When a female has an orgasm...


  • Ask Dr G
  • Sunday, 24 Nov 2013

Hi Dr. G,

I sent my questions earlier but it has yet to be published.   

I am now in my mid 30s. Before my wife gave birth to the kids, my average time of intercourse was between 20 – 30 minutes, but now it has reduced to 5 – 8 minutes. Is that normal? Sadly, sometimes it can even be reduced to 2 – 3 minutes.

I’m unable to control ejaculation upon reaching orgasm. Do I suffer from Premature Ejaculation or Erectile Dysfunction?

Lastly, how do I know if my wife has an orgasm during intercourse?

Regards
Austin

Dear Austin,
Thank you so much for your kind patience and understanding. I am sure it feels like an eternity when your “bedroom bothers” are not resolved and questions unanswered. Worry not, Dr. G is still listening, he may be slow, but better late than never! 

The reality is, I have been inundated with letters from readers since the column started four months ago (Yes, it has been four months and this is the 20th week of letters I have responded to. Thanks guys!!)

The other interesting fact is also a sudden surge in the number of letters following the last week’s “Too much self pleasure” article in the column. I guess the more controversial the subject matters; the more discussions we generate. Hopefully, this will break down taboo!

Of course, I am not going to shy away from controversy this week, and hoping to shed some lights on issues of “Female sexual climax”. (Well, “attempt” is probably the right word, as female sexuality is still a big mystery even in the scientific research)

First of all, let me get the easier of your two problems resolved. You have apparently suffered from Secondary Premature Ejaculation (PE) or Acquired Premature Ejaculation. From your description, prior to your wife giving birth, your control of ejaculation was supra optimal and enable you to sustain interval of intercourse of more than 20 minutes (You lucky guy!!). It is also obvious you luck has probably run-out as the control is declining and currently only sustaining an interval of a “humanly” five to eight minutes. There is a high possibility your performance may continue deteriorating resulting in Premature Ejaculation (Sorry!!)

The vast majority of PE sufferers experience this problem from the first sexual encounter. The minority may present the symptoms like you (later part in life). The bad news is the real mechanism of the secondary PE is poorly understood. The good news is the treatments of primary and secondary PE are identical. I urge you to see your doctor to assess your suitability for medical intervention.

Now coming to your question of “How do we know when (or if) a women has reached the orgasm during intimacy?”

Female orgasm is the involuntary rhythmic contraction of pelvic muscles controlled by the autonomic nervous system resulting in the sudden discharge of sexual tension during sexual response cycle. This is also accompanied by euphoric pleasurable sensation, multiple bodily muscular spasm and vocalization. In general, the experience is followed by the state of relaxation, controlled by neuro-hormones such as endorphin, oxytocin and prolactin. 

In the clinical context, the detection of female orgasm is strictly dependent on the physiological muscular contraction and the characteristics of patterns of changes in heart rates, blood pressure and depth of respirations. I guess one way of identifying your partners has reached the climax is to wire her up with ECG and muscular contraction sensors. I am sure many women may not be so willing or accommodating under such “intervention”.

In the psychological context, there has been 26 documented definitions or orgasm. The scientific literature has focused on the psychology of female sexual climax and concluded “female orgasm is psychologically more complex than male”. A recent study published by Australian Study of Health and Relationship reported 69% of women out of 19,307 participants reported having had an orgasm in their lifetime. Other research from Laumann reported even lower number of women having achieved sexual climax with their partners (29%).

As women tend to achieve orgasm less readily than men, thus faking an orgasm is more common amongst women. Recent American research highlighted 48% of women participants admitted they had “faked” orgasm at least once. 

I guess what Dr. G is trying to say is, in real life, it is virtually impossible to detect whether your partner has achieved the climax.

Regards

Dr. G

PS. Sharon Stone once said: “A woman might fake an orgasm, but men can fake the whole relationship”



Dear Dr. G,

I have heard so much about you on radio, television and newspaper.

I think I am suffering from ED as I have not been experiencing morning erection for the past one month. I am 50 years old and have no major health problem such as heart disease or diabetes. I am 175cm and 68kg.

On a few occasions when I was attempting intercourse with my wife with suboptimal erection, I still try hard to penetrate and may have injured my nerves in the pelvis or penis. At the same time I had frequent and uncontrolled urination. I don't know whether I am suffering from a urinary tract infection, prostatitis, prostate enlargement or ED due to damaged nerves.

I don't think it was due to work stress, as my work is not high-pressured job as others.

Can you help me with my problem?

Is there any treatment for ED if it is due to damaged nerves?

Thank you.

Regards

Alan 

Dear Alan,

I am so sorry you are having such a hard time in the bedroom (I confess “hard” may be the wrong choice of word).

When a man suffers from sexual dysfunction, he always would like to find a reason. It is true that up to 80% percent of men have reasons to suffer from erectile dysfunction (ED). This may include diabetes mellitus, high blood pressure, depression, dyslipidemia and stress. The reality is the other 20% may have no identifiable cause of ED. This is idiopathic in nature and we cannot even blame on the aging process, as you are merely 50 years old. I guess in the true “Asian Manner”, we can often blame “chi” or lack of it!

I can sense your anxiety that you may have injured your penile nervous or vascular system when having intercourse with sub-optimal erection. On the contrary, penile injury or facture can only occur when organ has “positional compromise” when fully erect. So, be assured you have not cause irreversible damage to the penis neurovascular system as they are securely protected in the depth of the pelvis.

I am confident your sexual dysfunction is related to the enlarged prostate. You mentioned you have experienced frequent and uncontrolled urination, which are common symptoms associated with Benign Prostatic Hyperplasia (BPH). The enlarged organ will have the effects of reducing your urine flow and results in residual urine, this in turn will cause urinary frequency, urgency and even urge incontinence. 

There are increasing scientific data highlighting the association of prostatic enlargement with ED, however, the real mechanism is unknown. There is also clinical evidence to suggest the positive effect of alpha-blockers (which are used to relax the prostate muscles) on the improvement of the erectile rigidity. 

So, Dr. G’s advice is try the medications, you never know, your flow of urine might improve with a “hard” bonus!

Regards
Dr. G


Dear Dr. G,

My father is currently having BPH complication that requires surgical treatment. He is overseas now and we are facing the issue of mixed recommendations on the best way to treat the problem. The two options are either using TURP or Laser. Can you please shed some light on this problem? 

Is the definitive treatment depends on case-by-case basis? Perhaps you can also let us know how advance is our Laser treatment in Malaysia. 

Thank you in advance for your early reply

Regards
HM

Dear HM,

I am sorry to hear that you Dad had encountered the complications of Benign Prostatic Hyperplasia (BPH). The common complications for such common complaint may include recurrent urinary tract infections (UTI), acute retention of urine, bleeding or bladder stone formation. For the real unlucky ones, the complication may even render patient dialysis-dependent after renal failure secondary to bladder outflow obstruction.

In the past, the “Gold Standard” of the endoscopic prostate operation is Trans Urethral Resection of Prostate (TURP). The Gold standard is by no meant the ideal solution. The operation is often associated with blood loss and transfusion. Other life threatening complication may include TUR syndrome, which is caused by the excessive absorption of water during the operation. This may increase the length of hospital and prolong the duration of recovery. Other complications may also include retrograde ejaculation (or termed dry orgasm) and erectile dysfunction (ED).

In view of the said complication, there is a constant quest to replace TURP, and the Laser has certainly provided the paradigm shift in the management of patients with BPH. The advantages of Laser may include less blood loss, shorter hospital stay, less life-threatening complications such as TUR syndrome. Some researchers even demonstrated less sexual dysfunction following laser operations.

There are essentially two methods of laser therapy for prostate enlargement. This may either be laser enucleation or vapouristion of the prostate. The outcomes of both techniques are equivocal, but the efficacy is surgeon-dependent.

Lastly, please be assured that most Malaysian Hospitals (Both Private and Government Hospitals) are in the forefront of BPH laser technology. Therefore, I am sure your Dad would be in safe hands of our local Urologists.

I wish him a safe operation and a speedy recovery.

Yours truly,
Dr. G

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