REBECCA B. SINGSON, MD, FPOGS, FACS, FPSCPC

1. Men need to be wound up and excited during sex for them to achieve orgasm while women need to be relaxed with their partners to enjoy sex and reach peak pleasure.
2. A man’s pleasure in sex is in the release of tension. He can go from foreplay to orgasm within 2 minutes. In contrast, a woman’s pleasure is in the gradual build-up of sexual tension and in fact, generally needs at least 20 mins. of foreplay before being ready for actual intercourse. She is like an oven than needs pre-heating. This is where a lot of men fall short. They think when they’re ready, their partner is ready. Unless the woman is dripping with lubrication, don’t attempt at intercourse because it’s a sign that her body in not ready. Doing so prematurely can lead to pain and laceration.
3. There is an important purpose for this prolonged foreplay for women. There are 4 phases of the Human Sexual Response: the Excitement Phase, the Plateau Phase, the Orgasmic Phase and Resolution Phase. Excitement Phase is the phase of seduction which leads to the congestion of the organs. It takes around 20 mins. to get from Excitement Phase to Plateau Phase at which time the lower part of the vagina engorges to create friction (resulting in increased pleasure for the man), as well as for the vagina to lengthen. Vaginal lengthening is essential prior to intercourse because if the man starts thrusting before his partner’s vaginal canal has lengthened, he can induce a laceration at the end of the vagina and cause massive bleeding which has resulted at times in an emergency situation requiring suturing. (In my practice of 20 years, I have seen and managed 4 cases).
4. Effective foreplay begins in the brain before you even touch each other’s bodies. Sexual turn ons for the woman: giving flowers, holding her hand, hugging her, complimenting her and her looks with big words like, “You are extremely irresistible”, “Your lips are so luscious”, “I’ve never met a sexier woman”. For the man, it’s rubbing his ego, allowing him his space, complimenting him on how good he is at turning you on. A sure turn off for a lot of men would be to choreograph his moves and be judgmental of him.
5. Generally, a man’s satisfaction in sex relies in his ability to please his woman. A woman’s satisfaction in sex is in how well a man pleasures her. Or course, there are variants and extremes depending on how selfish or egoistic a person is.
6. Orgasm for women is the release of sexual tension involving a response of all the muscles surrounding the vagina, anus and the uterus, contracting and repeating at 0.8 second intervals. The actual number and intensity of contractions varies from one woman to another but the important thing to remember is that the intensity of orgasm depends on the length of the Excitement Phase. That’s why it’s so important to spend a lot of time in foreplay because the longer and more excited you get your female partner to be, the more intense and pleasurable her orgasm will be.
7. Orgasm is controlled by the sympathetic portion of the nervous system. This means that if you take some drugs like antihypertensives , or a big dose of alcohol which affect the sympathetic portion of the nervous system, it may interfere with your ability to achieve orgasm.
   It had long been known that the center for orgasm of women was the clitoris until Grafenberg described the G-spot, which can be located this way: with the woman lying on her back, if her partner inserts a finger in the vagina with the palm facing the ceiling, on the anterior wall of the vagina within an inch from the opening, you can feel a 1×1 cm rough ridge, which when stimulated gives the woman the sensation she wants to pee. When stimulated rapidly alternating with or without clitoral stimulation, it can lead to an intense orgasm.
8. At the height of orgasm, some women release ejaculatory fluid from the urethra akin to the male prostatic fluid. It can be a generous amount and so may lead the woman and her partner to think she may have urinated. But in the absence of the smell of urine, this has got to be ejaculatory fluid.
9. After an orgasm, women generally have no refractory period before reaching their next orgasm. Thus women can be multi-orgasmic. The men, in contrast, have a refractory period and need a period of time before achieving their next orgasm.
10. Sexual satisfaction is one of the most important human experiences. However, as much as 50% of all married couples experience some sexual dissatisfaction, yet rate themselves to be happily married. This implies that sexual satisfaction not a necessary component to a happy marriage.

For women in menopause, hormone replacement therapy may greatly enhance a woman’s libido, promote vagina lubrication and prevent the vaginal atrophy that happens with the drop of estrogen. The thinning out of the vaginal walls results in dyspareunia or painful intercourse. This can be reversed with estrogen replacement which may be given Italy, transdermally or transvaginally.

Aside from hormones, vagina lasers administered intravaginally once a month for three months of the year can also promote vaginal lubrication and thickening, enhancing sexual satisfaction, removing the pain with intercourses, tightening the vagina after childbirth, and reversing mild to moderate incontinence (involuntary passing of urine when you cough or sneeze after childbirth.