Petr Weiss

Vaginal Orgasm Is Associated with Vaginal (Not Clitoral) Sex Education, Focusing Mental Attention on Vaginal Sensations, Intercourse Duration, and a Preference for a Longer Penis

INTRODUCTION Evidence was recently provided for vaginal orgasm, orgasm triggered purely by penile-vaginal intercourse (PVI), being associated with better psychological functioning. Common sex education and sexual medicine approaches might undermine vaginal orgasm benefits. AIMS To examine the extent to which womens vaginal orgasm consistency is associated with (i) being told in childhood or adolescence that the vagina was the important zone for inducing female orgasm; (ii) how well they focus mentally on vaginal sensations during PVI; (iii) greater PVI duration; and (iv) preference for above-average penis length. METHODS   In a representative sample of the Czech population, 1,000 women reported their vaginal orgasm consistency (from never to almost every time; only 21.9% never had a vaginal orgasm), estimates of their typical foreplay and PVI durations, what they were told in childhood and adolescence was the important zone for inducing female orgasm, their degree of focus on vaginal sensations during PVI, and whether they were more likely to orgasm with a longer than average penis. MAIN OUTCOME MEASURES The association of vaginal orgasm consistency with the predictors noted above. RESULTS Vaginal orgasm consistency was associated with all hypothesized correlates. Multivariate analysis indicated the most important predictors were being educated that the vagina is important for female orgasm, being mentally focused on vaginal sensations during PVI, and in some analyses duration of PVI (but not foreplay) and preferring a longer than average penis. CONCLUSIONS Focusing attention on penile-vaginal sensation supports vaginal orgasm and the myriad benefits thereof. Brody S, and Weiss P. Vaginal orgasm is associated with vaginal (not clitoral) sex education, focusing mental attention on vaginal sensations, intercourse duration, and a preference for a longer penis.

Simultaneous Penile–Vaginal Intercourse Orgasm is Associated with Satisfaction (Sexual, Life, Partnership, and Mental Health)

INTRODUCTION Previous multivariate research found that satisfaction was associated positively with frequency of specifically penile-vaginal intercourse (PVI; as opposed to other sexual activities) as well as with vaginal orgasm. The contribution to satisfaction of simultaneous orgasm produced by PVI merited direct examination in a large representative sample. AIMS To examine the associations of aspects of satisfaction (sexual, life, own mental health, partner relationship) with consistency of simultaneous orgasm produced by PVI (as well as with PVI frequency and vaginal orgasm consistency). METHODS A representative sample of Czechs (N = 1,570) aged 35-65 years completed a survey on aspects of satisfaction, PVI frequency, vaginal orgasm consistency, and consistency of simultaneous orgasm produced by PVI (the latter being a specially timed version of vaginal orgasm for women). MAIN OUTCOME MEASURES Analysis of variance of satisfaction components (LiSat scale items) from age and the sexual behaviors. RESULTS For both sexes, all aspects of satisfaction were associated with simultaneous PVI orgasm consistency and with PVI frequency (except female life satisfaction). All aspects of satisfaction were also associated with vaginal orgasm consistency. Multivariate analyses indicated that PVI frequency and simultaneous orgasm consistency make independent contributions to the aspects of satisfaction for both sexes. CONCLUSIONS For both sexes, PVI frequency and simultaneous orgasm produced by PVI (as well as vaginal orgasm for women) are associated with greater life, sexual, partnership, and mental health satisfaction. Greater support for these specific aspects of sexual activity is warranted.

Pornography and Sex Crimes in the Czech Republic

Pornography continues to be a contentious matter with those on the one side arguing it detrimental to society while others argue it is pleasurable to many and a feature of free speech. The advent of the Internet with the ready availability of sexually explicit materials thereon particularly has seemed to raise questions of its influence. Following the effects of a new law in the Czech Republic that allowed pornography to a society previously having forbidden it allowed us to monitor the change in sex related crime that followed the change. As found in all other countries in which the phenomenon has been studied, rape and other sex crimes did not increase. Of particular note is that this country, like Denmark and Japan, had a prolonged interval during which possession of child pornography was not illegal and, like those other countries, showed a significant decrease in the incidence of child sex abuse.

International Index of Erectile Function (IIEF) Scores Generated by Men or Female Partners Correlate Equally Well With Own Satisfaction (Sexual, Partnership, Life, and Mental Health)

INTRODUCTION Erectile dysfunction has adverse implications for both men and their female partners. The International Index of Erectile Function (IIEF) is a widely used self-report measure. It was unclear whether scores generated by women on behalf of men are comparable to self-reports, and how IIEF scores are associated with satisfaction for both sexes in both sexual and nonsexual realms (e.g., mental health). AIMS To examine sex differences in IIEF-5 scores generated by both sexes, and to examine associations of IIEF-5 scores with satisfaction aspects (sexual, life, own mental health, partnership) and with womens vaginal orgasm consistency (VOC). METHODS A representative sample of Czechs (787 men and 720 women not from the same couple) aged 35-65 years completed the IIEF-5, LiSat satisfaction scale items, and provided penile-vaginal intercourse (PVI) frequency, and for women, VOC. MAIN OUTCOME MEASURES Correlations between satisfaction measures and IIEF-5 scores separately by sex. To examine sex differences: t-test for IIEF-5 score and tests for difference of a correlation for associations of IIEF-5 with satisfaction measures. Analysis of covariance examined the association of IIEF-5 scores and VOC. Multiple regression calculated satisfaction scores from IIEF-5, PVI frequency, age, and for women: VOC. RESULTS IIEF-5 scores generated by men and by women were similar, and similarly positively correlated with all satisfaction measures (r: 0.41-0.45 with sexual, 0.23-0.34 with other; all P < 0.001). IIEF-5 correlated positively with VOC. Multivariate analyses indicated IIEF-5 scores; PVI frequency (and for women, VOC) make independent contributions to aspects of satisfaction for both sexes. CONCLUSIONS In this representative sample, women generated IIEF-5 scores similar to men-generated scores. For both sexes, greater IIEF-5 scores and PVI frequency (plus VOC for women) are associated with greater sexual and nonsexual satisfaction. Better erectile function was associated with greater VOC. Greater support for optimizing specifically PVI function, frequency, and quality is warranted.

Heterosexual Anal Intercourse: Increasing Prevalence, and Association with Sexual Dysfunction, Bisexual Behavior, and Venereal Disease History

Representative samples of the Czech population were surveyed with regard to sexual behavior in 1993, 1998, 2003, and 2008 (N = 7,720). Lifetime prevalence of heterosexual anal intercourse increased from 1993 to 2008 (16.6% to 19.7% among women, 15.7% to 25.3% among men). Anal intercourse was associated with lifetime number of sex partners, current masturbation, and histories (prevalence of which increased from 1993 to 2008) of homosexual sex, prostitution, venereal disease (adjusted for number of sex partners), and womens sexual dysfunction. The authors discuss the possible reasons for the increasing prevalence and the associations. Multivariate predictors of ever having a sexual dysfunction or a venereal disease are also presented.

Vaginal Orgasm Is Related to Better Mental Health and Is Relevant to Evolutionary Psychology: A Response to Zietsch et al.

Zietsch et al. report [1] that in a large sample of Australian twins, “orgasm rates during masturbation, intercourse, and other sexual activities” were uncorrelated with 19 traits. The authors conclude that “female orgasm” might not have evolved by providing adaptive advantages to the woman and that female orgasmic disorder might not be a valid psychiatric construct. There are several problems with their approach and conclusions. One major problem with the approach taken is the failure to differentiate vaginal orgasm from orgasm occurring during penile–vaginal intercourse (PVI) but due to concurrent clitoral masturbation (by self or partner). Vaginal orgasm refers to a woman’s orgasm triggered purely by PVI without concurrent clitoral masturbation by self or partner. This differentiation is methodologically crucial. There is well-supported evidence (much of which was presented in this journal) that lack of specifically vaginal orgasm is associated with a variety of accurate indicators of poorer mental health, but orgasm from clitoral masturbation during PVI has opposite associations. Such indicators of poorer mental health have important psychiatric and sexological diagnostic and evolutionary theoretical implications. Zietsch et al. ignored these findings. Thus, when reporting no association between their orgasm measure and neuroticism, Zietsch et al. failed to cite a previous twin study published in this journal that found such an association [2]. Zietsch et al. conclude that female orgasm does not promote pair-bonding. However, they did not adequately test this hypothesis because longer relationships (an issue that they did address) are not necessarily better relationships or those that can best support the reproductive fitness of the offspring. The quality of parental pair-bonding can be of great importance. Impairment of specifically vaginal orgasm (not other sources of orgasm) is associated with poorer intimate relationship quality [3–5] and lesser sexual satisfaction [4–6]. An important psychological dimension for intimate relationships is the capacity for attachment. In contrast to a healthy secure attachment style, there is anxious attachment (preoccupation about abandonment) that is associated with relationship and mental health problems. Anxious attachment is also associated with poorer vaginal orgasm consistency, but other orgasm triggers are either unrelated to or related to more insecure (anxious or avoidant) attachment [7]. Relatedly, impairment of specifically vaginal orgasm is associated with more use of immature psychological defense mechanisms. Immature defenses are related to psychopathology and involve automatic avoidance of anxiety through distortion of reality (examples include somatization, dissociation, displacement, autistic fantasy, devaluation, and isolation of affect) [8–10]. Impaired vaginal orgasm is associated with more use of immature defenses, as is more orgasm from clitoral masturbation during PVI. Orgasms through noncoital sexual activities are either unrelated or related to more use of immature defenses [7–11]. Women who are vaginally anorgasmic have immature defenses scores similar to those of outpatient psychiatric groups (depression, social anxiety disorder, panic disorder, and obsessive– compulsive disorder) [8]. A likely basis for these consistent results is that immature defenses can block a woman from having a vaginal orgasm. However, it might also be that specifically vaginal orgasm supports emotional growth. Thus, the absence of vaginal orgasm is an indication of less mature psychological development (which in turn is associated with a broad range of psychopathology). Conversely, studies also found that women with a variety of psychiatric and character disorders have lesser ability to have a vaginal orgasm but not lesser ability to have a clitoral climax compared with women without such disorders [12–15]. Moreover, in large representative samples of Swedish and Czech women, lack of vaginal orgasm was associated with lesser satisfaction with own mental health [4,16]. Zietsch et al. note that if intercourse orgasm were associated with pair bonding, then greater intercourse orgasm rates should be related to higher libido, but they did not find such an association. However, they used an unusual measure of libido. In contrast, in a large representative sample, history of vaginal orgasm was associated with greater libido [4]. A large representative study found that history of vaginal orgasm is protective against female sexual arousal disorder with distress [17], and a group of women with inhibited sexual desire had lower frequency of vaginal orgasm but not lower frequency of orgasms from masturbation during PVI, compared with controls [18]. A laboratory study further revealed that for both sexes, PVI orgasm produced a dramatically greater rise in prolactin than did orgasm from masturbation (adjusted for individual control conditions) [19]; the postorgasmic prolactin surge produces a sense of satiety and also rebalances central dopaminergic levels. The issue of at least central dopaminergic tone being rebalanced has implications for psychological health as well as for sexual satiety [19]. Furthermore, optimal sexual and psychological function might involve not simply endless libido, but the capacity for sexual satisfaction. In large representative samples of Swedes and Czechs, vaginal orgasm was associated with greater satisfaction with sex life [4,5], with similar results in a convenience sample of Chinese women [6]. Zietsch et al. also make the mistake of attributing intercourse orgasm simply to direct or indirect clitoral stimulation (as in their reference to what they imply is the importance of clitoris–vagina distance). However, clitoral stimulation leads to pudendal nerve activation, but vaginal and especially cervical and uterine stimulation during intercourse additionally stimulate the pelvic, hypogastric, and vagus nerves [20]. In women with spinal cord injury (their brains can receive stimulation from the vagina and cervix via the vagus nerve but not from the clitoris, which is dependent on the spinal cord), cervical-vaginal stimulation leads to orgasm as confirmed by both self-report and functional magnetic resonance imaging [21,22]. This is strong evidence that the clitoris is not needed for female orgasm, especially not for vaginal orgasm. Of note, the vagus nerve is also involved in attention, emotion regulation, and likely pair-bonding [23], and better vagus nerve (parasympathetic) tone and regulation is associated with PVI (but not other sexual activity) frequency [24–26]. New functional magnetic resonance imaging research with healthy women has demonstrated that in addition to regions of overlap, there are distinct 3523

Erectile Dysfunction and Premature Ejaculation: Interrelationships and Psychosexual Factors

INTRODUCTION Both erectile dysfunction (ED) and premature ejaculation (PE) impair the quality of sexual intercourse for both men and their female partners. AIMS This study aims to examine with a large representative sample the interrelationships of measures of ED, PE, typical intravaginal ejaculatory latency time (IELT), mens perceived relationship quality with their mother, and age of first being in love. METHODS In this cross-sectional study, a nationally representative sample of 960 Czech coitally experienced men (aged 15-84), provided age, International Index of Erectile Function 5-item (IIEF-5), Index of Premature Ejaculation (IPE) scores, IELT, rating of relationship with their mother, and age at first being in love. MAIN OUTCOME MEASURES Correlations, partial correlations adjusting for age, analysis of covariance (ANCOVA), and multiple regression statistical methods were used. RESULTS IIEF-5, IPE, and IELT were significantly intercorrelated (IIEF-5 and IPE: r=0.64). Better IIEF-5 scores were associated with younger age at first (and ever) being in love. Poorer IPE score, shorter IELT, and mild-moderate ED were associated with poorer perceived mother relationship (which was also associated with first being in love at an older age). Multiple regression analyses revealed that: (i) greater IELT was associated with better erectile function and better mother relationship, but not with age; and (ii) IELT of <1 minute was associated with poorer perceived mother relationship and poorer IIEF-5, but marginally with age. History of homosexual activity was unrelated to IIEF-5, IPE, IELT, and perceived mother relationship scores. CONCLUSIONS The findings suggest that degrees of ED and PE are often comorbid, and both ED and PE are associated with less favorable early experiences with women. Brody S and Weiss P. Erectile dysfunction and premature ejaculation: Interrelationships and psychosexual factors. J Sex Med 2015;12:398-404.

Sexual Health and Overall Wellness (SHOW) survey in men and women in selected European and Middle Eastern countries

Objective To investigate whether better sexual health is associated with improvements in overall health and wellness, a more loving and intimate relationship, and a more positive outlook on life. Methods The Sexual Health and Overall Wellness survey used self-administered questionnaires to collect data from men and women aged 25–74 years who had had sexual intercourse at least once within the previous 12 months. Results Across nine countries, 3780 self-administered questionnaires were completed: 1893 from men (mean age, 44.6 years); 1887 from women (mean age, 44.2 years). The majority of men and women were satisfied with the frequency of sexual intercourse over the previous 4 weeks (59% and 66%, respectively); the majority (67% and 55%, respectively) reported that having sex was ‘very important’ or ‘absolutely essential’. For men and women, there was a strong association between satisfaction with sex and overall health, and between satisfaction with sex and an overall positive outlook on life. Conclusion For men and women, satisfaction with different aspects of sex was important, and was strongly associated with satisfaction with general health, relationships and other aspects of wellbeing.

A Comparison of Male Sex Workers in Prague: Internet Escorts versus Men Who Work in Specialized Bars and Clubs

Prague, the Czech Republic, is a popular sex tourism destination where sex work is decriminalized and young men offer sexual services at low prices relative to countries in Western Europe. This quantitative survey aimed to identify some of the demographic characteristics of these young men and their experiences in the sex industry. Internet escorts (N = 20) and sex workers in bars and clubs (N = 20) completed the survey anonymously in spring 2011. The results showed that sex workers in clubs often had troubled pasts and were forced into sex work to survive. They also reported incidents of violence, serious alcohol and drug use, as well as frequent gambling. The larger group of sex workers in Prague is made up of Internet escorts who have backgrounds that are not atypical for the average Czech youth. They had fewer problems with drugs and alcohol but were twice as likely as sex workers in bars and clubs to be victims of violent crime. Plans for interventions to help those who would change their line of work, as well as the importance of sociocultural context in understanding sex workers, are discussed.

Current Hormonal Contraceptive Use Predicts Female Extra-Pair and Dyadic Sexual Behavior: Evidence Based on Czech National Survey Data:

Data from 1155 Czech women (493 using oral contraception, 662 non-users), obtained from the Czech National Survey of Sexual Behavior, were used to investigate evolutionary-based hypotheses concerning the predictive value of current oral contraceptive (OC) use on extra-pair and dyadic (in-pair) sexual behavior of coupled women. Specifically, the aim was to determine whether current OC use was associated with lower extra-pair and higher in-pair sexual interest and behavior, because OC use suppresses cyclical shifts in mating psychology that occur in normally cycling women. Zero-inflated Poisson (ZIP) regression and negative binomial models were used to test associations between OC use and these sexual measures, controlling for other relevant predictors (e.g., age, parity, in-pair sexual satisfaction, relationship length). The overall incidence of having had an extra-pair partner or one-night stand in the previous year was not related to current OC use (the majority of the sample had not). However, among the women who had engaged in extra-pair sexual behavior, OC users had fewer one-night stands than non-users, and tended to have fewer partners, than non-users. OC users also had more frequent dyadic intercourse than non-users, potentially indicating higher commitment to their current relationship. These results suggest that suppression of fertility through OC use may alter important aspects of female sexual behavior, with potential implications for relationship functioning and stability.