Roundups Sexual Health

Sexual Health Roundup: All About Female Orgasms, Bicycle Seats, and Sex Over 55

Martha Kempner

In this week's sexual health roundup: a series of essays address debates over what really leads to female orgasms; bicycles seats may be bad for women's sexual health; and a new websites gears sexual health information to grandma. 

All About Women’s Orgasms – Should We Care Where They Originate?
A series of essays in the Journal of Sexual Medicine looks at female orgasms and is once again fueling the debate over how orgasms are made — do they come from the clitoris, the vagina, or the elusive G-spot. The issue includes an essay by researchers at Rutgers University who conducted multiple studies in which they asked women to masturbate while having an MRI. They found that different areas of the brain are activated from clitoral stimulation and vaginal stimulation. The areas overlap but only slightly suggesting there really are different “types” of orgasm. Others disagree, however; a French gynecologist writes in her essay that female orgasm is dependent on clitoral stimulation and suggests that because the front wall of the vagina is closely linked with the internal parts of the clitoris, so-called “vaginal” orgasms could in reality be clitoral in origin. Yet another essay suggests that women who can have vaginal orgasms — without any clitoral stimulation — are physically and psychologically healthier.  It pointed to research finding that women “who have vaginal orgasms have a lower resting heart rate than others who did not experience them” and that those “who can reach a sexual peak without clitoral stimulation are less likely to use specific maladaptive psychological coping mechanisms.”

While I think we can all agree that these kind of studies are interesting, I fear they can hurt women.  Orgasms feel good no matter where they originate or which parts of the brain they light up and I think we should just be encouraging women to have whatever kind they can have. As one of the authors put it: “Looking for the G-spot orgasm or the vaginal orgasm as a need, as a duty, is the best way to lose the happiness of sex.”

Spin Class May Be Bad for Your Sexual Health

In a recent sexual health roundup, I noted a study that found exercise can lead to spontaneous orgasms but all exercise regimens might not be created equal when it comes to sexual health. A new study, also in the Journal of Sexual Medicine, may have you thinking twice before hitting your usual spin class. Research has already concluded that spending too much time on a traditional bicycle seat is bad for men’s health as it can lead to erectile dysfunction. Researchers at Yale University have now determined that these seats—which have a pointed nose—are not good for women either.  For the study, researchers had regular cyclists—those who rode upwards of 10 mile a week bring their bikes to a lab where they watched them ride (the bikes were set up so they were stationary) and measured the impact on their pelvic floor. The women also reported whether they were experiencing pain, numbness, or tingling. 

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The study concluded that the most important factor was the height of the handlebars—if the  handlebars were lower than the seat, women were forced to lean forward which put more pressure the perineum— the region between the back of the vulva and the anus which is made up of soft tissue.  This can lead to pelvic floor pain.  

As the researchers point out, this is correctable.  If you don’t want to switch to yoga or Pilates, at least see if you can raise your handlebars.

Safer Sex for Grandma

Forgive me if I’ve told this story before but when my grandmother started dating a few years after my grandfather died, the good sexuality educator in me couldn’t resist the opportunity to tell her she really ought to be using condoms. The exact response from my grandmother, who was a health care professional might I add, was “I don’t have to.  If I got HIV, by the time I’d get sick, I’ll be dead anyhow.”  I’m not sure how many older adults who find themselves back in the dating scene after being divorced or widowed feel exactly this way but data suggests they aren’t using condoms and they are getting STDs.

Over the past few years, research has found that STD incidence among adults over 55 is on the rise. For example, between 2005 and 2009, the number of cases of syphilis and Chlamydia in seniors in central Florida rose 71 percent and 62 percent, respectively.

A new campaign, which includes a Public Service Advertisement (PSA) and a website, encourages older adults to think about safer sex. The 30-second PSA shows fully clothed older people of all shapes and sizes simulating amusing sexual positions and ends by saying while there are many ways to do it there’s only one way to do it safely: “Use A Condom.” The ad directs viewers to the website http://safersex4seniors.org.  As Melanie Davis, the coordinator for the site explains, the ad: “…celebrates the sexuality of adults in mid- and older age. The joy in the actors’ faces captures the message we need to get across: that healthy, protected sex is life affirming and enriching.”  

Roundups Sexuality

This Week in Sex: Why Men Fake Orgasms and How Real Ones May Help Them Avoid Prostate Cancer

Martha Kempner

Many men pretend to have orgasms to make their partners feel better—and report higher levels of sexual satisfaction, at the same time. Another study suggests that the more ejaculation, the better if men want to reduce their prostate cancer risk. And there may be more help for women with sexual arousal problems.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

When Men “Fake It,” Their Motives Are Often Altruistic 

In the pilot episode of the TV show Masters of Sex, Dr. William Masters seems shocked to learn that women might fake orgasms. When he asks his new assistant, Virginia Johnson (who becomes his research partner and later his wife), why women might do such a thing, she replies: “To get a man to climax quickly. Usually so the woman can get back to whatever it is she’d rather be doing.”

Masters and Johnson, whose real-life work and relationship was fictionalized in that Showtime series, were pioneers of sex research in the 1950s and 1960s. Those who follow in their footsteps today are still trying to answer some of the same questions.

A new study from two Canadian researchers looks not at why women fake orgasms, but why men do—and what, if any, correlation there is between faking it and relationship satisfaction.

Researchers surveyed 230 young men between ages 18 and 29 who had admitted to faking an orgasm at least once in their current relationship. Using an online survey, they asked these men at what point in their relationship they began to fake orgasms, how often they did so, and why. They also measured sexual desire and relationship satisfaction.

On average, the men began faking orgasms 14 months into the relationship. On average, the men said they faked an orgasm in about 30 percent of their sexual encounters; 71 percent of participants reported having faked an orgasm during penile-vaginal intercourse; 27 percent during oral sex; 22 percent during anal intercourse; 18 percent during manual stimulation by a partner; and 5 percent while being stimulated with a sex toy by a partner.

Many of the reasons the men gave for faking orgasm revolved around making their partners feel better—including giving their partner an ego boost, feigning simultaneous orgasms, or avoiding upsetting their partner.

Interestingly, men who faked it for these relationship reasons tended to report higher levels of sexual desire. The authors theorize, “It is possible that men feel good when giving a partner pleasure, either out of love and generosity, or because it provides indirect reassurance of their own sexual adequacy, leading them to associate this reward with sexual activity, further leading them to seek more sex (i.e., experience higher levels of sexual desire).”

Men who faked orgasms also had higher levels of relationship satisfaction, though the authors point out that pretending might not lead to relationship satisfaction; those who are already satisfied may be more likely to fake orgasms for the sake of their partner’s feelings.

While it’s reassuring to know that some men fake orgasms for altruistic reasons, we here at This Week in Sex are not big fans of the fake orgasm, regardless of the gender or the reason. Once in a while is understandable “to get back to whatever it is [you’d] rather be doing,” as Johnson said. But, for the most part, we think it’s better to talk to partners about why you didn’t have a real one this time and what could be different next time.

Is Frequent Ejaculation a Cancer Prevention Method? 

Another new study found that men who ejaculated more frequently were less likely to be diagnosed with prostate cancer. Researchers followed about 32,000 men for almost 20 years, using the national Health Professionals Follow-up Study  at the Harvard School of Public Health. The men were all in their 20s when the study started in 1992 and therefore their 40s (or close to it) when it ended in 2010. They filled out questionnaires that asked about their sexual behavior (including masturbation), and researchers also looked at the men’s medical records.

During the course of the study, about 4,000 of the men were diagnosed with prostate cancer. The researchers’ analysis showed that men who ejaculated at least 21 times a month in their 20s were 19 percent less likely to be diagnosed with prostate cancer than men who ejaculated no more than seven times a month at that age. Similarly, men who ejaculated more often in their 40s were 22 percent less likely to be diagnosed with prostate cancer diagnosis.

There are some limitations of the study, including the possible inaccuracy of self-reported data on ejaculation and the lack of diversity among participants. In addition, one urologist who spoke to Reuters questioned the fact that the relationship between ejaculation and prostate cancer applied mostly to less invasive forms of the disease. Dr. Behfar Ehdaie of the Memorial Sloan Kettering Cancer Center in New York, who was not part of the study, noted: “If ejaculation frequency was truly a causal factor for prostate cancer development, we would expect to find the association across all prostate cancer risk categories.”

And, of course, correlation does not equal causation. There could be other reasons that men who ejaculate less often are more likely to get prostate cancer. Specifically, as study co-author Dr. Jennifer Rider points out, men who ejaculate less than three times a month may be suffering from other health issues.

Still, there could be a prevention strategy in the findings. Rider told Reuters in an email: “The results of our study suggest that ejaculation and safe sexual activity throughout adulthood could be a beneficial strategy for reducing the risk of prostate cancer.”

Given that ejaculation tends to be enjoyable, it seems like a pretty good idea to try even while more research into the correlation is being conducted.

Emerging Options for Women With Sexual Arousal Issues

When the drug Addyi was under development, people referred to it as “female Viagra” because it was intended to address women’s sexual dysfunction. But the two treatments actually work very differently. While Viagra causes an erection by increasing blood flow to the penis, Addyi (or flibanserin) works on chemicals in the brain to increase sexual desire.

Now, researchers are developing a new treatment for women that is actually much more similar to Viagra. A company called Creative Medical Technologies filed a patent last week for a treatment that uses regenerative stem cells to increase blood flow to the vagina. Unlike Addyi, this treatment is designed for women who desire sex but are having trouble becoming aroused. Increasing blood flow to the vagina can cause the clitoris to become erect and the vagina to lubricate, both of which are important parts of the arousal stage of sexual response.

The treatment still needs more research and, of course, FDA approval, which was a very controversial process for Addyi’s maker. Moreover, it’s not clear how big the market is for female sexual dysfunction treatment, as prescriptions for Addyi have been low since its market release last October.

Commentary Sexuality

There Really Isn’t Any Bad News for People Who Like to Masturbate

Martha Kempner

A recent Maxim article warned readers that masturbation may be harmful in the long run if they do it too often or the wrong way. Thankfully, the article is based on pseudoscience and misunderstandings—there is no reason to stop the activity.

Masturbation is such an under-appreciated form of sexual activity. It has been blamed in urban legends for everything from hairy palms to lack of productivity, and has a reputation of being reserved for those who can’t find anyone else to have sex with them. But that’s just not true. Most people masturbate. It feels good. It carries no risk of pregnancy or disease. It can take as much or as little time as you have. And it’s relaxing. So why have media outlets warned readers that they might be doing it too much or the wrong way?

Recently, in a December 15 article titled “We’ve Got Bad News for People Who Love Masturbating,” Maxim’s Ali Drucker tells readers: “If you or someone you love frequently enjoys doing the five-finger shuffle, there’s a study that suggests they might face negative effects over time.” The article actually points to three pieces of “research” that seem to suggest masturbation isn’t as good as other forms of sexual behavior, that one can become addicted to it, and that the “grip of death” can make men incapable of experiencing pleasure any other way.

Well, Rewire has good news—these conclusions are largely based on junk science and misunderstandings.

The first study Drucker cites, originally published in Biological Psychology, is called, “The post-orgasmic prolactin increase following intercourse is greater than following masturbation and suggests greater satiety.” Prolactin is a hormone that is released by the pituitary gland. Its main function is to stimulate milk production when a woman is lactating, but it also plays a role in the sexual response cycle. According to the study, which was first published about ten years ago, prolactin is released after orgasm as a way to counteract the dopamine released during arousal. Some scientists believe that the more satisfying the experience is, the more prolactin levels will go up afterward.

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For this study, Stuart Brody and his colleagues compared data showing prolactin levels after penile-vaginal sex to those after masturbation and found that levels after intercourse were 400 percent higher than after masturbation. They interpreted this to mean that intercourse is more physiologically satisfying than masturbation.

On the surface, this conclusion isn’t surprising. Many people don’t view masturbation as the same as a shared experience with a partner. It doesn’t tend to produce the same physical or psychological feelings. But that doesn’t mean it’s not a fun and satisfying way to spend a few minutes (or hours, if you’re ambitious or bored).

When I read the study, I did not interpret it to say that intercourse was better than masturbation, just that our biological reactions to different sexual behaviors were different. I had never read anything by Professor Brody before and reached out to him, assuming that people were overstating his results and that he did not mean to discourage masturbation. I thought, what sex researcher would ever want to discourage masturbation?

However, he replied, “Instead of any fresh quotes, I attach my review paper on the evidence regarding health differences between different sexual behaviors.” He sent me a different article, a literature review in which he says in no uncertain terms that penile-vaginal intercourse (PVI) is the best kind of sex and that “sexual medicine, sex education, sex therapy, and sex research should disseminate details of the health benefits of specifically PVI.”

As a sex educator, I can’t imagine telling anyone that penile-vaginal sex is inherently better. For one thing, not everyone is in a couple, and not all couples have a penis and a vagina between them. And even for cisgender heterosexual couples, PVI is only one of countless potentially pleasurable behaviors. Moreover, many women find it less satisfying and less likely to end in orgasm than behaviors that incorporate clitoral stimulation.

But Brody not only thinks it’s the best form of sex—he thinks we sometimes do it wrong. He writes that “PVI might have been modified from its pure form, such as condom use or clitoral masturbation during PVI.” He also explains that Czech women who were vaginally orgasmic were more likely than their peers who didn’t have orgasms through PVI to have been taught during childhood that the vagina is “an important zone for inducing female orgasm,” concluding that “sex education should begin to be honest” about sexual behaviors.

I thought we’d moved on from the idea that we should all be having heterosexual, penile-vaginal sex in its “pure form” (missionary position?) and that women who couldn’t orgasm this way were both bad at sex and shit out of luck.

Colleagues in the field told me that many of them ignore Brody’s studies because he makes wild inferences based on soft science and, as implied by his research, is wedded to the idea that for sex to have the most benefits it needs to include PVI.

Nicole Prause, a researcher who has written critiques of Brody’s work, told me via email that, “His work almost exclusively uses data from other researchers, not his own, meaning the design is never really appropriate for the claim he is actually trying to make.” She went on to say that Brody’s studies on orgasm are often based on self-report, which is notoriously unreliable. Although the study Maxim cites was based on blood tests, “He has never once verified the presence of orgasm using a simple physiological measure designed for that purpose: anal EMG. Many women are thought not to be able to reliably distinguish their orgasm, so his purely self-report research is strongly suspect. If this is his area of focus, he should be studying it better than everyone else,” she concluded.

But Brody’s research on prolactin isn’t the only questionable science that Maxim relies on for its cautionary tale on masturbation. The article goes on to discuss the role of oxytocin and dopamine and points out that there’s less oxytocin released during masturbation. This is probably true—oxytocin is known as a bonding hormone and is triggered by contact with other people, so it’s not surprising that it’s not released when you’re orgasming alone. The Maxim article, however, argues that if the brain is flooded with dopamine (a neurochemical) during masturbation without the “warm, complacent, satisfied feeling from oxytocin,” you can build up a dopamine tolerance, or even an addiction, and get into “a vicious cycle of more masturbation.”

David Ley, PhD, a clinical psychologist and sexuality expert, explained in an email that many people describe dopamine as the “brain’s cocaine,” but this is an overly simplistic way of looking at it. It doesn’t mean we’re at risk of desensitizing our brain or getting addicted to jerking off. Ley wrote:

It appears that there are many people whose brains demonstrate lower sensitivity to dopamine and other such neurochemicals. These people tend to be “high sensation-seekers” who are jumping out of airplanes, doing extreme sports, or even engaging in lots of sex or lots of kinky sex. These behaviors aren’t caused by a development of tolerance or desensitizing, but in fact, the other way around—these behavior patterns are a symptom of the way these peoples’ brains work, and were made.

OK, dopamine isn’t cocaine and neither is masturbation: We’re not going to get addicted if we do it “too” much.

But, wait, Maxim throws one more warning at us—beware the “death grip.”

Though the article describes this as “the idea that whacking off too much will damage your dick,” the term, which was coined by sex advice columnist Dan Savage, is more about getting too accustomed to one kind of stimulation and being unable to reach orgasm without it. There is some truth to this—if you always get off using the same method, you can train your body to react to that kind of stimulation and it can be harder (though rarely impossible) to react to others. There are two solutions, neither of which involve giving up on masturbation: Retrain your body by taking some time off from that one behavior and trying some others, either by yourself or with a partner, or incorporate that behavior into whatever else you’re doing to orgasm (like clitoral masturbation during intercourse).

In fairness, the Maxim article ends by acknowledging that masturbation can have benefits, but I still think it did its readers a disservice by reviewing any of this pseudoscience in the first place. As Ley said in his email, “This article, targeted towards men (because we masturbate more), is still clearly pushing an assumption that there is a ‘right kind of sex/orgasm’ and that masturbation is just a cheap (and potentially dangerous) substitute … That’s a very sexist, heteronormative, and outdated belief based on a view of sex as procreative only.”

So for a different take on it all: Sure, there might be more prolactin and oxytocin produced during intercourse than masturbation, but that does not mean that masturbation isn’t enjoyable or worthwhile. You won’t become addicted to it, but you might want to mix up how you get to orgasm or just incorporate your preferred stroke into all other sexual activity.

What you shouldn’t do is view the Maxim article—or any of the research it cites—as reasons not to stick your hands down your own pants.