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The New Joy of Sex: Part 4. The allure of any size and shape. 2008, based on the works of Alex Comfort and Susan Quilliam. Listen to the podcast at How To Sex. Breasts. “In our maturer years,” wrote Erasmus Darwin, “when an object of vision is presented to us which bears any similitude to the form of the female bosom; we feel a general glow of delight, which seems to influence all our senses, and if the object be not too large we experience an attraction to embrace it with our lips as we did in early infancy the bosom of our mothers.” Breasts are the natural second target, but often the first one we reach. Just how sensitive they are, in men as well as in women, varies enormously, and according to physical state and mood. As with other sexual organs, size is unimportant in relation to sensitivity; if it still creates insecurity, however, fascinated attention is a more effective cure than surgery. Some breasts don’t answer at all, even in the emphatically non-frigid; some answer to extremely gentle touches, some to very rough handling (but they are sensitive structures; don’t let a need for forceful contact get the better of sound common sense.) Going round and round the nipple with the tongue tip or the glans, soft kneading with both hands, gentle biting, and sucking gently like a baby are the best gambits; she can do the same for him. (While there, both can occasionally check for suspicious lumps.) If her breasts are big enough to meet, one can get a surprising degree of mutuality from inter-mammary intercourse. This is a good expedient on occasions when she doesn’t feel like vaginal intercourse. She lies half flat on pillows, he kneels astride (big toe to her clitoris if she needs helping) with his foreskin, if he has one, fully retracted. Either he or she can hold the breasts together; wrap them around the shaft rather than rub the glans with them. It should protrude clear, just below her chin. Intercourse between the breasts is equally good in other positions; head to tail, or with her on top (especially if she has small breasts), or man sitting, woman kneeling; experiment accordingly. An orgasm from this position, if she gets one, is “round” like a full coital orgasm, and she feels it inside. Breast orgasms from licking and handling are “in between” in feel. His ejaculation this way gives her what’s known as a “pearl necklace”; he should rub the semen well into her breasts when he has finished (see semen.) Breasts, vagina, and clitoris all at once make the fastest and most concentrated buildup of sensation once intercourse has begun, for some women at least. Many easily stimulated women can also experience a rather special pleasure from suckling a baby. Nipples. a direct hotline to her most sensitive parts. She says: “Unlike a man’s nipples, a woman’s can have a direct hotline to her clitoris and vagina. A man who can dial this correctly and will only take the time can do anything. Palm-brushing, eyelash-brushing, licking, and loud sucking like a baby can work wonders; the orgasms one gets from these are mind-blowing without detracting a jot from intercourse to come after. Please take time.” He, meanwhile, can get a very special jolt from this, made more intense still if she is actually lactating; male suckling is more of a majority interest than you might think. On him, rather than by him, stimulation is less likely to have an effect; few men can get a nipple orgasm, but try a stiff pair of feathers (see feathers) or very gentle fingertip friction; men’s nipples easily get sore. If the effect seems lacking, assiduous attention over time may help; try gentle circles with a toothbrush. There is no proof in the theory that caffeine creates temporary nipple sensitivity, but it’s still worth a try. Fluctuating hormones before her period can turn sensitivity into discomfort, and if there is itching, swelling, bleeding, or discharge, get it checked out. This applies to him as well as to her. If a partner likes pain, or to test the possibility without putting the question direct, pinch nipples lightly, then harder (never when sore, lactating, or newly pierced.) The aim is a balance of pleasure and pain; after, once pressure is released, the whole body will be achingly sensitive for hours. If this appeals, move to nipple clamps (not clothes pegs, which aren’t adjustable); a linked pair with one on each of his and her breasts also provides a neat accompaniment to any movements that create a gentle tug. When taken off, pinch with fingers, then release slowly to allow the blood to flow back in comfortably. Limit time on such play; 15 minutes is enough. Buttocks. a turn-on in almost equal measure far both sexes. Next in line after breasts, buttocks alternate with them as visual sex stimuli for different cultures and individuals. Actually the original primate focus, being brightly colored in most apes; apparently equally fancied by the Neanderthals, who produced some of the best Stone Age figurines. The buttocks are a major erogenous zone in both sexes, though less sensitive than breasts because they have fewer nerves and a layer of fat, and so need stronger stimulation (holding, kneading, slapping, or even harder beating; see discipline.) Intercourse from behind (see rear entry) is a pleasure in itself, but be careful if she has a weak back. In any position the muscular movements of coitus stimulate the buttocks in both sexes, particularly if each holds the partner’s rear fairly tightly, one cheek in each hand. These extra sensations are well worth cultivating deliberately. Visually, good buttocks are a turn on in almost equal measure for both sexes. Penis. while the penis is emphatically his, it also belongs to both of them. Not only the essential piece of male equipment, even if it is often and expressively described as a “tool,” the penis has more symbolic importance than any other human organ, as a dominance signal and, by reason of having a will of its own, generally a “personality.” No point in reading all this symbolism back here, except to say that lovers will experience it, and find themselves treating the penis as something very like a third party. At one moment it’s a weapon or a threat, at another something they share, like a child. Without going into psychoanalysis or biology, it’s not a bad test of a love relationship if, while the penis is emphatically his, it also belongs to both of them. In any case, its texture, erectility, and so on are fascinating to both sexes, and its apparent autonomy, a little alarming. Like the vagina, the penis collects anxieties and folklore, and is a focus for all sorts of magical manipulations. Male self-esteem and sense of identity tend to be located in it, as Samson’s energy was in his hair. If it won’t work, or worse, if she sends it up, or down, the results will be disastrous. This explains the irrational male preoccupation with penile size. Size has absolutely nothing to do with physical serviceability in intercourse, or; since female orgasm doesn’t depend on getting deeply into the pelvis; with capacity to satisfy a partner, though many women are turned on by the idea of a large one, and a few say that they feel more (see size.) If anything, thickness matters more than length. Nor has flaccid size anything to do with erect size; a penis that is large when at rest simply enlarges less with erection. There is no way of artificially “enlarging” a penis. Nor, except in very rare cases, is a penis too big for a woman; widthwise, the vagina will take a full-term baby. If his penis, whatever its length, knocks an ovary and hurts her, he shouldn’t go in so far. A woman who says she is “too small” or “too tight” is usually making a statement about her arousal levels; she needs time, understanding, and foreplay. Shape also varies; the glans can be blunt or conical. This matters only in that the conical shape can make receptacle-tipped condoms uncomfortable through getting jammed in the tip. Women who have really learned to enjoy ...

The New Joy of Sex: Part 3. A Lover's State of Mind and Soul. 2008, based on the works of Alex Comfort and Susan Quilliam. Listen to the podcast at How To Sex. Hormones. The fuel in the sex machine, keeping desire, arousal, and performance ticking over, as well as driving affection and love. For the most part, they form a constant underpinning of mood, supporting though never replacing the honest-to-goodness sexual diesel generated by enthusiastic lovers. A peak or a valley, on the other hand, can impact. Sexually, the crucial fuel is testosterone, for her as well as for him. His will peak during his twenties, then settle into a more or less consistent pattern, dipping over the course of a long term relationship and rising in a new one; no excuse for straying, but a possible explanation of the temptation to do so. With age, it will gently decline; but rarely enough to cause problems; if his erection is failing, that’s reason for action, not resignation. In her, testosterone has the same effect, raising desire, demand, and energy; in the last third of her menstrual month, when levels of the hormone are high, try more urgent, fighting sex. Around the menopause, as estrogen drops away and testosterone levels stay high, she may find to her delight a lust that lasts for months or years; a second adolescence of which she can take full advantage. Oxytocin, the “cuddle hormone,” both bonds partners in affection and makes them less likely to want to be sexual; one reason why the postorgasmic default is to hug rather than go for a second bout. Add in prolactin, the “done that, time to rest” hormone also released at orgasm, to explain why, for him in particular, the default may well be to sleep. Prolactin is released when breast-feeding too, another reason why postpartum she may be utterly turned off all things sexual; just as the contraceptive pill, breast-feeding, and stress may imbalance her general hormone levels, with the same low-desire result. But never be held hostage; hormones may affect mood, but they can’t overrule action; clear thinking, reassuring communication, and making love regardless are often enough to offset imbalances. These notes are mainly included here for interest and understanding; all genuine lovers will want to know what’s under the hood in order to make the car purr more sweetly; but largely there are no bedroom applications. If the machine falters, however, science is increasingly able to supply an answer; see your doctor. Preferences. More of us than we may think have a wide sexual range; that is to say, are able to respond sexually to either gender. Yes, many recognize who they are early in life and never shift. But adolescents often experiment before settling, and adults dream; same-sex relationships are in the top three sexual fantasies for heterosexuals, and some of the most surprising people; like Hans Christian Andersen; live out such dreams in real life. Preferences are not a choice that can be overridden in the long term; you may like both sexes, but if you don’t, the irrelevant one simply doesn’t smell right and there is no negotiating that. If you occasionally wonder; as opposed to having strong and clear desires in a particular direction; you are probably not gay but curious. If you have strong, clear desires, don’t agonize but talk it through; ringing a gay or lesbian help line won’t mean you are persuaded or presupposed into it, but will mean you speak to someone who has asked themselves the same questions as you have and found appropriate answers. Your own answer, once found, could transform your sex life and also your life in general; passion can flow and activities that seemed off-putting with one gender can, with the other, feel natural and fulfilling. Surely it doesn’t need saying that the joy of sex is rooted in knowing who you really are. As to the whole political agenda, happily in most countries all of the above is not the “problem” it was when this book was first written, though in most cultures it’s still a challenge and in others it’s still actively against the law, either secular or religious. We, however, believe that one person’s flavor of sexuality is no one else’s business; everyone should be free to follow their inclinations without fear or favor. If you don’t, you not only waste your own life pretending to be someone you aren’t, you also potentially waste the life of a partner who knows there is something not quite right but can’t pinpoint it. Whatever your preferences, be honest with yourself and your beloved, and never think you can “cure” a partner of their own preference by imposing yours upon them. This book is written for the straight reader but, within the context of a loving relationship, behaviors borrowed from the whole range of possible preferences can have their uses. Don’t dismiss (or judge) anything until you have tried it at least once. Confidence. It is, surely, a self-fulfilling prophecy that the more confident you are, the more you will enjoy sex. This is not about arrogance; the assumption that one is God’s gift will be an instant turnoff, particularly to women, if only because they know with that sort of mental map a man won’t have bothered to learn enough to be even moderately useful. At the other end of the extreme, a partner who starts off lacking in confidence only proves delightful if they ultimately benefit from care and feeding; lasting and insistent insecurity is draining in bed and out of it. But true sexual confidence; being relaxed, knowledgeable about oneself, willing to learn about another, ready to ask for what’s needed, happy to take charge, and unwobbled by either failure or rejection; makes for that ultimate in sexual partners, one who is able both to give and receive with an equal abundance of pleasure. This has nothing to do with looks. Nowadays, almost all women; and an increasing number of men; are scared of being spurned on that count, but this is because the media manipulates body image. If you don’t love your body, change your mind; if your partner doesn’t love your body, change your partner. Note to her: men are almost always more focused on sensation and the feelings of acceptance that sex gives than on your size, shape, or degree of firmness. If he has ever hugged you clothed, he already knows your shape; if when you are unclothed he has an erection, then he not only accepts but lusts after it. Note to him: women care hardly at all about shape, so relax please. He, however, may have other insecurities. He is asked to demonstrate potency in much more obvious ways than she is, and the men’s magazines may have convinced him that unless he can do so he will be rejected. But in terms of pure erection, there are always other ways; and for most women those ways are just as acceptable, certainly on an occasional basis. If generally nervous, the answer is to end up in bed only with a partner one is relaxed with and then try things out. As with all human activities, the way to mastery is through play. Whatever one’s size, experience, and ability; or disability; good sex is one of the most powerful confidence-builders because it places each partner right in the center of the other’s attention; beyond that, genuine compliments, demonstrated affection, and a total lack of comparison will complete the magic spell. She says: “Show me that you think I’m beautiful and everything else follows.” His words may be different, but the essential message will be the same. Cassolette; her greatest sexual asset alter her beauty. French for perfume box. The natural perfume of a clean woman: her greatest sexual asset after her beauty (some would say greater than that.) It comes from the whole of her; hair, skin, breasts, armpits, genitals, and the clothing she has worn: it is her own signature scent and no two women are the same in this respect. Men have a natural perfume too, which women are aware of, but while a man can be infatuated with a woman’s personal perfume, women on the whole simply tend to notice if a man smells right or wrong. Wrong means not so much unpleasant as intangibly not for them. Often their awareness of a man includes co...

The New Joy of Sex: Part 2. A private performance of fine arts. 2008, based on the works of Alex Comfort and Susan Quilliam. Listen to the podcast at How To Sex. The antique idea of the woman as passive and the man as performer used to ensure that he would show off playing solos on her, and early marriage manuals perpetuated this idea. Today, she is herself the soloist par excellence, whether in getting him excited to start with, or in controlling him and showing off all her skills. Solo recitals are not, of course, necessarily separate from intercourse. Apart from leading into it, there are many coital solos; for the woman astride, for example; while mutual masturbation or genital kisses can be fully fledged duets. Solo response can be electrifyingly extreme in the quietest people. Skillfully handled by someone who doesn’t stop for yells of murder but does know when to stop, a woman can get orgasm after orgasm, and a man can be kept hanging just short of climax to the limit of human endurance. The solo-given orgasm, whether from her or from him, is unique; neither bigger nor smaller in either sex than a full duet but different; sharper but not so round. And most people who have experienced both like to alternate them. Trying to say how they differ is a little like describing wine. Differ they do, however, and much depends on cultivating and alternating them. Top-level enjoyment doesn’t have to be varied, it just often is. In fact, being stuck rigidly with one sex technique usually means anxiety. In this book we have not, for example, focused on coital postures to the exclusion of all else. The common positions are now familiar to most people from writing and pictures if not from trial; the more extreme ones, as a rule, should be spontaneous, but few of them have marked advantages. This explains the apparent emphasis in this book on extras; the “sauces and pickles.” That said, individuals who, through a knot in their psyche, are obliged to live on sauce and pickle only are unfortunate in missing the most sustaining part of the meal; exclusive obsessions in sex are very like living exclusively on horseradish sauce through allergy to beef; fear of horseradish sauce, however, as indigestible, unnecessary, and immature is another hang-up, namely puritanism. One of the things still missing from the essence of sexual freedom is the unashamed ability to use sex as play. In the past, ideas of maturity were nearly as much to blame as old-style moralisms about what is normal or perverse. We are all immature, and have anxieties and aggressions. Coital play, like dreaming, may be a programmed way of dealing acceptably with these, just as children express their fears and aggressions in games. Adults are unfortunately afraid of playing games, dressing up, and acting scenes. It makes them self-conscious: something horrid might get out. In this regard, bed is the place to play all the games you have ever wanted to play; if adults could become less self-conscious about such “immature” needs, we should have fewer deeply anxious people. If we were able to transmit the sense of play that is essential to a full, enterprising, and healthily immature view of sex between committed people, we would be performing a mitzvah: playfulness is a part of love that could be a major contribution to human happiness. But still the main dish is loving, un-self-conscious sexual pleasure of all kinds; long, frequent, varied, ending with both parties satisfied, but not so full they can’t face another light course, and another meal in a few hours. The piece de resistance is good old face-to-face matrimonial, the finishing-off position, with mutual orgasm, and starting with a full day or night of ordinary tenderness. Other ways of making love are special in various ways, and the changes of timbre are infinitely varied; complicated ones are for special occasions, or special uses like holding off an over-quick male orgasm, or are things that, like pepper steak, are stunning once a year, but not dietary staples. There are, after all, only two “rules” in good sex, apart from the obvious one of not doing things that are silly, antisocial, or dangerous. One is: “Don’t do anything you don’t really enjoy,” and the other is: “Find out your partner’s needs and don’t balk at them if you can help it.” In other words, a good giving and taking relationship depends on a compromise (so does going to a show; if you both want the same thing, fine; if not, take turns and don’t let one partner always dictate.) This can be easier than it sounds, because unless their partner wants something they find actively off-putting, real lovers get a reward not only from their own satisfaction but also from seeing the other respond and become satisfied. Most wives who don’t like Chinese food, will eat it occasionally for the pleasure of seeing an Asian food loving husband enjoy it, and vice versa. Partners who won’t do this over specific sex needs are usually balking not because they have tried it and it’s a turnoff (many experimental dishes are nicer than you expected), but through ignorance of the range of human needs, plus being scared if these include things like forcefulness, cultivating extragenital sensation, o r role-playing, which previous social mythology pretended weren’t there. Reading a full list of the unscheduled accessory sex behaviors that some normal people find helpful might be thought a necessary preliminary to any extended sexual relationship. Repolishing. Couples should match up their needs and preferences (though people don’t find these out at once); you won’t get to some of our suggestions or understand them until you have learned to respond. It’s a mistake to run so long as walking is such an enchanting and new experience, and you may be happy pedestrians who match automatically. Where a rethink really helps is at the point where you have gotten used to each other socially (sex needs aren’t the only ones that need matching up between people who live together), and feel that the surface needs repolishing. If you think that sexual relations are overrated, the surface does need repolishing, and you haven’t paid enough attention to the wider use of your sexual equipment as a way of communicating totally. The traditional expedient at the point where the surface gets dull is to trade in the relationship and start all over in an equally uninstructed attempt with someone else, on the off chance of getting a better match-up by random choice. This is emotionally wasteful, and you usually repeat the same mistakes; better by far to repolish. As to practicalities, we suggest couples either read the book together or (perhaps even better) read it separately, marking passages for the other partner’s attention. This works wonders if; as is often the case; you don’t really talk easily about sexual needs, or are afraid of sounding tactless. Finally, if you don’t like the repertoire or if it doesn’t square with yours, never mind; the aim of The Joy of Sex is to stimulate your creative imagination. Sex books can only suggest techniques in order to encourage you to experiment. You can preface your own ideas with “this is how we play it,” and play it your own way. But by that time, when you will have tried all your own creative sexual fantasies, you won’t need books. Ingredients. Tenderness. a constant awareness of what your partner is feeling, plus the knowledge ol how to heighten that feeling, gently, toughly, slowly, or last. This, in fact, is what the whole book is about. It doesn’t exclude extremely forceful games (though many people neither need nor want these), but it does exclude clumsiness, heavy-handedness, lack of feedback, spitefulness, and non rapport generally. Tenderness is shown fully in the way you touch each other. What it implies at root is a constant awareness of what your partner is feeling, plus the knowledge of how to heighten that feeling, gently, toughly, slowly, or fast, and this can only come from an inner state of mind between the two of you. No really tender person can simply turn over and go to sleep afterwards. Many if not most inexperienced men, and some women, are just naturally clumsy; either through haste, anxiety, or lack of sensing how the other sex feels; so don’t grab breasts, stick fingers into the vagina, bend the penis, or (and this goes for both sexes) misplace bony parts of your anatomy. More wome...

The New Joy of Sex: Part 1. The art of gourmet lovemaking. 2008, based on the works of Alex Comfort and Susan Quilliam. Listen to the podcast at How To Sex. Preface 1. I first wrote this book nearly 20 years and over 8 million copies ago. I am a physician and human biologist for whom the natural history of human sexuality is of as much interest as the rest of human natural history. I had notes on it. My wife encouraged me to bring biology into medicine, and my old medical school had no decent textbook to teach a human sexuality course. Joy was compiled and very importantly, illustrated, just after the end of that daft and extraordinary non-statute in Western society, the Sexual Official Secrets Act. For at least two hundred years, the description, and above all the depiction, of this most familiar and domestic group of activities, and of almost everything associated with them, had been classified. When, in the sixteenth century, Giulio Romano engraved his weightily classical pictures showing sixteen ways of making love, and Aretino wrote poems to go with them, a leading ecclesiastic opined that the artist deserved to be crucified. The public, apparently, thought otherwise (“Why”, said Aretino, “should we not look upon that which pleases us most?”) and Are tin’s Postures have circulated surreptitiously ever since, but even in 1950s Britain pubic hair had to be airbrushed out to provide a smooth and featureless surface. People today, who never experienced the freeze on sexual information, won’t appreciate the propositions of the transformation when it ended; it was like ripping down the Iron Curtain. My immediate predecessor in writing about domestic sex, Dr. Eustace Chesser, was (unsuccessfully) prosecuted for his low-key, unillustrated book Love Without Fear, and even in 1972 there was still some remaining doubt about whether Joy would be banned by the Thought Police. The main aim of “sexual bibliotherapy” (writing books like this one) was to undo some of the mischief caused by the guilt, misinformation, and lack of information. That kind of reassurance is still needed. I have asked various people; chiefly older couples; whether The Joy of Sex told them things they didn’t know, or reassured them about things they knew and already did or would like to do. I have had both answers. One can now read books and see pictures devoted to sexual behavior almost without limitation in democratic countries, but it takes more than a few decades and a turnover of generations to undo centuries of misinformation; and of this material, much is anxious or hostile or over the top. People who worried, when the book first came out, if they did some of the things described in it may now worry if they don’t do all of them. That we can’t help, nor the fact that the same people who went to doctors because of sexual fear and inhibition under the old dispensation now go complaining of sexual indigestion under the new. Sexual behavior probably changes remarkably little over the years; sexual revolutions and moral backlashes chiefly affect the degree of frankness or reticence about what people do in private; the main contributor to any sexual revolution in our own time, insofar as it affects behavior, has not been frankness but the advent of reliable contraception, which makes it possible to separate the reproductive and recreational uses of sexuality. Where un-anxious books dealing as accurately as possible with the range of sexual behaviors are most valuable is in encouraging the sexually active reader; who both wants to enjoy sex and to be responsible about it; and in aiding the helping professions to avoid causing problems to their clients. It is only recently, as ethology has replaced psychoanalytic theory, that counselors have come to realize that sex, besides being a serious interpersonal matter, is a deeply rewarding form of play. Children are not encouraged to be embarrassed about their play; adults often have been and are still. So long as play is not hostile, cruel, unhappy, or limiting, they need not be. One of the most important uses of play is in expressing a healthy awareness of sexual equality. This involves letting both sexes take turns in controlling the game; sex is no longer what men do to women and women are supposed to enjoy. Sexual interaction is sometimes a loving fusion, sometimes a situation where each is a “sex object”; maturity in sexual relationships involves balancing, rather than denying, the personal and impersonal aspects of arousal. Both are essential and built-in to humans. For anyone who is short on either of these elements, play is the way to learn: men learn to stop domineering and trying to perform; women discover that they can take control in the give-and-take of the game rather than by nay-saying. If they achieve this, Man and Woman are one another’s best friends in the very sparks they strike from one another. This book has changed considerably since its first edition and it will be revised again in the future as knowledge increases. What will not change is the central importance of un-anxious, responsible, and happy sexuality in the lives of normal people. For what they need; in a culture that does not learn skills and comparisons in this area of living by watching; is accurate and unbothered information. The availability of this, and public resistance to the minority of disturbed people who for so long limited it, is an excellent test of the degree of liberty and concern in a society, reflected in the now-old injunction to make love, not war. It is a socially relevant test today. Alex Comfort, MB, D Sc, 1991 Preface 2. I am a relationships psychologist and sexologist whose lifetime aim, through a variety of expert roles, has been to help people enhance their emotional and sexual partnerships. So when the publishers of The Joy of Sex approached me to “reinvent” the book for the twenty-first century, it seemed to me the fulfillment of everything I have been working for. I well remember the original publication of Joy, and the awed giggles with which I and my friends read, discussed, and then put into practice its suggestions. So I know firsthand what over the decades proved to be true: Joy is an astonishing and inspirational child of its age, born not only out of social but also political changes that irreversibly altered the sexual landscape for individuals, couples, and society. Barely a decade before the book’s 1972 publication, the contraceptive pill had, for the first time in history, enabled women to have control over their own fertility. In its wake came increased female education, emancipation, and self-belief, as well as a whole host of liberalizations, sexual and social; increasing permissiveness, more frequent cohabitation, easier divorce, more available erotica, and gay rights. Joy was not only a product of this revolution, it also helped create it. Dr. Alex Comfort’s aim was to write the first book that gave readers accurate knowledge about sexuality, and permission to use that knowledge. The text and illustrations were designed to both reassure the reader that their sexuality was normal and to offer further possibilities with which to expand their sexual menu. He was hugely effective in his intention; 8.5 million copies of The Joy of Sex have been sold to date and it has been translated into fourteen languages. More than that, it was a key influence on the social changes of the late twentieth century and has been a byword for sexual vision ever since. Why, then, reinvent? There have already been content revisions, in the author’s lifetime and after his death in 2000, the most recent being the highly successful thirtieth-anniversary edition by Alex’s son Nicholas Comfort. But the very changes that Joy itself wrought in society have meant that the book has come to need updating in a more fundamental way. This was my task; to re create The Joy of Sex for the contemporary world; to do what Alex Comfort would have done had he been writing today. The majority of the text remains the same, but substantial additions have been made. Many of these are informational; there have been countless key scientific discoveries in recent years in the fields of physiology, psychology, psychotherapy, and medicine, while the advent of sexology; the specialist study of sexual matters; has resulted in both rigorous academic research and a more widespread public awareness of, and skill in, sex. Alongside these informational updates, a great deal of refocusing has...

STDs: What Are They and How Do You [not] Get Them?By Everyday Health. Listen to the ► Podcast at How To Sex. This episode deals with the following STD concerns: Chlamydia, Genital Herpes, Gonorrhea, Hepatitis B, HIV, HPV, Molluscum Contagiosum, Syphilis, Trichomoniasis, Chlamydia, Genital Herpes, Gonorrhea, Hepatitis B, HIV, HPV, Molluscum Contagiosum, Syphilis, Trichomoniasis.The number of cases of sexually transmitted diseases (STDs), now more commonly referred to as sexually transmitted infections (STI), in the United States hit an all-time high in 2019, according to data released on April 13, 2021, by the Centers for Disease Control and Prevention (CDC). The CDC’s surveillance report shows that nearly 2.5 million new cases of gonorrhea, syphilis, and chlamydia were reported that year.Chlamydia remained the most common condition reported to the CDC, with close to 1.8 million cases, up 19 percent since 2015. Gonorrhea diagnoses reached 616,392, up 56 percent since 2015. And primary and secondary syphilis diagnoses reached 129,813, up 74 percent since 2015.Of high concern is that congenital syphilis cases, that is, syphilis in newborns, nearly quadrupled between 2015 and 2019, reaching 1,870 cases. From 2018 to 2019 the number of stillbirths caused by syphilis increased from 79 to 94, and the number of congenital syphilis-related infant deaths rose from 15 to 34 deaths.While the 2019 STD statistics reflect pre-COVID-19 pandemic numbers, preliminary data from 2020 suggests many of the same trends continued during the pandemic. Experts attribute some of the growth in STDs in 2020 to disruptions in STD testing and treatment programs caused by the pandemic.While 2.5 million cases of chlamydia, gonorrhea, and syphilis may sound like a lot, it’s likely an undercount: Many people with these and other STDs, formerly known as venereal diseases, go undiagnosed and untreated. The CDC estimates that nearly 20 million new sexually transmitted infections occur every year, accounting for almost $16 billion in healthcare costs annually.Inequities in STD BurdensThe numbers of STDs increased in all age groups and among all racial and ethnic groups in 2019, according to CDC statistics. However, some groups saw higher rates of STDs than others:People ages 15 to 24 accounted for 61 percent of chlamydia cases and 42 percent of gonorrhea cases.Gay and bisexual men accounted for nearly half of all primary and secondary syphilis cases.Here’s what you need to know about how to spot, treat, and prevent STDs.What Is the Definition of an STD?“STDs are diseases that are passed from one person to another through sexual contact,” a representative of the CDC says.According to the CDC, some of the common STDs are chlamydia, gonorrhea, herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV), human papillomavirus (HPV), and syphilis. "Many of these STDs do not show symptoms for a long time," per the CDC, "but they can still be harmful and passed on during sex.”Virtually all STDs can be transmitted through anal, vaginal, or oral sex. In addition, some STDs can also be transmitted through close skin-to-skin contact, even if no intercourse occurs.HPV, for example, can be spread through skin-to-skin touching. In addition, “Molluscum contagiosum, a viral skin disease, can be spread through sexual or casual contact, as can scabies, an itchy skin condition caused by a mite infestation. It is also possible to get scabies from an infected sleeping bag or bed,” says Edward W. Hook III, MD, an endowed professor of infectious disease translational research in the departments of medicine, epidemiology, and microbiology at the University of Alabama in Birmingham, who works with the CDC.STDs don’t just affect the genital regions: “Oral herpes can be transmitted through oral and genital sex,” says Dr. Hook.It is important to remember that STDs may have no symptoms. However, new vaginal or urethral discharge or a new rash after sexual contact should be evaluated by a medical professional.When symptoms do occur, they can include the following:Chlamydia Symptoms of chlamydia can include vaginal discharge in women, penile discharge in men, and burning during urination in men and women.Gonorrhea Gonorrhea can cause thick, cloudy, or bloody discharge from the vagina or urethra, and pain or burning when peeing. If you have gonorrhea in your anus, it may cause itching in and around the anus, discharge from the anus, and pain when defecating. Gonorrhea in the throat may cause a sore throat.Hepatitis B Acute hepatitis B can cause fever, fatigue, loss of appetite, nausea or vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice (yellowing of the skin and whites of the eyes). Symptoms can appear anywhere from six weeks to six months following exposure to the hepatitis B virus. Chronic hepatitis B sometimes causes symptoms similar to acute disease.Genital Herpes Signs of genital herpes typically include red bumps that develop into blisterlike sores in the genital area and sometimes on the buttocks or thighs. A new infection with HSV-2, the virus that causes most cases of genital herpes, may also cause flulike symptoms, including fever, headache, feeling tired and achy, and swollen glands.Oral Herpes Symptoms of oral herpes can include itching of the mouth or lips, sores or blisters on the lips or inside the mouth, and flulike symptoms such as fever, headache, body aches, and swollen glands.HIV Early symptoms of HIV infection can resemble those of the flu: fever, headache, muscle aches, and sore throat. They may also include swollen lymph nodes, diarrhea, nausea and vomiting, a fungal infection of the mouth, and a rash on the abdomen, arms, legs, or face. If HIV goes untreated, later symptoms can include fatigue, weight loss, night swea...

The Many Pregnancy Prevention OptionsBy Everyday Health. Listen to the ► Podcast at How To Sex. Contraception Options 101: Everything You Need to Know About Birth ControlHere’s the lowdown on pregnancy prevention with pills, patches, implants, and other types of birth control, plus information on effectiveness, availability, cost, and more.By Cheryl Alkon; By John Paul McHugh, MD courtesy of American College of Lifestyle MedicineUpdated on August 28, 2023It’s a fact: If you’re a woman, and you have sex with a man, it’s possible you’ll get pregnant. But if you don’t want to have a baby, there are many forms of birth control to help prevent pregnancy.Birth Control: A Definition and OverviewWhile abstinence, or refraining from intercourse, is the only way to prevent pregnancy with 100 percent certainty, contraception, or birth control, comes in several different forms, both non-hormonal and hormonal.Non-hormonal methods generally create a physical barrier between the sperm and the egg; a notable exception is the copper IUD, which changes the uterine environment but does not actually present a physical barrier. Two permanent contraception methods require surgery: sterilization, or tubal ligation, for women and vasectomy for men.Hormonal methods generally prevent ovulation (the release of an egg), make it more difficult for sperm to enter the uterus, or prevent a fertilized egg from implanting in the uterus.What’s the Best Birth Control Method?“It varies, and it depends on you and your lifestyle,” says Keosha T. Bond, an assistant medical professor at The City University of New York School of Medicine in New York City. “I try to explain there’s no one-size-fits-all. It’s more, ‘What can I do, and how does my body react?’ There are so many contraceptive methods out there, but not every one will fit every person.”How Effective Is Birth Control?The effectiveness rate of various birth control methods is based on perfect use; meaning the method is used consistently and correctly every single time, and typical use, which includes people who use the method inconsistently or incorrectly.Knowing what all your birth control options are will help you and your partner choose what works best for you. “I think it’s awesome to be talking about it. A lot of people just don’t know” about birth control, says Christine Carlan Greves, MD, an obstetrician and gynecologist with Orlando Health in Florida.Birth Control Methods: All Your Contraception OptionsHere’s a look at the various kinds of birth control available today.Hormonal Birth ControlContraceptive methods that use hormones alter how your body works in order to prevent pregnancy. These range from daily-use options, such as birth control pills, to long-term-use approaches, such as hormonal IUDs, which can stay in place for several years, says Dr. Bond.Hormonal Contraception Option: Birth Control PillsThere are two types of birth control pills: combination pills that contain both estrogen and a form of progesterone called progestin, as well as progestin-only pills (also known as the mini pill).The pills work by preventing ovulation, so there is no egg for sperm to fertilize, or by thickening cervical mucus so sperm cannot travel to an egg.Birth control pills need to be taken every day as directed. Most types of progestin-only pills must be taken within the same three-hour time window every day. Some pills can also be used to stop your period.How effective are birth control pills? Combined and progestin-only birth control pills are more than 99 percent effective if used perfectly and 93 percent effective if used typically.How much do they cost? You need a prescription to get birth control pills. They may cost nothing or up to $50 a month and can be free or low-cost with most types of health insurance, Medicaid, or other government programs.Hormonal Birth Control Side EffectsSome people don’t do well on hormonal contraception. “Each woman is different, and you have to understand your body,” says Bond. If you notice one or more of these side effects, let your doctor know:NauseaWeight gainChanged menstrual cycles, including spottingSome women like the effect of ‘the pill’ on their breast size. They are glad to have that kind of ‘weight gain’.Who Shouldn’t Take Hormonal Birth Control?For some people, the use of hormones is not recommended. “The pill is easy and awesome, but if you have migraines with aura (vision changes during a bad headache) or have a history of deep vein thrombosis, stroke, or other cardiac changes,” talk to your doctor to learn if you should consider another birth control option, says Dr. Greves. Moreover, if you have a blood-clotting disorder, you don’t want to take estrogen, and if you have breast cancer, you don’t want to take estrogen or progestin. Smokers and those considered overweight or obese should talk to their doctors about which contraceptives are recommended for them.Hormonal Contraception Option: The Shot, Depo, or Depo-ProveraAn injection of medroxyprogesterone (Depo-Provera) (also known as the birth control shot) can prevent pregnancy for three months.The shot contains high-dose progestin to prevent ovulation, and it also makes cervical mucus thicker to prevent sperm from reaching the egg.In most cases, your doctor or nurse will give you the shot every quarter, but in some cases, you may be able to bring the shot home to give it to yourself.How effective is the shot? Injectables are more than 99 percent effective with perfect use and 96 percent effective with typical use.How much does it cost? It can cost nothing or up to $150, and it can be free or low-cost with many health insurance plans, Medicaid, and some government programs.Hormonal Contraception Option: Birth Control Implant, or NexplanonThe birth control implant, also called Nexplanon, is a small rod about the size of a matchstick that is placed into the upper arm. It releases progestin to prevent pregnancy for up to three years.The implant must be inserted by a trained healthcare provider and can be removed at any time if you want to get pregnant.How effective is the implant? The implant is more than 99 percent effective.How much does it cost? It can cost anywhere between $0 and $1,300, but it’s totally free with most health insurance plans, Medicaid, and some government programs.Hormonal Birth Control Option: Vaginal Ring (NuvaRing or Annovera)Like combination birth control pills, the vaginal ring contains both progestin and estrogen. It’s a small ring that a woman wears inside her vagina, and the hormones work to prevent ovulation and pregnancy.There are two types of vaginal rings: ethinyl estradiol and etonogestrel (NuvaRing) and ethinyl estradiol and segesterone (Annovera). Each NuvaRing lasts for up to five weeks. You take the old one out and put in a new one about once a month, and it can be used to safely skip your period. Each Annovera ring lasts for one year, but you must put it in your vagina for three weeks, then take it out for one week every month, du...

Recklessness ruptured my plumbing, and permanently curtailed my sex life. By Anonymous. Listen to the Podcast at How To Sex. I Fucked up. I am writing this mainly because there is not a lot of information about this particular injury Around October of last year I was having sex with my girlfriend, when I thrust too hard at the wrong angle and tore my Urethra and two blood vessels in my penis. When the injury first occurred I was close to climaxing. Because of this, when the injury happened and the blood vessels and urethra were torn, blood started mixing into my urethra. I was cumming bloodI was not in pain but I could feel that my dick was not pointing in the right direction and turned on the lights, blood was everywhere and pouring out of me at an alarming rate (think you’re cumming but it doesn’t stop and its blood) At this point I’m panicking and yell out that I need to go to the hospital immediately. I throw on loose pants without zipping them up, a hoodie, and grab a towel to soak the blood that’s coming out. Then me and my girl go to the hospital. The hospital near me specialized in bodily injury and doesn’t have the type of urologist doctor that I need to see, so I have to drive 30 minutes away to the closest hospital that has a Urology department. Once I get to this secondary hospital, I am immediately taken in and put into a room of my own once they see my dick; and about an hour later I see a Urologist who runs some tests and tells me about the ruptured urethra and blood vessels. I need surgery. The surgery is a process called “de gloving” where they “de-glove” the skin around your penis, roll it down, and make an incision into the underside of the skin and go in and stitch up the torn vessels and urethra, these are dissolvable stitches and they stay in your penis until they go away on their own. About 8 hours later I actually went into surgery, I don’t remember anything. I was wheeled into the operating room and the anesthesiologist cracked a dumb joke, and then I was out. I woke up with my penis wrapped up in bandages and a catheter in me. If you have never had to use a catheter, count yourself lucky. I was told I needed to keep the catheter in for 10 days. These were the longest 10 days of my life. If you asked me what the pain was on a scale of 1-10, it was 7 with the opioids, and 11 without them. Any little movement with my penis and I got searing pain. Wearing any type of clothes was out because I just could not take it, I was pretty much naked during those ten days. Anytime the catheter twisted? Pain. Anytime I had to roll out of bed to go get something from the fridge? Pain. Worst of all? Erections. As the men reading this will know, erections are not really voluntary, we just get them sometimes. Morning wood is a real thing and its not controllable. Want to know what getting an erection feels like when you have stitches in your dick and a catheter? Worse than words could ever explain. I woke up screaming three times a night. I would tear something and I could see the stale blood along the catheter as my erections came and went. The blood became crispy, and if I didn’t clean it when it happened, the next erection would be 5 times as painful because it would grow along the stale, sharp leftover blood on the catheter. I quickly learned how to kill erections, but it was still really bad. I’m actually leaving out some details because I’m not fully recovered yet and the phantom pain comes back as I’m trying to recall it. As of today, I have the catheter out and can walk around again, but erections are still painful, I imagine that will go away in the next few weeks. Yes, You Really Can Fracture a Penis shaft — Here's What That Means Proceed with caution if you're squeamish. BY SOPHIE SAINT THOMAS - 2018 There are a lot of sexual myths out there, but doctors confirm that broken penises aren't one of them. Remember when Lexie Grey supposedly broke Mark Sloan's penis back when all our favorite characters on Grey's Anatomy were still alive? Nope, Shonda Rhimes wasn't making that up. While there aren't actually bones in the penis, a penile fracture is a real-life injury. We spoke to several urologists to learn how it happens, what a broken penis looks like, and how to treat one. What exactly is a fractured penis (often known as a "broken dick")? First, a quick refresher on what inside a penis can break in the first place: A penis contains two chambers of tissue called the corpus cavernosum, which fill with blood when the penis becomes erect. Blunt force to an erect penis can tear the sheath surrounding these chambers (and even rupture the erectile tissue inside) so that the blood inside leaks out to other areas of the penis. If you need another visual, Alex Shteynshlyuger, a urologist in New York City, says to think of this covering less like a bone and "more like a sausage casing." (Doctors, however, call the covering of the corpus cavernosum the "tunica albuginea.") How do penile fractures happen? A penis can be broken during vigorous penetrative sex or through masturbation. When this happens during partnered sex involving a penis and vagina, "generally speaking, the penis will come out of the vagina and strike against the pubic bone," says Leslie Deane, an associate professor of urology at Rush University Medical Center in Chicago. While a penis can fracture during sex in any position, research suggests that Female on top, or rear-entry positions such as ‘reverse cowgirl’ or ‘doggy style’ may lead to penile fractures more often than ‘missionary’ or ‘spooning.’ A penis may be more likely to exit a vagina or anus entirely when thrusting from behind and then, instead of reentering, bang against something hard like the perineum. (If you're an anal sex beginner, it's important to take things slow. Deane says penile fractures aren't uncommon, and that he sees several cases a year. He adds that he observes higher rates of the injury around Valentine's Day and that alcohol is sometimes involved. What does a broken dick look like? According to Stacy Loeb, an assistant professor of urology and population health at New York University, a penile fracture may be accompanied by a popping noise, a rapid loss of erection, and acute pain. "The penis may develop swelling and bruising, referred to as an 'eggplant deformity,'" Loeb says. This means that the eggplant emoji isn't totally off-base as a representation of dicks: It just looks like a broken one. Shteynshlyuger adds that some penile fractures lead to bleeding from the tip of the urethra and that patients may notice blood in their urine. If you're having fun with a penis that suddenly "pops," goes soft, and causes its owner immense pain, seek medical attention immediately. You might have a broken dick on your hands. How is a broken penis treated? Still reading? Good, because there's some positive news: If treated, broken dicks stand a great chance of making a full recovery. Unfortunately, Deane says, surgery is required in most cases. While there are less severe penile injuries that can occur during sex, such a...

Tie up your man and go to town. By alf_2712. Listen to the Podcast at How To Sex. Bondage sex is often associated with Sado Masochism. But that vaste generalization does a great disservice to a wide range of sexual proclivities. Each part of this grouping ought to be understood on it’s own attributes. Bondage is simply adding real or perceived restrictions in a sexual encounter. It’s the fantasy of lost control over a situation which thrills many lovers. It often incorporates a fantasy scenario and some role-playing. Sadism is the infliction of discomfort to a lover. Masochism is a self-inflicted discomfort. Today we’re hearing from Alfie, about her lover’s favorite kink. He allows himself to be restrained and subjected to sexual frustration, in the form of a very delayed ejaculation. Healthy lovemaking of this sort may include switching roles, or may remain in fixed roles of a dominant & a submissive. Sometimes it’s only a fantasy desired by one of them, yet the other lover plays a role simply to satisfy the other’s sexual sesires. Here’s Alfie. My favorite Tease & Denial plot. Spread eagle is my definitely my favorite bondage position. I love it. Tying at the feet is not always necessary, but the hands, absolutely. Even though a pair of cuffs in the middle do have their place, I’m a firm believer in hands at the corners. Some sort of strapping under the bed, whatever; we just want his arms out. Face up, of course. You will need: n a bed big enough for both of you n some kind of restraint system already attached at all four corners of the bed frame, to tie his limbs outward, toward the four corners of the bed n a bowl or basket containing: A: a bottle of tasty massage oil, B: a cock ring, and C: a feather, furry mitt, or something which is very ticklish. Besides these, the following are preferred; n big tits If you’ve got them n and minty gum can be nice. No need for a blindfold. believe me, his eyes are your friend. You might also keep a glass of water, gotta keep those spit and sweat glands pumping. Ice water if you’re a bitch. And a word on gagging. it’s up to you! But if you’re gonna gag, gag properly (i.e. rubber is better than your thong). Let’s get started! But let him breathe freely. His muffled voice is more for your experience of domination. Get your man on your bed. Your face and hairdo should be impeccable and sultry, with lipstick mascara, and whatever else makes you look like a high-class slut. But somehow keep your hair from falling into your face on onto his oily body. You want his to see your impeccable face and styled hair for the entire event. If there’s a clock in the room, hide it. Get him on his back and give him a kiss. A pillow under his head is good. And he’s naked, right? Completely naked? Dote on him and ask if he likes the position of the pillow. This doting just camouflages the torment you have planned for today. You don’t have to be also naked, yet; but let your clothing help set a sensual mood. A Silky robe or his favorite lingerie is a good choice to start with. Make focused attention on his comfort before you gently attach the restraints. Adjust the wrist restraints so you can fit one finger between the material and his skin. You want barely any wiggle room in his arms. And his legs? Well, that’s up to you. Being bound on the bed and all accessible is going to make him squirm whether his legs are forced straight or not. I say leave em. But he might accidently hurt you if he suddenly flinches his legs. Once all restraints are attached, extend each of his limbs and tighten the length up, so he’s truly spread-eagle and limited from squirming around during the event. Tease and denial is the name of the game here. Or “edging” if you like. And edging it is. We’ll be taking him right to the edge of an orgasm, more than a few times. You know you’re doing well if you lose count. I hope your blowjob skills are up to date, ‘cause tongue is king here. Not to say it’s your only asset (it’s not). but subjecting him to excruciating pussy-torture can come a bit later. In case it’s not clear already, this guide is written from a woman’s perspective; so if you’re not one, some parts of it may not be applicable. Set the scene: So! Your man-slave is bound and the fun can begin. What’s first? Well, “what’s first” is the part that I don’t really know about. I hope the setting is nice, the light not too bright; the room not too cold. Sensual music or nature sounds can be nice. I like to get on top for a moment after the restraints are on, & give him a hickey, then slither down to his knees. Scratch his stomach and sides on the way down (good nails are good to have; nothing like a French manicure at your man’s balls). Yeah, scratch his balls a little. Sensual disrobing: By now it’s time to take something off. Make it a sensual performance for his enjoyment. I let my g string panties stay on a little longer, but you ain’t got a smooth stomach for nothing. Apply the Massage Oil: Now it’s time to bring out the massage oil. I Hope you taste tested it first. Sweet Almond or olive oil is reliable. Sweet Almond unscented oil has a very neutral taste. Artificial scents might smell nice, but usually are bitter tasting, and might upset your stomach. Plan on lots of tasting. Mmm, oil. Again, don’t use any water-base lubricant for this event. Whatever oil it is you use, it’ll warm up in your hand and be a little more liquidy. We don’t need to let it yet, though. So kneel facing him, right up between his thighs; & get yourself all slippery; it’s easy to start with your own arms, and then your chest and beyond. Show him how slippery. Cover yourself from your neck down to your thighs. Now straddle over his waist as you coat his arms, shoulders, neck, chest, and armpits. It’ll make little suction noises when you dump it on your hands and on to his body. Cover everything in front of you, down to his knees, up to his nipples, only enough on his cock to get it shiny. Don’t put oil on his head, or yours. Take a minute to lightly rub his armpits, flanks, and nipples. Now slowly slide your panties down each hip, then shift off him as you draw a leg out of the thong. Then get up and stand over him, facing his feet, with your ass and cunt in his full view. Now slowly descend to your knees, and apply oil on your ass, once coated sufficiently, lean over with a hand resting on the mattress right next to his crotch, so he can see you further rub the oil slowly over your anus and labia. Add some more oil on his pelvis, thighs, hips, just make sure you’re carefully supporting your own weight as you slide your hands over his oily body. We don’t need any cracked ribs ruining the event. When you’re both coated, rotate around and kneel between his thighs. Now slowly lean over and give one of his nipples a lick, then lay flat on top of him again. Let your tits make first body contact to his chest, and pause to oscillate a bit, before fully landing your entire torso onto his, with your thighs along the inside of his. You can probably feel gravity pulling you towards his feet. You can position your breasts nicely between his thighs on the slide down stroke, then slide back up to his face and do it again. Maybe lick his balls. Get up on your knees and rotate to straddle his stomach now, on your knees again, his eyes facing your ass. Pour or squirt some oil into your palm and hold it for, oh, ten seconds. Then cup your hand with it up under his balls, and drag the liquid up to his belly button. Massage his entire scrotum sack, gently fondling each of his balls as you go. Finally, drip a bit of oil over his cock tip, then use an open palm to very gently rub just his glans, the top cap of his cock. Add some more oil on his cock tip, and sensually spread the oil down his entire cock shaft. Ooh, all slippery, all of a sudden. Grasp his cock below the head and slide your hand back down again, and massage his balls some more, It’s amazing if the sack is trimmed or shaven. Put your thumb and forefinger in an ‘okay’ circle position around the base of his cock, above the balls, and squeeze. Draw your hand up a little and see that cock head ...

Fundamentals, Types and Roles, Safety Rules, and More By Nuna Alberts, LCSW. Listen to the Podcast at How To Sex. If you’ve ever fantasized about getting kinky in the bedroom, you’re not alone. The runaway success of E. L. James’s Fifty Shades of Grey trilogy of books; the three top-selling print and e-books in the United States between 2010 and 2019; not to mention the sales of the movies they generated, prove that interest in BDSM (bondage and discipline, dominance and submission, and sadism and masochism) is anything but rare.BDSM can involve role playing, sensory manipulation, and more. Here are a few popular ways enthusiasts like to get kinky! Prevalence: How Many People Practice BDSM? Further proof: Nearly 47 percent of women and 60 percent of men have fantasized about dominating someone sexually, while slightly more women and less men are aroused by the idea of being dominated, according to a 2016 study. The same study also found that almost 47 percent adults would like to participate in at least one nontraditional type of sexual activity, and 34 percent said that they’d done so at least once in the past. No wonder if you search the phrase “BDSM” on Google it will return more than 500 million results. By comparison, the phrase “missionary sex” returns about 163 million results. The History of BDSM: Not So New Explore a little more and you’ll also discover that BDSM is nothing new. Among BDSM’s historical high points: Art and texts from ancient Greece and Rome show physical pain being used as an erotic stimulus, per the book An Illustrated History of the Rod, by William M. Cooper, first published in 1868. The Kama Sutra, the revered Sanskrit text on sexuality written in India about 2,000 years ago, describes six appropriate places to strike a person with passion and four ways to do it. It also has chapters titled “Scratching,” “Biting,” and “Reversing Roles.” The Marquis de Sade, a French aristocrat who lived from 1740 to 1814, wrote a variety of erotic novels and short stories involving being beaten and beating others. Eventually the author’s name gave rise to the term “sadism.” Similarly, the term “masochism” is derived from the name of Austrian nobleman and author Leopold von Sacher-Masoch, whose 1870 novel Venus in Furs describes a dominant-submissive relationship. Back in 1953, a Kinsey Institute study found that 55 percent of women and 50 percent of men were aroused by being bitten. And even pre-Fifty Shades of Grey, 36 percent of U.S. adults reported having had sex using masks, blindfolds, or other forms of bondage. Is BDSM Still Considered a Medical Disorder? At one time, mental health experts were dubious about whether those who practiced BDSM were mentally healthy. But the American Psychiatric Association took a huge step in destigmatizing kink with the release of the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. For the first time ever, the guidelines drew a clear distinction between consenting adults who engage in sexual behaviors outside the mainstream, such as BDSM, and those who force others to engage in those behaviors without consent. That means simply experimenting with, say, whips and chains, is no longer a sign of mental illness that by itself “justifies or requires clinical intervention,” the manual states. There are true sexual disorders that are similar in theme. Sexual sadism disorder, for instance, involves inflicting physical or psychological pain on another for the purpose of sexual pleasure. And sexual masochism disorder involves deliberately involving yourself in a situation in which you are humiliated, beaten, or abused for the purpose of sexual excitement. The difference between these two disorders and BDSM is consent, in the case of sexual sadism disorder, and that BDSM does not go to the degree of causing significant distress or impairing function, in the case of sexual masochism disorder. The Psychology of BDSM: Why Are People Drawn to It? Most of the available evidence shows that the majority of BDSM enthusiasts are mentally healthy and typical in every respect except that they find traditional (“vanilla”) intimacy unfulfilling and want something more intense. “People always ask if it’s normal to be interested in BDSM,” says Michal Daveed, a spokeswoman for The Eulenspiegal Society, a nonprofit organization in New York City that describes itself as the “oldest and largest BDSM support and education group” in the country. “Normal is a funny word to describe a really widespread and diverse humanity. If your definition of normal is how many people are doing this, it’s way more people than you may think,” says Daveed. “And if your definition of normal is ordinary, the BDSM world is full of ordinary people whose sexuality happens to be hardwired a particular way.” One landmark 2008 study backs Daveed up. It found that people who engaged in BDSM were more likely to have experienced oral sex or anal sex, to have had more than one partner in the previous year, to have had sex with someone other than their regular partner, and to have taken part in phone sex, visited an internet sex site, viewed an X-rated film or video, used a sex toy, had group sex, or taken part in manual stimulation of the anus, fisting, or rimming. However, they were no more likely to have been coerced into sexual activity and were not significantly more likely to be unhappy or anxious. Indeed, men who had engaged in BDSM scored significantly lower on a scale of psychological distress than other men. “Our findings support the idea that BDSM is simply a sexual interest or subculture attractive to a minority, and for most participants not a pathological symptom of past abuse or difficulty with ‘normal’ sex,” the researchers concluded. “BDSM is a healthy expression of sexuality,” says Filippo M. Nimbi, PhD, a researcher at the Institute of Clinical Sexology and in the department of dynamic and clinical psychology at Sapienza University, both in Rome. Dr. Nimbi is also the coauthor of a study that compared 266 consensual BDSM practitioners to 200 control subjects who described their sex lives as traditional. (10) Echoing the earlier study, the researchers found that the BDSM group tended to report fewer sexual problems than the general population. “People engaging in BDSM are usually people who have thought a lot about their sexuality,” Nimbi said. “They have explored and faced their sexual boundaries. Basically, they know what they like, and they do it. This has a positive outcome on their sexual experiences and on the overall quality of their lives.” Many people think it’s a pathology or a perversion to, say, want to be spanked hard and to be happy about that, he added. “We each develop our erotic fantasies from our different tastes, experiences, and curiosities, beginning in childhood and lasting until the end of our lives. Everyone is different. We can develop the same fantasy from different stories, and we can develop different fantasies from the same stories. Some people find in BDSM a way to be free, to get wild, to let go, and to play a different role from their everyday lives. And if they get satisfaction and respect the ‘rules,’ why should it be abnormal?” The Physicality of BDSM: Why Does It Feel Good? Patti Britton, PhD, MPH, cofounder of the credentialing and training institute Sex Coach U and a past president of the American Association for Sexuality Educators, Counselors, and Therapists (AASECT), as well as other experts are quick to point out that seeking the pain-pleasure connection is not unique to the BDSM community. Think of athletes who push past physical comfort to experience a “runner’s high,” or people who chase thrills by engaging in dangerous extreme sports, like skydiving. Think of the bliss that aficionados of super spicy food experience when biting into a pepper sets their mouth on fi...

A discussion of Advanced Maturity and Sexuality By Mark Stibich, PhD. Listen to the ► podcast at How To Sex. Many people in their 70s and 80s are not only sexually active, but satisfied with their senior sex lives. University of Michigan Institute for Healthcare Policy and Innovation. Let’s talk about sex. Though the frequency or ability to perform sexually may decline with age due to physiological changes, these don't necessarily affect how a person experiences or enjoys sex. Aging-related problems like erectile dysfunction (ED), vaginal dryness, or urinary incontinence can affect sex. But their impact can also be minimized by using medication, managing chronic conditions, seeking individual or couples counseling, and changing sexual practices. This article explores the sex lives of adults 65 and over and the problems that can interfere with sex as the body ages. It also discusses the various treatment options and ways to maintain—or even jumpstart—your senior sex life. Studies suggest that men are almost twice as likely as women to still have sex or masturbate in their later years. A British study found close to 60% of men ages 70 to 80 and 31% of men ages 80 to 90 are still sexually active. In women, those figures drop to 34% and 14%, respectively. This lower rate of sexual activity in older women may be due to a lack of opportunity rather than a lack of desire. Research shows that older women are less likely to have partners (due in large part to the fact that they often outlive their partners). This is sometimes referred to as "the partner gap." It is common for men to experience sexual problems after age 40. Reasons include a natural decline in testosterone levels, heart disease, and prostate problems. The inability to achieve or sustain an erection or reach orgasm or ejaculation are common concerns. Erectile Dysfunction Erectile dysfunction (ED), formerly known as impotence, is the inability to achieve or maintain an erection firm enough for sexual penetration and long enough to achieve orgasm. While ED is more common in older men, aging itself does not cause the problem. ED is related to conditions, sometimes several at once, that directly or indirectly interfere with erections. Risk factors include high blood pressure, diabetic nerve damage, smoking, obesity, Peyronie's disease, depression, and even certain medications. An accurate diagnosis is needed to ensure the right treatment. ED drugs like Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil) are often the first-line treatments for ED. Lifestyle changes and counseling can also help. For some men, hormonal therapy, penis pumps, and penile implants may be recommended. Is There a Female Viagra? Benign Prostatic Hyperplasia Benign prostatic hyperplasia (BPH) is a non-cancerous enlarged prostate and one of the most common health problems in older males.6 BPH can cause symptoms like difficulty urinating, frequent urination, or waking up in the middle of the night to urinate (nocturia). On top of this, BPH can cause sexual problems like low libido (low sex drive) and delayed ejaculation (difficulty reaching orgasm). Among the treatment options, testosterone therapy may help restore libido. There are also certain drugs used off-label that may help with delayed ejaculation, including cabergoline (originally marketed as Dostinex) and Wellbutrin (bupropion).7 Because some BPH medications can also cause sexual dysfunction, a change in the dose may help resolve these concerns. Lifestyle Changes to Treat Erectile Dysfunction Sexual Health Problems in Older Women More than a third of older women experience sexual problems. These are typically due to menopause, when estrogen levels steeply decline. Hormonal changes can lessen sexual desire and make it harder to become aroused. Sexual organs also change as a person gets older. A woman's vagina will shorten and narrow. The vaginal walls become thinner and less flexible, tearing more easily. Vaginal lubrication decreases, making vaginal intercourse more painful. Hypoactive Sexual Desire Disorder Hypoactive sexual desire disorder (HSDD) is diagnosed when an absence of sexual fantasies, thoughts, and desires causes personal distress. It is a problem that is common among many older women. A medication known as Addyi (flibanserin) is used to treat HSDD in women. It is currently only approved for premenopausal women, but research shows that it can also improve libido in older women as well. Risk of Low Libido After Menopause Vaginal Dryness Vaginal dryness is uncomfortable and can make sex painful. Over-the-counter (OTC) remedies that can help relieve irritation and itching from vaginal dryness include lubricants such as K-Y Jelly or vaginal suppositories like Replens. If OTC remedies don’t help, your doctor may prescribe estrogen cream as well as estrogen-containing vaginal rings and vaginal suppositories. There are also plant-based products, like black cohosh, that have estrogen-like effects. These should be used with caution in women who have had or are at risk of breast cancer. Pain With Sex Painful intercourse is more likely in older women as vaginal tissue tends to thin and tear easily after menopause. Standard treatments for vaginal dryness can often help ease pain during sex. If that is not effective, prescription drugs like Osphena (ospemifene) and Intrarosa (prasterone) can treat thinning vaginal tissues and help relieve moderate to severe vaginal dryness. Dealing With Painful Intercourse After Menopause Pelvic Organ Prolapse The pelvic floor muscles and tissues hold the bladder, uterus, cervix, vagina, and rectum in place. Pelvic organ prolapse (POP) occurs when the pelvic floor weakens, causing the pelvic organs to drop and bulge (prolapse) in the vagina. This can cause pelvic pain and pressure, pain with sex, and urinary incontinence. POP is often treated with pelvic floor physical therapy to strengthen the supporting muscles. In some cases, surgery may be needed. What Is Uterine Prolapse? Other Health Concerns Chronic medical conditions become more common as a person ages. Many of these can interfere with an older person's sex life. Arthritis and Chronic Pain Arthritis and other chronic pain conditions are common among older adults and can make sex very difficult. Depending on the cause, doctors may recommend physical therapy to strengthen muscles and improve flexibility. Nonsteroidal anti-inflammatory drugs (NSAIDs), both over-the-counter and prescription, can be taken before sex to help ease the pain. Opioid drugs, while effective as a pain reliever, can cause a drop in testosterone and contribute to ED. If the pain only occurs in certain sexual positions, let your partner know and try different positions. Bolstering your bodies with pillows and cushions can also help. Best Positions for Sex With Back Pain Diabetes In the United States, almost one-third of adults over 65 have diabetes. Approximately half of these are undiagnosed. Diabetes can cause sexual dysfunction in both men and women. This can be due to circulation problems, medication side effects, or nerve damage. Prob...