Like other functions of the body, sexual and reproductive functions are also very important. Sex is concerned more with the mind and any distractions or lack of confidence will worsen the situation. In humans, there is also an aspect of pleasure in it.
This second edition has been brought out as a more refined and refreshed one along with addition of two chapters and more information on vaginal microbiome, sex education and role of foreskin in men, POIS (Postorgasmic illness syndrome), and about the impacts of anti-androgenic drugs on sexual dysfunction. Index is added for convenience of the readers.
There are not many books available in the field of sexual medicine, especially with more practical approaches rather than scientific theories. Similarly, genital dermatology (venereology) books are available only for postgraduates. This is the first book that has the combination of both sexual medicine and genital dermatology which will be of great use and interest to budding doctors of this field. It covers topics from embryology up to the problems in anatomy, physiology, pathology and the psychological aspects of sexual functions and their management in a simple and practical way. This book throws light on the problems faced by both men and women.
Here is an excerpt from the book:
Common Sex Health Concerns and Their Management
Majority of the sex problems have a psychosexual background. Whether it is related to youngsters, middle aged persons or even old aged people, sex-related problems have a background of psychosexual causes. Basically sex is not in between two thighs, but between two ears…. That is, it begins in mind and ends with mind.
Even in people with an organic cause for the sex problem or in cases of drug induced sex problems also, there lies an element of psychosexual aspect as well like pressure of performance, which affects the condition more badly. So it is very essential to find out the root cause of the problem and try to solve the same by clearing their doubts and proper counseling along with drugs. In case of organic causes and drug-induced problems along with removing the cause, counseling will improve the performance.
Sex problem is like an entangled thread. People will present to you their sex problems as a mass of entangled thread. They themselves did not know the basic cause and they will present to you with guilty and inferiority complex. It is the physician’s duty to find out the end of this entangled thread and slowly try to remove all folds and release the thread to a straight woven thread and thereby solve their problems successfully.
BASIC REASONS THAT CAN PRECIPITATE SEX PROBLEMS IN YOUNGSTERS
- Misconceptions and myths about sex and sexuality prevailing in the society.
- Advertisements appearing in magazines and periodicals.
- Misappropriate information spread through TV channels and other media.
- Porn videos available on websites.
- Lack of sex education in schools.
- False information from friends.
- Restrictions in the society for free discussion about sex with elders, parents, teachers.
- Finally, persistent unclear doubts, leading to low self-esteem and guilty complex.
During sex, mind and body have to coordinate together. The individual’s mind has to be focused on the partner’s body and on sexual pleasure alone and it should not get diverted. If the individual is not able to focus his mind on these, then he or she may not be able to complete the “sexual response cycle” and this will end up in sex problems. Failure to complete the first coitus (could be situational) will also lead to sex problems. This situational problem might be due to misconceptions, poor esteem, disliking of partner, pressure on performance, social pressure, bad odor, halitosis, guilty complex, anxiety, fear of being caught, fear of STIs/HIV, pregnancy, lack of time and hurry, uncongenial place, lack of adequate privacy, and faulty position, etc.
Some other causes:
- Upbringing
- Religious taboos
- Misinterpretations by parents, friends, elders, etc.
- Depression – low self-esteem (look, job/position, financial and/or education), no issues, lack of personal relations, or conflicts
- Childhood traumatic experience, or child sex abuse
- Stress at home or work – inconsistent meeting hours between couple due to work schedule
- Disliking – spouse, sex, odor
- Oedipus complex or grown up together
- Liking toward altered behavior like paraphilias or homosexual attractions
- Lack of stimuli or monotony (elderly and middle aged)
- 5 “S” – Smoking, Scotch, Sugar, Stress, and Sedentary life
- Poor orientation due to lack of friends, mental retardation or due to low IQ
- Love affairs with someone else
Each individual case would differ. It is the duty of the examining physician to identify the cause. For this, the present history or history of evolution of illness alone is not sufficient. Especially in a case of unconsummated marriage, the history should be elicited from their childhood onwards, their attitude toward marriage before and after, masturbation activity and attitude toward masturbation, sexual attractions, sexual orientations, childhood sex abuse, drugs, alcohol, and smoking habits, etc. have to be elicited. Then a detailed history about the first sexual experience has to be obtained. His initial response (hugging, kissing or a silent spectator, or producing
excuses), partner’s response (dominating, demanding, making comments about appearance and stature, sex organs, and about performance), and sexual posture, PME, expectations and phobias have to be elicited carefully. Even small information will give the clue to his/her problem. Pain during the attempted coitus for him/her, feeling of hurting the partner, especially after a child birth or after an abortion also can precipitate sex problems. Fear of STI/HIV also plays a role in sexual failure.
FACTS ABOUT VARIOUS MISCONCEPTIONS
Masturbation
Masturbation is deliberate self-stimulation which produces sexual arousal and reaches a self gratification with orgasm.
Males
Sex is an instinct just like that of our appetite. This feeling starts from the adolescent period onwards. If one get married early as in olden times, the need for masturbation would not arise. But the age of getting marriage is getting delayed nowadays beyond the third decade of life. When the individual cannot be able to have sexual advance with his/her neighbors, classmates, or relatives, and because of fear of STI/HIV, not courageous to have sex with sex workers, the only way to gratify their sexual needs (safe and not expensive) is through masturbation.
Even among married persons masturbation is not uncommon. When the spouse is sick, pregnant, following delivery, abortions and when the individual stays away from home (abroad, migration), partner’s reluctance toward sex and during menstruation of the spouse, habit of masturbation continues and it helps a lot.
About 94% of males enjoy masturbation which leads to orgasm. There is no difference in the physiology of penetrative sex and masturbation except the intimacy. Same quantity and quality of semen is leaked out. But there is lot of misconceptions prevailing about masturbation in the society. The ejaculatory material (ejaculum) and the quantity of semen are same for both masturbation and intercourse. It is assumed that masturbation will lead to weakness, impotency and infertility, affect vision, lead to dark circles around eyes, cause pimples over face, hair fall, and tremors of hands, thinking that semen is precious and not to be wasted. At the same time no such comments are received for increased frequency of sex after marriage. Alternate medical systems believe that semen is precious and not to be wasted. These false ideas are well-established in the society and are well carried away through generations in the absence of proper sex education. Because of such messages prevailing in the society, people develop a feeling of guilty and poor esteem about themselves which later pave the way for sexual dysfunctions.
As genitals are highly sensitive organ, some sort of genital touching and pleasure are experienced from infancy onwards. Boys learn masturbation either themselves or from their friends. Masturbation is an alternative for coitus without any harm. It actually does good to the individual and to the society. It is the safest sexual activity
as far as STI/HIV is concerned. It relieves unnecessary stress and mental tension. It reduces the intensity of hyperactive sexual disorders and keeps the relationship among the family members in a cordial way. If there is no such way of masturbation to let out the increasing urge for sex, then the daily newspapers will have to allot a separate page for sex crimes alone. Without masturbation we would not have been able to bring down the incidence of HIV/STI to the present level. So actually we have to encourage the individuals to do masturbation to save the society from sex crimes and to cut down the incidence of sexually transmitted infections. Moreover, masturbation plays a part in the drugless management of premature ejaculation.
Masturbatory techniques may vary from person to person. Common way is moving the foreskin forth and back over the glans to get stimulated. In phimotic individuals, the act of mere shaking the penis and scrotum is used for masturbation. Some boys masturbate by thrusting against the bed or through a hole in the wall or some other objects. Even among these individuals, people who have the different way of masturbating (like thrusting against bed) have more guilty feeling than others. The frequency of masturbation will greatly vary from person to person. But there will not be any question of overindulging. Nobody can overindulge sex or masturbation as there is refractory period in men after each ejaculation which varies according to their physique, genetic predisposition, and age, duration of marriage, sleep, rest, and general well-being. Nobody can overeat as well as cannot overindulge
in sex also.
Females
In women, reaching the orgasm during intercourse is either delayed or absent most often. So women are used to find their own way to achieve orgasm through specific and quickest way. Most of the females discover their own way to masturbate as a result of the exploration of their own genitalia. Many females do not begin masturbation till the age of 30, as they fail to reach orgasm in coitus, or they start masturbation during their husbands are away from home. 62% of women would masturbate at sometime during the course of their sexually active period.
Many women often fear that masturbation would do the physical harm and some consider it morally wrong and abnormal or sin. Women practice more different ways to masturbate. Clitoris, vaginal introitus and labia minora are the more sensitive parts of female genitalia. Females run their hands over their genitalia and find their own way to get erotic stimulation. Fantasy about coitus does not play important role as in men. Unlike men, women are not much interested or delighted to see men in nude poses or relished the beauty of male sex organs. Likewise sex toys and inserting objects into vagina are often rare as the inner aspect of vagina is not so sensitive. 10% of females masturbate by crossing their legs and pressing them to exert steady and rhythmic pressure on the whole genital area. Such pressure affects the clitoris, labia minora and majora. Nipple and areola of the breasts are also erotically sensitive in nearly half of the females. They use to stimulate them with their hands along with genital manipulation. Breast stimulation alone is not sufficient to produce orgasm. Orgasm is attained quickly through masturbation in females rather than through coitus. False belief that masturbation is bad for health is prevailing among females also. Masturbation is a safe sexual outlet for females as well. Women are benefitted by masturbation which relieves their premenstrual pain, pave way to achieve orgasm during coitus, and increase the fertility rate since the wider opening of cervical os, permitting more number of sperms to get enter.
Fatigue after masturbation in both sexes is due to utilization of large amount of energy due to muscular contractions, tachycardia, and tachypnoea during orgasm like any other strenuous muscular activities. It is actually not weakness but only tiredness. This exhaustion will be relieved by rest within a matter of few hours or after a night sleep. The harmful effects of masturbation are not directly to the act, but the feeling of weakness, guilt, and the fear involved, affect their psych.
Blending practical approaches with academic depth, this comprehensive second edition unites sexual medicine and genital dermatology in a unique, accessible guide. From embryology to psychological aspects, it expands into advanced themes like vaginal microbiome, sex education, foreskin, POIS, and drug-induced dysfunction—ideal for dermatology and venereology students, as well as doctors seeking clarity beyond theory in holistic sexual health care.
Click here for complete details, chapter breakdowns, and author information.
