Author: The Beauty Nation

Estrogen and Osteoporosis

Scientists have discovered that estrogen is crucial to the bone remodeling process, aiding the body’s absorption of calcium to contribute to bone mineral content. When estrogen levels fall after menopause, the delicate balance of bone remodeling is tipped toward the side of the breaking down of bone.

Women need to be especially careful to supply their bones with enough calcium and vitamin D both before and after menopause.

It’s also wise to include green leafy vegetables, whole grains, and beans in your diet. Those foods contain substantial amounts of magnesium, a crucial mineral for calcium absorption. If you don’t absorb the calcium you ingest, kidney stones or calcium deposits may form in your arteries and joints.

As you move through your 40s toward menopause, your digestive tract is kept on changing. You can become lactose intolerant, which means that your body cannot tolerate the sugars in milk. Otherwise, you may want to cut dairy products from your diet and replace them with calcium supplements.

But you can take steps at any stage of adult life to increase your chances of preventing osteoporosis. A few lifestyle changes now could save you from losing too much bone after menopause and becoming a candidate for the bone-thinning and stress fractures of this disease, which can go undetected until it’s too late.

Among those in this high-risk group are people who have taken steroids for extended periods of time, women who have amenorrhea, those with eating disorders such as bulimia or anorexia, or women who had early surgical menopause.

By maintaining a moderate level of physical exertion may help to keep your bones dense. Doing weight-bearing exercise puts stress on your bones, stimulating the build-up of bone tissue. Remember to support your physical activity program with adequate rest, nutrition, and calcium intake.

What Causes Osteoporosis?

Simply stated, with osteoporosis bones become more porous, abnormally thin, with loss of the calcified architecture or calcium. We have two types of bone: compact or cortical bone, which seems solid and hard, and trabecular bone, which is spongy and lighter. The compact bone is found mainly in the shafts of our long bones such as legs and arms; trabecular bone is found in the ends of the long bones, in the spinal vertebrae, and in the heel bones, ribs, and jaw.

You may be surprised to learn that bone is not a permanent, static substance. It is a living tissue.

Old bone cells are constantly being broken down and replaced with new bone cells in a process called bone remodeling or bone formation. The continual remodeling and repairing are in response to wear and tear, mechanical stress, and the metabolic demands placed upon them. As metabolically our bodies need to have access to calcium and other minerals, most bone mass is built during childhood and adolescence.

During our growing years, the osteoblasts stay way ahead of the osteoclasts (bone loss), creating more bone than is destroyed. It is in early adulthood, with the proper nutrition and exercise, and good health in general, our bones not only grow larger but also grow denser.

Unless you’ve had a condition that depletes the bone mass, your bones continue to increase slightly in density until the age of 35. At that time, both men and women begin to lose a little up to 1% a year of their bone density. Men usually start with greater bone mass, however, so if they get osteoporosis, it usually occurs much later in life.

It’s believed that our bones reach their peak density between our mid-twenties and late thirties.

For example, rapid bone loss occurs with bed rest, anorexia, malabsorption, from several diseases and medications. It is also common for the transition into menopause to be a period of rapid bone loss. With prolonged and accelerated rapid loss, the compact bone becomes thinner, the trabecular bone becomes spongier, with larger holes, and the bones become weak and vulnerable to breakage.

Studies show that women who take estrogen for at least seven years cut their risk of hip fractures in half during the time they use the drug. However, once you stop the therapy, bone loss resumes at the usual accelerated rate found in the early stages of menopause.

Caucasian women aged around 50 are at much more risk than men, and one-half of will suffer one or another osteoporotic fracture during her lifetime, this high incidence of osteoporosis is not universal. Women in less industrialized/Westernized countries living more traditional lifestyles like the native populations of Africa and New Zealand, the Japanese and Chinese, have much lower rates of osteoporotic fracture. Unfortunately, the osteoporotic fracture rate is gradually rising in developing countries as they “modernize,” changing their lifestyle, eating, and exercise patterns.

The risk factors encouraging bone breakdown are low nutrient intake, high intake of nutrient robbers like sugar, coffee, alcohol, excess sodas, phosphorus, protein, and fat; an overall acid-forming diet; drugs and medications; inactivity and a profound lack of exercise; food allergies; mal-absorption; and endocrine factors like ovary removal, low hormone levels, adrenal or thyroid weakness.

Quick Check:

1. Women above 65 years old.
2. A genetic disorder or other words, it is inherited.
3. Illness related to osteoporosis like rheumatism and arthritis.
4. Suffer major bones fractured in early years (bones fractured, broken at the finger, facial, skull, etc.)
5. Menopause before 40 years old.
6. During the reproductive period, there was no menstrual accumulation of more than 2 years.
7. Use of steroids for extended periods of time.
8. Alzheimer’s or memory loss that leads to movement abnormalities.
9. Thyroid problem for more than 1 year.
10. Medical history of the thyroid.
11. Liver patient.
12. Suffers from bad or failed vision.
13. Long-term consumption of alcohol.

In order to find out more about bone health, you may go through testing in urine, blood samples, or bone scans. Many knew of bone loss but neglect to do any tests.

Calcium is what gives bone its strength, but it also serves many other functions.

It is needed for our muscles to grow, contract, relax, and most importantly our heart muscle needs calcium to function. It also allows the smooth muscles of our blood vessels to relax and therefore plays a role in lowering blood pressure.

Calcium is required for a healthy nervous system.

About 99 percent of the calcium in our bodies resides in our bones; in order to be available to perform these crucial functions, there is a give-and-take of calcium between our bones and our other tissues via the bloodstream.

Our skeleton not only holds us up so we can dance and walk, but also functions as a calcium bank, and when too much calcium is withdrawn from the bank and not replaced, osteoporosis is the result. Bone is largely composed of calcium, and calcium intake clearly plays a role in building and maintaining strong bones.

However, ingesting lots of calcium either from food or supplements isn’t the only answer to preventing this condition. In spite of all the hype about milk and calcium supplements, the scientific evidence that humans need huge amounts is weak. Women in less-developed countries consume much less calcium and milk than we do, yet they have much less osteoporosis.

By taking estrogen, particularly soon after menopause, and continued life long can decrease the risk of hip fracture by 30-40 percent and spinal fractures by up to 50-75 percent in women.

Woman Menopause Health and Risk

The four most common and serious health problems that women face as they get older are

Cardiovascular Disease and Osteoporosis

Breast Cancer and Diabetes.

Women’s risk begins to rise with these conditions at the time of menopause and continues to increase as they age.

Breast cancer is the disease that strikes the most fear in the hearts of women, and as epidemic’ as it is breast cancer, is a far less common cause of death.

It is unfortunate that these health problems have been associated with menopause when they actually result from a high-stress life in an increasingly toxic environment, compromised nutrition, and diminished physical strength and endurance. These hazards increase the risk of these four diseases as well as the symptoms of menopause.

If you’re not a smoker, don’t have diabetes, aren’t obese, and don’t have hypertension, being a premenopausal woman is good temporary insurance against heart disease. Women have fewer heart attacks and less heart disease before the age of 50 than men has tended to cloud the issue of heart disease.

However, as women go through menopause and lose estrogens’ protective effects on their circulatory systems, they quickly take on the risk factors for cardiovascular disease that have traditionally been perceived as belonging mostly to men.

In fact, cardiovascular disease (heart attacks and vascular events like stroke) is the number one cause of death for women over the age of 50.

Every year, approximately 500,000 women die from heart attacks and strokes, compared with 260,000 deaths of women from all types of cancer. According to the National Institute of Nursing Research, heart disease is fatal more often in women than in men.

The fact that women are older when they develop coronary artery disease is referred to treatment later, and are admitted and transferred to hospitals later than are men.

1. Angina or chest pain is a dangerous signal that the arteries are partially blocked and the heart is not getting enough oxygen. It is important that you do not ignore any chest pain. Your heart may be in danger of suffocation. The longer the pain is, the higher the risk.
2. A heart attack occurs when the artery is blocked by a threshold amount of plague, plague cramps or completely blocking blood flow. Deprivation of blood for a long time causes heart cells to die and heart damages. Chunks of plaque get pulled off the wall and lodge elsewhere as a clot and this can cause damage to the brain, a lung, or a leg.

Risk Factors for Cardiovascular Disease and Cholesterol

After menopause (heart attack is uncommon in women under fifty), the major risk factors for cardiovascular disease are thought to be similar to men: high blood pressure and elevated cholesterol, and other fats in the blood in which both of which are influenced by diet and lifestyle.

Because cholesterol is one of the substances that cause plaque in artery walls, high cholesterol is a factor in cardiovascular disease. However, the relationship seems to be more complicated than we thought and is becoming controversial.

Cholesterol is found throughout our bodies and is needed for many functions; for example, it is a precursor for progesterone and all the sex hormones.

As you may know, there are two main types of cholesterol that are carried in the bloodstream, bad cholesterol (Low-density lipoprotein/ LDL) and good cholesterol (High-density lipoprotein/ HDL) that transports cholesterol to the liver, where it is metabolized and then excreted; it is thought to be the good stuff–high levels of it seem to protect us from the coronary mishap.

Triglycerides are another type of blood fat that raises the risk of cardiovascular disease; it appears that even when women have normal cholesterol, high triglycerides increase heart disease.

Generally, triglycerides should be between 50 and 150 mg per dl (decilitre), but in women, anything over 100 may be too high. What is more important is what happens to cholesterol and your arteries when they become damaged from oxidation by free radicals.

Free radicals damage the vessels and oxidized cholesterol creates more free radicals, and your body lays down plaque over the damaged area as a protective mechanism. That’s why there’s been so much interest in antioxidant nutrients, such as vitamins C and E and beta carotene for cardiovascular protection. Other fatty and protein substances have been implicated in athero-sclerosis.

A blood fat called lipoprotein may be the first to adhere to the wall, and LDL then adheres to this sticky substance. Vitamin C seems the key to preventing this process.

Elevated amounts of homocysteine, an amino acid, have recently been associated with clogged arteries and an increased risk of heart attack and stroke. Folate and vitamins B-6 and B-12 help get rid of excess homocysteine.

Platelets, the blood cells responsible for blot clotting, also play a role. When platelets form blood clots, they release inflammatory substances that damage the lining of the arteries; the clots also contribute to closing off the blood supply in arteries narrowed by atherosclerosis. This is why aspirin, which decreases the blood’s tendency to clot, is recommended as a preventive.

Stroke may also occur when the blood flow to the brain is disrupted because a blood vessel is blocked by atherosclerosis or has ruptured. Without oxygen, brain cells die, causing the loss of the ability to sense and/or control certain functions related to the affected part of the brain.

Hypertension is high blood pressure that leads to increases the risk of cardiovascular disease as well as stroke, kidney failure, and other serious diseases. About half of all women over fifty have high blood pressure; it is also another silent killer because usually there are no symptoms and few early signs, other than a high blood pressure reading.

Diet and lifestyle are the main risk factors for atherosclerosis and heart attack, and they play a huge role in high blood pressure in some people. There are cholesterol-lowering drugs that reduce cholesterol by an average of 35 percent, and blood-pressure-lowering drugs as well.

Both have side effects and we’re only now beginning to see studies showing how lowering these measurements translate into preventing heart attacks or strokes. Unfortunately, physicians often pursue less aggressive treatment and fewer invasive procedures with female patients who have heart disease symptoms than with their male counterparts.

And since the incidence of heart disease rises in women after menopause, it is generally thought that estrogen exerts a protective effect.

Part of estrogens’ protective effect relates to their ability to act as an antioxidant. If true, it may be more prudent to get more antioxidant protection through nutritious food or supplements.

The lateral coital position is reported as the most effective coital position available to men and women, presuming there is an established marital-couple interest in mutual effectiveness of sexual performance.

As described in premature ejaculation, when a facility in lateral coital positioning has been obtained, there is no pinning of either the male or female partner. There is mutual freedom of pelvic movement in lateral coital position in any direction, and there will be no cramping of muscles or necessity for tiring support of body weight.

The lateral coital position provides both sexes flexibility for free sexual expression.

This position particularly is effective for the woman, as she can move with full freedom to enjoy either slow or rapid pelvic thrusting, depending upon current levels of sexual tensions. In this coital position, the male can best establish and maintain ejaculatory control.

From the female superior to a lateral coital position, there are several successive steps to be taken.

The husband with his left hand should elevate his wife’s right leg while moving his leg under hers so that his left leg (now outside of her right leg) is extended from his trunk at about a 45-degree angle.

The wife simultaneously should extend her right leg (the one that is being elevated) so that positionally she is now supporting her weight on her left knee with the right leg extended, instead of being on her knees as in the female-superior position. As she makes these adjustments, she should lean forward to parallel her trunk to that of her husband.

Then the male clasps his partner with his left arm under her shoulders, his hand placed in the middle of her back, and his right hand on her buttocks, holding the two pelves together. The two partners then should roll to his left (her right) while still maintaining intravaginal containment of the penis.

Once the partners have moved into the lateral positioning, the two trunks should be separated at roughly a 30-degree angle. The male rolls back from his left side to rest on his back. The female remains relatively on her stomach and chest with minimal elevation of her left side and her head turned toward her husband. Pillows should be placed beneath both heads for comfort and to provide support for the woman’s slightly angled position.

Occasionally there is value in a supportive pillow placed along her right side. The only weight that must be supported is that of the wife’s right thigh, which rests upon the husband’s left thigh. His left thigh is supported by the bed, so there is no problem with long-continued weight support.

The concern for arm placement is resolved if the woman’s right arm is circled under her pillow and the husband’s left arm (in the same fashion) moves under her pillow beneath her shoulders or underneath her neck. This leaves the woman’s left arm and hand and the husband’s right arm and hand for mutual play and body caressing.

The female accomplishes leverage for pelvic thrusting by pulling up her extended right leg slightly so that her knee comes to rest on the bed. Her left leg should be cast over her husband’s right hip with the knee resting comfortably on the bed. The two knees provide her with all the traction she needs for pelvic thrusting whenever sex tension demands for any form of thrusting develop.

In view of the physical complexity of changes in position, usually, it is suggested that man and wife try converting the simulated female-superior mounting position to the lateral position at least two or three times before establishing a coital connection and then attempting conversion from superior to lateral positions.

The trial runs usually begin in a humorous vein, yet with functional seriousness, husband and wife easily can work out the problems of comfortable arms and legs placement and rapidly accomplish facility with the position-conversion technique.

Again, the lateral coital position is the most effective coital position from the mutuality of shared male and female freedom of sexual experimentation. The potential return is well worth the effort of the marital couple involved in learning to convert from the female-superior positioning.

One of the more realistic goals this form of therapy may suggest to the non-orgasmic woman relates to self-reorientation which tends to improve or helps to ensure maximum interdigitation of the dual-system basis of effective sexual function theorized in the topic of therapy and orgasmic dysfunction. The goal seeks to create or encourage the best possible climate in which each system; biophysical and psychosocial can function.

When the marital partners extend their psycho sensory interchange to coition in the female superior position, the wife once mounted is instructed to hold herself quite still and simply to absorb the awareness of penile containment. Interspersed with moments of sensate pleasure created by her proprioceptive awareness of vaginal dilatation should be the opportunity to feel and think sexually.

Sexual pleasure

The vaginal distention should be interpreted in relation to the sensual desire for further increment in sexual pleasure. This increasing demand for sexual stimulation can be further implemented by the female’s partner if she will institute a brief period of controlled, slowly exploring, pelvic thrusting.

The husband’s specific responsibility at this moment is to provide the needed erect penis without any concept of a demanding thrusting pattern on his part.

In anticipation of her need, the co-therapists must encourage the wife to think of the encompassed penis as hers to play with, to feel, and to enjoy, until the urge for more severe pelvic thrusting involuntarily emerges into her levels of conscious demand. It may take several episodes of female-superior coital positioning, as the woman plays pelvically with the contained penis before full sensate focus develops vaginally.

Once vaginal sensation develops a pleasant or even a fully demanding vein, the next phase is to add to the sensate picture the male-initiated, non demanding, slow pelvic thrusting. The non-demanding thrusting by the husband should be kept at a pace communicated by his wife.

This constrained form of male pelvic thrusting is suggested for two reasons:

• to create an obvious opportunity for extension of the female’s sensory potential.
• to provide sufficient stimulative activity to maintain an effective erection.

At this time the question frequently asked by the male member of marital couples whose concept of sexual interaction has been based primarily on the stock formula of performing, produce, and achieve is, “What if I feel like ejaculating?” It requires continuous effort by the co-therapists to convey the concept not only that acquiring ejaculatory control is possible but also that such facility usually is enhancing for the male as well as his female partner.

Ejaculation and Orgasm

The couple must be educated to understand that ejaculatory control enlarges the range of sensual pleasure in the sexual relationship for both marital partners. However, it is appropriate for co-therapists to emphasize the fact that ejaculation or spontaneously occurring orgasm is not caused for alarm, nor is this involuntary breakthrough considered a breach of direction.

The marital couple must be reassured that if such a breakthrough from the original direction occurs, the experience should be enjoyed for itself. Within a reasonable length of time, the couple is encouraged to provide another opportunity in which to follow the originally described interactive concepts.

When the husband has developed security of erective maintenance, the episodes of vaginal containment with exploratory pelvic thrusting should continue for as long as both partners demonstrate pleasurable reactions.

At appropriate intervals during the total coital episode, the partners should separate two or three times and lie together in each other’s arms. Once rested, they should return to whatever manner of manual sensate pleasuring they previously enjoyed and continue without any concept of time demand.

They should remount, again using the female superior position, repeating earlier opportunity for the wife’s stimulative proprioceptive awareness of vaginal containment of the penis to be emphasized by alternate periods of exploratory thrusting and lying quietly together in the coital connection. The timing and duration of sexually stimulative activity should follow the directive formula as outlined in the Therapy topic.

Generally interpreted, any period of time is acceptable that emerges from mutual interest and continues to be enjoyable for both marital partners without incidence of either emotional or physical fatigue.

Once both partners have been successfully educated to employ experimental pelvic movement during their episodes of coital connection rather than following the usual prior pattern of demanding pelvic thrusting, a major step has been accomplished.

Women have little opportunity to feel and think sexually while pursuing or receiving a pattern of forceful pelvic thrusting before their own encompassing levels of excitation are established.

If a woman initiates the demanding thrusting, she usually is attempting to force or to will an orgasmic response. The wife repeatedly must be assured that this forceful approach will not contribute to the facility of response. If the husband initiates the driving, thrusting coital pattern, the wife must devote conscious effort to accommodate to the rhythm of his thrusting, and her opportunity for quiet sensate pleasure in coital connection is lost.

Frequently, it is of help to assure the wife that once the marital couple is sexually joined, the penis belongs to her just as the vagina belongs to her husband. When vaginal penetration occurs, both partners have literally given of themselves as physical beings in order to derive pleasure, each from the other.

When conceptually she has a penis to play with, usually the woman will do just that. If she will allow the vaginally contained penis to stimulate slowly and feelingly, in the same manner, she enjoyed sensate pleasure from manual body stroking or the manipulation of her genital organs under her controlled directions, she will find herself overwhelmed with sexual feeling.

As Vaginal Sensation Increases

The woman and confidence in ejaculatory control develop for the man, penile-containment episodes progress in a more confident vein.

The teasing technique of mounting, dismounting, and remounting is extremely valuable as a means of female sex tension increment.

There are several clinical pitfalls to be avoided under careful co-therapist direction as the marital couple is moved from phase to phase of increasing sexual responsivity by day-by-day consideration and direction.

At initial, the cooperating male partner must be manipulated to ejaculation with a regularity at least approximating that described during the interrogation periods on Day 1 or 2 as his concept of ideal ejaculatory frequency. This concern for regularity of release of cooperative male partners’ sexual tensions is but turn about the application of the principles of sex-tension relief, directed toward regularity of orgasmic release for the cooperative wife of the premature ejaculator.

Second, there must be regularly recurring vacations from the physical expression of sexual functioning. At least every fourth day is declared a holiday from physical sexual expression. However, the daily conferences between marital partners and the co-therapists continue at a seven-day-a-week pace.

Through the two-week period during which the distressed marital couple is following the Foundation program. There is so much material that must be presented, evaluated, and restarted when the couple’s marital relationship is explored in-depth that daily conferences are a regular part of the treatment format.

When the wife’s physical progress is obvious, the partners are infinitely more willing to look at their particular contributions (or lack of them) to the marital relationship. As they improve the climate of the marriage, inevitably they are contributing a vital ingredient to the woman’s psychosocial structuring. This structure, in turn, positively influences the accrual of her sexual tensions.

There is yet another factor of sex-tension increment derived from daily living with the subject by the marital partners. Presuming strategically placed vacations from overt sexual function, there is tremendous tension increment in the continuity of sexual expression, if orgasmic or ejaculatory levels of tension are restricted by frequency control.

Once confidence in the female-superior coital position has been established, with the woman enjoying the sensate pleasure of pelvic play with the intravaginally contained penis, the marital couple is directed to convert the female superior position to a lateral coital position.

With husband and wife mounted in a female superior position, there may be some difficulty in converting to a lateral coital position without first practicing the maneuver. Initially, the practice should take place without intromission if the conversion is to be accomplished smoothly, but the functional return for both sexual partners certainly is well worth the effort expended in the learning process.

Foreplay

Emphasis should be placed upon the fact that there is marked individual variation in the time span in which each area of sensory perception is appreciated. Mood, level of need, quality of partner involvement, etc., all vary widely, frequently on a day-to-day basis.

There will be occasions when spontaneous nonspecific or even asexual social interaction will replace all the “touch and feeling” (foreplay) that have been so enjoyable and so necessary at other times.

Whenever exercises in sensate focus (especially those using specifically positioned opportunities) have initiated newfound levels of stimulative appreciation for the non-orgasmic woman, the appropriately sequential step is suggested for couple exploration during their next phase of sexual interaction.

It is essential to successful therapy to emphasize again and again the concept that sexual response can neither be programmed nor made to happen. The marital couple also must be encouraged continually to create an environment that fulfills the stimulative (biophysical and psychosocial) requirements of each partner and in which sex-tension increment can occur without any concept of performance demand.

Each successive phase of the physical approach is introduced subsequent to establishing some evidence of encompassing psychosexual pleasure as perceived by the non-orgasmic woman during a prior episode. These phases develop in sequence from the first day’s sensory exploration which takes place following the roundtable discussion.

If there is obvious female pleasure in the first sensate experience, the next phase includes the specific manipulative approach to genital excitation, using, if possible, the positioning. If the first day’s exercise in sensate pleasure has not developed a positive experience for the non-orgasmic woman, the second day will again be devoted to these primary touch-and-feeling episodes, instead of moving into the genital manipulative episodes usually scheduled for the next day.

In turn, the genital manipulative episodes are continued until there is obvious evidence of elevated female sex tension, before moving on to the next phase in the psychosensory progression.

Sexual Intercourse Position

Subsequent to reported success in manual genital excitation, the marital, partners are asked to try the female-superior coital position, which means the wife may translate previously established levels of sensate pleasure into an experience that includes the sensation of penile containment.

The specific techniques of this position have been discussed and illustrated as Female superior mounting is but another step in the gradual development of sexual awareness leading from simple, sensate focus to effective response in coital connection.

The husband is asked to assume a supine position in anticipation of his wife’s superior mounting. Intromission is to take place when both partners have reached the level of sexual interchange (full erection for the man; well-established lubrication for the woman) that suggests the desire for further physical expression.

The most effective intercourse technique probably is the teasing approach of light-touch moving at random from the breasts to the abdomen to the thighs to the labia to the thighs and back to the abdomen and breasts without concentrating specifically on pelvic manipulation early in the stimulative episode.

Particularly should direct approach to the clitoral area be avoided initially in this process. This “exercise” becomes even more effective as a means of female sex-tension increment when interlaced with sensate-focus, stroking techniques introduced after the roundtable discussion.

The male partner must be careful not to inject any personal demand for sexual performance into his female partner’s pattern of response.

The husband must not set goals for his wife. He must not try to force responsivity His role is that of accommodation, warmth, understanding, and holding, but he should not be so pacific that his own sexual pleasure is negated for either himself or his partner.

Through total cooperation he allows his wife to drift with sensate pleasure and provides her with sensual stimulation without forcing her to contend with an accompanying sense of goal-oriented demand to respond to a forcing form of manipulation.

The co-therapists must make it quite clear to the husband that orgasmic release is not the focus of this sexual interaction. Manipulation of breast, pelvis, and other body areas varying from the lightest touch to an increase in pressure only at partner direction, should provide the wife with the opportunity to express her sexual responsivity freely, but without any concept of demand for an endpoint (orgasmic) goal.

It must be emphasized that the effectiveness of a stimulative session is not lost to the woman simply because the session is terminated without orgasmic experience.

Sexual Interest

There is a tremendous accrual of sexual facility and interest for any woman when she knows that there will be a repeat opportunity for further sexual expression in the immediate future.

Thus, the husband’s light, teasing, non-demanding approach to touch and manipulation allows the female partner full freedom to express her interests, her demands, her sexual tensions. This sequence of opportunities permits the accumulation of stimulative effects which will provide the source of her ultimate release of maximum sex-tension increment at some future point.

All specific exercises aimed toward the wife’s fulfillment of her orgasmic capacity always are introduced by the direction of the co-therapists on the basis of the marital-couple reports. When husband and wife describe the fact that previous directions have produced a positive return of stimulative pleasure, their next level of sexual involvement is approached. This treatment concept means, of course, that a steady progression of exercises does not necessarily take place on a daily schedule.

For instance, marital partners who never have verbally shared sexual reactions or expressed sexual preferences to each other usually take longer to appreciate a positive level of sexual-tension return than less restrained, more communicative husbands and wives.

Yet another example of delayed reactive potential centers upon marital couples that have coped with functional distress for extended periods of time. These husbands and wives usually require longer to adapt to and become comfortable with their revised patterns of sexual behavior than those whose sexual dysfunction has been relatively brief.

It has been further observed that successful marital-couple adaptation to a state of sexual dysfunction, in itself a possible indication of individual and marital-couple strengths, may present a higher level of inherent resistance to reversal of the stated inadequacy than more dissident, fragmented marital relationships.

Cotherapists must constantly bear in mind during the rapid-treatment program that the authoritative introduction of specific exercises represents a deliberate breakdown of a woman’s sexual responsivity into its natural components.

Each exercise is introduced singly and continued until appreciated. All exercises are accrued one after another in a natural building process until they have been reassembled into the whole of an established sexual response pattern.

For descriptive purposes, the directive pattern might be likened to the song Partridge in a Pear Tree, in which each item is repeated as a new one is added in each successive verse until all items are assembled.

Therefore, the marital couple must be reminded quietly each time a new direction for specific sexual activity is introduced that this introduction of new material is not an indication that previous exercises and their concomitant pleasures must be relinquished in order to enjoy the new experience.

Rather, as each new psychophysiological concept is provided for marital partner assimilation, older exercises are constantly restated until the whole reactive process is assembled.

At this point, marital partners frequently may have acquired a gavotte-like approach to sexual expression when employing the directive suggestions rather than spontaneously incorporating each new physical approach or stimulative concept into their own style or pattern of behavior.

The marital couple will need reminding that on a long-range basis there is little return from clocking each component of the therapeutic pattern for a specific length of time or introducing each new exercise into their sexual interaction in a purely mechanical manner, solely because it has been suggested by impersonal authority rather than mutually evolved.

The husband has directed to place himself in a sitting (slightly reclining, if desired) position, with his back against a comfortable placement of pillows at the headboard of the bed. With the husband’s legs adequately separated to allow his wife to sit between them, she should recline with her back against his chest, pillowing her head on his shoulder.

Length of torsos should determine the reclining angle that permits her head to rest comfortably. Her legs are then separated and extended across those of her husband.

This coital position provides a degree of warm security for the woman (“back-protected” phenomenon) and allows freedom of access for the man to encourage creative exploration of his wife’s entire body in the sensate-focus concept.

This and other forms of nonverbal communication allow sharing of her particular desires as they occur as manifestations of her sexual value system, and constitute a secure way by which her marital partner can identify and fulfill these desires by meaningful interaction. This means of direct physical communication also provides the woman with freedom to request specifics of genital play without the distraction of forced verbal request or a detailed explanation.

Any spontaneous form of expression of a man’s own sexual tensions is one of the most interactive contributions that he can make to his wife. It is a viable component of sexual “give to get” in any circumstance of physical sharing. This principle applies equally to the marital couple carrying out the simplest sensate-focus exercise in the therapy program as it does to a marital couple that has never known sexual dysfunction.

The husband must not presume his wife’s desire for a particular stimulative approach, nor must he introduce his own choice of stimuli. The husband’s assumption of expertise has no place in the initial learning phase of a marital couple seeking to reverse the life’s non orgasmic condition.

The trial and error hazard this poses is not worth the small possibility of accidental pleasure that might be achieved.

In truth, error in some facet of this controlled manipulative form of physical communication has already been established, or the marital couple members probably would not consider themselves in need of professional support.

Only after both marital partners have established the fact of the wife’s sexual effectiveness with controlled genital play and have developed dependable physical signal systems should trial-and-error stimulative techniques be crone a naturally occurring dimension of pleasure.

It is well to mention that even those partners with an established, effective sexual relationship may find it both appropriate and advisable to check out their physical signal systems by verbal communication from time to time.

An additional value derived from the non-demand position and its accompanying sensate exercises is its contribution to removal of the potential spectator’s role. This role can become as much a pitfall for the non-orgasmic woman as it is for the impotent male. Already considered in descriptions of female-oriented patterns of sexual dissimulation, the spectator role is dissipated when sexual involvement of husband and wife becomes mutually encompassing for both partners.

Sexual Education

Sexual education direction for the husband is an integral part of the genital-play episodes. The cotherapists must be certain that the basics of effective pelvic play are clearly enunciated if the male partner is to provide effective measure of stimulative return for the woman involved.

The husband is instructed both to allow and to encourage his wife to indicate specific preferences in stimulative approach either by the light touch of her hand on his or by moving slightly toward desired approach or away from excessive pressure.

Probably the greatest error that any man makes approaching a woman sexually is that of direct attack upon the clitoral glans, unless this is the stated wish of his particular partner. The glans of the clitoris has the same embryonic developmental background as that of the penis, but usually is much more sensitive to touch. As female sex tensions elevate, sensations of irritation, or even pain, may result from direct clitoral manipulation.

Clitoris Stimulations

Rarely do women, when masturbating, manipulate the clitoral glans directly. Therefore, the male approach to clitoral stimulation would do well to correspond to that employed by women when providing self-release. There is a further, perhaps more subtle, reason for relative care in the intensity of stimulative concentration directed to the clitoris.

This originates from the fact that the clitoris, as a receptor and a transmitter of sexual stimuli, can rapidly react to create an overwhelming degree of sensation. When such a high level of biophysical tension is reached before the psychosocial concomitant has been subjectively appreciated, the woman experiences too much sensation too soon and finds it difficult to accept.

In the interest of a pleasurable, evolving sexual responsivity, the clitoris should not be approached directly. Specifically, manipulation should be conducted in the general mons area, particularly along either side of the clitoral shaft. It must be remembered that the inner aspects of the thighs and the labia also are erotically identified areas for most women.

Pressure and direction of manual stimulation should be controlled initially by the female partner for two educative reasons.

1. full freedom of manipulative control provides her with the opportunity to feel and think sexually without having to adjust to a partner’s assumption of what pleases her.
2. female control of manipulative activity also educates the male partner into the particular woman’s basic preferences in stimulative approach to the clitoral area.

It must also be borne in mind by the male partner that there is no lubricating material available to the clitoris. As female sex tension increases there will be a sufficient amount of lubrication at the vaginal outlet. This should be maneuvered manually from the vagina to include the general area of the clitoris.

Vaginal lubrication used in this manner will prevent the irritation of the clitoral area that always accompanies any significant degree of manipulation of a dry surface.

A further dimension of sexual excitation is derived from manipulation of the vaginal outlet when lubricating material is acquired for clitoral spread by superficial finger insertion. There is usually little value returned from deep vaginal insertion of the fingers, particularly early in the stimulative process.

While some women have reported a mental translation of the ensuing intravaginal sensation to that of penile containment, few had any preference for the opportunity.

Non-Orgasmic

Whether distressed by primary or situational dysfunction, must develop adaptations within areas of perceptual, behavioral, and philosophic experience. A non-orgasmic woman must learn or relearn to feel sexual (respond to sexual stimuli) within the context of and related directly to shared sexual activities with her partner as they correlate with the expression of her own sexual identity, mood, preferences, and expectations.

The bridge between her sexual feeling (perception) and sexual thinking (philosophy) essentially is established through comfortable use of verbal and nonverbal (specifically physical) communication of shared experience with her marital partner. Her philosophic adaptation to the acceptance and appreciation of sexual stimuli is further dependent upon the establishment of “permission” to express herself sexually.

Any alteration in the sexual value

system must, of course, be consistent with her own personality and social value system if the adaptation is to be internalized. Keeping in mind the similarities between male and female sexual response, the crucial factors most often missing in the sexual value system of the non-orgasmic woman are the pleasure in, the honoring of, and the privilege to express need for the sexual experience.

In essence, the restoration of sexual feeling to its appropriate psychosocial context (the primary focus of the therapy for the non-orgasmic woman) is the reversal of sexual dissembling. This, in turn, encourages a more supportive role for her sexuality. In the larger context of a sexual relationship, the freedom to express need is part of the “give-to-get” concept inherent in capacity and facility for effective sexual responsivity.

Professional direction must allow for woman’s justifiable, socially enhancing need for personal commitment, because her capacity to respond sexually is influenced by psychosocial demand.

Enjoyment of Sexual Expression

The commitment functions as her “permission” to involve herself sexually, when prior opportunities available to formation of a sexual value system have not included an honorable concept of her sexuality as a basis upon which to accept and express her sexual identity. Commitment apparently means many things to as many different women; most frequently encountered are the commitments of marriage or the promise of marriage, the commitment of love (real or anticipated) according to the interpretation of “love” for the particular individual.

Regardless of the form the commitment takes, after it is established the goal to be attained is enjoyment of sexual expression for its own positive return and for its enhancement of those involved.

During daily therapy sessions, interrogation of the sexually dysfunctional woman is designed to elicit material that expresses the emotions and thoughts that accompany the feelings (sexual or otherwise) developed by the sensate-focus exercise. Also continually explored are the feelings, thoughts, and emotions that are related to the behavior of her marital partner.

Her reactions when discussing material of sexual connotation are evaluated carefully to determine those things which may be contributing to ongoing inhibition or distortion being revealed by the regular episodes of psycho physiological interaction with her husband.

When a non orgasmic female involves herself with her partner in situations providing opportunities for effective sexual function, her ever-present need is to establish and maintain communication. Communication, both physical and verbal in nature, makes vital contributions, but it loses effectiveness in the rapid-treatment method if allowed to be colored by anger, frustration, or misunderstanding.

While verbal communication is encouraged throughout the two-week period, physical communication is introduced in progressive steps following the initial authoritative suggestion to provide a non demanding, warmly encompassing, shared experience for the woman, with optimal opportunity for feeling.

After the early return from sensate-focus opportunity as directed at the roundtable discussion has been judged fully effective by marital partners and cotherapists the marital couple is encouraged to move to the next phase in sensate pleasure genital manipulation.

The cotherapists should issue specific instructions to the marital partners as “permission” is granted to the female to enjoy genital play. Instructions should include details of positioning, approach, time span, and above all, a listing of ways and means to avoid the usual pitfalls of male failure to stimulate his partner in the manner she prefers rather than as she permits him the privilege to function.

Neither the biophysical nor the psychosocial systems which influence expression of the human sexual component have a biologically controlled demand to make specifically positive or negative contributions to sexual function.

This fact does not alter the potential of the systems’ interdigitational contribution to the formation of effective patterns of sexual response. When this potential is not realized by the natural development of psycho physiological sexual complements, the result is sexual dysfunction.

The initial psychosocial contributions toward realization of this potential may come through positive experience of early imprinting. As defined, imprinting is a process whereby a perceptual signal is matched to an innate releasing mechanism which elicits a behavioral pattern. Established at critical periods in development, imprints thereafter are considered more or less permanent.

Infantile imprinting of sexually undifferentiated sensory receptivity to the warmth and sensation of close body contact is considered a source of formative contribution to an individual’s baseline of erotic inclinations and choices.

This material essentially is unobtainable in specific form during history-taking. It becomes important to the rapid-treatment program only as it is reflected by statements of preference in physical communication or other recall pertinent to ongoing patterns of sexual responsivity.

In the treatment of orgasmic dysfunction, Foundation personnel make use of two primary sources of material. These sources reliably reflect the female’s prevailing sexual attitudes, receptivity, and levels of responsivity.

History of non-orgasmic women

The first source

derived from the history, is identified by the non-orgasmic woman of erotically significant expectations or experiences (positive or negative) currently evoked during sexual interchange with her marital partner. The co-therapists must identify those things which the husband does or does not do that may not meet the requirements of his wife’s sexual value system previously shaped by real or imagined experience or expectation.

Past experiences of positive content involving other partners, or unrealizable expectations perceived as ideal, maybe over idealistically compared by her to the current opportunity; or negative experiences or negative expectation-related attitudes may intrude upon receptivity to her partner’s sexual approach. Thus, a rejection or blocking of sexual input may be the end result.

A discussion of memories of perceptual and interpretive reactions associated with specific sexual activity may add further dimension to knowledge of the wife’s currently constituted sexual value system, since these memories often have been noted to function as signals for the subconscious introduction of stored experience, either positive or negative in nature.

The second source

directly applicable material upon which the rapid-treatment therapy relies for direction indeed, it characterizes this particular mode of psychotherapy is developed from the daily discussions that follow each sensate-focus exercise. As repeatedly stressed, defining the etiology of the presenting sexual inadequacy does not necessarily provide the basis for treatment. A reasonably reliable history is indispensable, but it is used primarily to provide interpretive direction and to amplify the definition of that which is of individual significance. (It even is used from time to time to demonstrate negative patterns of sexual behaviors)

Sexual Function

During the two-week rapid treatment program, the daily report and ensuing discussions between the co-therapists and marital partners describing the non orgasmic wife’s reactions (as well as those of her interacting husband) provide an incisive measure of the degree to which the requirements of her functioning sexual value system are being met or negated, or the extent to which she progressively is able to adapt her requirements.

These discussions provide a simultaneous opportunities for a more finite evaluation of the levels of interactive contribution to sexual function by her bio physical and psychosocial systems.

The treatment

of both primary and situational orgasmic dysfunction requires a basic understanding by patients and cotherapists that the peak of sex-tension increment resulting in orgasmic release cannot be willed or forced. Instead, orgasmic experience evolves as a direct result of individually valued erotic stimuli accrued by the woman to the level necessary for psycho physiological release.

Just as the trigger mechanism which stimulates the regularity of expulsive uterine contractions sending a woman into labor is still unknown, so is the mechanism that triggers orgasmic release from sex-tension increment. Probably they are inseparably entwined to identify one may be to know the other.

It seems more accurate to consider female orgasmic response as an acceptance of naturally occurring stimuli that have been given erotic significance by an individual sexual value system than to depict it as a learned response. There are many case histories recorded in this and related studies reporting orgasmic incidence in the developing human female at ages that correspond with ages reported in histories of onset of male masturbation and nocturnal emission.

These clearly described, objective accounts are considered accurate by reason of their correlation with subjective recall provided by several hundred women interrogated during previously reported laboratory studies. The initial authoritative direction in therapy includes suggestions to the marital couple for developing a non demanding, erotically stimulating climate in the privacy of their own quarters.

At no time during the two-week therapy program is either of the marital partners under any form of observation, laboratory or otherwise. Only the phenomenon of vaginismus is directly demonstrated to the husband of the distressed wife, under conditions routinely employed by appropriate practitioners of clinical medicine.

The cotherapists’ initial directions suggest ways of putting aside tension-provoking behavioral interaction for the duration of the rapid-treatment program and allow the woman to discover and share knowledge of those things which she personally finds to be sexually stimulating.

Further professional contribution must suggest to the marital couple ways and means to create an opportunity for the woman to think and feel sexually with spontaneity. She must be made fully aware that she has permission to express her sexual feelings during this phase of the therapy program without focusing on her partner’s sexual function except by enjoying a personal awareness of the direct stimulus to her sexual tensions that his obvious physical response provides.

The initial and most important step in the vaginismus treatment is the physical demonstration of the existence of the involuntary vaginal spasm conducted to the clinical satisfaction of both marital partners.

First, anatomical illustrations of the involuntary constriction in the outer third of the vagina are made available to the marital partners and the specific anatomical involvement is explained in detail. Then the basic aspect of clinical therapy is accomplished in a medical treatment room with the female partner draped and placed in the gynecological examining position.

Vaginal Spasm

The obvious presence of involuntary vaginal spasm, demonstrated by any attempt at the vaginal insertion of an examining finger, frequently is more of a surprise to the female partner than it is to her husband. She may be completely unaware of the existence, much less the severity, of the involuntary spastic constriction of her vaginal outlet.

The chaperoned pelvic examination is not terminated before the husband also has been gloved and encouraged to demonstrate to his’ and to his wife’s satisfaction the Severity of the involuntary constriction ring in the outer third of the vagina.

Once the clinical existence of vaginismus has been demonstrated to the satisfaction of both marital partners, resolution of this form of sexual inadequacy becomes relatively easy. Hegar dilators in graduated sizes are employed in the privacy of the marital bedroom.

The actual dilatation of the vaginal outlet is initiated and conducted by the husband with the wife’s physical cooperation, at first with her manual control and then verbal direction. Again, the rationale behind the Foundation’s demand for availability and cooperation of both marital partners, when attempting to alleviate varying forms of human sexual inadequacy, is underscored.

After the larger-sized dilators can be introduced successfully, it is a good policy to encourage intravaginal retention of the larger dilators for a matter of several hours each night.

Usually, a major degree of the involuntary spasm can be eliminated in a matter of 3 to 5 days, presuming daily renewal of dilating procedures.

To date, there has not been a failed attempt to relieve the involuntary spasm of vaginismus, once the clinical existence of the outlet contraction has been demonstrated to both husband and wife and the cooperation of both partners in the dilatation therapy has been elicited.

When coitus is attempted during the first month or six weeks after initial relief of the involuntary vaginal spasm, preliminary dilatation of the vaginal outlet occasionally may be indicated. In many instances, however, the simple clinical demonstration of the existence of the vaginal constriction and the subsequent controlled usage of the dilators for a few days is quite sufficient to remove permanently this involuntary obstruction to vaginal penetration.

While physical relief of the spastic constriction of the vaginal outlet is usually accomplished without incident, the psychosocial trauma that contributed to the involuntary constriction must not be ignored. When physical symptoms of sexual dysfunction are relieved or removed, the tensions that have led to the onset of the symptoms usually become much more vulnerable to treatment.

For a marital couple contending with vaginismus, an explanation of the psychophysiology of the distress, what it is, how it developed, and assurance that relief is possible are all important factors in the therapeutic program. As stated previously, the first and most important step in symptomatic relief is to demonstrate to both husband and wife the clinical existence of the dysfunction. Thereafter, the therapist is dealing with a receptive, if somewhat surprised, audience.

The easiest way to relieve the sexual tensions, the sexual misconceptions, even the established sexual taboos, is through direct dissemination of information. Women handicapped sexually by the influence of religious orthodoxy, married to men with sexual dysfunction, victimized by rape, contending with unexplained dyspareunia, frustrated by aging constriction of the vaginal barrel, or confused by homosexual and heterosexual conflict all have one thing in common.

They all exhibit an almost complete lack of authoritative information from which to gain some degree of objectivity when facing the psychosocial problem evidenced by the symptoms of their sexual dysfunction.

Sexual Knowledge

With no knowledge of what to expect sexually, no concept of natural levels of sexual responsivity, and even real distrust for authority, theirs is a desperate need for definitive information. Education to understand the psycho-physiological aspects of the problem is a point of departure for these traumatized women.

Confidence comes slowly from a gradually increasing degree of objectivity that develops from their psychosocial acceptance of the basic concepts of the naturalness of human sexual functioning.

With pertinent sexual information absorbed, with the physical dysfunction illustrated, explained, and relieved, women with the resolution of involuntary vaginal spasms have been reoriented to lives of effective sexual functioning.

Of the 29 women referred for relief of their sexual dysfunction, all have recovered from the vaginismus, and 16 were orgasmic for the first time in their lives during the two-week attendance at the Foundation.

4 more women have reported orgasmic return during the follow-up period after termination of the acute phase of their treatment. 6 women were previously orgasmic before the onset of the secondarily acquired symptoms of vaginismus. Their orgasmic responsivity returned spontaneously after treatment. Three women remained non-orgasmic, despite clinical relief from their involuntary vaginal spasm.

Vaginismus, once diagnosed, can be treated effectively from both psychological and physiological points of view, presuming full cooperation from both members of the sexually dysfunctional marital couple.