Performance Enhancers

Sexual performance enhancers are those objects, practices, or interventions that aid in the arousal, sensation, or consummation of a sex act. These include a large category of sex-related apparatuses, machines, and furniture, and a variety of drugs, exercises or techniques, and surgical procedures. Elements that improve sexual performance can range from stimulation by pornography or fetishes (for example, sexual fixations on shoes, rubber, leather, etc.) to medical interventions that provide a means of overcoming sexual dysfunction such as impotence, premature ejaculation, or other health-related issues. Performance enhancers work to improve the sexual experience through physical, psychological, and/or physiological means. The following provides an overview of the different types of sexual performance enhancers.

SEX-RELATED APPARATUS, MACHINES AND FURNITURE

Anal beads are smooth round balls that range in size from small pearls to golf balls and are held together by a strong cord with a ring at one end. The beads are inserted into the anus and then slowly pulled out with the ring, usually during sexual orgasm, to increase arousal and sensation of the anus.

Ben Wa balls (Burmese bells or Geisha balls) are small, hollow balls usually made of metal that contain a small weight that rolls around. The balls are inserted into the vagina or anus for sexual stimulation and may be left inside the body for prolonged periods or may be removed to enhance erotic sensation or climax. Additionally, these balls may be used to strengthen the pelvic floor muscles of the vagina.

Cock rings are rings made of various materials, such as metal, elastic, or string, that are fitted around the base of the shaft of the erect penis. Some versions have an additional ring that fits around the testicles. Other cock rings fit around both the penis and testicles. The ring functions by limiting the outflow of blood from the penis thereby resulting in a firmer and longer-lasting erection. Caution should be exercised to prevent injury to the penis from either constricting the penis too tightly or using the cock ring for prolonged sessions.

Dildos are vibrating or non-vibrating shafts made to resemble the shape, size, or appearance of a penis. They may be made of a number of materials, including latex, rubber, silicon, metal, and glass, and are used for vaginal or anal penetration (or to simulate fellatio). Devices made of sturdier materials such as metal or glass are sometimes shaped to provide direct stimulation to the G-spot in women and thus enhance the act of penetration. Dildos may be used during masturbation or to enhance the sex act between partners. A strap-on is a dildo attached to a strap that is fastened around the waist, often with a second strap similar to a g-string that stabilizes the dildo in a position that allows the wearer the illusion of having a penis. Women may wear a strap-on to penetrate either sex. Men may use such a device in cases of erectile dysfunction or to have simultaneous intercourse with multiple partners. Because dildos come into direct contact with body fluids, they must be washed and sterilized if shared between partners. Further, a dildo used in the anus should have a flanged based to prevent its total insertion into the rectum (which may require medical intervention to retrieve it). Those versions used primarily in the anus and left there rather than thrust in and out are referred to as butt plugs.

Lubricants are viscous lotions or gels that aid in insertion and penetration during vaginal or anal intercourse. Though the vagina produces natural lubricant, certain conditions such as nursing or menopause and some medications can cause vaginal dryness; the use of personal lubricants can improve sexual function.

Penis extenders are hollow sleeves that are placed over the penis to increase its length or thickness. They may be made of a variety of materials including latex or silicone and may have a textured surface manufactured to produce an erotic sensation for both the user and the partner. Penis extenders also refer to mechanical traction devices that fasten over the penis and adjust to produce tension on the shaft in an effort to train the penis to grow longer. There is no scientific study that shows any lasting effectiveness of these devices, and overzealous use may damage penile or scrotal tissue.

Penis pump (or vacuum pump) is a hollow cylinder with a manual or motorized vacuum mechanism that fits over the penis and uses suction to draw blood into the penis resulting in an erection. Although these pumps are frequently touted as a method for permanently increasing the size of the penis (and presumably the pleasure of both the man and his partner), there is no research to support these claims. These penis pumps serve primarily to aid in masturbation. A medical version of the vacuum pump is sometimes recommended to treat impotence. After the vacuum causes the penis to become erect, a compression ring is then snugly fitted around the base of the penis to prevent any subsequent outflow of blood from the vasculature. The resulting erection may be sustained for a considerable amount of time, though it is suggested that the rings be removed after no more than thirty minutes to ensure that damage does not occur to either the tissue or blood supply of the penis. Further, overzealous pumping may result in blisters or damage to penile tissue.

Vibrators are battery or electrically powered devices that enhance sexual arousal and pleasure through direct or indirect stimulation of the sex organs. Though they are often phallic-shaped and intended for insertion into the body, some are meant to be used externally only. Vibrators were originally developed in the mid-1800s for use as a medical treatment for the treatment of "hysteria" in women. Formerly, physicians treated the condition by manually massaging the clitoris with their hands until the patient reached orgasm. The vibrator was invented as a labor-saving device.

Sex machines (or fucking machines) are mechanical erotic stimulation devices used to mimic the penetration of a penis into a vagina or anus. Typically, the machine has a motor or some sort of rotational mechanism on a shaft to which a dildo is attached. These devices may act alone or may be incorporated into a frame used to restrain a person as part of the sex act. These automated devices are often associated with BDSM sexual activity. Care must be applied to avoid excessive force that could result in damage to vaginal, anal, or rectal tissues.

Sex furniture is frequently (though not exclusively) employed by participants in BDSM activities. Specialized furniture, such as angled pillows, whipping stools, or slings, serve to provide sexual pleasure through optimizing genital penetration or for administering sexual discipline to one's partner.

Sex toys (euphemistically called marital aids) include devices such as dildos, vibrators, or more specialized devices or objects such as feathers, ticklers, leather, whips, restraints, paddles, crops, and a wide variety of fetish items employed to enhance sexual play.

DRUGS AND PHARMACOLOGIC AGENTS

Erectile dysfunction drugs are a class of pharmacologic agents used, as the name suggests, for improving erectile function in men. They include sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) and are taken orally prior to sex. The use of Viagra to treat erectile dysfunction was discovered as the result of a study by its developer, Pfizer, on the use of the drug to treat hypertension and angina. Though the drug failed to effectively treat angina, researchers noted marked erections among men in the study group. After FDA approval, the company then changed its marketing strategy and promoted Viagra to treat erectile dysfunction.

These drugs work by causing the smooth muscles of the arteries in the penis to relax, thereby dilating the blood vessels and allowing the penis to fill up with blood and resulting in an erection. Because of these drugs' effect on smooth muscle, patients with cardiovascular disease or taking certain medications should not use this class of drugs.

When oral drugs fail, injections of agents such as apomorphine into the erectile tissue of the penile shaft may manage to elicit an erection, though this practice has fallen out of favor now that erectile dysfunction drugs have become readily available.

The marketing success of the erectile dysfunction drugs has led to an explosion of fake versions and herbal supplements that lack proven active agents. Though these pseudo-aphrodisiacs are generally ineffective when submitted to scientific scrutiny, they may occasionally provide positive results through a psychological or placebo effect.

Estrogen creams, patches, or tablets may be used to treat atrophic vaginitis (or vaginal atrophy), an inflammation of the vagina due to the lack of estrogen in the body or a lack of sexual activity. The condition manifests as a thinning of the vaginal walls and a decrease in the amount of lubrication produced, frequently leading to painful intercourse and/or vaginal bleeding. A physician may prescribe estrogen to relieve symptoms and restore sexual function. Increasing sexual activity (with the use of a water-soluble lubricant) may also help. Depending on age, risk factors, and method of administration of estrogen, women may have an increased risk for stroke, deep vein thrombosis (DVT), breast cancer, endometrial cancer, and pulmonary emboli.

Ginseng, an herbal remedy from the ginseng plant, is purported to improve sexual function in women and men. Though the scientific literature suggests that ginseng performs better than placebo in promoting sexual vitality, there is no definitive consensus on its effectiveness in improving sexual performance.

Testosterone supplements may be prescribed to treat hormonal deficiencies that result in erectile dysfunction or impotence in men. In such cases, oral supplements may improve the ability to attain and maintain an erection, though it will not cure any underlying condition causing the dysfunction. In addition, testosterone supplements (administered by injection, pill, patch, or cream) can effectively improve libido in some women.

EXERCISES AND TECHNIQUES

Kegel exercises are named for Arnold H. Kegel, the doctor who discovered the technique of conditioning and strengthening the muscles of the pelvic floor (pubococcygeus muscles). Regular practice of the exercises may result in stronger vaginal muscle tone that may improve sexual enjoyment for both partners. The technique involves isolating the pelvic muscles by stopping and starting the flow of urine. Once the muscles can be distinguished, the woman tightens and relaxes these muscles two hundred times per day. Variations include elevator Kegels where the woman slowly tightens in increments (as if on an elevator that stops on several floors). The technique may also be performed with the use of a Kegel exerciser, a medical device that is often a cylinder of polished stainless steel with rounded bulges at the end. The device is inserted into the vagina and works by making the muscles of the pelvic floor support its weight (usually around one pound).

Semans technique (or start-stop method) is a procedure developed by Dr. James Semans to treat premature ejaculation. The method works by having a partner manually stimulate the man until he is just about to ejaculate and then stop until the sense of urgency goes away. Then stimulation is resumed. The procedure is repeated until the man finally ejaculates. Over time, the method helps the man to prolong his erection before reaching climax.

SURGICAL INTERVENTIONS

Augmentation phalloplasty is a term used to describe plastic surgery to increase the size of the penis. Generally, the procedure involves removing fat from one area of the body (such as the buttocks or abdomen) and injecting it into the penis to increase its girth (the thickness) and, to a lesser degree, its length.

Body piercings (especially to the genitals or nipples) are often undertaken to increase erotic sensation during sexual stimulation. An example is the Prince Albert (named for Queen Victoria's consort who allegedly wore a ring on the end of his penis), which pierces the outside of the frenulum (an elastic band of tissue just below the glans of the penis) and the inside of the urethra. Though penile piercings became popular in the gay culture of the early 1970s, they have since become associated with heterosexuals as well. Body piercings can be a strong sexual stimulator. Infection, scarring, and loss of function (especially in erectile tissue) are possible risks. Further, because of the constant stimulation caused by this type of body piercing, a desensitization may occur resulting in diminished physical sensation.

Genital beading (or pearling) is a procedure where items such as small pellets, ball bearings, or studs are implanted under the skin of the penis near the glans. This practice, popular in Indonesia and southern Asia, is performed to increase the sexual pleasure of one's partner, though frequently it is reported to cause discomfort, bleeding, infection, scarring, and pain.

Penile implants are a drastic treatment for erectile dysfunction or impotence. In such procedures, A rigid, semi-rigid, or inflatable penile implant is surgically inserted into the penis resulting in the ability to mechanically induce an erection. The rigid or semi-rigid implants result in a permanent erection, though the semi-rigid versions may be bent upward for sexual function and downward during other times. The inflatable implant works on the principle of hydraulics; a pump is implanted in the groin and is manually activated to fill cylinders from an implanted reservoir of saline, resulting in a more naturally functional erection. Though the procedure is reliable, it is also irreversible.

Vaginoplasty is a surgical procedure used to correct structural defects of the vagina including the loss of vaginal muscle tone due to disease or vaginal childbirth. Women who have difficulty experiencing orgasm due to loss of tone may opt to undergo surgery to tighten the muscles to restore sexual pleasure (to themselves or their partners).

see also Dildo; Penis Extenders.

BIBLIOGRAPHY

Kaplan, Helen Singer. 1974. The New Sex Therapy. New York: Brunner/Mazel.

Maines, Rachel P. 1999. The Technology of Orgasm: "Hysteria," the Vibrator, and Women's Sexual Satisfaction. Baltimore: Johns Hopkins University Press.

Tannahill, Reay. 1980. Sex in History. London: H. Hamilton.

                                              Diane Sue Saylor