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Alan Pease, author of a book titled "Why Men Don't Listen and Women Can't Read Maps", believes that women are spatially-challenged compared to men. The British firm, Admiral Insurance, conducted a study of half a million claims. They found that "women were almost twice as likely as men to have a collision in a car park, 23 percent more likely to hit a stationary car, and 15 percent more likely to reverse into another vehicle" (Reuters). Yet gender "differences" are often the outcomes of bad scholarship. Consider Admiral insurance's data. As Britain's Automobile Association (AA) correctly pointed out - women drivers tend to make more short journeys around towns and shopping centers and these involve frequent parking. Hence their ubiquity in certain kinds of claims. Regarding women's alleged spatial deficiency, in Britain, girls have been outperforming boys in scholastic aptitude tests - including geometry and maths - since 1988. On the other wing of the divide, Anthony Clare, a British psychiatrist and author of "On Men" wrote: "At the beginning of the 21st century it is difficult to avoid the conclusion that men are in serious trouble. Throughout the world, developed and developing, antisocial behavior is essentially male. Violence, sexual abuse of children, illicit drug use, alcohol misuse, gambling, all are overwhelmingly male activities. The courts and prisons bulge with men. When it comes to aggression, delinquent behavior, risk taking and social mayhem, men win gold." Men also mature later, die earlier, are more susceptible to infections and most types of cancer, are more likely to be dyslexic, to suffer from a host of mental health disorders, such as Attention Deficit Hyperactivity Disorder (ADHD), and to commit suicide. In her book, "Stiffed: The Betrayal of the American Man", Susan Faludi describes a crisis of masculinity following the breakdown of manhood models and work and family structures in the last five decades. In the film "Boys don't Cry", a teenage girl binds her breasts and acts the male in a caricatural relish of stereotypes of virility. Being a man is merely a state of mind, the movie implies. But what does it really mean to be a "male" or a "female"? Are gender identity and sexual preferences genetically determined? Can they be reduced to one's sex? Or are they amalgams of biological, social, and psychological factors in constant interaction? Are they immutable lifelong features or dynamically evolving frames of self-reference? Certain traits attributed to one's sex are surely better accounted for by cultural factors, the process of socialization, gender roles, and what George Devereux called "ethnopsychiatry" in "Basic Problems of Ethnopsychiatry" (University of Chicago Press, 1980). He suggested to divide the unconscious into the id (the part that was always instinctual and unconscious) and the "ethnic unconscious" (repressed material that was once conscious). The latter is mostly molded by prevailing cultural mores and includes all our defense mechanisms and most of the superego. So, how can we tell whether our sexual role is mostly in our blood or in our brains? The scrutiny of borderline cases of human sexuality - notably the transgendered or intersexed - can yield clues as to the distribution and relative weights of biological, social, and psychological determinants of gender identity formation. The results of a study conducted by Uwe Hartmann, Hinnerk Becker, and Claudia Rueffer-Hesse in 1997 and titled "Self and Gender: Narcissistic Pathology and Personality Factors in Gender Dysphoric Patients", published in the "International Journal of Transgenderism", "indicate significant psychopathological aspects and narcissistic dysregulation in a substantial proportion of patients." Are these "psychopathological aspects" merely reactions to underlying physiological realities and changes? Could social ostracism and labeling have induced them in the "patients"? The authors conclude: "The cumulative evidence of our study ... is consistent with the view that gender dysphoria is a disorder of the sense of self as has been proposed by Beitel (1985) or Pfäfflin (1993). The central problem in our patients is about identity and the self in general and the transsexual wish seems to be an attempt at reassuring and stabilizing the self-coherence which in turn can lead to a further destabilization if the self is already too fragile. In this view the body is instrumentalized to create a sense of identity and the splitting symbolized in the hiatus between the rejected body-self and other parts of the self is more between good and bad objects than between masculine and feminine." Freud, Kraft-Ebbing, and Fliess suggested that we are all bisexual to a certain degree. As early as 1910, Dr. Magnus Hirschfeld argued, in Berlin, that absolute genders are "abstractions, invented extremes". The consensus today is that one's sexuality is, mostly, a psychological construct which reflects gender role orientation. Joanne Meyerowitz, a professor of history at Indiana University and the editor of The Journal of American History observes, in her recently published tome, "How Sex Changed: A History of Transsexuality in the United States", that the very meaning of masculinity and femininity is in constant flux. Transgender activists, says Meyerowitz, insist that gender and sexuality represent "distinct analytical categories". The New York Times wrote in its review of the book: "Some male-to-female transsexuals have sex with men and call themselves homosexuals. Some female-to-male transsexuals have sex with women and call themselves lesbians. Some transsexuals call themselves asexual." So, it is all in the mind, you see. This would be taking it too far. A large body of scientific evidence points to the genetic and biological underpinnings of sexual behavior and preferences. The German science magazine, "Geo", reported recently that the males of the fruit fly "drosophila melanogaster" switched from heterosexuality to homosexuality as the temperature in the lab was increased from 19 to 30 degrees Celsius. They reverted to chasing females as it was lowered. The brain structures of homosexual sheep are different to those of straight sheep, a study conducted recently by the Oregon Health & Science University and the U.S. Department of Agriculture Sheep Experiment Station in Dubois, Idaho, revealed. Similar differences were found between gay men and straight ones in 1995 in Holland and elsewhere. The preoptic area of the hypothalamus was larger in heterosexual men than in both homosexual men and straight women. According an article, titled "When Sexual Development Goes Awry", by Suzanne Miller, published in the September 2000 issue of the "World and I", various medical conditions give rise to sexual ambiguity. Congenital adrenal hyperplasia (CAH), involving excessive androgen production by the adrenal cortex, results in mixed genitalia. A person with the complete androgen insensitivity syndrome (AIS) has a vagina, external female genitalia and functioning, androgen-producing, testes - but no uterus or fallopian tubes. People with the rare 5-alpha reductase deficiency syndrome are born with ambiguous genitalia. They appear at first to be girls. At puberty, such a person develops testicles and his clitoris swells and becomes a penis. Hermaphrodites possess both ovaries and testicles (both, in most cases, rather undeveloped). Sometimes the ovaries and testicles are combined into a chimera called ovotestis. Most of these individuals have the chromosomal composition of a woman together with traces of the Y, male, chromosome. All hermaphrodites have a sizable penis, though rarely generate sperm. Some hermaphrodites develop breasts during puberty and menstruate. Very few even get pregnant and give birth. Anne Fausto-Sterling, a developmental geneticist, professor of medical science at Brown University, and author of "Sexing the Body", postulated, in 1993, a continuum of 5 sexes to supplant the current dimorphism: males, merms (male pseudohermaphrodites), herms (true hermaphrodites), ferms (female pseudohermaphrodites), and females. Intersexuality (hermpahroditism) is a natural human state. We are all conceived with the potential to develop into either sex. The embryonic developmental default is female. A series of triggers during the first weeks of pregnancy places the fetus on the path to maleness. In rare cases, some women have a male's genetic makeup (XY chromosomes) and vice versa. But, in the vast majority of cases, one of the sexes is clearly selected. Relics of the stifled sex remain, though. Women have the clitoris as a kind of symbolic penis. Men have breasts (mammary glands) and nipples. The Encyclopedia Britannica 2003 edition describes the formation of ovaries and testes thus: "In the young embryo a pair of gonads develop that are indifferent or neutral, showing no indication whether they are destined to develop into testes or ovaries. There are also two different duct systems, one of which can develop into the female system of oviducts and related apparatus and the other into the male sperm duct system. As development of the embryo proceeds, either the male or the female reproductive tissue differentiates in the originally neutral gonad of the mammal." Yet, sexual preferences, genitalia and even secondary sex characteristics, such as facial and pubic hair are first order phenomena. Can genetics and biology account for male and female behavior patterns and social interactions ("gender identity")? Can the multi-tiered complexity and richness of human masculinity and femininity arise from simpler, deterministic, building blocks? Sociobiologists would have us think so. For instance: the fact that we are mammals is astonishingly often overlooked. Most mammalian families are composed of mother and offspring. Males are peripatetic absentees. Arguably, high rates of divorce and birth out of wedlock coupled with rising promiscuity merely reinstate this natural "default mode", observes Lionel Tiger, a professor of anthropology at Rutgers University in New Jersey. That three quarters of all divorces are initiated by women tends to support this view. Furthermore, gender identity is determined during gestation, claim some scholars. Milton Diamond of the University of Hawaii and Dr. Keith Sigmundson, a practicing psychiatrist, studied the much-celebrated John/Joan case. An accidentally castrated normal male was surgically modified to look female, and raised as a girl but to no avail. He reverted to being a male at puberty. His gender identity seems to have been inborn (assuming he was not subjected to conflicting cues from his human environment). The case is extensively described in John Colapinto's tome "As Nature Made Him: The Boy Who Was Raised as a Girl". HealthScoutNews cited a study published in the November 2002 issue of "Child Development". The researchers, from City University of London, found that the level of maternal testosterone during pregnancy affects the behavior of neonatal girls and renders it more masculine. "High testosterone" girls "enjoy activities typically considered male behavior, like playing with trucks or guns". Boys' behavior remains unaltered, according to the study. Yet, other scholars, like John Money, insist that newborns are a "blank slate" as far as their gender identity is concerned. This is also the prevailing view. Gender and sex-role identities, we are taught, are fully formed in a process of socialization which ends by the third year of life. The Encyclopedia Britannica 2003 edition sums it up thus: "Like an individual's concept of his or her sex role, gender identity develops by means of parental example, social reinforcement, and language. Parents teach sex-appropriate behavior to their children from an early age, and this behavior is reinforced as the child grows older and enters a wider social world. As the child acquires language, he also learns very early the distinction between "he" and "she" and understands which pertains to him- or herself." So, which is it - nature or nurture? There is no disputing the fact that our sexual physiology and, in all probability, our sexual preferences are determined in the womb. Men and women are different - physiologically and, as a result, also psychologically. Society, through its agents - foremost amongst which are family, peers, and teachers - represses or encourages these genetic propensities. It does so by propagating "gender roles" - gender-specific lists of alleged traits, permissible behavior patterns, and prescriptive morals and norms. Our "gender identity" or "sex role" is shorthand for the way we make use of our natural genotypic-phenotypic endowments in conformity with social-cultural "gender roles". Inevitably as the composition and bias of these lists change, so does the meaning of being "male" or "female". Gender roles are constantly redefined by tectonic shifts in the definition and functioning of basic social units, such as the nuclear family and the workplace. The cross-fertilization of gender-related cultural memes renders "masculinity" and "femininity" fluid concepts. One's sex equals one's bodily equipment, an objective, finite, and, usually, immutable inventory. But our endowments can be put to many uses, in different cognitive and affective contexts, and subject to varying exegetic frameworks. As opposed to "sex" - "gender" is, therefore, a socio-cultural narrative. Both heterosexual and homosexual men ejaculate. Both straight and lesbian women climax. What distinguishes them from each other are subjective introjects of socio-cultural conventions, not objective, immutable "facts". In "The New Gender Wars", published in the November/December 2000 issue of "Psychology Today", Sarah Blustain sums up the "bio-social" model proposed by Mice Eagly, a professor of psychology at Northwestern University and a former student of his, Wendy Wood, now a professor at the Texas A&M University: "Like (the evolutionary psychologists), Eagly and Wood reject social constructionist notions that all gender differences are created by culture. But to the question of where they come from, they answer differently: not our genes but our roles in society. This narrative focuses on how societies respond to the basic biological differences - men's strength and women's reproductive capabilities - and how they encourage men and women to follow certain patterns. 'If you're spending a lot of time nursing your kid', explains Wood, 'then you don't have the opportunity to devote large amounts of time to developing specialized skills and engaging tasks outside of the home'. And, adds Eagly, 'if women are charged with caring for infants, what happens is that women are more nurturing. Societies have to make the adult system work [so] socialization of girls is arranged to give them experience in nurturing'. According to this interpretation, as the environment changes, so will the range and texture of gender differences. At a time in Western countries when female reproduction is extremely low, nursing is totally optional, childcare alternatives are many, and mechanization lessens the importance of male size and strength, women are no longer restricted as much by their smaller size and by child-bearing. That means, argue Eagly and Wood, that role structures for men and women will change and, not surprisingly, the way we socialize people in these new roles will change too. (Indeed, says Wood, 'sex differences seem to be reduced in societies where men and women have similar status,' she says. If you're looking to live in more gender-neutral environment, try Scandinavia.)" penis enlargment herb penis elargement tool enlargment manhattan penile best enlargement exercise pnis erection penis pills size vimax best enhancement exercise penis vimax herbal penis enlargement pills permanent penis enlargement
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Top Questions of our Time Series: Sex Slam bam thank you Ma’am or Mr.? That’s some people’s method and it works for those who mutually agree they want a quick fix. But for most people this is not the method of choice. So, why is it that this is so prevalent? The reason for this could be that American culture is simply not accepting of sexuality in general and that is why sexuality leaks into what many consider to be ‘shadow’ areas, such as pornography, strip clubs, and prostitution. Carl Jung, one of the founding fathers of psychology, would definitely label sexuality as the shadow side of our culture. For most people who watch or visit these areas, it’s not something they discuss with their acquaintances or even their family and friends. In fact, the actual act of having sex with a person is not discussed too openly in our culture. Alfred Kinsey was one of the first and most famous people to openly discuss this cultural issue in public. Sure, sex is flashed in our faces on TV shows, movies, and advertisements, but few people actually openly discuss the act of having sex with another person. For whatever reason that is, this is an article that is going to discuss one of the top questions of our time: What is a great way to have sex, even for those who are inhibited. I am going to explain a term, I am certain I am not the first to use it, or explain concepts like it, however, I have not seen the term before. That term is Mindful Sex. Mindful sex involves slightly slowing down in every aspect of the act of sex, from creating the setting, to the foreplay, to the actual act of sex, whatever you consider that to be. The following is the gist of it: Setting: This part is not necessary if the act of sex is spontaneous in any given moment. If it is not spontaneous, sometimes it is a good idea to set the setting. When creating the setting, whether you are lighting candles, putting on music, or preparing special lingerie, moving slightly slower than you usually would. As you move slower begin to pay attention to your senses. If you are lighting candles, notice what you are lighting it with, is it a match, a lighter? Notice what the flame looks like, how it moves, does the candle have a smell, if so, take a moment to inhale it. If you are setting up special lingerie, take a moment to feel the lingerie. Is it made of silk? How does the silk feel? Are you spraying perfume/cologne on it? Take an extra moment to inhale that. You get the idea, with anything you are doing, move slightly slower and take a moment to pay attention to what you are seeing, hearing, smelling, feeling, and tasting. You do not need to think about any of this, just notice your sensations. If you notice you are thinking about something, notice that and then simply bring your attention back to what you are sensing. By moving slightly slower you have the opportunity to do this and in return make the process more meaningful and enjoyable. Foreplay and Sex: Some people consider foreplay to be sex, some consider intercourse to be sex. So I am putting them together because these ideas apply to both of them. There are many aspects to foreplay and sex and different people will have different variations on what they like. The tragedy of it all is that most people, having not felt free to discuss sex in public and they have only relied on what the media has influenced them to think about how sex should be. While they’ve had sex, they have never freely explored it on their own. Some people like to start out with oils and massage, some people like to start out with kissing all over the body, while others are into more fetish areas such as acting out a fantasy of being ruled over by a dominant figure of some kind (e.g., dominatrix). As far as fetish goes, this goes as far as our imagination can take us. As you practice Mindful Sex you will give yourself the chance to discover what it is that you really like and you will begin to feel more comfortable communicating that to whomever you are having sex with, even if that person is yourself (i.e., masturbation). Here is the gist: As you begin to practice mindful sex, it is important to remember one thing: Whatever it is that you are doing, do it slightly slower than usual. This does not mean go in slow motion, it means just go slightly slower than you would think to go. As you move slightly slower, you give yourself the opportunity to really be there in that moment and notice things that you may not have noticed. If you are giving a massage, you get to feel how the person’s skin actually feels, is there a scent to the oil? If so, inhale it. If the oil is edible, take an extra moment to lick it and truly taste it in your mouth. Look over your partner and take a moment to take in all the little nuances of the person’s body. By slightly slowing down, you also allow yourself to relax a bit, and this not only helps in making this a richer experience, but also helps reduce anxiety if that is an issue (e.g., being overly sensitive or premature ejaculation). You can apply this in every moment of sex that you find yourself in. For example, when you are giving oral sex, go slightly slower and notice the smell and taste involved, feel the texture of the other person, is it soft/rough? What does the person’s vagina or penis look like? As you go slightly slower you’ll find that it is not so difficult to notice these things and it will draw you deeper into the experience and give you the gift that you have not been privy to experience in the past. Ofcourse, you can apply this to intercourse as well. No matter your gender or sexual orientation, there is often some sort of sexual intercourse involved. It is important to let your partner know that you want to go slightly slower this time in whatever way you feel comfortable communicating that. As the intercourse begins, notice the sensations you are feeling. All parts of you are experiencing sensations from your head to your penis or vagina to your feet. If you find yourself thinking about something, notice that you are thinking about something and gently bring yourself back to your sensations. If you find yourself judging your self or the other person, just notice that you are judging and gently bring yourself back to your sensations. Gifts: Paying attention to your sensations may also broaden your horizons on things you want to do. Maybe you notice that while having intercourse that you are not tasting anything so you decide to taste your partner by kissing or licking him/her. Maybe you want to smell your partner more to bring in that sensation. Maybe you open your ears and begin to hear what the sex you are having sounds like. Maybe you’re now noticing for the first time what other areas of your body are being touched during intercourse besides your penis, vagina, or nipples. You might just discover an erotic area of your body that you had not noticed before (e.g., back of the knees, toes). Having mindful sex is simply a teaching and a suggestion. If a spontaneous act of aggressive sex comes out and it is not a slightly slowed down process, than that is Ok too. This is simply an opportunity to broaden your awareness about yourself during the act of sex and deepening the richness of your experience. Of all things we have to experiment with on this planet, this is surely one of the top. So, responsibly, go off and try this out, have fun, and broaden your horizons! 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Male sexual dysfunction is one of the most common health problems affecting men and is more common with increasing age. Chronic ED affects about 5% of men in their 40s and 15-25% of men by the age of 65. Transient ED and inadequate erection affect as many as 50% of men between the ages of 40 and 70. In around 95% of the cases, a suitable treatment can be found. Erectile dysfunction is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for erectile dysfunction. Viagra, Levitra and Cialis Currently, there are three oral medications approved by the Food and Drug Administration (FDA) for the treatment of erectile dysfunction: sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). All these agents block the enzyme phosphodiesterase type 5 (PDE-5) and belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Viagra was the first and is probably the most famous of the three PDE-5 inhibitors used to treat erectile dysfunction. Viagra was approved as an effective agent for treating erectile dysfunction in March 27, 1998. Viagra is manufactured by Pfizer, Inc. Levitra was the second PDE-5 inhibitor to come to market in the United States, and it was approved by the FDA in August 19, 2003. Levitra is manufactured by Bayer Pharmaceuticals Corporation. Cialis was the third PDE-5 inhibitor to come to market and was approved by the FDA at the end of November 21, 2003. Cialis is manufactured by Lilly ICOS LLC. The major advantage of PDE-5 inhibitors is that they do not cause an erection at inappropriate times, because they act only in response to sexual stimulation. If there is no sexual stimulation drug remains in the background. All three are taken orally prior to planned sexual activity, acting to increase blood flow in the penis in response to sexual stimulation. However, there are important differences between the three, differences that could influence safety, specificity, duration of action, adverse effects, and ultimately, public acceptance within this class of drug. Mechanism of Action PDE-5 inhibitors do not directly cause an erection of the penis, but they alter the body's response to sexual stimulation by enhancing the effect of the nitric oxide, a chemical that is normally released during stimulation. Nitric oxide causes relaxation of the muscles in the penis, which allows for better blood flow to the penile area. Effectiveness of PDE-5 Inhibitors All 3 PDE-5 inhibitors have demonstrated excellent efficacy. Viagra, at 84%, is slightly more effective than Cialis at 81% and Levitra at 80%. Pharmaceutical Forms, Onset of Action and Duration of Effect Viagra and Levitra differ only minimally in terms of their structure, while Cialis differs markedly from Viagra and Levitra in terms of its molecular structure, which is also reflected in pharmacokinetic differences. Viagra: 25 mg, 50 mg 100 mg tablets Onset of action: 30 minutes (effect delayed if taken with food) Duration of action: 4 to 5 hours Levitra: 2.5 mg, 5 mg, 10 mg, 20 mg tablets Onset of action: 25 minutes (effect delayed by fatty meal) Duration of action: 4 to 5 hours Cialis: 5 mg, 10 mg, 20 mg tablets Onset of action: 16-45 minutes (effect NOT delayed by food) Duration of action: 36 hours All three drugs require sexual stimulation to be effective. Viagra should be taken on an empty stomach it works better if you do not eat a high-fat meal around the time you take it. Levitra may be slightly less effective if you eat a high-fat meal, but a moderate-fat meal does not reduce its effectiveness. Cialis works without regard to what you eat. Viagra and Levitra have similar half-lives, and onset and duration of action. Cialis has a slower onset of action and longer duration of action, which is attributed to its longer half-life. Patients who wish for spontaneity may opt for Cialis, which may allow for successful intercourse up to 36 hours postdose, even though it takes longer to reach peak effect. The considerably longer duration of effect for Cialis will likely allow less frequent dosing and greater impulsiveness between partners, but also could potentially prolong adverse effects. Dosage The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for either Levitra or Cialis is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. A lower dose of 5 mg is available for patients who take other medicines or have conditions that may decrease the body's ability to use the drug. Levitra is also available in a 2.5 mg dose. None of these PDE-5 inhibitors should be used more than once a day. Possible Side Effects Although all three drugs are generally well tolerated, side effects are still possible. Most common side effects: Viagra: facial flushing, headache, indigestion Levitra: facial flushing, headache Cialis: headache, indigestion Less Common Side Effects: Viagra: altered vision, dizziness, nasal, congestion Levitra: indigestion, nausea, dizziness, nasal congestion Cialis: back pain, muscle aches, nasal congestion, facial flushing, dizziness Precautions and Contraindications All PDE-5 inhibitors are absolutely contraindicated in persons who take organic nitrates. Alpha-blockers Viagra has precautionary labeling advising against taking 50 mg or 100 mg doses within four hours of taking a alpha-blocker. The 25 mg dose of Viagra has not been shown to significantly decrease blood pressure and in patients who take 25 mg of Viagra, use of any of the alpha-blockers is considered safe. Levitra is contraindicated in patients taking alpha-blockers. Cialis is contraindicated in patients taking alpha-blockers, except for tamsulosin (Flomax). Since both Viagra and Levitra have moderate vasodilatory and hypotensive effects, they should not be given in the presence of marked arterial or orthostatic hypotension, and should only be administered with caution in aortic stenosis or hypertrophic obstructive cardiomyopathy. Men who have had a heart attack or stroke within the past 6 months and those with certain medical conditions (e.g., uncontrolled high blood pressure, severe low blood pressure or liver disease, unstable angina) that make sexual activity inadvisable should not take Cialis. Dosages of the drug should be limited in patients with kidney or liver disorders. Conclusions The differences between the 3 drugs are not great. All appear to be effective and safe. Levitra has less side effects compared to Viagra and lasts about the same time as Viagra in the body. Cialis has few side effects and lasts longer in the body. This allows increased spontaneity and less frequent dosing than either Levitra or Viagra. However, the longer half-life of Cialis imposes increased risk for drug interactions. penis enlagement herb natural penis enlargment and lengthening penis enlargement picture top rated pnis enlargement pills penis elargement technique guide to penis enlargment penis enlargement review permanent penis enlargment cheap penis enlargment pills
Vaginismus is an involuntary contraction of the muscles surrounding the entrance to the vagina, making penetration painful, and or impossible. The muscle group involved is called the pubococcygeal muscles (PC). These are the same muscles used for kegel exercises. Normally, the vaginal sphincter keeps the vagina closed until the need to expand and relax. This relaxation allows for sexual intercourse, medical examination, insertion of tampons and childbirth. Vaginismus occurs when the vagina is unable to relax and permit the penetration of the penis during intercourse however, when vaginismus does occur, the sphincter goes into spasm resulting in the tightening of the vagina. In some women vaginismus prevents all attempts at successful intercourse. Vaginismus may even occur anytime in life, even if a woman has a history of enjoyable and painless intercourse. The severity of vaginismus varies from woman to woman. Some are able to insert a tampon and complete a gynecological exam but are unable to insert a penis. Others are unable to insert anything into their vagina. Vaginismus is not due to a physical abnormality of the genitals. Some women wonder if their vagina is too small to "accomodate" a penis, or perhaps they have no vaginal opening at all. This is understandable especially when the vaginal muscles are in spasm as they can give the appearance that the opening is nonexistent. These concerns, however, are incorrect as the genital area is completely normal. In addition to vaginismus, there are a number of other disorders, such as endometriosis, pelvic inflammatory disease, and Bartholin cysts that can result in painful sexual intercourse or penetration. It's important that a reliable diagnosis is obtained so that the appropriate treatment can be recommended. Nonphysical Causes: The cause of vaginismus is often a result of an aversive stimulus associated with penetration. Some of the more common aversive stimuli are traumatic sexual assaults, painful intercourse, and traumatic pelvic exam. Vaginismus may also result from the patient having strong inhibitions about sex stemming from strict religious beliefs or cultural norms. This disorder does not mean that women suffering from this disorder are frigid. Many are very sexually responsive and may have orgasms through clitoral stimulation. Many women with vaginismus may seek sexual contact and sexual foreplay as long as actual intercourse/vaginal penetration is avoided. Concepts such as penetration, intercourse and even sex can cause fear or trepidation in the mind of may a young inexperienced woman who may hear stories about painful first intercourse, which then reinforce the fear of penetration. This fear can compound and create a pattern of sexual anxiety, causing the vagina to remain dry and unrelaxed before intercourse. Treatment: The treatment of vaginismus is usually a therapy program that includes vaginal dilation exercises using plastic dilators. It's important that the use of dilators proceeds in a systematic progression under the direction of a sex therapist and should actively involve the woman's sexual partner. The treatment include gradually more intimate contact eventually culminating in successful and pain free intercourse. Sex education is also very important to counter sexual naivety and dispel any misinformation which has been identified as a factor in 90% of vaginismus cases. This education should include information about sexual anatomy, physiology, the sexual response cycle, and common myths about sex. Psychotherapy and Counseling See a qualified, licensed professional. Anyone can call themselves a sex therapist, so find a qualified psychologist or psychiatrist; one you trust. Try to get referred by your own physician or health care provider.