Sex: The ups and downs

By Dr. Sharmila Samaranayake

Sexuality is the biologic force that is necessary for the procreation of the human race. Sex can bring pleasure or pain, happiness or despair. Sexual stimulation is a combination of both mental and physical pleasure.

The male sex organs are the penis and testis which are situated outside the body. The penis once stimulated hardens and gets erect. During this stage the average penis becomes 8 -12 cm. This happens when the blood flow increases to the penis. The urethra which runs inside passes urine from the bladder to the outside and also serves as a passageway for sperm (male reproductive cells). The sperms are ejected from the penis at orgasm – the peak of sexual response.

In the female, the sex organs are situated mostly inside the body. They are the vulva, vagina, 2 ovaries, tubes and the uterus. The vulva is mostly covered with pubic hair. The clitoris is a bud like projection and is the female equivalent of the penis. The vagina is a muscular tube which extends inwards. It is also known as the birth canal.

Who is a virgin?

A person who has not experienced sexual intercourse is a virgin, the term usually referring to a female. Those days virginity was considered of utmost importance and bleeding at first intercourse was considered a proof of virginity. But some females have stretchable hymens which do not break at intercourse. If the hymen has been torn by fingers, tampons or exercise and strenuous sports, bleeding will not occur. Therefore this test of virginity is proven wrong. Around 25% of virgins do not bleed at their first intercourse.

What is orgasm?

It is the climax or the peak of sexual satisfaction. It is an automatic reflex. In the male it is usually associated with ejaculation, the expulsion of semen. In a female the degree of satisfaction can vary. Some can have more than one orgasm, while some do not have any. If both partners are happy and lead satisfactory sex lives then it should not be a problem. Self stimulation to gain an orgasm is called masturbation. This is not considered abnormal unless it becomes an obsession.

Common sexual problems in men

Erectile dysfunction

Erectile dysfunction (ED) is the inability to attain and maintain an erection which is sufficient for satisfactory sexual performance. This problem can have a significant impact on the person and the partner. It is the commonest male sexual disorder.

Common causes for ED are diabetes, high blood pressure, and chronic illnesses like chronic kidney failure, neurological problems and psychiatric illnesses like depression. Sometimes psychological factors may be the cause. Drugs which may cause erectile dysfunction include some antidepressants, sedatives, some anti - fungals like ketoconazole etc. Trauma and certain cancers of the bladder and prostate can also lead to this condition. Obesity, smoking, high cholesterol levels in the blood, high blood pressure and lack of exercise are some risk factors which are associated with erectile dysfunction.

If you are suffering from erectile dysfunction it is best to discuss it with your family physician. Underlying causes like diabetes, hypertension must be checked and treatment can be started. It is important to quit smoking, reduce weight if you are obese and engage in physical activities.

Sildenefil, commonly known as Viagra is a drug which can be used successfully. This should be prescribed by a qualified doctor. If you are on warfarine or nitrates do not use it. Other methods of management of erectile dysfunction are vacuum therapy to increase blood flow to penis, injection of certain drugs to the penis and surgery which comes under specialized management.

Premature ejaculation

When a person ejaculates before or shortly after vaginal penetration it is called premature ejaculation; usually if it happens within less than one minute of starting the sexual act.

This is highly subjective for the man and partner. The average time for ejaculation according to much research is 5.4 minutes. It may vary from 3 – 15 minutes. Premature ejaculation is also a common condition. This can occur with early sexual experience and anxiety. Therefore it is more common in young males.

There is also a familial predisposition for this condition. Sometimes illnesses like diabetes, hyperthyroidism, prostatitis (inflammation of the prostate gland) can lead to premature ejaculation.
Management involves counselling and behavioural treatment with the aim of increasing sexual confidence. It is best to discuss the problem with a psychiatrist or your family physician. Certain medicines like fluoxatine, clomipramine, tramadol etc can be used in this condition but once again should be prescribed by a qualified medical practitioner. Local anaesthetic impregnated condoms are now available in Sri Lanka to delay ejaculation.

Female sexual dysfunction

Sexual problems affect 40 – 50% of women in the world. But they are not discussed openly and many females silently suffer. Disorders include loss of desire for sex, loss of arousal, problems with orgasm and pain during sex.

The cycle of female sexual response has four phases – excitement, plateau, orgasmic and resolution. Desire and arousal also play a major role. But the norm of female sexual function is not established yet. It depends on each individual and the couple. If there is a problem it is best discussed with a psychiatrist or a qualified medical practitioner. Usually couple therapy, psycho education, counselling and support are offered.

  • Loss of desire or lack of sex drive can occur due to stress, depression, mood disorders and tiredness or at pregnancy and menopause where hormonal levels change. Previous traumatic sexual experience and relationship problems can also lead to it. When there is no desire, relationship problems can arise.
  • Inability to reach orgasm can be a problem to the female, as well as the partner. However, all women do not reach orgasm through vaginal intercourse. Some women do not need to get an orgasm to enjoy sex.


Vaginismus is when muscles in and around the vagina go into spasm making sexual intercourse painful or impossible. Even insertion of a finger is difficult. It can be a very distressing condition to both partners. It is mainly psychological and can also occur due to fear of sex, relationship problems and fear of pregnancy or due to painful conditions of the vagina.

This condition can be successfully managed with counselling, sex education and teaching relaxation techniques. Sometimes medicines like anxiolytics can be used.

Pain during sex (dyspareunia) is common after menopause as oestrogen hormone levels drop and the vagina feels dry. Vaginal lubricating creams and gels can be used in this condition.

(The writer is attached to the Health Education Bureau)

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