5 Tricks for Staying in the Moment During Sex

The post-dinner cleanup is done, the TV is off, and it's finally time for the sex session you've been craving all day. But as you segue from foreplay to the main event, your mind takes a turn—to work deadlines or your friend's gossipy Facebook post. Before you know it, you're mentally a million miles away from your partner.


The inability to focus on the here and now during sex is something a lot of people experience, especially women, says Angela Skurtu, a therapist and author of Helping Couples Overcome Infidelity: A Therapist's Manual. "I've noticed that my female clients have a harder time with this, while men tend to be better at compartmentalizing."

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To have satisfying sex, says Skurtu, you must do two things. "You need to focus on relaxing and figure out what turns you on in the moment." To arrive at that place and get you out of that easily distracted head space, we asked Skurtu and sex therapist Tammy Nelson, author of Getting the Sex You Want, for their best actionable tips.


Be mindful outside of the bedroom

To start doing it automatically in the bedroom, practice being more present in the rest of your life. "Any minute of any day, take a moment to focus on one sensation, whether it's sight, smell, taste, touch, or sound," says Skurtu. Try listening to a song, for example, and pay close attention to all the words and the melody, rather than use it as background music. Or really enjoy every bite of your meal, focusing on nothing but the flavors.

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Once you've got the hang of it, try it during sex. Focus on how every kiss feels, or pay attention to your partner's breathing and the way his fingertips feel warm on your skin. Zoning in on the small details will anchor your brain so your thoughts don't wander and you're physically and emotionally there with each touch and stroke.

Play this sexy game

Keep yourself connected to the action at hand through a little playful competition, like a grown-up twist on truth or dare, suggests Skurtu. "You're thinking of the next dare or truth you'll ask, rather than your daily life," she explains. Each option will play off what's going on between the sheets, keeping you tuned in to the moment. For example, if he's just kissed you on the mouth, smile and reply, "I dare you to kiss me like that below the belt next." A truth option? "Tell me where I can kiss you like that on your body."

Take the lead

Being the aggressor or dominant partner means you're in charge of the action—and that keeps your brain solidly in the here and now. "Focus on your partner and making them feel good," suggests Nelson. Taking the lead doesn't mean you have to plan a menu of crazy-sexy moves; it's more about paying attention to what the other person wants and finding out by experimenting and asking questions. You'll stay focused on what's happening between the sheets and learn more about turning on your partner too.

RELATED: Your G-Spot: What It Is, How to Find It, and All the Things It Can Do for Your Sex Life
Switch locations

Having wandering thoughts during sex "could mean you are bored," says Nelson. If this happens, consider doing it in a different part of the house—like the couch, floor, steamy shower . . . whatever sounds sexy and fresh. A change of scenery often works, but if it doesn't, think about bringing in sex toys, such as handcuffs or a vibrator. "When something new is happening, it's easier to focus on the newness," notes Skurtu.

Keep distractions out of sight

Can't stop thinking about that big pile of laundry in the corner of the bedroom? The best thing you can do is move it to another room so you can't see it and consequently think about it. Same goes for your phone, a stack of bills, or anything else that could possibly distract your brain.

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"I tell people to make their bedrooms sanctuaries," says Skurtu. Think about all of the things that may cause you stress or anxiety, and give them the heave-ho. If watching the nightly news gives you anxiety, for example, keeping a television in your room is a major no-no for a positive and mindful sex life.

Here's What All Women In Sexless Marriages Need To Know

Stuck in a sexless marriage? You’re not alone. According to data scientist Seth Stephens-Davidowitz, the top-searched marriage complaint on Google is “sexless marriage.” (What’s more, searches for “sexless marriage” are three and a half times more common than “unhappy marriage” and eight times more common than “loveless marriage.”)

Many of those searching for answers are women struggling to understand why their spouses aren’t reciprocating their desire for sex. We reached out to marriage therapists and sex experts to share the advice they give women stuck in sexually unsatisfying marriages. Read what they had to say below.
"Many women are the ones with a higher sex drive in their marriages but women commonly don't discuss this dynamic openly with friends. Also, the media portrayal of relationships makes women think that males have a constant high level of sexual desire. On the contrary, many women struggle in sexless marriages. Outside of therapy, I'd say that finding a support system can be invaluable. There are forums online where women share their experiences, such as the Dead Bedrooms forum on Reddit." -- Samantha Rodman, psychologist and couples' counselor "It may not be you, so stop beating yourself up. It is no indicator of how sexy you are as a woman if he is initiating or not. Many times men stop initiating sex because they are stressed or they are experiencing some kind of erectile dysfunction and they're too afraid to tell you. Men define their sexuality by their ability to perform and if they cannot achieve an erection upon demand they may withdraw. Keep being affectionate and let him know there is no pressure to get to the 'finish line.' Let him know you still want to cuddle and be close and then if you still want a 'happy ending,' well, frankly, you can take care of it yourself. If he wants to participate, he might find himself more turned on than he thought himself capable. Don't wait for him to take charge.

 It is OK as the woman to be the driving force of your sex life." -- Tammy Nelson, certified sexologist and sex therapist and the author of Getting the Sex You Want "Our libido often dips with age and in tandem with life stressors -- juggling multiple jobs, kids, family, home and self care. That said, if several months have passed with no sex and it's troubling you, the matter needs to be addressed. Sometimes, all you need to do is communicate. But there may be physical, psychological or marital issues that require work. If it turns out there is a physical issue -- your over-40 husband is having trouble maintaining erections, for instance -- a trip to the doctor can do wonders. But if the issue is decreased physical attraction, know that it usually has less to do with appearance and more to do with unexpressed and unresolved unhappiness in the relationship or marriage. If this is the case, you're in the right place: couples' counseling." -- Robert Weiss, LCSW, senior vice president of clinical development at Elements Behavioral Health"If he has erectile dysfunction or the inability to get or maintain an erection, he may have prostate issues and it is important to get that checked out right away. Have him schedule an appointment with a urologist. Rule out any health problems before you begin talking about what could be happening emotionally. When you have ruled out cancer, his testosterone levels have been checked, and you have had discussions around his stress levels, then you can look deeper into your relationship." -- Tammy Nelson "If your spouse is not willing to see a sex or relationship therapist (alone or with you), it's very telling. I recommend going to professional in almost all cases if either partner is still emotionally committed to their sexless marriage. But if your partner really doesn't give a damn about you or the marriage and the two of you are just co-existing, then you really need to think about what you want the rest of your life to be like." -- Pepper Schwartz, certified sexologist and the author of Prime: Adventures and Advice on Sex, Love, and the Sensual Years"The good news is that for most otherwise healthy (emotionally intimate) couples who are both willing to put in work, it’s relatively easy to spark a new fire. To start, a little romance never hurts. And yes, I am talking about toys, new positions, new places and unexpected romance within your relationship. Be intimate, share quiet moments where you simply look at each other, hold hands and talk about your feelings. Nothing, not even sex, is more intimate than having a compassionate partner who has your back. As for the sex itself, try mixing it up. Tell your spouse about your secret sexual fantasy, and ask if he or she is willing to try it. And then ask about your partner's secret fantasy and offer to indulge it." -- Robert Weiss

Hypnotism Isn’t the Only Way to Have a Hands-Free Orgasm

What do you mean, ‘hands-free’?
“Hands-free orgasms refer to any kind of orgasm that didn’t involve your own hands,” says certified sex coach Gigi Engle, Womanizer sexpert and the author of “All The F*cking Mistakes: A Guide to Sex, Love, and Life.”
It usually doesn’t refer to orgasms that came with the help of your partner’s hands, oral stimulation, or a hand-held toy.
But, she says, “If you consider it ‘hands-free,’ it is.”
After all, there’s no gatekeeper on orgasms and what qualifies as hands-on versus hands-off.

So, you just use other body parts instead?
That’s one option! But it can also (ahem) come from your partner’s other body parts.
Or any of these (among other) sextivities:
humping and grinding
vaginal or anal penetrative play (with anything other than a hand or finger)
wearable sex toys
dirty talk
orgasmic breathing or erotic hypnosis
Kegels and muscle clenching
What if you don’t really want to be physical?
“Some people can have not only hands-free orgasms, but touch-free orgasms,” says Searah Deysach, longtime sex educator and owner of Early to Bed.
If that sounds unfathomable, consider this:
“Orgasms happen in the brain before they happen in the genitals,” says Carol Queen, PhD, sexologist for Good Vibrations and curator of the Antique Vibrator Museum. “So, sometimes, orgasms happen just in the brain.”

Intrigued? Learn about orgasmic breathing and erotic hypnosis below.
Orgasmic breathing
Orgasmic breathing entails channeling your inner erotic energy.
“It’s similar to the deep diaphragmatic breathing used in some forms of meditation and yoga, and involves taking deep, intentional breaths,” Deysach explains.
Tantra expert and certified sexologist Barbara Carrellas made an MP3 you can buy that teaches you how to do it.
“While not everyone will find breath orgasms possible, even with practice, it is certainly worth giving a try,” Deysach says.
If you want to learn more about orgasmic breathing, Carrella’s book “Urban Tantra: Sacred Sex For the Twenty-First Century” is a good resource.
Erotic hypnosis “Erotic hypnosis is the practice of descending into your subconscious to the point where the entire outside world ceases to exist,” explains tantra expert Karen Botha with Sensual Massage in Romford, Essex.
“This allows you to explore your deepest fantasies and enjoy the physical effects of this on your body — without ever being touched,” she says.
Basically, it’s a guided meditation that helps you relax so much that you’re able to think your way into orgasm. Thrilling!
To try it, Engle says it’s as simple as Googling “erotic hypnosis” and following along with one of the videos.

The No BS Guide to Clitoral Stimulation

Tips for satisfying yourself with clit stim action
Knowledge is pleasure.
And if you have a clitoris, the more you know about it, the more options you’ll be able to explore en route to achieving satisfaction. (Or, if you’re aiming to please someone who has a clitoris, you can work with your partner to discover the techniques that take them to tingle town.)
We’ve reached out to experts and research to put together a guide for flying solo and giving or receiving some seriously satisfying clitoral stimulation. After all, getting busy with your own bod can help you chuck unwanted inhibitions.
Plus, find out the truth about clitoral anatomy. It’s more than just a tiny hotspot.
Throw out any taboos or guilt surrounding masturbation right now.
You won’t go blind. You won’t get addicted. And, no, it’s not cheating on a partner. It’s more than about feeling great, too.
Pleasuring yourself has health benefits that go beyond the body — it can help untangle shame that affects confidence with yourself, partnered sex, or in a relationship.
“It’s hard to know what to ask for from your partner if you don’t know what you like,” says Diana Sadat, a sex therapist and clinical counselor in Vancouver, British Columbia.
“Masturbation is a chance to explore what feels good. You may notice that stimulating in round patterns feels better than up and down, or that you enjoy stimulation using your inner labia over your clitoris rather than direct clitoral stimulation.”
Start out soft and slow and then apply more pressure or speed as your body asks for it.
A little teasing yourself can also amp up the pleasure and save on hand cramps. Begin, stop for a few seconds, and then delve back in. Repeat as necessary.
Positions and ways to stimulate your clitoris
1.“Aye, there’s the rub.” Use your hand, fingers, or a sex toy to slide up and down or back and forth across your clitoris and clitoral hood.
2.“Tap dance.” A gentle tapping motion on your clit and hood can help you slowly build to orgasm. Speed it up as you wish.
3.“Get in the grind.” No hands required, and no need to take off your clothes. (It can be better if you leave those jeans on!) Straddle a pillow and grind your pelvis to get yourself there.
4.“Peace pinch.” Use your first two fingers like a peace sign to softly pinch your clitoral hood and gently tug up and down, or slide your fingers in a back-and-forth motion.
5.“Orbit the planet.” Use your finger to trace slow circles around your clit and hood, touching your labia in the process.
6.“Fun zones.” Because of the unique shape of the clitoris, you may become aroused and even achieve orgasm by massaging other erogenous zones, on their own or along with the clitoris. Try your labia, vaginal opening, inner thigh, perineum, and anus. Lie on your belly and reach backward for easier access to everything, including the clit. This is also a great position to get your grind on while touching the rest of your sexy self.
7.“Penetration station.” The internal structures of the clitoris encircle the vaginal canal, so penetrating your vagina with your fingers or a sex toy can bring bliss. Combine with any of the above external stimulating techniques for a double delight.
8.“Good vibes.” You can use a vibrating sex toy to enhance or practice any method mentioned above. Vibrators can be especially good for those who need to put minimal movement on their hands or wrists. Use the lowest setting first and rev as desired.
Different techniques can elicit different types of pleasure, and how you go about stimulating yourself is completely up to you.
Sadat just has one universal tip: Give your bod a chance to warm up.
“It takes your clitoris some time to get aroused and for blood to begin to flow,” she explains. “So begin to stroke around your clitoris, touching your labia without directly going for the clit for a bit until you feel ready for that type of stimulation.”

 How do I stimulate my clit from the inside?
Before we go any further on this stimulating topic, we’ve got to debunk the inaccurate concept that the clitoris is just a mini, pea-sized version of the penis.
As reported by the Atlantic, the clitoris is actually shaped more like a wishbone.
But even that comparison doesn’t come close to celebrating its glory. The full anatomy of the clitoris looks like an upside-down flower with large petals extending inside the body that embrace the vaginal canal. It can even become erect when aroused.
So in that regard, don’t focus only on what you see and can touch externally. If we touched penises based on that mentioned myth, we’d only be touching the tip and missing out on bigger pleasures.
Is the G-spot really another C-spot?
That elusive ‘G-spot’ is not hiding inside the vagina like a secret unicorn.
Research indicates that it’s likely the place where your clitoris meets the anterior (front) vaginal wall. This is where the clit’s bulbs form a heart shape that hugs the canal.
So for people who have vaginas, the orgasm probably really is all about the clitoris, but we can stimulate it indirectly from inside the vagina, directly from outside the vagina, or both.
If you’re wondering how to find that spot internally without turn-by-turn directions from Siri, you’re not alone.
According to Our Bodies Ourselves, you should try reaching about a third of the way from the vaginal opening and playing with a mix of pressure and stimulation on the front (or upper) wall to see what feels good. It may take some practice and experimentation to locate.
Don’t get frustrated if vaginal penetration doesn’t make you come, even if you’ve found that extra sensitive internal trigger spot.
In a recent study on the female orgasm, only 18 percent of American women said that vaginal penetration alone could give them the big O. Other respondents in the study said they either needed direct clit stim (about 37 percent) to get them there, or that it greatly ramped up their climaxing pleasure (about 36 percent).

Re-cap: Clitoral anatomy 101
##Glans clitoris. This is the external nub we think of when picturing the clitoris. Even though it’s ‘the size of a pea,’ it holds thousands of nerve endings.
##Clitoral hood. We all like a good hoodie, and the clitoris is no different. The labia minora connect to form the clitoral hood. When you’re aroused, the hood retracts slightly to expose the glans. If you have a hooded clitoris, don’t worry, its normal.
##Clitoral body. The clitoral body is internal. It connects to the glans and is suspended from the pubic bone via a ligament.
##Corpora cavernosa. The clitoral body consists of two corpora cavernosa that become erect during arousal.
##Paired crura. The clitoral body branches off to form two appendages. These “legs” straddle the urethra and the vaginal canal and become engorged with blood when you’re turned on.
##Vestibular bulbs. The vestibular bulbs form an upside-down heart shape, with the urethra and the vaginal canal at the heart’s cleavage. The bulbs reach through and behind the labia, around the vaginal canal, and toward the anus. They also swell when you’re hot and bothered.
Knowing every part of your clitoris is kind of like putting together a unique outfit. Each of our bodies and the makeup below is different.
For some people, playing with the clitoral hood brings pleasure, while for others, the vestibular bulbs bring on all the sensation. You don’t have to address every part, just the ones that work for you.
And that may change as you age or explore, and it may be different when you’re with a new partner.

 Clitoral stimulation for a partner or with a partner
If you’re the clitoris owner, don’t be shy about letting on about your stimulation likes or dislikes. There’s also no shame in making all the contact you want with your own clit during a sexual encounter!
If you’re dating someone with a clitoris, don’t be afraid to ask about your partner’s desires too. Frame the question around how invested you are in discovering their pleasure points and taking the time to do so — without placing pressure on them to perform.
Experimenting (with consent), vocalizing (no, you don’t have to be a screamer unless you want to), and listening to desires are all equally important when it comes to having sex with someone.
That go-to spot that felt good last week? It may have moved two inches over to a new spot!
You just never know, and that’s why we’re giving out all the options on giving and receiving clitoral stimulation.
How to focus on the clitoris during partner play
1. Be handsy
Many penetrating positions (whether using a penis, hand, or toy) allow for either a partner’s hand, your own hand, or even both, to play with the clitoris and clitoral hood.
2. Pillow props
Grind your clit on an artfully placed pillow or bunched-up blankets while your partner penetrates your vagina with a penis, toy, or fingers from behind.
3. Furniture fun
Use the furniture for support, especially when you want to stimulate yourself with your hand during a from-behind penetration.
Kneel on a pillow on the floor and lean your bod against the mattress so you don’t have to balance with one arm. A headboard or sofa back work well too.
4. Ride and glide
Your partner’s pelvis is a great tool for clit stim. It can help if your bae is in a seated or slightly reclined position when you straddle them and slide up and down, rubbing your clit and hood on their pubic bone or belly.
For added oomph, you or your partner can place a lubed-up finger or thumb beneath the clit. Vaginal penetration with a penis or toy is optional but can heighten the fun.
5. Reverse the ride
The reverse cowgirl position has you straddling your partner, facing away from them. If you and your partner both have a clitoris, slide several pillows under your partner’s pelvis to do the ride and glide in reverse while also tilting their clit toward you for easy hand or even oral access.
If your partner has a penis, opt for vaginal penetration. Your partner can also reach a hand around and stimulate your clit, or you can do it the way you like best.
6. Thigh high
This is a twist on the reverse cowgirl position. Instead of straddling both your partner’s legs, straddle just one.
Your partner should bend their knee so you can ride up and down the thigh. Vaginal penetration with a penis, hands, or toy works well here.
7. Tongue twister
Try oral action, with the tongue gently circling the clitoris and hood with a mix of pressure.

 A pleasurable work in progress
If a certain technique doesn’t get your headspace on cloud nine, alone or with a bed mate, don’t stress.
Clitoral stimulation isn’t a one-size-fits-all ritual. Mix it up until you find the position, pressure, and rhythm that feels good to you.

Playtime possibilities
##Switch the direction of your rub.
##Add or subtract pressure.
##Alter or mix techniques.
##Speed or slow the rhythm.
##Change the number of fingers.
##Add or change toys.
##Switch between external stim and vaginal penetration.
Keep in mind that we’ve only had 3-D imagery of the full clitoral structure for about a decade when researchers finally produced a sonography of it. That means before 2008, not much was understood about the clit’s really cool internal parts and how they interact with the rest of the genital area.
And we’ve still got a lot to learn about it.
Scientific research may lag behind on studying the clit, but that’s all the more reason for you to do your own independent (or partnered) study on what gets you off!

G-Spot Discovered? Not So Fast!

The press release proclaims “Study Confirms Anatomic Existence of G-Spot.” The study itself is titled “G-Spot Anatomy: A New Discovery.”  It was just published in The Journal of Sexual Medicine.  The author, Adam Ostrzenski, is an “internationally renowned gynecologic surgeon” with multiple degrees (MD, PhD, Dr Hab) and many peer-reviewed articles listed in PubMed.
The G-spot, or Gräfenberg Spot, is an area on the anterior wall of the vagina that can be stimulated to produce sexual excitement, stronger orgasms, and maybe even female ejaculation. Its existence is questionable. Wikpedia has an extensive article explaining the controversy and the published evidence, pro and con, with links to the original sources. You can read more than you ever wanted to know about it there, so I won’t bother trying to repeat it here. A 2012 review of the G-spot literature concluded: 
“
Objective measures have failed to provide strong and consistent evidence for the existence of an anatomical site that could be related to the famed G-spot. However, reliable reports and anecdotal testimonials of the existence of a highly sensitive area in the distal anterior vaginal wall raise the question of whether enough investigative modalities have been implemented in the search of the G-spot.
Dr. Ostrzenski claims to have found the G-spot and taken its picture (above). Believers in Bigfoot and the Loch Ness monster have pictures too. They even had “Bigfoot hair” that later turned out to be synthetic wig fibers. Ostrzenski’s “proof” is no more credible than theirs.
 
The Study
This “discovery” was based on dissecting out the pictured structure in the cadaver of one (yes, only one !) 83 year old woman who died of head trauma. The dissection was performed in Warsaw, Poland, but I will scrupulously refrain from making any Polish jokes. The author declared it was a G-spot based on visual inspection of the specimen alone; he said it was an 8.1 mm sac-like structure with a head, body, and a rope-like tail that disappeared into surrounding tissues. After excision, it could be stretched to 33 mm.  He said the walls of the structure “resembled fibroconnective tissues and resembled erectile tissues.” Both? Apparently he didn’t even bother to take the most obvious, rudimentary next step of examining slices of the specimen under a microscope (with appropriate staining) to determine what kind of tissue it was.  One wonders if he even preserved the specimen in formalin so histological study might still be possible.  And he doesn’t tell us whether he had tried to find it in other cadavers and failed before this “success.”
Visual inspection of one autopsy specimen? How could he possibly know what it was that he had found? Is this a G-spot structure or something else? During embryological development of the genitourinary system there are structures that form and are reabsorbed: could this be a left-over remnant of that process? Could it be a tumor? A variant of normal anatomy having nothing to do with sexual response? Something else? Why didn’t he look for it in a second autopsy (or, preferably, a whole series) before rushing into print? And even if he could document the existence of a never-before-described anatomical feature, wouldn’t it take something more than simple observation to determine that it was the G-spot?
A Big Oops
In the discussion section of his article, Ostrzenski makes an embarrassing mistake: he claims that the G-spot gene has been identified and has been already incorporated into a GeneChip microarray. That struck me as odd. How could they have identified a gene for a structure whose very existence was in doubt?
The reference Ostrzenski provides for this claim doesn’t support it.  In that reference, G-spot does not mean what he thinks it means. By “G-spot” they don’t mean anything to do with vaginal anatomy: they mean DNA probes containing a contiguous run of 4 or more guanines (base pair nucleotides). They make that clear in the second sentence of the abstract. He read carelessly, and his foolish mistake should have been caught by his editors and peer-reviewers. If I thought to question it and look it up, why didn’t they?
Even If It Isn’t Real, It’s Profitable
Whether or not the G-spot exists, you can buy a sex toy, a curved vibrator, specially designed to stimulate it. And there is even a plastic surgery procedure called G-spot amplification to enhance its sensitivity. The ACOG has spoken out against this operation.  Guess who performs and teaches this surgical procedure, along with a number of other questionable vaginal procedures?
Yep, Ostrzenski himself.
The Hype Begins
CBC News, Science Daily and other news outlets promptly proclaimed “G spot anatomy found.” The very day this study was released, I got a PR e-mail announcing it, proclaiming that the existence of the G-spot had been proven, and offering me an interview with a doctor who would explain “how the discovery of the G-spot will change sex for men and women.” A doctor who, incidentally, does not inspire my confidence because she also happens to prescribe bioidentical hormones and practice anti-aging medicine. The Huffington Post wasn’t so sure this study would settle the debate but commented that
“
perhaps knowing it and understanding it goes beyond anything you can dissect or measure. It’s an untouchable pathway to bliss and the cosmos, making it something so much more.
Conclusion
In short, this published study is a junk-science travesty perpetrated by a researcher who has a vested interest in proving there is a G-spot so he can justify operating on it. No one deserving the name of scientist would claim to have discovered a new normal anatomical structure based on a visual inspection of one specimen with no further investigation. The author, the editor of the journal, and the peer-reviewers should all be ashamed of themselves.
Further Thoughts
In contrast to the vaccine/autism manufactroversy, there is a legitimate controversy about the existence of the G-Spot. We don’t have enough evidence to confidently conclude either that it does or doesn’t exist. At this point, I wouldn’t even venture an opinion.
I would argue that it really doesn’t matter very much. Clearly, some women respond to anterior vaginal stimulation, others don’t. This might have other explanations: conditioning, suggestion, experience, variations during embryologic development, the ability of any highly innervated area to trigger orgasm in some individuals, or other factors.
Women might think not being able to find their G-Spot means they are defective. Pursuing the elusive G-Spot might engage men in fruitless hunting expeditions when they could be finding other ways to please their partners and concentrating on spontaneous enjoyment rather than prescribed techniques.

Orgasmatron inventor seeks female volunteers

Women who cannot have orgasms can now have a device implanted in their spines that will trigger the sensation for them. Clinical trials of the “orgasmatron” have begun in the US, with the approval of the Food and Drug Administration.
The device was the focus of massive media attention two years ago, after New Scientist broke the news of its existence and used the term orgasmatron to describe it.
But despite all the coverage, few people are volunteering for the trial. “I thought people would be beating my door down to become part of the trial,” says Stuart Meloy, the surgeon who patented the treatment. “But so far I am struggling to find people.”
That does not surprise some experts, who think an implant is too radical a treatment for sexual problems. “Why would you do it invasively if you can do it with a vibrator?” asks Marca Sipski of the University of Miami, who studies sexual function in women with spinal cord injuries.

Only one woman has completed the first stage of the trial, and one other is now being signed up. Meloy hopes to find eight more to complete the first stage of the study, in which wires connected to a battery pack are inserted through the skin and into the woman’s spinal cord.

Remote control

The procedure is no riskier than an epidural, Meloy says. But epidurals can cause complications such as backache in up to a fifth of women. In the second stage, a self-contained device resembling a pacemaker will be implanted beneath the skin, switched on and off with a remote control.
Meloy, a pain specialist at Piedmont Anesthesia and Pain Consultants in Winston-Salem, North Carolina, stumbled on the idea while performing a routine pain-relief operation on a woman. During this procedure, two electrodes are inserted in the patient’s spine and tiny pulses of electricity are applied.
Patients are kept conscious throughout the operation so that they can say when they feel less pain. During one such operation, the patient began exclaiming emphatically. When Meloy asked what was up, she said, “You’re going to have to teach my husband to do that.”

This effect was already familiar to many surgeons performing such operations, but Meloy patented the idea of using it to treat sexual dysfunction. He tried to sell his idea to a company called Medtronic, but when the company lost interest he decided to go it alone. He expects a full implant to cost around $13,000.

“Excellent foreplay”

In October, he implanted wires in a married woman who responded to his call for volunteers in the local media. “When the device was switched on, the patient reported being almost instantly aroused. She described it as ‘really excellent foreplay’,” says Meloy.
The woman, who had not had an orgasm for four years, wore the device for nine days and had sex with her husband on seven occasions. Meloy says she had an orgasm every time. “She even told me she had the first multiple orgasm of her life using the device,” he says.
But Sipski thinks that as long as the required nerves in the body are intact, using a vibrator should work just as well. “My research shows that orgasm is a purely reflex response. Even the sensation associated with orgasm does not require the brain. Women with complete injuries to the spine can still experience orgasm.”
Paula Hall, a sex therapist with the UK counselling service Relate, says that most cases of sexual dysfunction are caused by psychological factors. “Lack of self-awareness and not experimenting enough are the most common reasons,” she says. “In situations where all else has failed, some people might consider surgery, but I don’t think having an operation is going to catch on.”
But Meloy is confident that it will. “I don’t see it any differently from procedures such as breast implants,” he says.

The female orgasm: brought to you by natural selection?

Women orgasm more readily during sex with a handsome partner, a study of heterosexual couples has found, with researchers concluding the female orgasm may be linked to an evolutionary urge to produce ‘quality’ offspring.
However, other experts in the field say that the jury is still out on the evolutionary function of the female orgasm.
In a joint study by anthropologists and psychologists at Pennsylvania State University, 110 heterosexual couples were asked to report details about their sex lives, who orgasmed and how often.
The male subjects also had details recorded about facial symmetry and masculinity, in an effort to determine their attractiveness.
Women with partners who rated high on the handsome scale reported orgasming more frequently than their less fortunate sisters.
“We found that objective measures of the quality of women’s mates — men’s attractiveness and masculinity — significantly predicted the women’s orgasms,” the researchers wrote in their paper, which was published in the journal Evolution and Human Behavior..
Assuming that female orgasm aids in conception, the researchers concluded that women may have evolved to orgasm more readily with attractive partners so as to pass on their healthy genes to offspring.

“Thus, possible conception-promoting correlates of female orgasm may be especially effective and/or likely when copulation occurs with masculine males,” the authors wrote.
Brendan Zietsch, a Postdoctoral Research Fellow at University of Queensland who has researched the female orgasm, said the study provided strong evidence that sexy men were more likely to produce orgasms in their female mates – but that this was not necessarily linked to natural selection.
“I do not find it compelling support for this evolutionary function of female orgasm. I would guess that men also orgasm more readily having intercourse with an especially sexy woman, but few would argue that this indicates that the function of male orgasm is to choose the best mate,” he said.
“My point is that arousal being related to both partner sexiness and orgasm frequency is compatible with numerous possible evolutionary explanations of female orgasm.”
He pointed out that the study also found no link between frequency of female orgasm and the man’s facial structure in cases of non-reproductive sex – such as orgasm during foreplay – but that this may be because more masculine, dominant men might spend less time on non-coital sex than other men.
“I think we are a long way from understanding the evolutionary function of female orgasm, if indeed it has a function,” he said.
Dr Maciej Henneberg, Professor of Anthropological and Comparative Anatomy at the University of Adelaide and an expert on evolution, said the study relied too heavily on self-reporting.
“The authors’ own findings are that only about half of women (52%) experience coital orgasm. This means it is not a constant feature. Their measures of "genetic quality” of males are purely speculative (appearance, facial asymmetry),“ he said, pointing out that the study may have underestimated other features women may find attractive in men, such as their social or psychological qualities.
One cannot assume that function of female orgasm is to aid conception nor place too much emphasis on the idea that the human libido is driven by the urge to procreate, he said.
"Most of human sexual intercourse is for reasons unrelated to fertility. Moreover, the ability to conceive in humans is low. It takes a persistent copulation every other day for three months to achieve conception, on the average.”
“All this leads to the conclusion that humans use sexual intercourse for bonding and pleasure, rarely for conception,” said Dr Henneberg.
“We are unusual amongst animals in this respect. Only dolphins, pygmy chimpanzees and maybe chimpanzees use sex for social contacts. Other mammals copulate only when a female is fecund (can conceive) and the intercourse takes a short time. We can do it for hours!”

Female orgasm: why O why?

Why do women have orgasms? That may seem like a strange question, but it’s one which has perplexed scientists for decades and provoked fiery academic debates along the way.
The real question is: what is the evolutionary function of the female orgasm? In men, orgasms have a fairly obvious evolutionary explanation, since they are tied to ejaculation. For women, it’s unclear what function they serve.
Most animal species don’t show any evidence of a female orgasm, although some do (certain monkeys and apes, for example).
As with many unsolved mysteries, plenty of theories have been put forward – some with evidence, some without.
Give it to me
One of the earliest theories – “pair bonding” – suggested female orgasms helped couples remain together. Children require a great deal of care, and so women who stayed “bonded” to a man long enough to have him provide care and resources for her child would have been at an evolutionary advantage.
The pair bonding theory of women’s orgasm is based on oxytocin (the brain’s love drug) being released in the brain during orgasm. Oxytocin increases feeling of tenderness and togetherness with a sexual partner, supposedly to the benefit of the woman’s child and the propagation of her genes into future generations.
Another explanation is the evocatively-named “upsuck theory”. This suggests that, when a woman orgasms, negative pressure is created in her uterus and this sucks sperm up into it, presumably aiding transmission to the egg. So under this theory, a woman’s orgasm serves to improve her fertility.
One clear problem with upsuck theory is that no-one has demonstrated any link between a woman’s “orgasmability” and her fertility. Also, the studies have substantial flaws – one, for example, was based mainly on data from one female.
Another problem with both of these theories is that not all women have orgasms. Some 13% of sexually active women have never had an orgasm in their life, and for another 22% of women they’re a very rare occurrence during sex with a partner (these women tend to be more successful going solo).
It’s just not working
If having orgasms during sex improved women’s pair bonding and/or fertility throughout evolution then, in theory, women who can’t have orgasms should be very rare (as is the case with men who can’t have orgasms).
Also, in a recent study of around 3,000 female twins, I found that women’s orgasmability was unrelated to whether they tended to have (or prefer) long-lasting relationships or many short-term casual relationships.
This would seem to contradict the pair-bonding theory. One could perhaps make a counter-argument that modern women’s orgasmability is disrupted by anxiety stemming from sexually restrictive societal values, such as certain religious ideas that sex should only be done within marriage and only for the purpose of having children.

But my study also found no correlation between orgasmability and neuroticism – that is, a predisposition to anxiety – nor with a woman holding sexually-restrictive values. Thus, it seems unlikely that society is to blame for women’s unreliable orgasms.
More, please
Another evolutionary theory holds the unreliability of women’s orgasms is central to their function. Under this theory, a woman’s orgasm tends only to happen with a high-quality partner (physicaly attractive, healthy, intelligent, attentive), allowing orgasm to serve as a mate selection tool.
The orgasm may motivate them to continue having sex with the high-quality partner, or perhaps make sure the sperm of the high quality partner is well “sucked up”.
Recent evidence suggests that women whose partners have more masculine faces (e.g. heavier and squarer jaw, heavier brow) are more likely to orgasm during sex. In that sense, a masculine face is thought to be associated with health and “good genetic quality”.
This theory has trouble explaining the many women who never orgasm during sex and the 20% of women who always, or almost always orgasm during sex (including those who are single and have had more than five different partners).
An intermediate rate (orgasming 40-60% of the time during sex) seems like it should be the best at discriminating between different quality partners, but this is actually the least common rate of orgasm reported. This poses a problem for the mate selection theory of female orgasm.
Oh, what’s the point?
One widely-held theory proposes that women’s orgasms serve no evolutionary function at all. The “byproduct theory” holds that female orgasms are an accident of the evolutionary, developmental and physiological processes that generate the functionally-important male orgasm.
In other words, women have orgasms because men do.
If that sounds like evolution being sexist, then think about male nipples – men have non-functional nipples purely because nipples are functional in women.
Despite decades of theoretical debate and a number of recent empirical studies, we still don’t know the evolutionary function of women’s orgasms, or if they have a function at all.
But rather than simply shrugging and rolling over to sleep, we scientists are collecting more data and thinking of new ways of investigating the mysterious female orgasm.

Condom fun and games

Dear Alice,
I am a peer health educator at Texas Tech University and I am putting together a health fair on condom usage for students. The "Condom Olympics" will be held in a dorm. I was wondering if you had any suggestions for information my group could use or any suggestions on games that we could play to teach people how to use condoms correctly.

Dear Reader,
Bravo to you and your colleagues for taking the initiative to educate your peers on this critical topic! Both internal and external condoms are effective at protecting against unintended pregnancy and sexually transmitted infections (STIs) when used correctly. Not knowing how to use condoms correctly, missing key steps(s) when using, or not using them at all (also referred to as human error) can increase the rates of condom failure; as such, demos on how to slide into (and out of) condoms are incredibly valuable. With the goal of teaching people how and why to use condoms correctly, it’ll be good to also cover information on related factors such as condom material, type, and safety. Here’s to helping students go for the gold… standard of condom use!
First, it’s helpful to consider your cast of condoms; spotlighting both internal and external condoms, different brands, sizes, textures, colors, tastes, and lubricated versus non-lubricated will make your presentation more meaningful and engaging. It’s possible that some people have never seen, held, or smelled a condom, so pass the little buggers around to let everyone become familiar with them. Because there are folks who are allergic to latex, be sure to highlight condoms made from a variety of materials to ensure everyone’s safety. For more information on what kinds of condoms to get, check out Time to go condom shopping! Brand, sizes, textures — what to buy? in the Go Ask Alice! archives.

Demonstrating the surprising strength and elasticity of condoms is not only fun, but another great way to illustrate why condoms are so effective as a method of preventing pregnancy and most STIs. For external condoms, instruct your audience to pinch about half-an-inch at the tip to prevent an air bubble and allow ejaculate a place to go, roll one over a fist and down an arm, down an upside down baseball bat (on the girthy end), or onto an obviously phallic shampoo container or water bottle. And depending on who’s in the room (and what you’re allowed to present), you might consider whipping out a dildo for a more realistic lesson.
Once you’ve covered the various options and condom traits, you can instruct present and future condom wearers of the world how to put 'em on and keep 'em on. To demonstrate proper use of internal condoms, a fun activity could be to gather a variety of water bottles or cups of various lengths and circumferences, and teach your participants how to insert the condom. Then, attendees can use any condom-less phallic objects and guide them into the internal condom. It’s crucial that you emphasize participants use only one condom at a time (i.e., no double-layering of condoms, and no mixing of internal and external condoms). For an added fun challenge, you can even squirt some liquid or jelly-like substance (such as lube) that resembles semen into the condom and have participants try to remove the condom without any spillage or leakage. During this time, remind participants to twist the outer ring of the condom to create a little pouch that will hold the semen substitute, before gently tugging at the condom for removal.
As you facilitate these activities, a few helpful pointers to share with your guests along the way include:
•Use a new condom for each partner and each sexual act.
•It’s recommended that external condoms are put on erect, or somewhat erect, penises.
•For added comfort and ease, consider squatting before inserting internal condoms.
•Use external condoms on sex toys to reduce transmission of dirt or microorganisms.
•Keep condoms in places that are room temperature, as opposed to warmer climates which can melt the condoms or change the chemical composition, thereby making them less effective.
•Discard condoms in the trash and not in the toilet.
Lastly, if you really want to wow them, consider demonstrating how to turn any type of condom into a dental dam for added protection against STIs during oral sex. This is done by unrolling a condom, trimming off the tip and elastic ring (or removing the inner ring within an internal condom), and cutting along the length with a pair of clean scissors. The condom then opens into a rectangle and can be placed over clitorises and anuses during oral sex. Stepping it up a notch, folks may even choose to use flavored condoms (or plain condoms with flavored lube) and do a taste test to guess the flavor! Who would’ve thought that condoms could be so much fun? For more help planning your event and additional tips, you can reach out to a health promotion specialist on your campus.

An explanation of contraceptive failure rates

Dear Alice,
When people say that contraceptives, like condoms, have a twelve percent failure rate, do they mean that they result in pregnancy in twelve out of every 100 women who use them? I hope that means that twelve percent of people who use them become pregnant in a year, or something like that. Otherwise, it sounds as risky as Russian roulette to rely on condoms.

Dear Reader,
You’ve got it, partly — a contraceptive method’s effectiveness is measured by its pregnancy prevention rate, but condoms aren't a risky gamble by any means. The effectiveness of contraceptives depends heavily on how consistently and correctly people use them. During a year of typical external (male) condom use, about 13 to 18 out of 100 sexually active people become pregnant. During a year of perfect condom use, that number drops to about two out of 100. As for the internal (female) condom, about 21 percent (typical use) and five percent (perfect use) of people who use this type of condom experience an unintended pregnancy within the first year of use. So, the more consistently and correctly condoms are used, the more effective they are — that’s why it’s helpful to practice using them. Each type of contraceptive has its own rate for perfect use and typical use. Knowing this information, as well as what makes that contraceptive more or less effective, can help determine what the most appropriate form is for that person and their partner(s).

Here's the difference between perfect use and typical use of contraceptives: Perfect use means using the contraceptive during sex consistently and correctly every single time, and reflects the effectiveness of the contraceptive itself. For example, perfect use of condoms means using them correctly every single time during sex. Typical use gets at the reality that people may use contraceptives incorrectly or may not use them every single time they have sex. That is, the typical use effectiveness rates include the possibility of human error (such as using a condom that's the incorrect size, using an expired condom, or improperly securing the internal ring with an internal condom) or omission among those who report using condoms. For example, a self-reported condom user could take a condom off too early while having sex. It follows that typical use contraceptive effectiveness is lower than perfect use — if someone uses a condom nine out of ten times they have sex, then there’s a higher chance of pregnancy than if they use a condom 100 percent of the time.
On the subject of effectiveness, it’s also helpful to note that condoms are also highly effective in preventing transmission of HIV and a number of other sexually transmitted infections (STIs). The Centers for Disease Control and Prevention (CDC) estimates that external condom use reduces the chance of getting HIV by 63 percent to 80 percent, depending on sex assigned at birth and type of sexual activity. Condoms also reduce the risk of other STIs, but their exact effectiveness also depends on a number of demographic, behavioral, and other factors.
You and your partner(s) can also use other methods of birth control in conjunction with condoms, as well as have emergency contraception on hand so that it can be taken as soon as possible in the case that it's needed. This can help decrease the risk of pregnancy and can address the human error that may occur with condom use. To make the best use of condoms, practice using them! You or your partner(s) may also want to try using condoms during (mutual or solo) masturbation — there may be less pressure and anxiety than during sex, so it might be easier to get the hang of the steps. Relying on condoms to prevent pregnancy or STIs is the opposite of risky — they’re one of the safest bets to make!
Hope this helps,

Tongkat Ali — Safe aphrodisiac for men?

Dear Reader,
Looks like you’ve been rooting around for some in-tree-guing herbal supplements. Tongkat Ali comes from a shrub tree in the Southeast Asian rainforests, but it's not widely available as a pill or an instant coffee additive. It was historically used to treat health problems ranging from fevers to intestinal worms but is most popularly known as an aphrodisiac for men. A quick note on gender: the studies on Tongkat Ali used the terms men and women, but didn't indicate whether their participants identify as cisgender. Also known as Eurycoma Longifolia (EL), it hasn’t shown any severe health consequences in experiments conducted with rats. Additionally, it hasn't yet been tested extensively in humans. Dietary supplements aren't subject to approval from the Food and Drug Administration, which means there is less oversight of the product. Thus, it's best to give careful consideration when using this product, while also consulting with a health care provider. If you do decide it's an appropriate choice for you, they can help you find the appropriate dosage.
What research can tell us about this supplement is primarily derived from studies in rats. In one study, rats given various doses of Tongkat Ali were found to have increased sexual activity and greater sperm quality. Bigger effects were seen at higher doses, and doses ranged from 30 to 150 milligrams of drug per one kilogram of body weight (mg/kg). In another experiment with rats, administering doses of 1,200 to 2,400 mg/kg caused some liver damage in a few test subjects but didn’t otherwise harm them. While there aren’t studies of long-term use in animals or humans (including studies in women), researchers suggested further investigation of the impacts on the liver as well as research into sustained use.

While there are a number of anecdotal claims that Tongkat Ali has helped with libido (sexual desire), testosterone levels, fertility, and sexual performance, research cannot confirm any of the claims due to the lack of evidence at this point in time. There have been some limited studies on Tongkat Ali’s effects on humans, and they may point to an increased sexual desire and sperm count, but there hasn't been enough definitive evidence to say for sure. Additionally, some studies have shown the supplement to have some positive effects on erectile dysfunction. However, the results are mixed, and thus, inconclusive. Claims that the plant increases testosterone and helps build muscle mass are also unconfirmed. Until more research is done on humans, it’s best to proceed with caution if you're considering using Tongkat Ali. If you're looking to learn more about increasing sexual desire and performance, be sure to check out the Sexual Questions category of the Go Ask Alice! Sexual & Reproductive Health archives, as well as the related Q&As. 
Wishing you safe and pleasurable experiences!

Can't ejaculate

Dear Troubled Spikey One and Frustrated,
You both seem to be experiencing a similar scenario, but each of you “cums” from a different perspective — one of you is troubled by a difficulty to ejaculate with your partner, and one of you is frustrated by your partner’s difficulty to ejaculate with you. Clearly, you're not alone in your concerns! That being said, there may be a number of approaches that can be taken to bring ejaculation back into your sexual activities, depending on the reason for the problems.
When it takes a very long period of sexual stimulation for someone with a penis to ejaculate, this is called delayed ejaculation (DE). This may look like 30 to 45 minutes of sexual activity before the individual ejaculates, and sometimes they may find themselves unable to do so. Folks who can't ejaculate at all may be experiencing anejaculation.
There are a number of possible causes for DE. Troubled Spikey One, you're right in suggesting that there could be a psychological element, but there are also a number of other physical and external contributors to consider when trying to get to the bottom of your or your partner’s DE.
Some of the non-physical causes include:

•Conditioning to a certain sensation through masturbation
•Mental health conditions, such as depression or anxiety
•Relationship stress or poor communication with partner
•Performance anxiety
•Low self-esteem or negative body image
•Cultural or religious pressure/expectations
•Difference between sexual expectations and reality
Trouble ejaculating may also be due to certain types of medications or substances, such as:
•Certain antidepressants
•Some medications for high blood pressure
•Some diuretics
•Certain anti-psychotic medications
•Certain anti-seizure medicine
•Alcohol (drinking excessively or alcoholism)
Finally, there are a number of physical causes that may cause someone to have trouble ejaculating:
•Older age
•Birth defects that affect the reproductive system
•Injury to the pelvic nerves that control orgasm
•Infections
•Prostate surgery
•Neurological diseases
•Hormonal conditions such as hypogonadism or hypothyroidism
•Retrograde ejaculation, in which the semen goes into the bladder instead of out through the urethra
Lists adapted from Mayo Clinic.
Speaking with a health care provider about these potential causes may help highlight the cause of the DE.
Both of you mention struggling with DE in your current relationships, so it might be worth examining the communication between you and your partners, inside and outside the bedroom. Do either of you have a fantasy you would like to explore? Have you shown each other the way you like to be touched? Is there tension or stress coming from other areas of your relationship that might be affecting you? Sometimes sex can be a space of expectations and pressure to perform; try letting go of the idea of how things “should” go and just exploring what you both enjoy. Additionally, have you tried incorporating sexual activities in which ejaculation or orgasm aren't the goal? This may be a time for you to explore your sexuality with your respective partners without adding pressure to ejaculate. You can check out the Sexual Variety category of the Go Ask Alice! Sexual & Reproductive Health archives for some more ideas. As long as they're consensual, there are no rules about when, how, or in what order you may find your sexual activities to be most enjoyable!