Can women enjoy sex without orgasm? This question is frequently asked and may be of great concern to women who are anxious about their sexual performance. Bardwick's data indicate that pleasant sensations are associated with "ripples" during the plateau phase. Others feel that nongenital sensations of physical and emotional closeness may be satisfying. Dissatisfaction may be engendered by a performance-oriented outlook in which orgasm or multiple orgasms become the primary goal. Women whose partners evaluate themselves in terms of the woman's satisfaction may be programmed to be orgasmic for the man's sake. Barring high levels of sexual tension, the woman who has not become more than mildly excited probably does not feel frustrated without orgasm. Although nonorgasmic coitus can produce adverse physical symptoms such as pelvic heaviness and low back discomfort, some women do appear to enjoy sex without orgasm.

During the orgasmic phase the primary response occurs in the female's orgasmic platform. About five to twelve contractions occur in the orgasmic platform at 0.8-second intervals. After the first three to six contractions, the interval between contractions increases and the intensity diminishes. The pelvic floor muscles that surround the lower one third of the vagina contract against the engorged vessels, thus forcing out the blood trapped in them: It is thought that a stretch reflex mechanism is one, factor responsible for orgasm. Contractions of the uterus begin at the fundus and progress to the lower segment of the uterus. The contractile excursion of the uterus parallels the intensity of the orgasmic experience.

The persons in the sample studied by Masters and Johnson were polled with regard to the subjective experience associated with orgasm. Three distinct stages of the woman's orgasmic experience were found. Orgasm begins as a sensation of "stoppage" or "suspension." This instantaneous sensation is followed by an intense sensual awareness oriented to the clitoris. A loss of sensory acuity has been described during this period. Some women described a sense of bearing down occurring simultaneously with the clitoralpelvic sensation. A feeling of receptive opening has also been expressed by parous women. This sensation has also been compared to those during the second stage of labor.

The little knowledge about the physiologic aspects of human sexual response existed until the publication of Masters and Johnson's classic volume in 1966. Until that time, sex education and counseling was largely based on theoretic formulations rather than fact. Although the amount of knowledge regarding biologic aspects of sexuality has grown rapidly, it alone does not provide a sufficient base for the health care practitioner in a sex education or counseling role.

To say that an understanding of only the physiologic aspects of the human sexual response cycle is sufficient would negate the importance of psychologic and sociocultural influences on human behavior. Human nature warrants that sexuality be considered in a biologic, psychologic, and sociologic framework.

Pressed vegetable oils, fresh or vacuum-packed wheat germ, and freshly ground whole-grain breads and cereals are our best sources of vitamin E. Our average intake of 6 to 15 units daily is only a fraction of the amount needed and that was obtained before foods were refined.

Vitamin E is non-toxic. As much as 3,000 units daily have been given to children for years. Consistently better results, however, have been obtained from the natural vitamin, d-alpha tocopherol acetate, than from the synthetic one. Mixed tocopherols are said to be unstable.

Though potassium is supplied by vegetables and fruits, relatively few vegetables are now being eaten. In the days when most people had home gardens, three to five vegetables were usually served at every lunch and dinner. Potassium is readily lost in the urine during the alarm and resistance reactions to stress and/or when the salt (sodium) intake is high. Deficiencies of potassium, therefore, have become common, especially when illness increases the requirement and decreases retention. Equal parts of potassium chloride and ordinary salt can be used in foods; and tablets supplying a gram of potassium chloride (15 grains) are available at drugstores.

Superior carbohydrates are supplied by root vegetables, whole-grain breads and cereals, and fresh fruits and juices. Though all starch is easily changed into sugar in the intestine, this conversion is sufficiently gradual that sugar is released slowly and can thus give a sustained energy pickup. Refined sugar over stimulates the production of insulin and alkaline digestive juices, interferes with the absorption of proteins, calcium, and many other minerals, and retards the growth of valuable intestinal bacteria; hence it should be used sparingly and only to increase palatability.

If sufficient calories are not obtained, body protein and/ or the proteins supplied in foods are used for calories. When the calorie needs are high, ,such foods as bananas, dried fruits, baked yams, cooked whole-grain cereals, root vegetables, and a variety of breadstuffs made of nutritious ingredients can be emphasized. Frozen undiluted fruit juices served over yogurt as a sundae or added to milk drinks can supply natural sugar as well as other nutrients in concentrated form.

Animal experiments indicate that during severe stress the vitamin-C requirements increase fantastically, often as much as 70 times more than needed during health. If a similar increase occurs in humans, approximately 5,000 milligrams would be needed daily during acute illnesses. This vitamin is nontoxic, 31 and taking massive quantities has sometimes resulted in amazing recoveries, but large amounts are rarely needed more than a few days.

Vitamin C is available in powder form and in tablets supplying 100, 250, and 500 milligrams each. During an acute infection, 500 milligrams every two or three hours taken in addition to the antis tress formula is usually ample, though perhaps 250 milligrams extra are needed with each dose of medication. Should bruises, bleeding gums, or nosebleeds occur, the quantities of both vitamins C and E should be immediately increased. When health is fully achieved, 75 milligrams of vitamin C daily is considered adequate by the National Research Council.