Health and medical information

Both men and women find the woman-on-top positions extremely satisfying. They enable a woman to take a more active role in controlling both the sensations she gives and those she receives. With her man underneath and relatively immobile, she can stimulate his penis easily by moving up and down, and more readily control the depth of penetration. For the man, such positions prove that his partner is taking the lead; with them, he can feel himself the object of her active seduction. Woman-on-top positions are also comfortable ones, particularly when the woman is much lighter than her partner or if she is pregnant.

He is the passive partner, feeling wanted and seduced, and can concentrate on his own arousal knowing that his partner is controlling her own stimulation

His hands can caress her back and buttocks, occasionally holding her to guide the angle of penetration

She takes the active role, raising and lowering herself onto his erection

She can push his legs apart or together with hers thus changing the sensations for both of them

1 To get into the simplest position, where the woman lies on top of her partner with her legs outside, it is probably best to start from a side-on embrace. Then she needs to gently throw a leg across her partner’s thighs, and climb gracefully on top. The man, of course, needs to have an erection, which the woman will have to guide inside her.

2 If the woman now brings her legs inside her partners this results in a snugger fit between both genital areas. If she keeps her legs tightly closed, she heightens the friction between the vagina and pelvis. She can add to the sensation by contracting her pelvic muscles.

3 Finally, if the woman spreads her legs out widely to the side, the pubic regions are perfectly aligned. From here, she can press down on her partner’s feet, which is highly arousing to him because she is obviously “using” her partner in order to satisfy herself.

Man

He can lie and enjoy the sensations she arouses. This is useful where he can’t take the lead due to fatigue or illness.

Woman

As well as being ideal for a woman to please herself, this helps when a partner is large, or when she is pregnant.

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The first vibrators were fashioned on the dildo, an artificial penis that has been used by both sexes for many thousands of years. The most recent variation on the traditional dildo is the battery-operated vibrator, which is widely available in sex shops. Vibrators are used mostly to stimulate a woman’s clitoris, and they can be a great help in cases when a woman otherwise has difficulty reaching orgasm during sexual intercourse.

The vibrator works by stimulating the millions of sensory nerve endings in the skin of the woman’s labia and the clitoris. A man can also benefit from a vibrator, applying it to his penis and surrounding area to heighten his sensations there.

During intercourse, the penis pushes and pulls against the labia and clitoris and, so to speak, flicks on millions of tiny switches that fire off electric impulses to the brain. In a basic sense, the more sensors the penis stimulates, the greater the sexual sensations. Sad though it may be, a vibrator is better than most penises; in a given moment it can trigger at least a million more sensors than the most educated penis, and that means orgasm is virtually inevitable. This does not mean that a vibrator is necessary, or that the penis is redundant. The whole idea of self-produced orgasm is simply to pave the way for satisfying sexual intercourse.

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In contrast with a man, the whole of a woman’s skin is an erogenous zone and all of it will respond to touches, caresses and kisses. However, there are certain areas where stimulation results in more intense arousal. These erogenous zones vary from woman to woman.

General Body Areas-A woman’s face has several erogenous zones including her hairline, forehead, temples, eyebrows, eyelids and cheeks. In general, women prefer light facial caresses. The mouth for most women is one of their most erogenous zones, and it can be stimulated readily with the fingertips and kisses. Stimulating a woman’s mouth can set alight her whole body, and has a direct effect in arousing her genital organs. On the other hand, erogenous stimulation of any other part of a woman’s body often produces a reaction in her mouth, in her breasts, and in her genital organs as well.

The earlobes are extremely sensitive to stimulation and can be caressed gently; some women even can have an orgasm after such a simple caress. The neck, particularly at the back and down the sides, is a very sensitive area. The arms, armpits, hands and back, hips and the whole of the lower abdomen can also be stimulated erotically.

An extremely sensitive zone is the area around the navel. Most women relish caresses with the fingertips, lips or penis over the whole length of their legs, particularly on the inner thighs.

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Sight This plays a greater role in arousing men than women, but a woman may take advantage of this by making herself as visually attractive as possible, with a properly made-up face, flattering clothes, and by ensuring that her movements – such as when undressing – are pleasing to watch. The eyes are supposed to be the windows of the soul, so it is very common to see lovers gazing intently into each other’s eyes, oblivious of everything else around them.

Hearing This contributes much, too, which is why music, played quietly and at the right moment, can be highly exciting for both men and women. We become excited when we hear our beloved approaching, his or her laugh and particularly his or her voice. Some men and some women have very beautiful voices, and are aware of their seductive effects. A man may have a warm, velvety voice whose every modulation has the power to move a woman’s heart. A good voice used well is a caress. A telephone call may simulate an act of love and be as potent as any form of foreplay. The opposite pertains, too, of course, and some women’s voices literally drive men mad.

Touch Small touches, even accidental touches, have an enormous effect on everyone. We all need touch very badly. We find it relaxing and reassuring, and it helps us to loosen up our inhibitions. Sometimes the greatest intimacy and the most acute closeness can come from simply touching and holding. Most of us have had experiences where dancing has been highly erotic, involving the rhythmical contact of two bodies. Dancing can be pure foreplay – try dancing cheek to cheek, hand in hand, breasts against a man’s chest, pelvis against pelvis, legs slightly apart, thighs brushing each other, sexual organs pressed together – all of which simulate sexual contact. The potent mixture of sight and sound created by movement, light and music only adds to the effect.

Taste A delicious meal accompanied by fine wine often puts a couple in a good mood and lowers their inhibitions so they are more inclined to make love. Talk over a meal, soft lighting, and the ritual of eating, can be very seductive, and lovers feel that there is a metaphor between eating and deriving emotional nourishment from a partner’s body.

Smell Women like wearing scent and men like smelling it but it can have a much greater effect than a woman ever thinks – especially when her body is warm; the scent evaporates and body smells mingle with the perfume, acting as a powerful stimulant. Coco Chanel once said that a woman should scent her body wherever she expects to be kissed, and with the array of scents available, both partners would delight in this. Women probably have the strongest preference for the unadulterated smell of a man’s skin, which in itself is very exciting, but as a way of showing interest, most wouldn’t mind if their partners used some aftershave.

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When a man becomes excited, his reactions, just like a woman’s, are not confined solely to his sex organs. Excitement begins in the brain, when a man becomes aroused by something either real or imagined. A man is aroused by mainly visual stimuli; clothing and make-up, as well as the sight of naked or semi-naked female bodies, turn him on. A man readily becomes conditioned by his experiences; objects or circumstances associated with sex may elicit arousal, also. In this way, without any physical contact, male arousal occurs frequently and rapidly.

The Penis Becomes Erect-Messages from the brain travel down the spinal cord to the genitals and shut off the outflow of blood from the penis, and this brings about an erection. A man’s usually limp, downward-hanging organ becomes a rigid, upward-pointing, dusky coloured, throbbing one with prominent veins.

By carefully controlling the variation and intensity of stimulative techniques, erection can be maintained for extended periods; it can be partially lost and rapidly regained many times during a long period of stimulation.

Erection can be easily interrupted by non-sexual stimuli, even though sexual stimulation is continued. Any form of mental distraction, a sudden loud noise, or a change in temperature or lighting, may result in partial, or even complete, loss of erection.

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Genital warts can usually be diagnosed on clinical grounds and may be confirmed by histology. Cervical HPV infection will commonly be diagnosed by cervical cytology with or without colposcopy and biopsy. There are no suitable serological tests and the virus cannot be isolated from clinical material by cultural methods. HPV may be undetectable except by hybridisation using nucleic acid probes.

Warts must be distinguished from the condylomata lata of secondary

syphilis by serological tests for syphilis and dark ground examination. If the lesion is large, fungating or ulcerated, a biopsy should be taken to exclude carcinoma. Warts should also be differentiated from molluscum contagiosum (p.45), vulval skin tags and penile papules (sebaceous glands).

Genital HPV infection is usually sexually acquired but autoinoculation can occur. Lesions may develop from one to six months or more after infection. HPV infection may be subclinical. Latent infection is usual after spontaneous regression or treatment and there is considerable recurrence.

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Herpes is an increasingly common sexually transmitted infection caused by herpes simplex virus (HSV). There are two types, HSV-1 and HSV-2, which are clinically and epidemiologically similar. HSV-1 is often associated with lesions on the face and fingers and sometimes with genital lesions; it is usually acquired during childhood. HSV-2 is usually acquired after sexual activity commences and is almost entirely associated with genital herpes.

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For treatment failures and for patients for whom tetracyclines are contraindicated, erythromycin (e.g. erythromycin stearate or ethyl succinate 500 mg every 8 hours 1 hour before food for 10 days for simple infections and longer in complicated cases) may be used.

In patients with persistent or recurrent urethral symptoms, repeated antibiotic prescriptions should not take the place of careful clinical evaluation and laboratory investigation.

Sexual partners of patients with NGU or NGC should be assessed and treated where necessary. Women with silent infection may develop pelvic inflammatory disease especially when using an IUCD. Males may develop prostatitis. Epidemiological treatment is recommended for the female contacts of a male with recent onset of NGU.

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Whether patients are treated for one or other of these infections or for both will depend on an assessment of the clinical features, laboratory investigations and local disease patterns. Many venereologists recommend that patients with gonorrhoea also be treated for chlamydia.

Sexual partners of patients with gonorrhoea or NGU or NGC should be investigated and treated on epidemiological grounds. Women with silent infection may develop pelvic inflammatory disease. Asymptomatic male partners may develop prostatitis or epididymitis. Failed treatment or recurrence may be due to reinfection by an infected partner.

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The effective management of STDs has four components, namely treatment, counselling, follow-up and contact tracing.

The management of bacterial STDs is one field of medicine where there is

a substantial degree of standardisation of drug therapy. Single dose treatments are available for some STDs and are of particular use for patients unlikely to comply with daily regimens or to attend follow-up. Where specific treatment is available, a full course in accordance with an authoritative recommendation should be prescribed.