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SEXUAL PERFORMANCE PROBLEMS: ORGASM DIFFICULTIES

Men can experience two forms of orgasm difficulty: quick ejaculation and retarded ejaculation. Men who have trouble maintaining control of ejaculation once high levels of sexual arousal are reached have the condition called quick ejaculation. I have worked with countless men who go to dehumanizing lengths to increase their ability to hold off ejaculation. Even though such strategies may allow them to "last longer," quick ejaculation may still happen once the distracting stimulus stops and sexual pleasure is noticed again.
One man I treated developed the habit of abruptly pointing his toes whenever he felt arousal mounting during lovemaking with his wife. In this way, he would cause the insteps of his feet to spasm in pain, thus distracting himself from his pleasurable sexual feelings. He did last a few minutes longer before ejaculating, but his feet surely did hurt after making love. Other men use desensitizing creams or multiple condoms to numb the pleasure of intercourse so as to last a few precious moments more. The problem with these techniques is that they mute all pleasure from sexual relating.
Ruining your sexual pleasure to prolong lovemaking is not a true solution to problems with quick ejaculation. Some men are probably quick ejaculators because of biological factors, but many such men can learn to control ejaculation better if they learn to be more, not less, aware of and sensitive to their body's progression through the sexual response cycle.
At the opposite end of the spectrum of male orgasm difficulties is the condition called retarded ejaculation. Here, the male can attain high degrees of arousal, fully firm erections, and full participation in intercourse or other forms of sexual stimulation. His penis cooperates wonderfully up to this point in the response cycle. But men with retarded ejaculation have persistent difficulty reaching a climax. It is as though such men get stuck in the arousal phase of sexual response, unable to progress to orgasm. This condition may sound heavenly to a man who suffers from quick ejaculation, but such is not the case. Retarded ejaculation is typically quite frustrating, both to the men who suffer it and to their spouses.
Comparable to the male condition of retarded ejaculation is female orgasmic dysfunction. Here, a woman is able to become highly aroused and experience vaginal lubrication and swelling, but she is unable to experience orgasmic release with any form of sexual stimulation. Some women are able to achieve orgasm from self-stimulation but not from any form of stimulation by a partner.
Many women and their male partners mistakenly assume that the only healthy form of female sexual response is experiencing orgasm in response to penile-vaginal stimulation of the sort that typically occurs during intercourse. The truth is that most women do not experience orgasm from intercourse stimulation. For most women to achieve orgasm, they must receive sufficient stimulation of the clitoris, the tiny sexual organ located above the vaginal opening. Most of a woman's sexually pleasurable nerve endings are located in the clitoris, not in the vagina. A penis moving in and out of a vagina does not provide enough clitoral stimulation for most women to progress to orgasm. The majority of women who do report regularly experiencing orgasm during intercourse typically describe, if interviewed carefully, a pattern of lovemaking that involves receiving rather direct clitoral stimulation. It is this clitoral stimulation, not the stimulation from penile-vaginal contact, that usually triggers orgasm for most women.
With these sexual facts in mind, it is important for you and your partner to be realistic in your sexual expectations. A perfectly normal and healthy variation of female sexual response occurs when a woman enjoys lovemaking that involves intercourse but has orgasmic response only to oral or manual clitoral stimulation.
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EPILEPSY AND PREGNANCY

Women with epilepsy are quite often concerned about getting pregnant. There appear to be five reasons for this concern. They wish to know:
if they are likely to hand their epilepsy on to their children;
whether their fits will get worse during pregnancy;
whether it is safe for the baby that the mother should take anticonvulsants drugs during pregnancy;
if there will be any problems in the newborn baby from these drugs;
if they can safely breast feed the baby.
With regard to handing on epilepsy to one’s children – as mentioned earlier, if one parent has epilepsy, the chances of one of the children having epilepsy are no greater than in the population at large. If both parents have epilepsy, it would appear that the risk of a child having epilepsy is about 10 per cent. So in fact the chance of a child inheriting epilepsy, particularly idiopathic epilepsy, is negligible.
As far as seizures during pregnancy are concerned, the situation is not as clear as it might be. There is evidence that for some women, seizure control may deteriorate, while for others there may in fact be no change or even an improvement. A patient told me recently that “she would like to remain pregnant forever” as she had not had a single fit during her pregnancy, compared with six fits in the preceding nine months!
As a general working rule, it is suggested that people who have more than one grand mal fit a month are those who are most likely to have a deterioration in seizure control during pregnancy. The deterioration, if it occurs, is most likely during the first three months of pregnancy. There are a number of theories why this may happen, but none has been proved. It may be of value to check the blood anticonvulsant levels during pregnancy, especially if there is a deterioration in seizure control. The blood levels may fall, necessitating an increase in dosage during the pregnancy.
The main concern for parents is whether the anticonvulsants can harm the unborn baby (foetus). It is known by most people with epilepsy that this is a potential hazard. The effects include physical abnormalities in the baby, a process known as teratogenesis. Abnormalities have been reported in the offspring of mothers on all the commonly used anticonvulsants with the exception of carbamazepine. This is particularly applicable to phenytoin, barbiturates and sodium valproate. Babies born to mothers who have been on carbamazepine have not been shown to have any physical abnormalities, but have a smaller head size than other babies. This has not been shown to be any handicap to the babies who have been followed up for five years.
The risk of abnormalities in the baby is difficult to assess, but it seems to be most common in mothers on polytherapy (receiving numerous drugs), especially if they are on three or more anticonvulsants. The risk in mothers on phenytoin, with or without other medications, appears to be about a 10% chance of the baby showing features of the ‘foetal hydantoin’ syndrome. This syndrome consists of cleft palate, abnormalities of the fingers, possible heart abnormalities and mild mental retardation. Thus, at present, if it is possible, it would seem wise to try to change patients over to carbamazepine before conception. This may not be possible in all patients and, of course, many women will first visit their doctor when already pregnant, at which time there is no purpose in making the change.
Anticonvulsants taken by the mother during pregnancy may have some effects on the baby immediately after birth, as they are transmitted to the baby across the placenta. These include the possibility of a mild bleeding tendency and some drowsiness. In mothers who have been taking barbiturates, the infant may occasionally show features of a withdrawal reaction with irritability, jitteriness and poor sucking. None of these features is [...]

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