Human sexuality; #4 (1 Of 2)

Human Sexuality the fourth in a series of seven classes is given as part of a four college course in human sexuality sponsored jointly by Amherst Mount Holyoke and Smith Colleges and the University of Massachusetts today. Dr. Phillips aroud a gynecologist at Westover Air Force Base speaks on the physiology of sex responds. During the past three weeks you have been given a framework in which to understand various types of all various aspects of human sexuality. Dr Copeland has spent a lot of time in as I have now grown to appreciate it a great deal of thought into trying to define for you the types of relationships you have the psychological and sociological factors that go into the creation of these relationships and the meaning and significance of them.

My part of the deal as an obstetrician gynecologist is to get down to more specific things. And of course when it comes to choosing a set of lecture or group of material to present to a group such as yours there's a very large variety of things to talk about. So because we only have another four sessions including this one we had to choose that that material which we thought would be most pertinent to you at this time. You may disagree and certainly the question periods are a time when you should feel free to talk about anything or ask about anything that you feel is related in the area of human sexuality. Tonight's lecture has to do with human sexual response. The next three lectures will cover pregnancy and birth contraception and abortion. So if there are questions about the other three

try and save them for the future sessions. Sexual response is something that you can describe. It had not been very well described until recently but with the work of Dr. Masters and Mrs. Johnson and the work of other investigators going back to the Kinsey group and earlier groups it is now quite possible to talk about what happens when a human being responds sexually in same way that we can talk anatomy and physiology any other part of your body. We can talk anatomy and physiology of the sexual response. Now granted that's not the really interesting aspect of sexual response but as a physician who day in and day out sees patients with multiple problems related to not understanding sexual response to keeping sexual response in the area of the Middle Ages the unknown. There's this mystique about it that seeing

patients with so many problems related to sexual response. I feel that it's very important for you to get certain things straight in your mind in the first place that I can think of to begin is with anatomy. You know everybody at least everybody who I ask knows you know to me of the penis. I had the experience recently of having two student nurses who are about to graduate from nursing school. When I say recently I mean about four hours ago two student nurses assisting me in the gynaecology clinic. And as we sort each patient keeping in mind our discussion tonight. I thought that I would go over different areas that they want to know about. Certainly now that they were finishing their training these were college students in a college nursing program and so I said to the first nurse as she was the first student she was standing next to me you know when Clara says she's the boss

everybody knows who the players are this and I said OK show me there was a patient who I was examining or if she was in a clinic for regular pelvic examination and the student said what you mean it's their right. She said Oh sure sure it is happening and I said well pointed out and I looked at the patient I said you don't want to learn it was with an. If you grew up who was who grasped what we were trying to accomplish in terms of teaching said sure go ahead bright and we will see what it's all about and of course she did not point to the first Bush can't see the clearest Clarissa's covered and glitters is not uncovered until certain stages of sexual excitement. So she pointed to the small label they laid the menorah. I said that's not a recession and we pointed out what just what Cloris was and she was a little bit

flushed and why and here I am about to graduate and be a medical individual and I don't know what it is I said OK well let's see what happens with your friend who's with you and who happened to be a married student and also finishing nursing school so we went to the next patient. And this time the two students came along and she didn't know where Clarice was either. She pointed to the back wall of the vagina. Isn't that weird. So there are certain basic at. On the other hand I've asked many women to describe the anatomy of the penis and it's very easy because the penis is there you can see it it's there and brothers it's there and you don't have to have this fantastic sex experience though the penis looks like. And as Dr. Copeland said it is readily accessible whereas the clearest is not you will have a picture of the male anatomy. And I think the important things that I would point out is that there is an opening in the penis which is a very small opening through which both

urine and sperm are released. I've seen many girls draw to separate openings in the penis feeling well how could they possibly come out of the same place. There is a small dot that carries the sperm and it does have a balance in it which shuts off the flow of sperm at the time of your nation. Well the anatomy is really of significance only from the point of view of understanding how it is affected and sexual response. And it is a mistake to concentrate just on the genital anatomy when you're trying to understand sexual response. In masters in Johnson's book and part of the papers that we gave out to you had to do with analyzing the material in Masters and Johnson in their book they show that one way to understand sexual response is to divide in terms of what happens to the genital organs

and what happens to those areas of the body outside of the genital organs and the areas that were areas of response and I don't know how clearly the papers came out but you can include first of all the skin skin is a very sensitive area. Many girls say well what are the erogenous zones. And they're practically any part of the skin can be described as erogenous zone. It is a receptor. Touch can be transmitted by nerve endings and. In response to such stimulation you get various kinds of physiological reaction which define the sexual response. Now what are the basic physiological reactions of the sexual response they are to. First of all congestion of blood vessels the ways in which you see this are for example in breasts the nipples in female and also in the male become firm

become rigid become erect. This is due to congestion of blood vessels. The skin becomes flushed. At one stage of sexual excitement the the breasts increase in size due to congestion with blood. There is a sensation in the Woman of the filling of the pelvis as blood flows into that area with dilating of her blood vessels in the man of course the obvious result of basal congestion with the blood flowing into blood vessels as erection. The other part of the physiological response has to do with muscle reaction. And as we go on later to describe what I want as I'm as like you will note that there are involuntary muscle responses and involuntary muscle responses. Well how do we put this all together. We say then that because of congestion blood vessels as a response to

sexual stimulation and because of changes in muscle tone certain areas of our body respond and we think of these as erogenous zones the breasts the genital organs in particular. If you have read Masters and Johnson or if you've read the Brecker and Brecker book you will see that you can divide a human sexual response cycle into different stages. The first day and this is true for the male as well as the female. And I think that is probably the most important message to get about sexual response. There are clearly defined aspects of it and the stages of sexual response. A For the first is a stage of excitement. Second is what is described as a plateau stage. The third is a orgasmic stage and the fourth is a stage of resolution. When it comes to identifying the stages in the mail of

course it's not very difficult excitation is erection in the female. The first stage of excitation is a secretion by the wall of the vagina of a sort of clear fluid so the woman feels this clear discharge from the vagina. It's often a conception of the male that once a woman starts to have this kind of secretion she's highly excited. In reality that's not so. This is a very early stage of a woman's response and it's a mistake to think that well once a woman starts discreet then she is ready to have an orgasm when she's ready to have intercourse. The fact of the matter is that a woman has to go through several different kinds of changes before she is elevated from this excitation state to a plateau state. Let me show this to you diagrammatic with. If we're talking in terms of time

the initial stage for a woman is that of excitation same of course for the man. It may take as long as three minutes may take 10 minutes and it varies with many factors which will go into a little while the excitation stage for the woman. In fact the whole what we're talking now is the sexual response cycle and we're talking first of all about excitation. He said that in woman it is represented by accretion from the vagina and Ingo argument of the breasts and the beginnings of a flush in the body. Not very much at this point. The woman then goes to what's called a plateau stage. When I say the woman I should offset and it's wrong just to think in terms that one

responds one way and one responds the other way Faizal congestion happens in both and the entire physiological process of sexual response occurs in both in the Plateau stage. The woman undergoes two very important changes. First of all the vagina slightly opens and second of all the barrel of the China expands. Why is this important. I'll go into some of the clinical aspects of this in a minute. The women then usually or not usually but often goes on to what's called an orgasm and then very very gradually. Goes through a resolution stage. This is this is the basic concept then of a sexual response cycle in the man.

The time may be slightly less excitation make her in a shorter period of time. I think that it can go straight to a slight plateau in an orgasm and then a very quick resolution. How does that make sense to you. OK the one thing that women don't appreciate and that men don't appreciate about women is that women have different ways of responding. The woman doesn't always go through a period of excitation into a plateau stage an orgasm and then a resolution stage. The woman may not have an orgasm. She may go through excitation a plateau. And then into a state of resolution without an orgasm maybe a perfectly pleasurable sexual experience. And she made all of the relationship with the male that she had been hoping for looking for without having an orgasm. The man says to himself she can't have an orgasm there must be something wrong with me that I can't stimulate her to an orgasm and he

can't appreciate this ability for the woman to have an adequate and completely pleasurable sexual experience without having an orgasm. Because in the man's case the usual effect of sexual response is to have an orgasm. The other thing that a woman can do which is kind of neat which men can't do is that a woman can go through a stage of excitation into a plateau have an orgasm start into a stage of resolution and then have another orgasm. A man can't do this. The man has what's called a refractory period. I never got fed and C in penmanship a refractory period during which time he was sexually unresponsive.

A woman does not feel that way. A woman goes through a period of resolution which can last a full hour and often does whereas the man's period resolution is one which is very quick and goes to sleep usually And during this period and during this period of resolution the woman can be stimulated to further orgasm. I think a very interesting clinical. Example of this was a patient who I saw recently who said that in her sexual relations with her husband he was always upset because she wished to have her orgasm first before they started to have intercourse. I remember the various kinds of sexual relations that Culkin described that would result in sexual response whether it be masturbation on a sexual or had a sexual interaction in a marriage state for this woman.

She found that if stimulated headed first particularly if the clearest was good she would reach an orgasm then she was ready to have intercourse and with intercourse. She would then have another orgasm. Her husband couldn't understand this because whenever he had an orgasm he didn't want to continue sexual relations. His feeling was that of tremendous letdown and a desire not to have any further sexual relations. A very important point for women to realize about men and men of course to realize about women. So women can be multi-orgasmic on the other hand they don't have to be orgasmic in order to enjoy sexual relations. Well what other things can they say about it in terms of the things that affect the sex response cycle. We know the technique may have something to do with it.

I think it's interesting to see the kinds of technique that a college student has in turn in relation to a sexual response cycle. A study that was done fairly recently by a group at the University of Connecticut showed that if you were to analyze college students in this country and compare male with female the following types of behavior were engaged in that. Ninety nine percent of males and females had engaged in lighting bracing or holding of hands. The 1 percent didn't back that about 97 percent had casual Good night kissing with the kids about 83 percent of females and 90 percent males had embraced

with clothing on in a long down position. That padding of the breast outside of the clothing had occurred for about 90 percent of males and about 80 percent females. That petting of the breast without clothing that occurred for about 68 percent of the females the 32 percent of females. Third and fourth year college students had not heard of having a breast without clothing. When you get down to the well let me continue with the rest of us put that padding below the waist with clothing that occurred for 81 percent of the males and 61 percent of the females heading below the waist of the male and the female for about 60 percent of each that intercourse have occurred for about 58 percent of the males. Forty three percent of the females. This is by the time they were third and fourth year college students about 43 percent of the females had intercourse. One finding I think that's quite interesting is

that 4 percent of the male college group had had a prostitute experience and no more than four percent. Which is quite a difference from studies that have been done by the Kinsey group in the 1950s. The part of the country where females have had most intercourse experience was in the northeast. I was in a small women's college in the northeast. That was more than 30 miles away from a metropolitan center. And for that group the statistics were that 57 percent of females had had intercourse. I find that one of the things that's most interesting about college students is that sometimes the girl thinks she's had intercourse and she hasn't

any intercourse involves the penis being in the vagina. Very graphic picture which I distributed to all of you so you understand we're talking about. And I've had the experience of seeing girls who were worried about being pregnant. Examining examining them and finding the hymen to be intact who felt that because penis had come in contact with the outside of the vagina they must have had intercourse. I've even seen girls who were sure they were pregnant and even though they had periods and on examination the following intercourse and on examination following this quote experience the hymen was intact in terms of the real the actual experience. I think this reason why there might be confusion. Well this is the kinds of experiences you have

and you wonder then how often does this experience result in a full sexual response on you. You hear so many people describing orgasm in female and it's so great responsiveness that the modern female supposed to have multi orgasm and so on. In the Kinsey group they had some women who were able to have an orgasm 50 times a week. And in reality although most males have had an orgasm by the age of 14 90 percent of women don't reach the point where the majority have had an orgasm until about 15 years later. What they'll Pomeroy has studied this and he has shown that whereas for the man the height of his sexual response is as a young adolescent for the woman the height is reached between the age of 25 and 30. That once the woman reaches this height of ability to respond sexually to

respond through the entire cycle not just the half of the fragile wall excrete but to go through the entire change of a full orgasmic cycle that once she reaches this it is maintained and it is maintained until late in life and I'm asked to study couples were studied in their 60s and 70s and even one man in his 90s. And we know that the ability to respond sexually is there and everyone physiologically anatomically. In fact even if the anatomical ability isn't there you can put it there in one of the chapters in Master's Book. He describes a group of patients of women who were born without vaginas and Hooman on official the China was created and these women were completely capable of having a full orgasmic response once they learned the various aspects of a sexual response cycle and they could understand what was happening to their bodies. A lot of women ask well how do I know if I've had an orgasm.

And the one who you know the area died individual knows all about orgasm who's going to answer who's been asked this question says well if you don't know what it is you haven't had it. My experience is that that's not so. That there are different levels of orgasm that a woman may very well have had an orgasm without realizing that she's had an orgasm. That it may be mild. True but when you describe to her what the various parts of this orgasmic response of your body is she is aha that's what it was. So more important than talking about what happens to the breast and what happens to the uterus the contractions of the uterus or the whitening of the vagina is really the subjective response of a woman who's had an orgasm that the Masters has a neat way of getting out of trying to describe a female orgasm. He says ask Mrs. JOHNSON. And in reality I'm sure that no male can describe a

female orgasm. Obviously it is different than the males orgasm. However you can ask women who just had an orgasm what it was like. And from that you can sort of as a man get an idea of what they're talking about. This is what Mrs. Johnson did and this is what the subjective description of orgasm was. The women felt that they were three different stages to the orgasm in the first stage. There seemed to be a sensation of suspension. So things had sort of stopped all around you know sort of the way the room feels right you know. And this. This was followed by a sensation of intense sensual awareness that it was a feeling that a very sensual feeling in the pelvis.

That and it probably is a reflection of congestion in the pelvis. It was a loss of sensory acuity some women say they don't see very well and they're starting their orgasm. Or that they don't hear very well most of the women who I find to having problems find that there is some increase in sensual acuity and somehow just as this about this talk about guys and they hear the baby cry for miles away or a pin drop. This I wonder about. Speaking to my phone I hope you microphones working that there is a feeling of intense Clitheroe awareness. You would probably have no difficulty finding where it is right at the beginning of the orgasm since a woman apparently has the sensation of the Clitheroe responsiveness and finally in women who've had a baby that there is a sense of opening or receptive

opening one of the things that's observed in women who've had a baby is that the wall of the vagina actually does pout open or the opening to the vagina does power. The second stage that is described by women is that there is a great feeling of warmth. The whole body is a great throughout the body want seems to expand or diffuse in Dr mask the studies show that the skin responds in terms of base so dilation of blood vessels bring a lot of blood to certain areas. Starting with the abdomen and expanding cross the chest the neck and face. And women describe distance of feeling warmth starting in helpless and spreading throughout the body. And at the third stage of an organism is that of a throbbing in the pelvis. One woman described it to me this afternoon as a as contractions and pelvis she'd had babies and she knew what uterine contractions were.

She said it's something like menstrual contractions when it's the first of the first night of a period. There is this throbbing in the pelvis that these are involuntary that they may happen three or four times ma'am five or eight times and in that this work each correlated to the numbers of contractions of the uterus which is probably what the woman is feeling by the this throbbing sensation. He's correlated this with intensity of orgasm. So that's something to think about in terms of whether you've had an orgasm or not. And certainly it can result in women as well as the man either from from any of the types of sexual stimulation that Dr. Koplan mentioned. One of the things that I thought was most interesting was the fact that in the college group

for the mail there is some sexual outlet in terms of orgasm on an average of two to three times a week. That 10 percent of all college males have an orgasm about seven times a week. And for the females it's not unusual for to her to have a grand total of one of two orgasms in the whole four years. And this was true of 50 percent of the college females and the group that Pomeroy study now that's an older study but he's written about it recently and it's felt that there hasn't been that much of a change. Well some of the things that influence a woman's ability to respond to orgasm in addition to her age and what you said now that women do respond to orgasm at a later age than men are sort of external factors for example who are having sex relations with.

There's this tremendous concentration on sex technique that man takes great pride in his ability to stimulate his mate. And if she can go to an orgasm then he has an ultimate joy. One of the things I find most interesting is that where a man took great pride in a in his make going to orgasm through petting experience before marriage comes marriage. He sort of concentrates on having intercourse particularly in couples who hadn't had intercourse before marriage hasn't of course after marriage and then the woman doesn't have the same pleasurable or full orgasmic response that she had before. And many people feel that sexual relations in marriage are one purpose for having children and forget about the pleasurable aspect or the physiological aspect of sexual response which they were able to enjoy and to share with each other before marriage. The So aside from marriage and age one of the another factor that

is important is a woman's menstrual cycle. It's been shown very interesting here at the University of North Carolina who gave women predominate as to where they walked around like I said on my bicycle that they would wear these but I was and they would keep track of their activity in relation to their menstrual cycle. I found two things women are very active on the day they are light and they have intercourse more often on the day that they feel like although they don't realize they're putting out an egg that day. I say this in particular to the men in the audience and that there is also an increase in intercourse or cultural activity and pre-menstrual period. This work was done by Dr Yewtree at the University of Carolina. That the man sees therefore can affect a woman's sexual responsiveness and her desire to have

intercourse. The Another aspect of sexual response has to do with pregnancy. In all manuals that are given to patients who are pregnant there are a list of instructions. One of the things on this list of instructions says you should not have intercourse or limit intercourse in the first three months of your pregnancy. And certainly in the last month of pregnancy you shouldn't have intercourse in the first six weeks following delivery. Well Dr. Masters found that women who were pregnant were very responsive sexually at certain times whereas at other times they were completely unresponsive. Various authors in the medical literature have shown that there is actually no complication of sexual intercourse during pregnancy. And in fact that if a woman is close to the time when she is due to happen baby responding sexually whether it be by stimulating breast and arriving at an orgasm or stimulating Clarissa and achieving

orgasm while having intercourse and having a long time that this may help the onset of labor. I would like to try and include some of the work I'm doing because that's the thing that is most closest to me in the study that I'm doing right now. Patients who are pregnant. I found that there are actually no complications when a woman has intercourse and last night her pregnancy we're hosting close to 75 patients without intercourse within 48 hours of their delivery that their labors and delivery seemed to be easier than the average patient particularly if the intercourse resulted in an orgasm. Now what happens when a woman has an orgasm among other things. So I've been losing sight. So what happens is that her uterus contracts and if you've already record a record book and so if you take this course without doing the reading then it among other things the uterus contracts.

If the uterus is ready to go into labor and it starts contracting it can continue and women can go on to labor and Doctor masters observe this and three of his patients. Another observation that he found that I thought was not necessary was that most when the woman is ready for delivery that is the opening to the uterus is completely open and the baby is very blunt. We call this the second stage of labor that women who are not masters had studied previously in his laboratory in terms of orgasm and this sensation of orgasm in their response to guys and these women describe the second stage of labor in the same sort of way that they describe their organism and it was a very similar kind of experience. You know this is of course taking into account the fact that this was a group that wasn't completely anesthetize wasn't asleep and knew what was going on. So pregnancy does relate to sexual relations and their ability to respond as

freely and as an overall evaluation of pregnancy and and sexual response. I think we can say that women are more responsive when they are responsible for pregnancy. How do these things affect a woman's relationship with a man. Well let's let's take something like breast stimulation. If the woman is premenstrual her breasts are often very very sensitive. They may be large tender nipples may be very sensitive man doesn't know this he doesn't have breasts that enlarged prematurely and so if he stimulates the woman as he does and in or out a different part of her menstrual cycle it's that of this being sexually exciting to him to her maybe to him but so far it's irritating. What about something like literacy. Men think that the the magic button is the clearest.

Reality there is no match to sexual response. Sex and sexual response is not or ability to achieve a full sexual response not a great secret that we're all keeping from you. The clearest is an area that is an erogenous zone that is sensitive and in many women his voice is very sensitive so that it is stimulated directly instead of it being sexually stimulating. A sexually irritating eye for the man who has learned from the guys on the block that that's the way to stimulate a girl. But he does this and she doesn't respond. Then his immediate response is Well there's something wrong with her or there's something wrong with my technique. In reality if a man can envision the very tip of his penis being stimulated that isn't a very very sensitive area and that is the hum along to the tip of the Clippers. So are a lot of these notions that people have just aren't what reality

shows. Another misconception that people have that has to do with the size of the penis Masters has shown and they've measured the penis at the time of intercourse. You may wonder how they do this. And in the laboratory that they've set up in St. Louis they've been able to film the lining of the vagina as it responds to sexual stimulation. I've been able to do all kinds of measurements of heart rate blood pressure of various blood values electrical Oddie graft changes during intercourse. They've shown that there is practically no difference in size to the penis at the time of intercourse when there's complete erection that the man has a larger penis to begin with doesn't increase as much as the man has a small penis. Begin with and the addition is shown at the vagina

itself accommodates itself to whatever size penises. So that fallacy that penis size very important to sexual stimulation is in reality a fallacy. So in terms of age in terms of that fact. In terms of the Comanches pregnancy AIDS relations between a man and woman these are very important contributing factors. I think that one of the points that Dr. Koplan made about bringing culture into the bedroom is perhaps a critical point in understanding sexual response within the last two weeks I've seen a couple 22 both 22 years old been married 18 months. The reason why they came to see me was they stated that since the first night of their marriage the girl did not respond sexually.

She had not had an orgasm during this time and sex relations were no fun for they were not pleasure. And this was really interfering with the relationship. During that first year and a half of their marriage she had a baby but it was now six months old. As I listened to the story and asked questions they told me that prior to their marriage they had been dating for two three years they had not had intercourse. That they had very good pending relationship and on a fair number or percentage of the time the girl did have an orgasm. Their marriage night they had intercourse and it was perfectly pleasurable and wonderful to both of them and they both had an orgasm and I found that very amazing because well you know it's people usually so exhausted. So over wrought with anxiety and it's amazing they can find any part of them could respond No no let's the sexual apparatus that following that night she had not responded.

Well I asked several questions are you afraid that you will become pregnant. She said No I'm taking the pill and I'm not worried about pregnancy. Well what happens when you have your sexual response together. Well what happens is we have intercourse. Well what about your petting. Well we haven't had it since we were married. Why haven't you tried it. Because we were taught in our training program before marriage that so many couples to go through such training programs that sex relations in marriage are awful having babies. And so whenever this couple had sex relations two or three times a week since they were married it would start immediately with intercourse there were times when it was impossible because the girl didn't even have an opportunity for the vagina to be lubricated the very beginnings of sexual response.

And so the pain is going even into the vagina occasionally she was able to be stimulated that much but never could her husband continuing to cause long enough so that the girl had an opportunity to have full sexual response. Well I ask and you know why don't you pay. And if their answer was Well you know we just didn't think that Mary people had it. We thought that all you did was having to call us and that was sexual response. Well this is bringing culture into the bedroom in a rather devastating way and within a week I was able to see the fall and I told them I want to see you within a week so that you can go over the various things that we've talked about we talked about the sex response cycle of importance for a woman to get to a certain stage of excitation before having intercourse. And as and when I saw him the last time he said the whole problem is so very simple. The I think that as an illustration bring Coltrane into the bedroom is important and

understanding sexual responses in full. I think that's a very good description of the place of the sexual act and what's involved has been written by Dr. Theodore lets in a recent book called The person I'd like to read it to you. Just take a minute. The proper carrying out of the sexual act and the enjoyment of it involves an ability to give way to the irrational the Timeless the purely animal in one. It includes a loss of individuality and a temporary confusion with another. It contains the potentiality of leaving behind the tensions of civilization as one loosens the bonds to reality to float again in the purely sensuous. Here one needs to be unabashed by the nakedness of impulse and drive by record record essence of the infant tile in the revealing of much that one has sought to hide from others.

The woman in particular requires the capacity to rescind control and give way before an accessory that threatens to overwhelm and annihilate her by its very intensity. The sexual act contains a definite and direct relationship to infant tire relatedness to the mother with a renewed interest in sucking in odor and skin eroticism and a reawakening of old forbidden desires to explore and play with orifices. So very much that has been learned needs to be undone much that has been forbidden and long repressed and kept unconscious. But that haunted dreams and mask of the Tory fantasies needs to be released commit sexual intimacy and enjoyment and to allow her film and rather than provoke shame and guilt. The very good sexual adjustment demands such abilities to reverse the socialization process and yet to permit the individual to be secure in the feeling that the regression and reversal will only be temporary and not reclaim the self. Fortunately the strength of the sexual drive is great and to some extent the movements

used in the sexual act are inherent firmly built into the organism. When the partners are reasonably mature and desire one another they can usually work through the difficulties and with patience find a unique source of profound pleasure as a shared experience that heightens their love it provides relief from tensions and a total exhaustion absorption that of Literates concern and can lead a couple to believe that no other pair has experienced similar pleasure and that they are uniquely matched the fulfillment binds them closer. Whereas frustration tends to separate them as their urges crave satisfaction. In the clinical cases that I have seen where sexual problems seem to be a major factor it seems to me that there are several characteristics about it that everyone has demonstrated first of

all is the feeling of the couple that they are the only ones who've ever been involved in this kind of a problem that everybody else is having this fantastic sex life and there is as a living heart. And it's the only one you know when you see patients. One of the women I saw this week had not had intercourse with her husband for four years. I've seen a patient who had been married 19 years and the hymen was intact. I saw another question been married seven years in the hymen was intact and this feeling well we're the only ones who have this problem so we obviously can't go to tell anyone about it because we're going to think it was some kind of weird person just leads to not going to find out what can be done about the problem. So and most of this is based on a lack of understanding of what sexual response is about. I think that a major problem is that there's a lack of communication. A husband and wife cannot talk to each other about a sexual problem they have.

They don't have a language to talk with I couldn't mention it and stress the fact that we don't develop a language that we can talk to each other that we can use to talk to each other about sexual problems and that's all. Well I think that there are very few resources to which a couple can turn I turn to physicians. Physicians have enough troubles with their own sex life and they haven't had time so they haven't had any training at all. We gave a course like yours that you know because the students who were in medical school had had no opportunity to discuss various aspects of human sexuality anywhere in their education and then they're asked to go out and see patients help solve their problem. And I think perhaps the most the greatest problem is what Dr Lith's said and that is in the quote. The problem of it being self-perpetuating. That there's frustration an inability to receive to achieve a good sexual relationship with one another.

This becomes a tremendous source of tension instead of mutual experience the other of a separateness from each other following this formal presentation and they for a college course in human sexuality questions from the audience resulted in an elaboration of the ideas offered during the lecture. It's impossible for a woman to become pregnant and for the hymen to be intact. I think that based on the work that Dr Masters has done which shows that all penises are the same size of time spent trying to conceive of the hymen staying intact in a woman who has had intercourse truly had intercourse as you see in the diagram in front of you I can't imagine homestate actually having written an article about how you make a bag no sense of right and wrong and the examination of the hymen following intercourse is a very typical appearance of the Highland woman of the

second quarter. Which is not consistent with being in town. Is there a difference between Clitheroe organizing and battle against masters to show that an orgasm is an orgasm. Whether the woman fantasies the orgasm whether she has it in her sleep or whether she has it standing on her head that has some cultures do. I only know that there may be a difference. And most women will tell you there is a difference in the subjective sensation of orgasm between stimulating tween orgasm arrived at by stimulation close and long as stimulation of vagina. But physiologically in terms of measuring the response curve there is no difference.

Now many women find mainly because they're learning their script. What has been placed on their template was clear all stimulation whether it be through masturbation or through petting. Find that this is what they have learned as the sequence of events leading to orgasm and so it takes time to learn to respond to magical stimulation. And there is a certain progression. Just as a woman must understand why the man has an orgasm he goes into a refractory stage and only wants this torrent of sleep and she never feels this way. He doesn't love her because he does this you say be but she can't understand it. In reality this is part of being the male in the same way the man can't understand what is a full sexual response on the part of a woman and as I tried to indicate there are at least three different paradigms. One pattern of course is

that she doesn't respond at all. I think that and certainly that's true for the male too that he might not be responding. Another problem for the male is that he might be too quickly responsive that is that this excitation and stimulation in some men. You know something like that and can take 30 seconds for the man to go from excitation to ejaculate and it's all over. That's what I call the problem of premature ejaculation. When I said it's not in the woman a full sexual response may not involve orgasm. That is she may respond in terms of her breasts becoming full terms of her nipples becoming a rect in terms of her body flushing in terms of hope and joy in expanding in terms of her uterus having some mild contractions without going on to a full kind of

orgasmic response such as I describe just so and I feel so inadequate to trying to scare females or get out so that she can go up to the plateau stage a response and stay there for a while. Whether you know or or more and then go through a slow resolution state and not be a perfectly pleasurable happy non frustrating experience man doesn't understand that because of a man is that excited sexually he has to go on to an orgasm in order to have the same sensation of fulfillment or pleasure that a woman has. The woman may also have a quote full sexual response by having an orgasm the woman actually made do with Amanda's to and responding to an orgasm and going into a refractory period. Although for most women the refractory period does not really exist. The knee and in the third pattern as I mentioned multi orgasm.

My feeling at orgasm is that of a very intense overwhelming body responds that in which there is the sense of loss of awareness. I mean if it was a pretty big clock on the wall I don't think I could tell you what time. Why even if I was staring right at it and there is also a sense of inevitability when me prostate when the there's a little barrier that you tickle of the prostate which is one of the areas that creates fluid the fluid that comes out of the penis is secreted from many different glands are not and all the sperm are produced in the testes that when this fluid about four ccs of fluid a teaspoon of fluid approximately when this fluid and there is that part of the man's anatomy goes through

the stock that you have in your diagram it comes to the uterus all the prostate he has the sensation that he's going to come and that I think is an overwhelming heart or a very important part of the man's orgasm that sensation the pre orgasmic sensation or the pre ejaculation sensation that of course is something that a woman doesn't have if you. You listen to some of the discussions of men there waiting for their wives or girlfriends or so on to have an ejaculation. And there is there is a belief among many males that are women that women and Jack obviously don't. Hope you all understand you secrete. And when you secrete you secrete from the wall of the baton one of the things that was taught for many many years was that there were two little glance at the opening of the vagina bottlings glands. I think it well it's not one of the diagrams that you have but you will see this

in books that secrete the descriptions of sexual stimulation. Not so they do scrape a little bit a couple drops lower but the true secretion of sexual response is from the wall of the time. From what I hear and from what Dr. M. says the big difference is that a woman's ability to respond sexually is much greater than the man's. Now when we all know it takes a longer to get there. Men are having orgasms 2 3 7 times a week when they're 14 years old and women don't really develop their ability to respond to orgasm regularly until they're well into their 20s many women of course many women develop at a much earlier age that when women do finally get to the stage where they are orgasmically responsive that this is a much more intense. And now at least from the work of Masters and Johnson I've done a much more pleasurable sensation than

anything a man can come to know and I've heard Dr. M. say that personally over and over again from what he sits there and watches all the patients in the laboratory. He was thinking it would be very nice if I could be a woman and be able to respond that way. Don't many males desire two or perhaps three orgasms. There is a refractory period that most males go through during which time any kind of stimulation to the penises instead of it being sexually exciting. Really you know it's a sort of numb feeling you don't respond. The man has not been shown at least in the working observations that Dr masters and Mrs. Johnson have done to be multi-orgasmic in the way that a woman is now you have to visualize what this means this means the woman has an orgasm. She Two minutes later can have another orgasm. A man does go through a refractory period which is longer than that period of time.

Most men now when you're talking about in a night kind of man have two or three orgasms sure aren't you in college can respond several times in a night. Probably not as often as you could have responded six years ago. You will find it six years from now. You can't respond that many times and any man who has been studied into their 50s 60s 70s 80s and 90s we find that the refractory period of time during which the penis will not respond to erection and to orgasm gets to be longer maybe as long a man in the 60s or 70s as a week during which time he can't respond. But at the end of that we care. I think another very important time in a couple's life is

at the medical office one of the things that happens with the man a pause is that because of a decrease in hormone in the body the woman's vagina is drawn in the. A couple where the woman is lacking estrogen and the vagina is drawn. If the husband does not stimulate the woman before him to cause the vaginal wall will not screech and she can't have intercourse comfortably it will result in bleeding irritation discomfort and all that's necessary really is some sexual stimulation away from the vagina so that it will respond. I recently saw a patient I had mentioned before I had not intercourse in four years and it really was right down to that factor. Their relations unmerited consisted only of having intercourse. There was no pretty colorful sex play. Now that she was men a pause of the John didn't screech and intercourse was very very unpleasant for her. And the answer was simple. What she needed was to be stimulated prior

to having intercourse. Women will respond to precaution all stimulation just as long as men. I haven't read anything that indicates that there is any magic age when women stop being sexually responsive and I recently had a patient who was 70 years old who had been a widow for 16 years who was remarry who came to the office saying that she and her fiance were having problems having intercourse and in explaining to her what was necessary. They were able to have perfectly normal sexual relations and at age 70 this was a very important problem to them. I think a story that was told in a meeting I was at last about a week ago along these lines is in keeping with that the man who told the story was a rabbi and he told that story that one of the people in his

congregation called saying Rabbi so and so I must see you right away. It's a great emergency and he said well that's great mercy I'll see you right away. And at 12 o'clock that day she came tearing to his office and he said yes what's the problem. She explained that she was seven years old and Shino husband had this perfectly perfectly happy marriage in the Proms. But she wanted the rabbi to know that she had had an affair and she was concerned about it. And he looked at her and he said I don't know whether to what to say I wasn't sure if I should congratulate her or not. But he asks some of the details of an extramarital affair and he asked some of the details and she explained that she'd had an affair with a very close friend of her husband and that this had occurred 15 years before and he said well what was the great

emergency to come running and tell me about it now. And her answer was Well I'd like to talk about it.