section_path: Health effects/Duration and genital complications
section_name: Duration and genital complications
paragraph_text: Duration and genital complications
  
  Sexual intercourse, when involving a male participant, often ends when the male has ejaculated, and thus the partner might not have time to reach orgasm. In addition, premature ejaculation (PE) is common, and women often require a substantially longer duration of stimulation with a sexual partner than men do before reaching an orgasm. Scholars, such as Weiten et al., state that "many couples are locked into the idea that orgasms should be achieved only through intercourse," that "the word foreplay suggests that any other form of sexual stimulation is merely preparation for the 'main event'" and that "because women reach orgasm through intercourse less consistently than men," they are likelier than men to fake an orgasm to satisfy their sexual partners.
  
  In 1991, scholars from the Kinsey Institute stated, "The truth is that the time between penetration and ejaculation varies not only from man to man, but from one time to the next for the same man." They added that the appropriate length for sexual intercourse is the length of time it takes for both partners to be mutually satisfied, emphasizing that Kinsey "found that 75 percent of men ejaculated within two minutes of penetration. But he didn't ask if the men or their partners considered two minutes mutually satisfying" and "more recent research reports slightly longer times for intercourse". A 2008 survey of Canadian and American sex therapists stated that the average time for heterosexual intercourse (coitus) was 7 minutes and that 1 to 2 minutes was too short, 3 to 7 minutes was adequate and 7 to 13 minutes desirable, while 10 to 30 minutes was too long.
  
  Anorgasmia is regular difficulty reaching orgasm after ample sexual stimulation, causing personal distress. This is significantly more common in women than in men, which has been attributed to the lack of sex education with regard to women's bodies, especially in sex-negative cultures, such as clitoral stimulation usually being key for women to orgasm. The physical structure of coitus favors penile stimulation over clitoral stimulation; the location of the clitoris then usually necessitates manual or oral stimulation in order for the woman to achieve orgasm. Approximately 25% of women report difficulties with orgasm, 10% of women have never had an orgasm, and 40% or 40–50% have either complained about sexual dissatisfaction or experienced difficulty becoming sexually aroused at some point in their lives.
  
  Vaginismus is involuntary tensing of the pelvic floor musculature, making coitus, or any form of penetration of the vagina, distressing, painful and sometimes impossible for women. It is a conditioned reflex of the pubococcygeus muscle, and is sometimes referred to as the PC muscle. Vaginismus can be hard to overcome because if a woman expects to experience pain during sexual intercourse, this can cause a muscle spasm, which results in painful sexual intercourse. Treatment of vaginismus often includes both psychological and behavioral techniques, including the use of vaginal dilators. Additionally, the use of Botox as a medical treatment for vaginismus has been tested and administered. Painful or uncomfortable sexual intercourse may also be categorized as dyspareunia.
  
  Approximately 40% of males reportedly have some form of erectile dysfunction (ED) or impotence, at least occasionally. Premature ejaculation has been reported to be more common than erectile dysfunction, although some estimates suggest otherwise. Due to various meanings of the disorder, estimates for the prevalence of premature ejaculation vary significantly more than for erectile dysfunction. For example, the Mayo Clinic states, "Estimates vary, but as many as 1 out of 3 men may be affected by at some time." Further, "Masters and Johnson speculated that premature ejaculation is the most common sexual dysfunction, even though more men seek therapy for erectile difficulties" and that this is because "although an estimated 15 percent to 20 percent of men experience difficulty controlling rapid ejaculation, most do not consider it a problem requiring help, and many women have difficulty expressing their sexual needs". The American Urological Association (AUA) estimates that premature ejaculation could affect 21 percent of men in the United States.
  
  For those whose impotence is caused by medical conditions, prescription drugs such as Viagra, Cialis, and Levitra are available. However, doctors caution against the unnecessary use of these drugs because they are accompanied by serious risks such as increased chance of heart attack. The selective serotonin reuptake inhibitor (SSRI) and antidepressant drug dapoxetine has been used to treat premature ejaculation. In clinical trials, those with PE who took dapoxetine experienced sexual intercourse three to four times longer before orgasm than without the drug. Another ejaculation-related disorder is delayed ejaculation, which can be caused as an unwanted side effect of antidepressant medications such as fluvoxamine; however, all SSRIs have ejaculation-delaying effects, and fluvoxamine has the least ejaculation-delaying effects.
  
  Sexual intercourse remains possible after major medical treatment of the reproductive organs and structures. This is especially true for women. Even after extensive gynecological surgical procedures (such as hysterectomy, oophorectomy, salpingectomy, dilation and curettage, hymenotomy, Bartholin gland surgery, abscess removal, vestibulectomy, labia minora reduction, cervical conization, surgical and radiological cancer treatments and chemotherapy), coitus can continue. Reconstructive surgery remains an option for women who have experienced benign and malignant conditions.