Erectile dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for his sexual needs or the needs of his partner. Most men experience this at some point in their lives, usually by age 40, and are not psychologically affected by it.

Some men, however, experience chronic, complete erectile dysfunction (impotence), and others, partial or brief erections. Frequent erectile dysfunction can cause emotional and relationship problems, and often leads to diminished self-esteem. Erectile dysfunction has many causes, most of which are treatable, and is not an inevitable consequence of aging.

Erection problems are common

in adult men.

In fact, almost all men experience occasional difficulty getting or maintaining an erection. In many cases, it is a temporary condition that will go away with little or no treatment. In other cases, it can be an ongoing problem that can damage a man’s self esteem and harm his relationship with his partner, and thus requires treatment.

If you have difficulty having or keeping an erection more than 25% of the time, it is considered a problem.

In the past, erection problems were thought to be “all in the man’s mind.” Men often were given unhelpful advice such as “don’t worry” or “just relax and it will take care of itself.” Today, doctors believe that when the problem is not temporary or does not go away on its own, physical factors are often the cause.

One way to know if the cause is physical or psychologic is to determine if you are having nighttime erections. Normally, men have 3 to 5 erections per night, each lasting up to 30 minutes. Your doctor can explain a test to find out if you are having the normal number of nighttime erections.

The Penis and Erectile Function

The Structure of the Penis. The penis is composed of the following structures:

• Two parallel columns of spongy tissue called the corpus cavernosa, or erectile bodies.

• A central spongy chamber called the corpus spongiosum, which contains the urethra, the tube that carries urine from the bladder through the penis.

These structures are made up of erectile tissue. Erectile tissue is rich in tiny pools of blood vessels called cavernous sinuses. Each of these vessels are surrounded by smooth muscles and supported by elastic fibrous tissue composed of a protein called collagen.

Erectile Function and Nitric Oxide. The penis is either flaccid or erect depending on the state of arousal. In the flaccid, or unerect, penis, the following normally occurs:

• Small arteries leading to the cavernous sinuses contract, reducing the inflow of blood.The smooth muscles regulating the many tiny blood vessels also stay contracted, limiting the amount of blood that can collect in the penis.

During arousal the following occurs:

• The man’s central nervous system stimulates the release of a number of chemicals, including nitric oxide, which is now considered the main contributor for eliciting and maintaining erection.

• Nitric oxide stimulates production of cyclic GMP, a chemical that relaxes the smooth muscles in the penis. This allows blood to flow into the tiny pool-like cavernous sinuses, flooding the penis.

• This increased blood flow nearly doubles the diameter of the spongy chambers.

• The veins surrounding the chambers are squeezed almost completely shut by this pressure.

• The veins are unable to drain blood out of the penis and so the penis becomes rigid and erect.

• After ejaculation or climax, cyclic GMP is broken down by an enzyme called phosphodiesterase-5 (PDE5), causing the penis to become flaccid (unerect) again.

Important Substances for Erectile Health

A proper balance of certain chemicals, gases, and other substances is critical for erectile health.

Collagen. The protein collagen is the major component in structural tissue in the body, including in the penis. Excessive amounts, however, form scar tissue, which can impair erectile function.

Oxygen. Oxygen-rich blood is one of the most important components for erectile health. Oxygen levels vary widely from reduced levels in the flaccid state to very high in the erect state. During sleep, a man can normally have three to five erections per night, bringing oxygen-rich blood to the penis.

Testosterone and Other Hormones. Normal levels of hormones, especially testosterone, are essential for erectile function, though their exact role is not clear.

Erectile Dysfunction and Oxygen Deprivation

The primary cause of oxygen deprivation is ischemia — the blockage of blood vessels. The same blood flow-reducing conditions that lead to heart disease, such as atherosclerosis, may also contribute to erectile dysfunction. Conditions such as unhealthy cholesterol levels, diabetes, and high blood pressure are associated with atherosclerosis and heart disease.

NEWS BULLETIN

Men who smoke a pack of cigarettes a day are 40% more likely to be impotent than non-smokers, according to new research.

The researchers suggest the prospect of sexual problems in the future may offer the deterrent needed to encourage young men to quit smoking.

The study, published in the journal Tobacco Control, focused on the responses of more than 8,000 men, aged 16 to 59, who were taking part in the Australian Study of Health and Relationships. Almost one in 10 said they had experienced erectile problems over a period of a month or more during the previous year.

More than a quarter (27.2%) were current smokers, and 6% of those smoked more than 20 cigarettes a day. Statistical analysis showed the more cigarettes the men smoked daily, the more likely they were to suffer impotence. Those who smoked 20 a day or less were 24% more likely to report difficulties, while those who smoked more than 20 a day were 39% more likely to say they had problems.

Christopher Millet, from Imperial College London, and colleagues in Australia say the study also shows that men who are older, have a lower level of educational attainment or take heart medicines have a greater chance of erectile dysfunction. On the other hand, moderate drinking – one to four units of alcohol a day – reduced men’s chances of impotence.

Causes

Over the past decades, the medical perspective on the causes of erectile dysfunction has shifted. Common wisdom used to attribute almost all cases of impotence to psychological factors. Now doctors believe that up to 85% of impotence cases are caused by medical or physical problems. Only 15% are completely psychologically based. Sometimes, erectile dysfunction is due to a combination of physical and psychological causes.

A number of medical conditions share a common problem with erectile dysfunction — the impaired ability of blood vessels to open and allow normal blood flow.

Heart Disease, Atherosclerosis, and High Blood Pressure

Heart disease, atherosclerosis, high blood pressure and high cholesterol levels are major risk factors for erectile dysfunction. In fact, erectile problems may be a warning sign of these conditions in men at risk for atherosclerosis. Men who experience ED have a greater risk for angina, heart attack, or stroke.

Erectile dysfunction is a very common problem in men with high blood pressure. More than 40% of men with erectile dysfunction have hypertension. Many of the drugs used to treat hypertension (such as calcium channel blockers and beta-blockers) may also cause ED.

Diabetes

Diabetes is a major risk factor for erectile dysfunction. Between 30 – 50% of all men with diabetes report some form of sexual difficulty. Blocked arteries and nerve damage are both common complications of diabetes. When the blood vessels or nerves of the penis are involved, erectile dysfunction can result. Diabetes is also associated with heart disease and chronic kidney disease, other risk factors for ED. [For more information,

Obesity

Obesity increases the risk for diabetes, heart disease, and erectile dysfunction.

Metabolic Syndrome

Metabolic syndrome -- a cluster of conditions that includes obesity and abdominal fat, unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance -- is also a risk factor for erectile dysfunction in men older than 50 years.

Benign Prostatic Hyperplasia

Surgery and drug treatments for benign prostatic hyperplasia, such as finasteride (Proscar), can also increase the risk for impotence. [For more information, see In-Depth Report #71: Benign prostatic hyperplasia.]

Neurologic Conditions

Diseases that affect the central nervous system can cause erectile dysfunction. These conditions include Parkinson’s disease, multiple sclerosis, and stroke.
Low levels of the male hormone testosterone can be a contributing factor to erectile dysfunction in men who have other risk factors. (Low testosterone as the sole cause of erectile dysfunction affects only about 5% of men. In general, low testosterone levels are more likely to reduce sexual desire than to cause impotence.) Abnormalities of the pituitary gland that cause high levels of the hormone prolactin are also associated with erectile dysfunction. Other hormonal and endocrinologic causes of erectile dysfunction include thyroid and adrenal gland problems.

Physical Trauma and Injury

Spinal cord injury and pelvic trauma, such as a pelvic fracture, can cause nerve damage that results in impotence. Other conditions that can injure the spine and effect impotence include spinal cord tumors, spina bifida, and a history of polio.

Medications

Many medications increase the risk for erectile dysfunction. They include:

• High blood pressure medications, particularly diuretics, beta-blockers, and calcium-channel blockers.

• Heart or cholesterol medications such as digoxin, gemfibrozil, or clofibrate.

• Psychotropic medication used to treat depression and bipolar disorder such as selective serotonin-reuptake inhibitors (SSRIs), tricyclic antidepressants, monoamine oxidase inhibitors, and lithium. Certain types of antipsychotic medication, such as phenothiazines (like compazine) and butyrophenones (like haloperidol), can also cause erectile dysfunction.

• Gastroesophagelal reflux disorder (GERD) medications, used to reduce stomach acid, such as rantidine (Zantac) and cimetidine (Tagamet).

• Hormone drugs such as estrogens, corticosteroids, and 5-alpha reductase inhibitors.

• Chemotherapy drugs such as methotrexate.

Psychological Causes

Anxiety. Anxiety has both emotional and physical consequences that can affect erectile function. It is among the most frequently cited contributors to psychological impotence.

Stress. Even simple stress can affect sexual dysfunction.

Depression. Depression can reduce sexual desire and is associated with erectile dysfunction.

Relationship Problems. Troubles in relationships often have a direct impact on sexual functioning. Partners of men with erectile dysfunction may feel rejected and resentful, particularly if the affected man does not confide his own anxieties or depression. Tension and anger frequently arise between people who are unable to discuss sexual or emotional issues with each other. It can be very difficult for the man to perform sexually when both partners harbor negative feelings.

Risk Factors

More than 18 million American men over age 20 have erectile dysfunction, and about 600,000 men age 40 – 70 experience erectile dysfunction to some degree each year.

Age

For most men, erectile dysfunction is primarily associated with older age. While ED affects less than 10% of men in their 20s, and 5 – 17% of men in their 40s, about 15 – 34% of men in their 70s have ED.

Nevertheless, impotence is not inevitable with age. In a survey of men over 60 years old, 61% reported being sexually active, and nearly half derived as much if not more emotional benefit from their sex lives as they did in their 40s.

Severe erectile dysfunction often has more to do with disease than age itself. In particular, older men are more likely to have heart disease, diabetes, and high blood pressure than younger men. Such conditions and some of their treatments are causes of erectile dysfunction.

Lifestyle Factors

Smoking. Smoking contributes to the development of impotence, mainly because it increases the effects of other blood vessel disorders, including high blood pressure and atherosclerosis.

Alcohol Use. Heavy drinking can cause erectile dysfunction. Alcohol depresses the central nervous system and impairs sexual function.

Drug Abuse. Illicit drugs such as heroin, cocaine, methamphetamine, and marijuana can affect sexual function.

Lack of Exercise. A sedentary lifestyle can lead to obesity and other health problems associated with erectile dysfunction

THERE IS HELP !!!!

Injections or Topical Treatments

Treatments Using Alprostadil

Alprostadil is derived from a natural substance, prostaglandin E1, which opens blood vessels. This medicine is an effective treatment for some men. It can be administered by:

• Injection into the erectile tissue of the penis (such as Caverject or Edex)

• A system that administers the drug in pellets placed in the urethra (MUSE system)

Candidates. Alprostadil is not an appropriate choice for men with:

• Severe circulatory or nerve damage

• Bleeding abnormalities or men who are taking medications that thin the blood, such as heparin or warfarin

• Penile implants

Injected Alprostadil. Injected alprostadil (Caverject, Edex) uses a very small needle that the man injects into the erectile tissue of his penis. About 80% of men describe the pain of administering the injection as very mild.

The drug should not be injected more than 3 times a week or more than once within a 24-hour period.

MUSE System. The MUSE system delivers alprostadil through the urethra. It works in the following way:

• The device is a thin plastic tube with a button at the top.

• The man inserts the tube into his urethral opening right after urination. (Urinating or urine leakage right after administration may reduce the amount of medication.)

• He presses the button, which releases a pellet containing alprostadil.

• The man rolls his penis between his hands for 10 – 30 seconds to evenly distribute the drug. To avoid discomfort, the man should keep the penis as straight as possible during administration.

• The man should be upright, (sitting, standing or walking), for about 10 minutes after administration. By that time, he should have achieved an erection that lasts 30 – 60 minutes. (If a man lies on his back too soon after administration, blood flow to the penis may decrease and the erection may be lost.)

• The erection may continue after orgasm.

The MUSE system should not be used more than twice a day and is not appropriate for men with abnormal penis anatomy.

Side Effects of Most Alprostadil Methods. Certain side effects are common to all methods of administration, although they may differ in severity depending on how the drug is given:

• Pain and burning at the application site.

• Scarring of the penis (Peyronie’s disease), which is most likely to occur with injections.

• Sudden, low blood pressure. Symptoms include dizziness, lightheadedness, and fainting. If these symptoms occur, the man should lie down immediately with his legs raised.

• Priapism (prolonged erection). Possible with any method, but less chance with the MUSE system than with injections. If priapism occurs, applying ice for 10-minute periods to the inner thigh may help reduce blood flow. Erections that last 4 hours or longer require emergency care.

• Women partners may experience vaginal burning or itching. The drug may have toxic effects if it reaches the fetus in pregnant women, so men should not use alprostadil for intercourse with pregnant women without the use of a condom or other barrier contraceptive device.

• Other side effects include minor bleeding or spotting, redness in the penis, and aching in the testicles, legs, and area around the anus.

Injections Using Papaverine and Phentolamine

Until the introduction of alprostadil, the two drugs used for injection therapy had been papaverine (Pavabid, Cerespan) and phentolamine (Regitine). Adverse reactions are usually minor but include pain, ulcers, and prolonged erections (priapism). These drugs are rarely used now.

Testosterone Replacement Therapy

Testosterone replacement therapy works best for men with ED who have been diagnosed with hypogonadism (low testosterone levels). Men who have ED and normal testosterone levels are not likely to benefit from testosterone therapy. Studies indicate that testosterone therapy can modestly improve erectile function and libido.

Forms of testosterone therapy include:

• Muscle injections using testosterone enanthate (such as Andryl or Delatestryl) or cypionate (Andro-Cyp, Depo-Testosterone, or Virion).

• Skin patch (Testoderm, Testoderm TTS, Androderm). Depending on the brand, patches may be applied daily to the skin of the scrotum or to the abdomen, back, thighs, or upper arm.

• Skin gel (such as Androgel or Testim). The gel is applied only to the shoulders, upper arms, or abdomen, not directly to the penis. It is extremely important that men thoroughly wash their hands with soap and water after applying the gel, and cover the application site with clothing once it dries. Testosterone gel has caused serious side effects (premature development, genital enlargement) in children who have come in contact with it through secondary exposure. Pregnant women must avoid contact with the gel because the testosterone can harm the fetus.

• Oral forms of testosterone are not recommended because of the risk for liver damage when taken for long periods of time.

Side effects may include acne, breast enlargement, headache, and emotional instability. Testosterone therapy may increase the risk for the following serious side effects:

• Rapid growth of prostate tumors in men with existing prostate cancers. (Taking testosterone does not appear to increase the risk for prostate cancer, but doctors remain concerned.)Benign prostatic hyperplasia (BPH), enlargement of the prostate glandLiver disease and possibly liver cancerWorsening of sleep apnea, especially in men who are obese or who have lung conditions.

Surgery and Devices

Vacuum Erection Devices

Vacuum erection devices, also called vacuum constriction devices, can generally be used by all men with erectile dysfunction. Patients must receive thorough instructions in the proper use of such devices. They typically work as follows:

• The man places the penis inside a plastic cylinder.

• A vacuum is created, which causes blood to flow into the penis, thereby creating an erection.

• Once an erection is achieved, the man places an elastic ring around the base of the penis to retain the erection. The ring should remain in place for no more than 30 minutes.

Lack of spontaneity is this method’s major drawback.

Penile Implants

Penile implants are an option for men who cannot take medication or for who less invasive treatments do not work. In general, they work well in restoring sexual function, and men are usually satisfied with the results.

Two types of surgical implants are used for the treatment of erectile dysfunction:

• A hydraulic implant consists of two cylinders placed within the erection chambers of the penis and a pump. The pump releases a saline solution into the chambers to cause an erection, and removes the solution to deflate the erection.

• A penile prosthesis is composed of two semi-rigid but bendable rods that are placed inside the erection chambers of the penis. The penis can then be manipulated to an erect or non-erect position.

Erectile tissue is permanently damaged when these devices are implanted, and these procedures are irreversible. Although uncommon, mechanical breakdown can occur, or the device can slip or bulge. In addition, a less than optimal quality of erection may result. Infection is a rare, but serious, complication.

Vascular Surgery

In rare cases, penile vascular surgery may be considered as treatment for erectile dysfunction. Two types of operations are available: revascularization (bypass) surgery, and venous ligation. Some insurance carriers consider these procedures experimental and will not pay for them.

According to the American Urologic Association, men who smoke or who have the following conditions are not candidates for penile vascular surgeries:

• Insulin-dependent diabetes

• Widespread atherosclerosis

• Consistently high blood cholesterol levels

• Injured nerves or damaged blood vessels

Revascularization. The revascularization procedure usually involves taking an artery from a leg and then surgically connecting it to the arteries at the back of the penis, bypassing the blockages and restoring blood flow. Penile arterial revascularization is appropriate only for young men (under age 45) who have blood vessel injury at the base of the pain that was caused by events such as blunt trauma or pelvic fracture.

Venous Ligation. Venous ligation is performed when the penis is unable to store a sufficient amount of blood to maintain an erection. This operation ties off or removes veins that are causing an excessive amount of blood to drain from the erection chambers. Long-term success rates for this procedure are less than 50 percent.

PDE5 Inhibitors

The most common medical treatment for erectile dysfunction is PDE5 inhibitor drugs:

• Sildenafil (Viagra)

• Vardenafil (Levitra)

• Tadalafil (Cialis)

These drugs are generally safe and effective for most men. These medications may not be appropriate for men with certain health conditions, such as severe heart disease, heart failure, history of stroke, or uncontrolled high blood pressure or diabetes. Men who take nitrate drugs cannot use PDE5 inhibitors, and these drugs can also interact with other medications. Talk to your doctor about whether PDE5 inhibitor drugs are a safe choice for you.

Herbs and Supplements

Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body’s chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. Patients should always check with their doctors before using any herbal remedies or dietary supplements.

Aphrodisiacs are substances that are supposed to increase sexual drive, performance, or desire. Many herbs and dietary supplements are marketed as aphrodisiacs. There are several special concerns for people taking alternative remedies for erectile dysfunction.

Yohimbe. Yohimbe is derived from the bark of a West African tree. Side effects include nausea, insomnia, nervousness, and dizziness. Large doses of yohimbe can increase blood pressure and heart rate and may cause kidney failure.

Viramax is a commercial product that contains yohimbine, the active chemical ingredient of yohimbe, and three other herbs: catuaba, muira puama, and maca. It has not been proven to be either effective or safe, and interactions with medications are unknown

Gamma-Butyrolactone (GBL). GBL is found in products marketed for improving sexual function (Verve, Jolt). This substance can convert to a chemical that can cause toxic and life-threatening effects, including seizures and even coma.

Gingko Biloba. Although the risks for gingko biloba appear to be low, there is an increased risk for bleeding at high doses and interaction with vitamin E, anti-clotting medications, and aspirin and other NSAIDs. Large doses can cause convulsions. Commercial gingko preparations have also been reported to contain colchicine, a substance that can be harmful in people with kidney or liver problems.

L-arginine (also called arginine). Arginine may cause gastrointestinal problems. It can also lower blood pressure and change levels of certain chemicals and electrolytes in the body. It may increase the risk for bleeding. Some people have an allergic reaction to it, which in some cases may be severe. It may worsen asthma.

Dehydroepiandrosterone (DHEA). DHEA is a supplement related to certain male and female hormones. Studies show inconclusive results in its treatment for erectile dysfunction. DHEA may interact dangerously with other medications.

Spanish Fly. Spanish fly, or cantharides, which is made from dried beetles, is the most widely-touted aphrodisiac but can be particularly harmful. It irritates the urinary and genital tract and can cause infection, scarring, and burning of the mouth and throat. In some cases, it can be life threatening. No one should try any aphrodisiac without consulting a doctor.

Other Dietary Supplements Marketed for Erectile Dysfunction. There are numerous other products marketed as “all-natural” dietary supplements and promoted as treatments for erectile dysfunction and sexual enhancement. The FDA has not approved any of these products. In recent years, the FDA has banned from the market many of these dietary supplements and warns that they contain the same or similar PDE5 inhibitor prescription drugs used in Viagra, Cialis, and Levitra.

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Erectile Dysfunction – Is There A Cure?

by Christian Goodman

Detailing certain emotions such as humiliation and pain is not exactly common place when referring to men. However, I do get many questions and concerns of exactly this nature. I frequently hear things that even the close friends, wives and girlfriends of these men may not know.

A specific topic many men share is dealing with erectile dysfunction (ED) also known as male impotence. In basic terms, it is being unable to produce or maintain an erection to the point that sexual performance is adversely affected. What this description does not include though is the psychological stress created by both the man or couple due to the issue.

A person may feel completely comfortable conversing about his cholesterol level or even blood pressure. These are of course potentially serious problems. But feelings of embarrassment or shame tend to accompany erectile dysfunction.

Emotional stressors and/or physical causes may be creating the problem. ED is a known side effect of many blood pressure medications or certain health conditions. However, I find that most often ED is most often emotionally caused.

There are many cases of ED that should have been a temporary issue as the believed causes were temporary.

However, the many emotions associated with ED can actually create enough added stress to continue the problem.

Knowing that as many as 1 in 5 men experience ED acknowledges that it is not a rare condition, but given the stigma surrounding lack of sexual prowess, it is logical to assume that these statistics are much lower than what the reality likely is.

Emotional and Relationship

Problems

So, lacking treatment, the man’s romantic or marital relationship is suffering provided he is inclined to enter into a relationship at all. Given the embarrassment many feel with this issue, is it even worth the risk? Now additional damage is done to his confidence which further perpetuates the problem.

The good news though is that ED can be treated regardless of physical or emotional causes.

When spontaneous erections occur can help mark the difference between the causes of ED. If an erection can be produced alone or if one wakes with an erection, then the ED is very likely emotional in nature. If not, then the cause can be both psychological and physical.

Treating ED can be as simple as beginning a regular aerobic exercise routine.

For those who prefer a medical solution, there are pharmaceuticals available. The efficacy of these medicines has only been shown to be about 40%.

There are also various devices on the market such as vacuum therapy which some find helpful. But others find this an awkward treatment and have even experienced irreversible damage.

Talk therapy which is a great way to help alleviate emotional problems associated with ED is showing very positive results.

With all the available treatments out there today, you (or your partner) can have the happy intimate life you seek. My Erectile Mastery Program is a safe, natural treatment that could be just what you have been waiting for.

Christian Goodmanis the creator of a unique stop premature ejaculation cure. He later developed this same method to work just as well as new Click Here! treatment for erectile dysfunction.

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Modernizing the Treatment of

Sexual Dysfunction in Men

Science Daily (Dec. 29, 2009) — Modern, couple-oriented treatment for male sexual dysfunction takes the psychosocial aspects of sex into account, as well as focusing on the purely physical aspects of the problem. The importance of this bio psychosocial approach, whether one looks at disorders of desire, arousal or orgasm, is supported by intercultural comparisons, among other data.

But sexual dysfunction can also arise as a consequence of a variety of diseases and their treatments, such as depression or diabetes, or can even be an early warning sign of serious physical illness such as heart disease. Hence an interdisciplinary approach, drawing on both medical and psychological techniques and insights, is essential.

In this week’s Deutsches Ärzteblatt International, Urologist Dirk Rösing and coauthors present an overview of current thinking and practice in the area of male sexual dysfunction.

The authors use research on prostate cancer to underline the place of one important new development in German sex therapy, a form of the internationally familiar “couples” therapy called “syndiastic” therapy. Questionnaire surveys to men with prostate cancer show that while the importance of the genital aspects of sexuality decreased in importance following radical surgery, the relationship and physical intimacy remained as important as before.

“Syndiastic” sex therapy was introduced in Germany in 2004, and focused for the first time explicitly on fundamental psychosocial needs, in a wider way, rather than purely on sexual function itself. Derived from a word Aristotle uses, meaning a disposition to “live in pairs” or “belonging,” this approach differs importantly from some other somatic or psychological treatments which focus mainly on restoring sexual function. Instead, it aims to broaden the understanding of sexuality, extend the range of physical experience, and improve overall satisfaction within the relationship.

Orgasm

is the sudden discharge of accumulated sexual tension resulting in rhythmic muscular contractions in the pelvic region that produce intensely pleasurable sensations followed by rapid relaxation. Orgasm is also in part a psychological experience of pleasure and abandon, when the mind is focused solely on the personal experience. It is sometimes called climaxing or coming.

In Masters and Johnson’s original research of the human sexual response cycle, orgasm is the third of four stages, occurring after the plateau phase and before the resolution phase. Another widely accepted model of the sexual response cycle, developed by Helen Singer Kaplan, M.D., PhD., involves just three stages: desire, excitement and orgasm.

Orgasms vary from person to person and for each individual at different times. Sometimes orgasm is an explosive, amazing rush of sensations, while others are milder, subtler, and less intense. The differences in intensity of orgasms can be attributed to physical factors, such as fatigue and length of time since last orgasm, as well as to a wide range of psychosocial factors, including mood, relation to partner, activity, expectations, and feelings about the experience.

Orgasm — A Total Body Response

There are several physiological components of orgasm. First, orgasm is a total body response, not just a pelvic event. Brain wave patterns have shown distinct changes during orgasm, and muscles in many different areas of the body contract during this phase of sexual response. Some people experience the involuntary contraction of facial muscles resulting in what looks like a grimace or an expression of discomfort or displeasure, but it is actually an indication of high sexual arousal.

The most characteristic physical feature of orgasm is the sensation produced by the simultaneous rhythmic contractions of the pubococcygeus muscle (pc muscle). Along with contractions of the anal sphincter, rectum and perineum, the uterus and outer third of the vagina (the orgasmic platform) for women, and the ejaculatory ducts and muscles around the penis for men, this constitutes the reflex of orgasm.

The first few contractions are intense and close together, occurring at about 0.8-second intervals. As orgasm continues, the contractions diminish in intensity and duration and occur at less frequent intervals.

Orgasm Differences Between Men and Women

Despite the anatomical differences between male and female genitals, orgasms in men and women are physiologically and psychologically, or subjectively, very similar.

In fact, studies have been done in which “experts” could not reliably determine gender when reading descriptions of orgasms with all anatomical references removed.

Women have described the sensations of orgasm as beginning with a sense of suspension, quickly followed by an intensely pleasurable feeling that usually begins at the clitoris and spreads throughout the pelvis. The genitals are often described as becoming warm, electric or tingly, and these physical sensations usually spread through some portion of the body. Most women also feel muscle contractions in their vagina or lower pelvis, often described as “pelvic throbbing”.

The subjective feeling of orgasm in men has been described quite consistently as beginning with the sensation of deep warmth or pressure that corresponds to ejaculatory inevitability, the point when ejaculation cannot be stopped. It is then felt as sharp, intensely pleasurable contractions involving the pc muscles, anal sphincter, rectum, perineum and genitals. Some men describe this part as a sensation of pumping. Finally, a warm rush of fluid or a shooting sensation describes the actual process of semen travelling through the urethra during ejaculation.

It is important to note that orgasm and ejaculation are not one in the same event. Although they typically occur together, a man may have an orgasm without ejaculating.

A major difference between the female and the male orgasmic phase is that far more women than men have the physical capability to have one or more additional orgasms within a short time without dropping below the plateau of sexual arousal.

Being multi-orgasmic depends on both continued stimulation and sexual interest. Because neither of these is present every time for most women, multiple orgasms do not occur with every sexual encounter.

On the other hand, upon ejaculation, men enter a recovery phase called the refractory period. During this time, further orgasm or ejaculation is physiologically impossible. However, some men can learn to have an orgasm without ejaculating, thereby making it possible to experience multiple orgasms.

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