Why might intensity of orgasm decline?

Why might intensity of orgasm decline?

Like many aspects of sex, intensity of orgasm can depend on the individual as well as the situation. Here are some of the more common reasons orgasms might become less powerful:
Levels of sex hormones decline for both men and women as they get older. Men’s testosterone levels drop gradually over time, which can dampen both desire and orgasm intensity.
For women, estrogen decreases at menopause are more abrupt. Some experts believe that the clitoris becomes less sensitive due to estrogen decline. Many women climax through clitoral stimulation; less sensitivity may diminish the intensity of orgasms.
Also, estrogen is important for keeping vaginal tissues flexible and lubricated. When levels fall, the vagina can become dry and narrow. Intercourse may become uncomfortable. (Read more about vulvar and vaginal atrophy
If a couple has been together for several years, they may fall into a sexual routine that does not excite one partner (or both) as much as it used to. Changing the pattern may help. Couples are encouraged to talk to one another to make sure each partner is getting his or her sexual needs met.
In addition, men who use pornography and/or masturbate daily may find that their orgasms become less intense or less satisfying.
Stress and Anxiety
Stress can affect sexual health in many ways, including orgasm. If a person is under pressure at work, feeling overwhelmed by family responsibilities, or anxious about the state of a romantic relationship, he or she may become distracted during sex, which could take away some of the pleasure.
Low Desire and Poor Arousal
Problems with sex drive (libido) or arousal (the body’s physical preparation for sex) may also lower orgasm intensity. These issues can have both physical and psychological causes, such as hormonal declines or relationship conflict. Patients are encouraged to see a doctor or therapist.
Weak pelvic floor
The pelvic floor is a muscle group that supports the pelvic organs, such as the bowel, bladder, and uterus. These muscles tend to weaken as people get older. Surgery, obesity, and childbirth may weaken them as well.
Kegel exercises are designed to strengthen the pelvic floor muscles. People who keep their pelvic floor toned often find that the intensity of their orgasms improves.
Birth Control Methods
Some men claim that they have orgasm difficulties when using condoms. Oral contraceptives can be similarly problematic for women, too.
It’s important to note that diminished orgasms are not a reason to stop using birth control or engage in unsafe sex. Couples should make sure they are using condoms correctly. Women may consider switching from oral contraceptives to another form of birth control, such as an IUD.
Communication is an essential component of any sexual relationship. If a partner’s orgasms become diminished, the couple can work together to solve the issue. The answer may be as simple as making more time for the relationship, asking for help with responsibilities, or changing birth control methods. It may also help to consult a doctor, sex therapist, or counselor.

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Is flibanserin (Addyi) safe for women who take antidepressants?

Female Sexual Health

Dr. Ahmad Motawi

What is Addyi?

Addyi is the brand name of flibanserin, a drug designed to treat acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women.
HSDD refers to a lack of sexual desire that causes distress and/or trouble with personal relationships. It’s normal for women to lose interest in sex from time to time, but for women with HSDD, the problem is persistent. Acquired HSDD occurs after a woman has had a healthy sex drive for some period of time, often many years. Generalized HSDD happens with any sexual partner and any sexual situation.
Addyi works by balancing chemicals the brain that influence sexual desire.
The drug was approved by the U.S. Food and Drug Administration (FDA) in August 2015. It is available in the United States since October 17, 2015.
Will Addyi be available outside the United States?
As of August 2015, it is unclear if and when women outside the U.S. will have access to Addyi. On August 21, 2015, The Pharmaceutical Journal reported that Sprout Pharmaceuticals, the drug’s developer, had not yet applied to the European Medicines Agency for permission to market Addyi in Europe.
Sprout plans to seek approval in Canada later this year, according to an August 20, 2015 report from CTV News.
What are some side effects of Addyi?
Some women who take Addyi experience dizziness or sleepiness. This is why Addyi is meant to be taken at bedtime. Women may also have nausea, fatigue, insomnia, and dry mouth.
What are some of the health risks of Addyi?
Addyi does have some safety concerns.
The drug is not safe for women with poor liver function. Also, women who take medications called CYP3A4 inhibitors should not take Addyi.
Two of the most serious concerns are loss of consciousness (syncope) and extremely low blood pressure (hypotension). If either of these situations occur, women should seek medical care immediately.
It is very important that women avoid drinking alcohol while they are taking Addyi. Risks of syncope and hypotension are higher when the drug is mixed with alcohol. Further research on this interaction is planned.
Women should always see their doctor before taking Addyi. A thorough medical exam may reveal other health conditions or medication that could be contributing to low sexual desire. Relationship problems may also be a factor to consider.
Patients who have no improvement in their desire or personal distress after 8 weeks should stop taking Addyi and seek further professional help.

Dr. Ahmad Motawi

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What is dyspareunia?

What is dyspareunia?

The term “dyspareunia” means painful intercourse. A woman may feel pain at the start of penetration or with deep penetration. Or, pain may happen only with specific partners or in certain positions.

There are many reasons a woman may experience pain during intercourse. Here are the most common ones:

• poor lubrication
• medical conditions (such as ovarian cysts or pelvic inflammatory disease)
• allergies
• birth control devices that don’t fit correctly
• relationship/emotional problems
• vaginismus

Many of these issues can be treated easily under a doctor’s care.

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How common is it to “fake” an orgasm, and why do people do it?

How common is it to “fake” an orgasm, and why do people do it?

Both men and women pretend to have orgasms, and the practice of “faking” is fairly common. Research suggests that women are more likely to fake orgasm than men are.
For example, a 2009 study published in the Journal of Sex Research reported that among a group of college students, 25% of the men and 50% of the women had pretended to reach orgasm. Among participants who had had vaginal intercourse, 28% of men and 67% of women said they faked orgasm.
Women often fake orgasm by making corresponding sounds, like moaning or gasping. They may breathe more quickly or move in ways that make their partner think they are climaxing.
Since men typically ejaculate when they reach orgasm, faking it may be more challenging. However, if a man wears a condom, he might be able to dispose of it before his partner realizes he hasn’t climaxed.
Men and women cite many reasons for faking orgasm. Sometimes, they just want the encounter to end, especially if they know they are not going to climax.
Often, people have their partner’s feelings in mind when they fake orgasm. They want their partner to think they enjoyed the experience. Or, they may want to avoid making their partner feel inadequate or anxious about performance the next time they have sex.
Some heterosexual couples feel that there is a proper sequence for orgasm, with the woman climaxing first. So a woman may fake her orgasm to follow this sequence, even if she feels she will actually reach orgasm with a little more time.
Experts have also found that some women fake orgasm because it makes them more aroused, leading to greater sexual satisfaction.
Many couples think of orgasm as a goal to be achieved by the end of sex and that if orgasm doesn’t occur, they have failed in some way. But orgasm is a complex process that may not happen all the time. Focusing instead on the intimacy shared rather than a big climax can make sex more fulfilling for both partners. And if one partner does not reach orgasm regularly, it may be an opportunity for couples to discuss what pleases them or experiment with new sexual activities.

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How likely is sexual activity to trigger sudden cardiac arrest?

How likely is sexual activity to trigger sudden cardiac arrest?

While it is possible for someone to suffer sudden cardiac arrest during or just after sex, the odds of this happening are very low.

Sudden cardiac arrest occurs when a problem in the heart’s electrical system stops the heart from beating. Sometimes, this is caused by arrhythmias (abnormal heart rhythms). There are no warning signs for sudden cardiac arrest, and medical attention is needed immediately.

Sudden cardiac arrest is different from a heart attack, which occurs when blood flow to the heart is blocked.

In November 2017, scientists discussed the likelihood of sudden cardiac arrest during sex at a meeting of the American Heart Association.

They studied the medical records of 4,557 adults who had had sudden cardiac arrest between 2002 and 2015 in Oregon, United States. They determined that 34 of these cases – 32 men and 2 women – were related to sexual activity. In other words, less than 1% of all patients in the group had experienced sex-related sudden cardiac arrest. The events occurred either during sex or within an hour afterward.

These patients were likely to be male, middle-aged, and/or African-American. Many of them had a history of heart disease, and most took heart medication, the scientists said.

One finding that concerned the researchers was that only a third of the patients received cardiopulmonary resuscitation (CPR). When cardiac arrest occurs, CPR can save a person’s life. They called for more public education on CPR and encouraged people to learn it.

The risk of sex-related cardiac arrest is low, but heart patients are still advised to talk to their doctor if they have concerns about sexual activity.

Sex is safe for most heart patients, but anyone who has uncontrolled high blood pressure, chest pains, a weak heart, a history of heart attack, advanced heart failure, or an arrhythmia should get a doctor’s approval first.

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What is orgasmic anhedoniapleasure dissociative orgasmic dysfunction?

What is orgasmic anhedoniapleasure dissociative orgasmic dysfunction?

The word “anhedonia” refers to the inability to experience pleasure from an activity that is normally considered pleasurable. People with orgasmic anhedonia (also called pleasure dissociative orgasmic dysfunction or PDOD) are unable to feel pleasure when they climax.

Orgasmic anhedonia/PDOD doesn’t affect sex drive. People with this rare condition still feel driven to have sex. Men still ejaculate. And women still know they’re reaching orgasm. The difference is that the pleasure is missing.

The situation can be quite frustrating for couples. People with orgasmic anhedonia/PDOD may be embarrassed or feel like they’re missing out. Partners may feel inadequate, like they are doing something wrong. Some partners are unaware of the situation.

Experts believe that orgasmic anhedonia/PDOD occurs because of a problem with neurochemicals in the brain, particularly dopamine. Patients may receive sexual stimulation, but there is a disconnect between the sensation and the part of the brain that recognizes that sensation as pleasurable.

It’s possible that the orgasmic anhedonia/PDOD is linked to psychological issues like depression or addiction. But it could also be connected to medications, high prolactin levels, low testosterone, or physical conditions like spinal cord injury.

If the cause of orgasmic anhedonia/PDOD can be identified, treating that issue may solve the problem. Sometimes, a combination of medical treatment and sex therapy is necessary.

People who do not feel pleasure during orgasm are encouraged to see their doctor.

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Sexual Health, Birth Control and Condoms

Sexual Health, Birth Control and Condoms

Sexual Health, Birth Control, and Condoms


What Causes Condoms to Come Off During Sex?

A condom may come off during sex because:

  • It's too large.Try a snug condom.
  • Loss of erection.Remove your penis, holding on to the rolled edge of the condom, as soon as you begin to lose your erection.

Where Can I Get Male Condoms?

Condoms can be purchased at most drug stores. Condoms also are sold in some vending machines in public restrooms.

How Effective Are Male Condoms for Birth Control?

Condoms are about 82% effective for birth control. With careful use, they are even more effective. Keep in mind that the best way to avoid getting pregnant is to not have sex (abstinence).

How Do Male Condoms Prevent STDs?

Latex condoms provide protection from sexually transmitted diseases by preventing the infected area from coming into contact with the partner. Polyurethane condoms provide some protection, although not as much as latex. Natural or lambskin condoms do not protect against STDs because they have larger holes or "pores" that allow the small particles that can cause some STDs to pass through. Many STDs -- including HSV, which causes herpes, and HPV or the human papillomavirus, which is the most common sexually transmitted infection -- can be transmitted from areas not covered by a condom.

Should Foam be Used With Male Condoms?

Contraceptive foam can offer added protection against pregnancy in case a condom breaks. Use of spermicides can irritate the genital tissues and may increase the risk of STDs, including HIV/AIDS.

How Effective Are Foam and Male Condoms?

When used together and properly, foam and condoms are about 97% effective in preventing pregnancy.

What Is a Female Condom?

The female condom is a lubricated polyurethane (plastic) tube that has a flexible ring at each end. One end of the tube is closed.

How Is the Female Condom Used?

Before sexual activity begins, the woman inserts the condom into her vagina so that the closed end of the tube covers the cervix, and the other end slightly covers the labia (lips on the outside of the vagina). The condom blocks sperm from entering the womb. Female condoms should be discarded after one use.


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What is postcoital dysphoria (“post-sex blues”)?

What is postcoital dysphoria (“post-sex blues”)?

Sometimes, people feel deep sadness or agitation after consensual sex. The medical term for these feelings is postcoital dysphoria (PCD), but some call it the “post-sex blues.”

In some cases, people become tearful or depressed after orgasm. In others, they become argumentative with their partner. These feelings occur even if the sexual encounter has been satisfying and enjoyable.

Not much is known about PCD, but research published in the journal Sexual Medicine in 2015 has revealed how common it is among women.

Researchers from the Queensland University of Technology (QUT) in Australia asked 230 female university students to participate in a survey about their experiences with PCD. The women ranged in age from 18 to 55 with an average age of 26 years.

Forty-six percent of the women said they’d experienced PCD in the past. About 5% said they’d had symptoms over the past month. And about 2% reported having PCD “always” or “most of the time.”

However, PCD was not linked to intimacy in close relationships, the researchers reported.

Experts aren’t sure why PCD happens. It may be that the bonding with a partner during sex is so intense that breaking the bond triggers sadness. Childhood sexual abuse may play a role as well.

The QUT researchers noted that their findings may not apply to other groups, as their participants were heterosexual, mostly Caucasian, and university students.

Additional studies with larger, more diverse groups may provide more clues. It is also uncertain to what extent postcoital dysphoria affects men.

People who are concerned about the post-sex blues are encouraged to talk to their doctor or a sex therapist.

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