to say that we are living in The Golden Age of Rationalization. It seems that there isn't anything that we can't deny or fool ourselves about. And sex is no exception. After all former President Bill Clinton did it on national television! "I did not have sex with that woman."

Let's get something straight here. You don't want to think that you're 'not really having sex', or you want to pretend to yourself that you haven't 'really' cheated on your partner, but the truth is - there is a lot more to sex that just a penis in a vagina. (Just ask anyone having homosexual sex!) Sex starts with fantasies and desire. As soon as you start to share those fantasies and desires with another person, you are inviting them to engage in sex. Sex involves a multitude of activities that jump-starts a person's desire and arousal. And there are so many ways to reach orgasm - oral sex, masturbation, stimulation of the breasts, telephone conversations to name a few. You can even come in your sleep!

I consider that all sexual activity falls under the category of sex because I think that it's part of the erotic and intimate relationship that one shares with their partner. To have a long, healthy sex life that is satisfying through the years, a person needs to have some variation to keep it interesting and fresh, as well as some flexibility to allow for adjustment to life changes. If our sexual repertoire is very limited, it increases the chance that we will become bored or frustrated. Psychologically, the more activities we consider to fall under the realm of sex, the more we can happily share with our partners in a sexual way to enhance that sexual relationship. After a woman gives birth for example, it may be several weeks before she may be ready to have any penetration. But she can receive enjoyment from giving her husband oral sex or a hand job, or she can get stimulated on other areas of her body. Similarly, if a man has prostate surgery, he may have transient or permanent erectile difficulties, but can still find ways of giving his partner sexual satisfaction with manual or oral stimulation, or even in combination with sex toys such as a dildo or a vibrator.

But if we have a very rigid idea about what sex is, we limit ourselves and create for ourselves dissatisfaction and frustration. We would then create the reality that we could not be happy unless we had penile-vaginal intercourse just so. For your health and happiness, leave that definition to the religious texts and reproductive biologists. Instead, consider that you can have happiness and sexual pleasure with a multitude of variations of activities. Just remember, if the world ran out of pumpkins, we could still have pecan pie on Thanksgiving. (I just love nuts!)

I've got you under my skin.

Touch is such an importance aspect of how we relate to the world and how we relate to each other. As infants, it is the first way that we experience our world and learn to make decisions about what is good and what is not good for us. And as adults, it is one of the most prominent ways that we have in communicating with our partners (if we take advantage of it). The mechanism of touch is known to be an important way of feeling calm, secure, and comfortable - a way of telling our brain that everything is ok. This happens by way of C-tactile fibers found over the surface of the arms, legs, back, and forehead. These respond to a slow, light caress - a typical soothing type of behavior. More research is being done specifically in this area to elucidate the importance of these fibers.

The types of nerve endings in our skin that we associate most with sex, however, are the classic ones of light touch, vibration, pressure, temperature, and pain. Because of the many different types of sensations we can experience, our skin can be considered our own personal playground. We have so many options in how to touch our partners to give them pleasure - from our hands, lips, tongues - or maybe from feathers, silk, wax, metal, leather, glass, you name it! This holds true for most of our skin that covers the outside of our bodies. It's a little different on the inside (i.e. vagina or anus). For those areas, we can normally only sense pressure and/or pain, which is interesting since a lot of emphasis is placed on the 'penetration' part of sex, even for women. But it is really the rest of the body that gives us more sensation. This is why masturbation (mutual or single) and oral sex can be so mindblowing!

So the question is, how much do we touch our partners to find out what ways excite them and what gives them pleasure? And of course, do we increase our intimacy by allowing ourselves to be touched? Do we follow a particular basic routine within our sex life, or do we occasionally take an excursion outside the realm of the familiar to experiment with new sensations and scenarios? You may find that ways you thought would be exciting for your partner to be touched are more irritating, and what you thought was unbearable is actually the cat's meow.

Now generally men are more focused on their genitals than the rest of their bodies in comparison to women, but that doesn't mean that their skin is not worth exploring. And gentlemen, did you know that many women can have orgasms from having other parts of their bodies stimulated (backs of knees, back of the neck, behind ears, scalp, between the shoulder blades, or thighs, to name a few). So get out there and experiment! Find a new use for an old pair of gloves or an old tie. Let your skin be your playground.