Dr Rajiv Desai

An Educational Blog

SEX EDUCATION

SEX EDUCATION:

Prologue:

When I was a small child of about 6 to 8 years old, I asked my relatives about how I came to this world. They told me that a child comes from heaven. I was wandering how it is possible; even at that immature age. Nobody told me that relationship between a man and a woman brings a child. When I got admission in medical college at the age of 17 years, my friends who got admission in engineering college came to my house to see anatomy books. I was surprised. I asked them what they want. They told me that they want to know everything about male and female genitalia as they are growing up and they have no knowledge about it. Most teens want to know about sex but do not know how to get information. So they buy magazines & books, see movies, visit sex workers, watch porn videos, search sex websites, ask questions to sex experts on media etc to learn sex. Teens are curious about sexual relations, erection, orgasm, masturbation, nocturnal emissions etc but neither parents nor teachers tell them about it. Fifteen million Indians attend the Hindi cinema every day which is already a major factor in the remolding of Indian sexual values. Pornography is the exhibition of explicit sexual subject matter for the purposes of sexual excitement & eroticism and every second 28258 internet users are viewing pornography.  

 

I will not discuss hermaphrodites (eunuchs having both male and female characteristics), homosexuality and bestiality.

 

Introduction:

In human species, sex is a biological desire of attraction towards opposite gender in order to replicate itself by the process of genetic recombination which ultimately results in procreating another human having a male variety or a female variety (known as sex of an individual). As sex is a biological desire for survival of species just like biological desires of hunger and thirst, it is associated with pleasure, satisfaction and gratification in the brain without which nobody would venture for sex. You also feel happy and satisfied after eating food (when hungry) and drinking water (when thirsty). However, you do not feel happy if forced to eat unwanted food or eat on full stomach.  In the same way, sex will not result in happiness if forced upon (rape) or indulging in sex after achieved full sexual satisfaction. Parents teach children about how/what/when to eat/drink to satisfy biological desire of hunger/ thirst but do not teach children about sex which is equally important biological desire. Teachers do not teach sex in schools/colleges as it is not in educational curriculum due to government policies in India and other developing nations. So the buck stops at the parents and the government. Clearly sexual reproduction is central to evolution and survival of our species through our strong sexual instinct. However, many people have poor sexual relationships founded on harmful myths & customs and therefore knowing the truth about our diverse and adaptable sexual evolution is important. Children are becoming more exposed to sexuality through the media at earlier & earlier ages and the parental guidance on issues of sex & behavior is sorely lacking and this combination can prove dangerous in a world where there are so many teachers who seem to think that these hormone-filled, older-than-they look students are just ripe fruits for picking and therefore inappropriate sexual conduct of teachers with students is on the rise.

A human’s sex is defined in the way their gametes (sperm/ ovum) are produced. A male (man) produces sperms (22 chromosomes plus Y or X chromosome) and a female (woman) produces ovum (22 chromosomes with X chromosome).  When the sperms in the semen of a man enters vagina of the woman during sexual intercourse, the sperms being motile moves up in the fallopian tube of a woman where it mates with the ovum of the woman creating a zygote which grows up to be a new human. If this new human has 44 plus XY chromosomes (total 46), it will be a male and if this new human has 44 chromosomes plus XX chromosomes (total 46), it will be a female. A specific gene on Y chromosome sets in motion a cascade of gene expression and biochemical changes which lead to the conversion of the undifferentiated gonads into testes in male embryos while in female embryos, the gonads follow a default differentiation pathway to form ovaries. So it is the Y chromosome which determines maleness and this maleness is derived from father and femaleness is derived from both parents. So biologically speaking, a son is more akin to father than mother but a daughter is equally akin to both father and mother. Also, during mating with ovum, a sperm having Y chromosome will lead to a male child and a sperm having X chromosome will lead to a female child and therefore it is the father who is responsible for sex of a child rather than the mother.

Sexual reproduction in general helps spread advantageous traits through recombination than asexual reproduction. One can see human history and find that humans of 21’st century are smarter, more intelligent and more able than humans who lived 5000 years ago due to spread of advantageous traits and removal of disadvantageous traits through genetic recombination due to sexual reproduction. 

For many lower species, sex is not determined by inherited traits, but instead by environmental factors experienced during development or later in life. Many reptiles have temperature-dependent sex determination; the temperature embryos experience during their development determines the sex of the organism. Many fish change sex over the course of their lifespan, a phenomenon called sequential hermaphroditism. The entire discussion will be focused on heterosexuality and sexual relationship between a biological man & a biological woman.

Sexual intercourse (coitus) is defined as an act of entry of male reproductive organ (penis) into female reproductive tract (vagina) and is considered to be the highest degree of sexual contact between a man and a woman. The corollary to this definition means that there are plenty of non-coital sexual contacts between a man and a woman which are also equally important, equally intimate and which can also gives satisfaction and pleasure. Non-penetrative sex (oral sex may or may not be penetrative) and mutual masturbation have been referred to as outercourse. Sex does not just refer to vaginal sex; it can mean oral sex and anal sex as well. Oral sex is when one person licks or sucks another person’s penis or vaginal area. Anal sex means when a man inserts penis in the anus of a woman (heterosexual) or man (homosexual).    

Coitus may be preceded by foreplay, which leads to sexual arousal of the partners, resulting in the erection of the penis and natural lubrication of the vagina. To engage in coitus, the erect penis is inserted into the vagina and one or both partners move their hips to move the penis backward and forward inside the vagina to cause friction ( stroking/ thrusting ), typically without fully removing the penis. In this way, they stimulate themselves and each other, often continuing until orgasm is achieved in either one or both partners. Satisfactory sexual intercourse for human couples lasts from 3 to 13 minutes, contrary to popular fantasy about the need for hours of sexual activity, according to a survey of U.S. and Canadian sex therapists.  

The natural purpose and result of sex is reproduction, however, it is often performed entirely for pleasure and/or as an expression of love and emotional intimacy. The men and women who engage in sex frequently are found to be happier and understand each other. Sex is a great mode of exercise and thirty minutes of sex burns 85 calories and 42 half-hour sessions or 21 hour-long sessions, will burn 3,570 calories, sufficient to lose one pound weight. Sex between cohabiting partners lowers blood pressure and reduces stress and strengthens immune system.Women who indulge in sex on regular basis produce more amount of estrogen and as a result they get smooth skin and shiny hair. Sex also boosts self-esteem. Sexual intimacy and orgasm increases levels of hormone oxytocin & endorphins and oxytocin allows people to feel the urge to nurture and to bond and endorphins reduce pain. Various studies found that frequent ejaculations were linked to lower prostate cancer risk in men. A study found that having sex three or more times a week was associated with a 50% reduction in the risk of heart attack or stroke as compared to those who practiced abstinence. In contrast to its benefits, sexual behavior can be a disease vector for various Sexually Transmitted Diseases (STD) including HIV/AIDS.

The male reproductive system consists of the testes and a series of ducts and glands. Sperm are produced in the testes and are transported through the reproductive ducts. These ducts include the epididymis, vas deferens, ejaculatory duct and urethra. The reproductive glands produce secretions that become part of semen, the fluid that is ejaculated from the urethra. These glands include the seminal vesicles, prostate gland, and bulbourethral glands. 

During ejaculation, which usually accompanies male orgasm, a series of muscular contractions delivers semen containing male gametes known as sperm cells or spermatozoa from the penis into the vagina.  Ejaculate is 90% water and consists mainly of semen. Semen is a milky opalescence and opaque. Opalescence increases when the ejaculate has a higher concentration of sperm.  65% of the semen arises from the seminal vesicles. 35% of the semen comes from the prostate. It is the semen from the prostate that gives semen its characteristic smell.  5% is of other fluids. Semen contains citric acid, free amino acids, fructose, enzymes, phosphorylcholine, prostaglandin, potassium, and zinc. When a man orgasms, he ejaculates between 1 and 5 milliliters of semen. The average is 2 to 3 milliliters (a small teaspoon).  An ejaculation can travel up to 3 feet or more, however, an average distance is about 7 to 10 inches (17 to 25cms). Normal human semen is defined as having a volume of 2 ml or greater, pH of 7.2 to 8.0, sperm concentration of 20 million spermatozoa/ml or more, sperm count of 40 million spermatozoa per ejaculate or more, and motility of 50% or more.  Sperm count declines with age, with men aged 50–80 years producing sperm at an average rate of 75% compared with men aged 20–50 years.   

The subsequent route of the sperm from the vault of the vagina is through the cervix and into the uterus, and then into the fallopian tubes. Millions of sperm are present in each ejaculation, to increase the chances of one fertilizing an egg or ovum because many sperms are destroyed as they travel through cervix, uterus and fallopian tubes. Every month a mature ovum is released from either one of a woman’s two ovaries.  When a fertile ovum from the female is present in the fallopian tubes, a sperm (male gamete) joins with the ovum, resulting in fertilization and the formation of a new embryo. When a fertilized ovum reaches the uterus, it becomes implanted in the lining of the uterus, known as endometrium and a pregnancy begins. Women’s fertility peaks around the age of 19-24, and can start to decline after 30.  A woman’s menstrual cycle is of about 28 days with first day of menses as DAY 1 and a day before next menses as DAY 28. Sperms remain alive for 72 hours after entry into the vagina, but its capacity to fertilize the ovum lasts for 48 hours. So, the 12th to 18th days of menstruation cycle is correct for getting pregnancy for a lady, because the Ovulation (releasing of ovum from the Graafian follicle of the ovary) happens on about the 14th day of the menstrual cycle from any one side of the ovary. The chance of fertilization reduces if sperms enter into the genital tract of the female 48 hours before or 12-24 hours after ovulation. The ovum remains viable for about 72 hours, but is capable of being fertilized for only about 12 – 24 hours. The sperms travel (swim) through the contractions of vagina, cervix and uterus with a velocity 2 mm per minute and then reach in the ampulla of fallopian tube where fertilization takes place. The average time taken by the sperms is 45 minutes to go in the ampulla from the cervix. So it is quite likely that a woman can become pregnant with in 45 minutes of completion of sexual intercourse. The prevention of fertilization of ovum by sperm is known as contraception. The common contraceptive methods used by a woman are oral contraceptive pills, intrauterine copper T and fallopian tube ligation. The common contraceptive methods used by a man are condoms and vasectomy. In fact, vasectomy may actually improve the sex life of man because there is no fear of unwanted pregnancy. A couple who has never been pregnant before is defined as infertile if they have been attempting pregnancy for one year without success.

 

                                            CHRONOLOGY OF SEX CYCLE:

MALE                                                               FEMALE

1)      libido / arousal                                           1)  arousal / lubrication of vagina

2)      erection of penis                                         2)  enlargement of vagina

3)      penetration in vagina                                 3)  reception of penis

4)      obligatory stroking / thrusting                 4)  optional stroking / thrusting

5)      ejaculation of semen / orgasm                 5) orgasm with contraction of uterus, vagina and pelvis muscles.

6)      refractory period                                        6) no refractory period—multiple orgasms possible.

 

 

Puberty, Menarche and Menopause:

Puberty is the time in life when a person becomes sexually mature and capable of reproduction. It is a physical change that usually happens between ages 10 and 14 for girls and ages 12 and 16 for boys.  Puberty starts when a part of the brain called the hypothalmus begins releasing a hormone called gonadotropin releasing hormone (GnRH).  GnRH then signals the pituitary gland to release two more hormones – luteinizing hormone (LH) and follicle-stimulating hormone (FSH) which stimulates testes to produce testosterone in boys and ovaries to produce estrogen in girls which in turn stimulate physical changes in boys and girls. Before puberty, body differences between boys and girls are almost entirely restricted to the genitalia but after puberty, due to sex hormones, there is a change in growth & function in bones, muscle, skin, breasts, and reproductive organs known as secondary sexual characters which are different in men and women.

In males (boys):

– Puberty usually begins with the testicles and penis getting bigger. 

– Then hair grows in the pubic area and armpits. 

– Muscles grow, the voice deepens, and acne and facial hair develop as puberty continues.

In females (girls):

– The first sign of puberty is usually breast development. 

– Other signs are the growth of hair in the pubic area and armpits, and acne.

– Menstruation (period) usually happens last. 

Both boys and girls usually have a growth spurt (a rapid increase in height) that lasts for about 2 or 3 years along with the signs listed above.

Adolescence (teenage) is the period of psychological and social transition between childhood and adulthood which overlaps the period of puberty. So puberty is a physical change and adolescence is a psycho-social change.

Menarche is the first menstrual bleeding (menses/ period) in a girl during puberty usually occurring between the ages of 11 and 15 years.

Menopause is the permanent cessation of ovarian function resulting in cessation of menstrual bleeding due to absence of estrogen and progesterone at the age of about 45 years in every woman. A woman has reached menopause when she has not had menses (period) for one year.  

 

Libido:

Libido is the conscious component of sexual function. Decreased libido manifests as a lack of sexual interest or a decrease in the frequency and intensity of sexual thoughts, either spontaneous or in response to erotic stimuli and fantasy.  54% of men think about sex everyday or several times a day, 43% a few times per month or a few times per week while 19% of women think about sex everyday or several times a day, 67% a few times per month or a few times per week.  Libido is sensitive to testosterone levels as well as to general nutrition, health, and drugs. Conditions particularly likely to decrease libido include drugs, hypogonadism, uremia, and depression.

 

Penis:

The penis is an external genital organ of human male. The penis is a reproductive organ and  additionally serves as the external organ of urination. The distal end of the penis is called the glans penis and is covered with a fold of skin called the prepuce or foreskin. Within the penis are two masses of erectile tissue (corpora cavernosa) which consists of a framework of smooth muscle and connective tissue that contains blood sinuses, which are large, irregular vascular channels. Erection of penis occurs as the result of a complex neuropsychologic process. Higher cortical input and a sacrally mediated parasympathetic reflex arc combine to stimulate erection. Nerve output travels through the pudendal nerves, which traverse the posterolateral aspect of the prostate. Terminating in the penis, these nonadrenergic/ noncholinergic nerves activate nitric oxide synthase, producing nitric oxide, which relaxes smooth muscle lining the sinusoidal spaces that connect the arterioles and venules within the corpus cavernosa. The blood flow within the sinusoids increases markedly, distending them and compressing the venules, causing veno-occlusion. The increased inflow and veno-occlusion together produce penile rigidity. The length of penis varies from being flaccid to being erect. A study found that the length of adult flaccid penis is 8 to 10 cm and the length of adult erect penis is 12 to 15 cm. More recent data (not yet published) indicates an average erect penis length is between 5 to 6 inches, and average flaccid penis length ranges between 1 and 4 inches. Length of the flaccid penis does not necessarily correspond to length of the erect penis; some smaller flaccid penises can grow much larger, and some larger flaccid penises cannot grow much larger. There is a popular misconception about size of penis and satisfaction of woman. Anybody having erected penis length of more than 5 cm (2 inches)  can penetrate woman’s vagina, satisfy her and make her pregnant. This is because the most sensitive area of the female genitals includes the vulva, clitoris, and the section of vagina closest to the outside of a woman’s body. Most people think that a tall man will usually have a large penis, but this is not entirely true. Also, there is no correlation between penile size and race. The famous sex researchers Masters and Johnson have concluded that size of the male penis can have no true physiological effect on female sexual satisfaction and they concluded that any size penis will fit and provide adequate sexual stimulation to the female. Also, sexual pleasure is in mind and not in sex organs, and therefore sexual pleasure/ orgasm is directly related to love, companionship and intimacy between partners rather than mere act of sexual penetration.

 

Vagina:                              

The human vagina is an elastic muscular canal in human female that extends from the cervix to the vulva with the length of the unaroused vagina is approximately 6 to 7.5 cm (2.5 to 3 in) across the anterior wall (front) and 9 cm (3.5 in) long across the posterior wall (rear).  During sexual arousal, and particularly the stimulation of the clitoris, the walls of the vagina self-lubricate and this lubricating fluid reduces friction between penis and vagina and smoothens sexual intercourse. With arousal, the vagina lengthens rapidly to an average of about 10 cm (4 in).  Vaginismus refers to an involuntary tightening of the vagina, due to a conditioned reflex of the muscles in the area which can affect vaginal penetration and sexual intercourse,    

The hymen is a thin membrane of skin that partially covers the entrance to the vagina. This membrane can bleed when it is torn as a man’s penis enters the vagina. However, neither the presence of the hymen nor bleeding during intercourse can truly indicate virginity.  Some girls are born without hymens, others will have hymens that stretch and don’t break during sex, and some will have torn their hymens during sport, inserting tampons, masturbation or even riding a horse. First night sex in a couple’s life is always filled with anxiety, nervousness and hesitation and there are many questions which creep up in the back of their mind. Will it hurt the first time? Will I bleed? This is the most common question that bride asks. The best advice is to use lubricating jelly on first night and the husband can gently insert his finger in the vagina of wife during foreplay to open up hymen before sexual penetration. The clitoris is a small pea-sized lump towards the top of the vaginal area above the urethra (urine hole) and the entrance to the vagina. It is very sensitive and when stimulated can lead to orgasm.

 

Foreplay:

Foreplay means anything that takes place before the act of penetration including kissing, fondling, caressing, stroking, mutual masturbation, breast fondling, genital touching, hugging, undressing, massaging, talking and teasing etc to arouse sexual passion. For a woman the most important aspect of foreplay is to be touched, lovingly, by her partner. Foreplay’s physical function is for the man to get an erection and for the woman to become aroused so that her vagina becomes lubricated enough for comfortable sexual intercourse. Foreplay in actual terms means stimulation, sexual and sensual. A good husband is a husband who gives orgasm to his wife during foreplay itself. Each woman will have her special sensitive places (and possibly some she doesn’t like to be touched) and it is the duty of her partner to find it out by experience and experiment so that he touches her in a way to make her aroused. Foreplay is not just a few moves you have to make before intercourse but foreplay is the way you treat your partner all the time. Non-sexual stroking of a woman by man as foreplay was found to produce 20% more of the hormone Oxytocin post-stroking, and reduced blood pressure in the woman. The pubic hair of both men and women are supplied at the roots with some of the most highly erotogenic nerve endings in the body. The arousal response when the pubic hairs are gently pulled, tugged, and stroked is stronger in women than in men. A man can gently massage on this intensely intimate area of his woman with caresses over the abdomen and thighs to arouse her.

 

Sex positions:

Sex positions are the physical bodily positions adopted by sex partners at the time of sexual intercourse. There are quite a lot of different positions for sexual intercourse. One of the most common is the missionary position, where a woman lies on her back and a man lies on top of her. A man and woman might also lie on their sides, the woman may sit on top of the man, or she may kneel on all four limbs while the man puts his penis into her vagina from behind. Every woman is different and every man is different and therefore it is up to the couple to choose the sex position at the time of coitus which gives them maximum comfort, adequate penetration and physical intimacy.

 

Sexual pleasure (orgasm):

Orgasm is defined as a peak of sexual response cycle controlled by autonomic/ limbic system of brain resulting in subjective feeling of intense pleasure accompanied by ejaculation in men and muscle contractions of pelvis, uterus and vagina in women.  Enjoying sexual activities with another person is possible whether you have an orgasm or not. Not being able to have an orgasm with another person doesn’t mean that you don’t fancy them or love them. Sexual excitement usually grows gradually and a person feels more and more pleasure and a kind of exciting tension. All the feelings of tension then disappear when the orgasm happens, and the person experiences feelings of intense pleasure. The feeling can be so strong that a person might not be able to see, or hear or think about anything for a moment. They might even groan and call out with the pleasure. Orgasms usually last only a few seconds but the feelings might last a lot longer. When a man has an orgasm he ejaculates. When a man has achieved a sufficient level of stimulation, ejaculation begins. At that point, under the control of the parasympathetic nervous system, semen containing sperm is produced. The semen is ejected through the urethra with rhythmic contractions. These rhythmic contractions are part of the male orgasm. They are generated by the bulbospongiosus muscle under the control of a spinal reflex at the level of the spinal nerves S2-4 via the pudendal nerve.  ?-Adrenergic stimulation produces contractions of the epididymis, vas deferens, prostate, and muscles of the pelvic floor. In addition, the neck of the bladder closes; preventing retrograde ejaculation of semen into the bladder.The typical male orgasm lasts several seconds. After the start of orgasm, pulses of semen begin to flow from the urethra, reach a peak discharge and then diminish in flow. Ejaculate will leave the penis at the rate of about 28 miles per hour but can reach speeds of 43 miles hour. The typical orgasm consists of 10 to 15 contractions, although the man is unlikely to be consciously aware of that many. Once the first contraction has taken place, ejaculation will continue to completion as an involuntary process. At this stage, ejaculation cannot be stopped. For women, the excitement stage is characterized by the onset of vaginal lubrication, clitoral erection, changes in the size and shape of the labia, nipple erection and swelling of the breasts. At this stage, symptoms increase in intensity. Orgasm in women involves rhythmic contractions of the uterus and the muscles round the vagina. Women normally experience three to 10 very strong contractions at 0.8 second intervals. In both sexes, oxytocin is released, which strengthens contractions.    

After a man has ejaculated he loses his erection and usually needs to stop for a while and there is a refractory period before another sexual arousal which may be from 15 minutes in young man to several hours in middle-age man. When a woman has an orgasm, her vagina often becomes very wet, but she can continue being sexually aroused as long as she likes due to absence of refractory period and therefore a woman can have multiple or successive orgasms. This biological fact is exploited by prostitutes who keep on having sex with different men one after another and getting aroused every time. Most women achieve orgasm through friction of the clitoris against the man’s pubic bone while engaged in intercourse or through stimulation of the clitoris by manual or oral contact. About 1 in 3 American women do not reach orgasm without some extra touching to genitals in addition to intercourse. Orgasms during intercourse are not proven to be better than other orgasms. Some women can reach orgasm just by having a vivid fantasy about sex or by having their breasts stroked. A Study found that 5 percent of the women reach orgasm at the same time as their spouses, with 70 percent attaining orgasm before and 25 percent coming after their husbands have ejaculated.  75% of men and 29% of women always have orgasms with their partner.

 

Age of consent:

The age of consent is the age at which a young person is legally able to understand and agree for consensual sex. In most countries, until you reach this age, it is illegal for somebody to have sex with you, however old he/she may be. Age of consent laws are there to protect young people from being sexually exploited by adults. Statutory rape is the crime that someone can be charged with if an adult has sex with a person who has not reached the age of consent but who agrees to have sex.  Age of consent for heterosexual sex is 16 years in India, 14 years in China, 13 years in Nigeria and 18 years in Afghanistan. So a 25 years old man can have consensual sex with 14 years old girl in Nigeria but it would be a rape in India.

 

Circumcision:

Circumcision is the surgical removal of the skin (prepuce) that normally covers and protects the glans (head) of the penis. The penis is covered with a continuous layer of skin extending from the pubis to the tip of the penis where the foreskin (prepuce) folds inward upon itself, creating a double protective layer of skin over the glans penis. The inner lining of the prepuce is mucous membrane and serves to keep the surface of the glans penis; soft, moist, and sensitive. Circumcision is a part of religious ritual, including Judaism and Islam as well as others. However, 85 percent of the world’s male population is not circumcised. During sexual arousal, the normally flaccid penis must become erect. As it changes from flaccidity to rigidity, the penis elongates and the double fold of skin (foreskin/prepuce) provides the skin necessary for full expansion of the penile shaft. Stretching of the foreskin over the glans penis activates preputial nerve endings, enhances sexual excitability, and contributes to the male ejaculatory reflex. After circumcision, the exposed head of the penis thickens like a callus and becomes less sensitive; and because erotically sensitive areas of the penis have been removed, the circumcised penis must thrust more vigorously with a much longer stroke in order to reach orgasm through stimulating the less sensitive penile shaft. As a circumcised man has to thrust his penis more vigorously in the vagina of a woman to get orgasm for himself, simultaneously, the woman also gets orgasm due to prolonged thrusting and hence some studies showed that women prefer circumcised men over uncircumcised men. Also, due to delayed orgasm in circumcised men, it is postulated that premature ejaculation is less common. Also, some studies suggested that the chance of HIV transmission is less in circumcised men as compared to uncircumcised men. The truth is that prepuce is not appendix and prepuce has definite role in protecting glans, lubricating glans, help in penetration, reduce friction in intercourse, allowing natural physiological intercourse, enhance pleasure during intercourse and maintaining sensitivity of glans surface. Every man must retract prepuce over glans daily at the time of bathing and clean prepuce under-surface with water to remove smegma and other secretions. It is the unhygienic care of prepuce that is responsible for HIV transmission rather than the mechanics of prepuce.  More studies are required to prove the beneficial effects of ‘clean’ prepuce. Except medical conditions like phimosis/ paraphimosis/ tear of prepuce, circumcision must not be done.

 

Erectile dysfunction (ED):

Also known as impotence is defined as the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance.

 Various myths about ED

–         Being impotent means you’re not a real man

–         Erectile dysfunction is shameful

–         A real man is a potent man and always has an erection when it’s needed

–         A real man can seduce any woman he wants to have sex with

–         A real man can make thrust in his partner until she has an orgasm

–         A man should give his partner an orgasm each and every time they have sex

–         You should be able to have sex with any woman on demand

–         Sexual confidence is everything; if you’re not confident in bed, you’re a wimp

–         Sexual intercourse requires a fully erect penis.

All these statements are untrue and each of them can contribute to erectile dysfunction. 

Stimulation of penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis) followed by increased blood flow in corpora and subsequently penile erection. What nitric oxide does is to stimulate synthesis of cyclic guanosine monophosphate (cGMP) in the smooth muscle cells of corpora which relaxes smooth muscles. This cGMP is inhibited by enzyme phosphodiesterase type 5 (PDE5) which is released after ejaculation/orgasm which in turn causes erect penis to become flaccid again. So basically erection of penis is a neuro-vascular phenomenon initiated by cerebral cortex (erotic stimuli/thoughts) via limbic system transmitting signals to lower spinal cord and through sacral nerves stimulate relaxation of smooth muscles of corpora in the penis. Any disturbance from cerebral cortex to venous sinuses/venules in corpora cavernosa can cause ED. Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases such as diabetes, kidney disease, chronic alcoholism, smoking, obesity, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease—account for about 70 percent of ED cases.  In addition, many common medicines—blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug)—can produce ED as a side effect.  Also, psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases.  According to the Massachusetts Male Aging Study, complete impotence increases from 5% among men 40 years of age to 15% among men 70 years and older. Population studies conducted in the Netherlands found that some degree of erectile dysfunction occurred in 20% of men between ages 50 to 54, and in 50% of men between ages 70 to 78.  The worldwide prevalence of erectile dysfunction was 152 million in the year 1995 and is expected to increase to 322 million in the year 2025.  Not many people are aware that in most cases physical rather than psychological causes are responsible for ED, and that ED is usually eminently curable. The popular drug sildenafil citrate (Viagra) is a selective inhibitor of enzyme phosphodiesterase type 5 (PDE5) which enhances effects of nitric oxide on smooth muscles of corpora to cause sustained erection in a person who was otherwise impotent. However, many men’s egos would not let them admit that there could be something wrong with their ‘jewels of manhood’. A person suffering from ED must consult andrologist.

 

Premature ejaculation:

Premature ejaculation is the phrase used when ejaculation occurs before the desired time. If a man is unable to ejaculate in a timely manner after prolonged sexual stimulation, in spite of his desire to do so, it is called delayed ejaculation. Premature ejaculation occurs when a lack of ejaculatory control interferes with sexual or emotional well-being in one or both partners. Some sex researchers have defined premature ejaculation as the condition where a man ejaculates before his sex partner achieves orgasm while others have defined it as occurring if the man ejaculates within two minutes of penetration. Normal time from penetration to ejaculation is about five minutes. Women are often not satisfied with this and in such cases; couple must indulge in extensive foreplay before penetration. There is only one way to overcome rapid ejaculation; and that is to train your body to stay aroused without ejaculating for longer when you make love.  Premature ejaculation is the most common sexual problem among men. A study found that that two out of three men ejaculate very quickly during sex – much too quickly for their liking, and certainly much too quickly for their partners’ liking. In fact, well over half of all men ejaculate after about three minutes of lovemaking (and most of the rest come within five minutes). Another study found that between 30 and 40 per cent of men are believed to suffer from this frustrating condition called premature or rapid ejaculation. Many studies have shown changes in brain chemistry – in serotonin levels, in fact affect how quickly or slowly an ejaculation takes place. Premature ejaculation can be treated with medicines, such as serotonergic anti-depressants or SSRIs so that the ejaculation can be delayed. This medication improves the transmittal of serotonin between two nerves. These medicines need to be taken 2 to 3 hours before the expected sexual activity.

 

Nocturnal emission:

A nocturnal emission is an involuntary ejaculation of semen that occurs during sleep. Studies show that approximately 83% of men have or will at some point, experience a nocturnal emission. The frequency range of 15 year old males experiencing nocturnal emissions is 12 times per week while for 40 year old male, it is 0.18 times per week. During puberty, there is increase in serum testosterone level which may have caused increased nocturnal emission. During REM sleep (dreaming),  there is intense activity in areas of the brain that control the autonomic nervous system which leads to activation of the erectile system of the penis followed by ejaculation of semen along with experience of orgasm during sleep. It occurs as the body can hold a maximum fixed amount of semen and when this maximum amount is reached, it needs to get rid of it or it is a natural way of releasing sexual tension  Nocturnal emission is not a sign of any physical or emotional problem. As a physician, I have seen many patients complaining of weakness due to nocturnal emissions as a result of ignorance because laymen believe that semen is the most potent substance and its loss will cause weakness.

 

Painful sexual intercourse:

Certain vaginal infections such as vaginal yeast infections, trichomoniasis and  genital herpes cause pain; as during sexual intercourse, the rubbing motion of the penis against the vagina  causes the symptoms of these vaginal infections (stinging, burning) to intensify. Many products contain irritants that can cause vaginal irritation, leading to discomfort or pain during vaginal sexual intercourse which includes tampons, contraceptive creams/ diaphragms, allergic reaction to condoms etc. Vaginal dryness often causes painful sexual intercourse due to lack of vaginal lubrication during arousal. Women with vaginismus experience strong, involuntary muscle spasms of the vaginal muscles during sexual intercourse giving pain. Occasionally, a woman will experience pelvic pain upon deep, thrusting penetration due to pre-existing pelvic inflammatory disease. Causes of painful sexual intercourse in men could be infections of the urethra, prostate, bladder, or seminal vesicles which can lead to intense burning or itching sensations following ejaculation. Also, painful intercourse is due to the painful retraction of a too-tight foreskin (phimosis), occurring either during the first attempt at intercourse or subsequent to tightening or scarring following inflammation or local infection or small tears in the frenum of the foreskin. A lubricant can be used to increase pleasure and reduce pain during sexual activity and may be used for lubricating the penis and the vagina before sexual intercourse.Most health professionals recommend a water-based lubricant over a petroleum-based product. Water-based lubricants are more easily absorbed by and are less irritating to the delicate tissues in and around the genitals. Not enough lubrication can be painful but excessive vaginal lubrication can also deflate sexual pleasure. Phimosis needs circumcision by a surgeon.

 

Sexually transmitted diseases (STD):

STD are a group of contagious infectious diseases whose principal mode of transmission is by intimate sexual activity involving moist mucous membrane of penis, vulva, vagina, cervix, anus, rectum, mouth, pharynx and their adjacent skin surfaces. STD includes syphilis, gonorrhea, HIV, hepatitis B, chancroid, genital herpes, chlamydia, human papilloma virus (HPV), trichomoniasis etc. Predisposing factors for STD includes sex at younger age, multiple sexual partners and unprotected sex. It is common and natural to feel sexually attracted towards more than one person at a time, particularly if you are a young, single adult but self-restraint is the key to control sexual promiscuity. The World Health Organization estimates that more than one million new cases of sexually-transmitted infections (STD) occur worldwide everyday.  Another study found that there are 340 million cases of STD worldwide every year. Best way to prevent STD is to have monogamous sexual relations with clean partner. Other ways to prevent STD are use of latex condoms and vaccines for hepatitis B and HPV. It has been proved that consistent use of latex condoms reduces the risk of HIV/AIDS transmission by approximately 85% relative to risk when unprotected and the same logic holds true for other STD. Condoms not only prevent STD but also prevent pregnancy as well. Safe sex is protecting yourself and your partner from any sexually transmitted diseases including HIV.  Both giving and receiving oral sex can lead to the transmission of sexually transmitted diseases. Health problems from STD are worse for women than men and may lead to infertility, ectopic pregnancy and cancer of cervix in women. Also, having non-HIV STD is a definite risk factor for acquiring HIV infection in future for both sexes.

 

Masturbation:

Masturbation refers to sexual stimulation, especially of one’s own genitals (self masturbation), often to the point of orgasm. The stimulation can be performed manually, by other types of bodily contact (short of sexual intercourse) and by use of objects.Masturbation is the self stimulation of the genitals for pleasure or self comfort. Studies on US population have shown that 92% of men and 62% of women have masturbated during their lifespan. In a study of undergraduate college students, 98% of men and 44% of women reported having ever masturbated.  Occasional masturbation is a normal behavior of many infants and preschoolers. Up to one-third of children in this age group discover masturbation while exploring their bodies. Masturbation also occurs widely among animals, both male and female. Many birds masturbate by mounting and copulating with tufts of grass, leaves or mounds of earth, and some mammals such as primates and Dolphins also rub their genitals against the ground or other surfaces to stimulate themselves.       

Men usually masturbate by grasping the penis and moving their hand up and down rapidly until they ejaculate (“come”). Women rub their clitoris and vulva and may move one or several fingers up and down inside their vagina until they orgasm. Reading or viewing pornography, or sexual fantasy, is often common adjuncts to masturbation. Everybody has their own way of masturbating that feels good for them. Masturbation is a good way of relieving the sexual tension that can build up over time, especially for people without partners or whose partners are not willing or available for sex. Masturbation also is a safe sexual alternative for people who wish to avoid pregnancy and the dangers of sexually transmitted diseases. It is necessary when a man must give a semen sample for infertility testing or for sperm donation.   Masturbation is natural and normal. It is a required release which human beings find comforting and necessary for their emotional well being. New Scientist (2004) reported that a large study by the National Cancer Institute in the US has found that frequent ejaculation – either through sexual intercourse, masturbation or nocturnal emissions – protects men against prostate cancer. Also, abstinence from sex for more than three days harms semen, as revealed by analysis of fertility treatment sperm donation centers. Also, one study found that men with repeated normal semen analysis results produced abnormal samples if they abstained for more than 10 days. It is hypothesized that abstinence of sex leads to storage of sperms which damages them. There is clearly a health benefit to male masturbation, for both productive health and continued normal physical health. Masturbation addiction is, simply put, the compulsive need to masturbate. The need becomes so overwhelming that the addict does not have the power to keep from masturbating which can inhibit normal sexual activities with the partner.

 

Premarital sex:

Premarital sex is defined as consensual sexual intercourse above the age of consent with either future spouse or friend or relative or acquaintance or sex worker before marriage. Premarital sex is common.  Premarital sex is not illegal in most countries except Islamic nations. By their late teenage years, at least 3/4 of all men and women have had intercourse, and more than 2/3 of all sexually experienced teens have had 2 or more partners. Even in traditionally conservative Indian society, a study by Savara and Sridhar in 1992 showed that 30 percent of the respondents had experienced premarital sex. The Family Planning Foundation of India undertook a study in 1990 among teenagers (between 14 and 17 years) and found that about one fourth of them expressed their acceptance of premarital sexual contact. In another study in India, they found that about one quarter of married women had sex with their husbands before marriage. Other premarital sexual partners for Indian women were mostly friends, relatives, and work acquaintances. Premarital sex among 18- to 20-year-olds in Indian metros is as high as 65.6 per cent amongst girls and 63.3 amongst boys. The all India occurrence of STDs in the age group of 18 to 30 is as high as 48 to 52 per cent and premarital sex is the biggest contributor. However, young adults who take a vow of virginity as adolescents are as likely to be infected with sexually transmitted diseases as those who do not take virginity pledges, according to researchers at the Yale and Columbia University  because  pledgers were less likely to use condoms at first sex than non-pledgers due to overconfidence. Recently, Indian Supreme Court held that premarital sex is not an offence except adultery and perceived immorality does not violate any law.

 

Sex in marriage:

The marriage gives legal, social and religious sanctity for sexual intercourse between a husband and a wife and the marriage is considered consummated only if there is a sexual intercourse between the couple. The success of marriage is considerably dependent on the sex and the married couples who practice sex more than usual are happier in comparison to other married. According to Hindu tradition, a husband should approach his wife sexually during her ritu (season), a period of sixteen days within the menstrual cycle. The Kama Sutra is a well-known product of Hindu society that extols the benefits of sexual intercourse. Christianity & Islam commonly views sex in marriage as holy and affirms that everything God created, including sex, is good. Adultery is sex between a married person and one other than the lawful spouse.     

Poverty and overpopulation affect sexual practice. Most of Indian wives portray their experiences with sexual intercourse as a furtive act in a cramped and crowded room, lasting barely a few minutes and with a marked absence of physical or emotional caressing. It is a duty, an experience to be submitted to, often from a fear of beating. None of these Indian wives removed their clothes during intercourse since it is considered shameful to do so.

Communication between life partners is essential for solving the problems in marriage, including sexuality. It is also advisable to visit sexologist, urologist, andrologist or gynecologist to solve sexual problems in marriage depending on the type of problem. In America, the average frequency of sexual intercourse for married couples is 2 to 3 times a week and average frequency of intercourse declines with age and menopause.  18-29 year olds have sex an average of 112 times per year, 30-39 year olds an average of 86 times per year, and 40-49 year olds an average of 69 times per year.  Premarital sexual education & counseling can contribute to sexual satisfaction through its ability to address and remove ; fear &  misunderstanding, and the resulting sexual reluctance  &  related problems.

 

Sex in menses:

There is generally nothing wrong with having sex during a woman’s period and it will not cause either partner any harm. Sexually transmitted infections may be passed on more easily during a woman’s period (both from the woman to the man and from the man to the woman), so a condom should always be used if there is any doubt over either partner’s sexual history or HIV status.

 

Sex in pregnancy:

Sexual intercourse should be avoided from the sixth to the twelfth week of the pregnancy, as it can cause miscarriage. Sexual abstinence is recommended during the last two months of pregnancy as well due to risk of the essential amniotic fluid leaking out, causing complications. During the fourth to seventh month of pregnancy, intercourse is allowed unless you are otherwise advised for medical reasons. These medical reasons are STD, low lying placenta, active bleeding, history of preterm labour etc. Avoid missionary position during sex in pregnancy and go for woman on top/ spooning/ side lying sex position.

 

Aging and sex (elderly sex):

 The myths that are associated with the subject of sex and aging include

– Impotence is a natural consequence of aging.

– Sexual activity can be dangerous for the elderly.

– The sex drive or libido diminishes with advancing years for both men and women.

None of the above is true.  

Human sexual response may be slowed by the aging process, but it is certainly not terminated.  Several recent reports indicate that the majority of women and nearly all men from 50-80 are still interested in sex. These studies also confirm that the majority of the elderly are capable of engaging in and enjoying sex. A young man needs few seconds or a minute to get erection but elderly individual needs 10 to 15 minutes to get erection of penis. A study has found that age typically does not significantly diminish the need and desire for sex, that regular sexual activity is standard when a partner is available, and that most elderly believe that sex contributes to both physical and psychological health. Another study found that male and female orgasm continue almost indefinitely, and that achieving orgasm is desired but not always achieved in elderly. Not only does sex lead to health benefits, but good health leads to improved sexuality. A recent British Medical Journal (BMJ) report concluded that the better one’s health, the more sex he or she can look forward to later in life. The average sexually active life expectancy for a 30-year-old today is nearly 35 years for a healthy man and 31 years for a healthy woman. At age 55, men in very good or excellent health can expect an additional 5 to 7 years of sexually active life, compared to their peers in fair or poor health. 

For most men, testosterone secretion continues throughout life albeit with diminished production with advancing age.  Reduced testosterone level in elderly men leads to fewer sperms, delayed erection, reduced force of ejaculation and increased refractory period in between repeated sex. The absence of estrogen in women can result in decreased vaginal lubrication which often results in painful intercourse, but fortunately this condition can be easily treated with lubricating creams. It is well-documented that older women experience fewer sexual problems than men as they age. Probably the most common reproductive problem for older men is prostatic hypertropy, enlargement of the prostate gland. Erectile dysfunction (ED) is another common problem seen in aging males due to physical cause, such as disease, injury, or side effects of drugs. The most prevalent problem for elderly women is low sex desire.   

 

Why sex education?    

More than half of all women are dissatisfied with their sex lives, and 10% of women have never experienced an orgasm before. In a survey of college students conducted by the All India Educational and Vocational Guidance Association, it was reported that 54 percent of male students and 42 percent of female students stated that they did not have adequate knowledge regarding matters of sex. 70% of couples today are having the unsatisfactory sex life. The problems in the sex life are damaging the men-women relationship. The numbers of divorces per year are increasing due to the unsatisfactory sex life. Annually, 46 million babies die from abortion worldwide. That’s approximately one baby being aborted every two seconds. Over half (56%) of all women having abortions between 15-44 age group are in their 20’s.  98% of all abortions worldwide are due to personal choice (unwanted or inconvenient or unintended pregnancy) because of lack of sex education.         

The most important reason for giving the school, responsibility for sex education is that many parents feel unable to handle this task themselves. Many have inhibitions about discussing sex with their children; others admit that they do not have the technical knowledge to answer all the questions their children ask. Nowadays, with the advent of various satellite television programs, children are exposed at their early ages to various programs, including considerable sexually related material. Sex education is a broad term used to describe education about human sexual anatomy, sexual reproduction, sexual intercourse, reproductive health, emotional relations, reproductive rights and responsibilities, abstinence, contraception, and other aspects of human sexual behavior. Common avenues for sex education are parents or caregivers, school programs, and public health campaigns. The existence of AIDS/HIV has given a new sense of urgency to the topic of sex education. According to WHO statistics in the year 2008; 33.4 million people were infected with HIV worldwide with death of 2 million people. Had sex education been implemented in developing nations, HIV spread would have been curtailed and thousands of lives saved. Broad sex education programs have global benefits, such as controlling the risk of overpopulation and the advancement of women’s rights.  It is widely accepted that young people have a right to sex education. This is because it is a means by which they are helped to protect themselves against sex abuse, exploitation, unintended pregnancies, sexually transmitted diseases and HIV/ AIDS   Rape resistance tactics must be taught to the girls in high school/college as a part of sex education. Teaching children about sex should start before they reach puberty as they must be mentally prepared for the changes that are going to occur in their bodies at puberty including nocturnal emissions in boys and menses in girls. Almost all U.S. students receive some form of sex education at least once between grades 7 and 12. Two main forms of sex education are taught in American schools; comprehensive and abstinence-only. Abstinence-only sex education tells teenagers that they should be sexually abstinent until marriage and does not provide information about contraception. Comprehensive sex education covers abstinence as a positive choice, but also teaches about contraception and avoidance of STD when sexually active. Various studies have compared comprehensive sex education programs with abstinence-only programs and shown that abstinence-only programs did not reduce the likelihood of unintended pregnancy of women who participated in the programs, but rather increased it. Sex education ought to be taught by teachers of unimpeachable integrity otherwise young students will fall prey to sexual exploitation by predators in the form of teachers. Also, Roman Catholic Church is investigating various matters of sex abuse of children by priests. Also, various Hindu religious priests are involved in sex scandal and prostitution racket in India. So various religions have been used by various priests for sexual exploitation of the devotees. Casting Couch is a term used when an employer or a person in high office solicits sexual favour from an individual who may be a job aspirant or employee or subordinate in return for employment or promotion in job. Basically, casting couch means exchanging sexual favour in return for economic security and career advancement. Casting couch is not uncommon in movie/ music/ television/ fashion/ corporate industry as well as in government and politics. If a woman is molested or raped by her employer/ superior/ senior and then, she accepts money or job or promotion from the perpetrator to maintain her silence; it is a type of casting couch in hindsight.

The Indian Supreme Court on 16’th November in the year 2005 decided that sex education in schools cannot be brought under the ambit of fundamental rights by making it a part of the right to education. I humbly disagree. With more than 4.5 million people infected by HIV, India has become the world’s second largest hub of the HIV/AIDS after South Africa thanks to absence of sex education in schools. A sex offender ( sex abuser) is a person who committed a sex crime  by legal jurisdiction and  includes offences such as child sexual abuse, child pornography, rape, and statutory rape.The Delhi-based Sakshi Violation Intervention Centre in a 1997 study that interviewed 350 school children, found that 63 per cent of the girl respondents had been sexually abused by a family member; 25 per cent raped, and over 30 per cent sexually abused by the father, grandfather or a male friend of the family.Delhi based organization RAHI found that 76% of respondents to its survey had been abused when they were children – 40% of those by a family member and 4% were abused by their own fathers or brothers. Child sex abuse is the term for an adult using his/her age or authority over a child forcing undesired sexual stimulation including making any type of sexual contact. Child pornography (also known as child abuse images) is depicting sexually explicit activities involving a child and it is considered as a part of child sex abuse. A pedophile is an individual (adult / adolescent) who fantasizes about, is sexually aroused by, or experiences sexual urges toward prepubescent children (generally <13 years) and may be involved in creating/viewing child pornography. Sexting is an act of sending sexually explicit messages or photographs, primarily through mobile phone, in the hope of soliciting sexual relations with the recipient. A study found that 20% of teens (13-19) and 33% of young adults (20-26) had sent nude or semi-nude photographs of themselves electronically. Additionally, 39% of teens and 59% of young adults had sent sexually explicit text messages. The teens who sext nude photographs of children or themselves (below the age of 18 years) may face charge of producing, possessing and/or distributing child pornography. Sexually explicit/ suggestive material can also be communicated through internet and ‘sex talk’ over phone. Recently, an adult sex offender was sent to prison for having “sex talk” on phone with a 12 years old girl in America. Incest is defined as the sexual intercourse between persons who are so closely related that their marriage is illegal or forbidden by custom irrespective of their ages. So incest between adults and those under the age of consent is considered a form of child sexual abuse. Sexual exploitation is the sexual abuse of children and youth through the exchange of sex or sexual acts or creating pornography for drugs, food, shelter, protection, other basics of life, and/or money. Shockingly, the educational system has missed out on informing its children that the moment an abuse has taken place, something wrong has taken place. Most civilized nations use the educational system as a crucial means to inform children about what amounts to a sexual assault or abuse or crime against a minor and about the various victim support systems but sadly, India remains uncivilized nation due to absence of sex education in schools. Also, in India, there is a moral brigade, who has objected to the sexually explicit content in textbooks, which they said offended certain sensibilities. Interestingly, Indian cyber law not only considers the publishing, creating, exchanging and downloading child pornography as an offence but also the browsing of child pornography as an offence. Curiosity cannot be used as an excuse for viewing child pornography. However, due to absence of sex education in India, intense curiosity about sex does exist in the minds of teens which may land them in trouble. Also, anyone who may accidentally receive child pornography via e-mail should not be considered as sex offender and prosecuted.

Various surveys by World Health Organization (WHO) showed that sex education in schools did not encourage young people to have sex at an earlier age or more frequently but early sex education delays the start of sexual activity, reduces sexual activity among young people and encourages those already sexually active to have safer sex.

 

THE MORAL OF THE STORY:

1)  Sex education is a fundamental right of every child.

2)  Sex education can save thousands of lives by preventing HIV spread and by preventing unintended pregnancies which otherwise are deemed for abortion.

3)  Sex education must include rape resistance tactics and awareness of sex abuse.

4)  Sex education help control overpopulation, advance women’s rights and promote happy sex life.

5)  Quackish sex education from pornography, uninformed acquaintances, media and unqualified sex experts does more harm than good.

6)  Every man and every woman is different during sex and therefore sexual relations can never be standardized.

 

Dr.Rajiv Desai. MD.

May 2, 2010

 

Postscript:

Sex education is not amounting to publishing sexually explicit material. I have taken utmost care and precaution to avoid using obscene/ vulgar language or picture on the subject of sex education. The issue is sex education and not to arouse sexual passion or eroticism.        

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