"KORO-A GENITAL RETRACTION SYNDROME EPIDEMIC IN NORTH BENGAL"




DEFINITION & NOMENCLATURE:------

"Koro" is a Genital Retraction Syndrome where a person thinks that his/her external genitilia (Penis/Testicles or Vulva / nipple of Breast ) will shrink, retract and disappear with or without fear of Death.

It occurs more in male than female patients.The earliest Chinese refrence is seen in'Yellow Emperor's classic of Internal Medicine' dated 300 BC,Western reference to the term koro is found in B.F. Matthes' Dictionary of Beginese Language (1874) of South Sulawesi ,Indinesia. The word is also used in Makassarese Language,meaning "to shrink"; the full dialect for it is garring koro. In Malaysian Language,keruk is the probable linguistic link of koro which means "to shrink". The term shuk yang or shook yong or suo yang (Chinese),Jinjina bemar (Assamese,India),Rok-joo(Thai) are coined for this diseas all in regional language, means "the shrinkage of penis".Actual word "KORO"originated from Malaysian word Tortoise (which is another name for "Penis" in slander language)as Tortoise has a habit of retracting their head resembling (like a PENIS)in to body,so people probably used that example to express this disease.

PSYCHOSOCIAL CLASSIFICATION

Koro has been described as"Culture Bound Syndrome"(which means it occurs in person with certain cultures where these cultural beliefs or myths generate and spread this classical form of disease,it is seen endemic with outbreaks or epidemics as in China,South East Asia, Malaysia, Indonesia (migrated people from China with classical )and certain part of Africa,Thailand,Singapore,India (non chinese local peoples as both classical and non cultural form ) and Western countries like Britain,America, France, Canada, Jordan (sporadic non cultural or secondary Koro where only shrinkage without any fear of death associatedwith CNS disorder,drug induced or under another psychiatric diorder) in mental disorder book and has been subgrouped as'Specific Culture-imposed nosophobia'or 'The genital retraction Taxon' or 'Cultural related beliefs as causes of occurrence'.

PREDISPOSING FACTORS & CAUSES

Psychosocial cultural belief which predispose "koro" a punishment of personal guilt of sex with other ladies/prostitutes(than Spouse/Wife),masturbation/Impotence or Sexual inadequacy (many such ancient folk stories are rampant in Chinese culture or theory of loss of yang humor (The Yan & Ying theory)or semen which is condsidered as vital energy,excess loss of this by frequent Ejaculation(depicted in Taosim which strongly inflence chinese medical thought) may lead to death.Witch Craft or evildoers or Fox spirit or ghost stories and folklore novels or KALA JADU (Assam & Bengal) are prevalent in China where it has been described that these spirits cause genitilia to retract in abdomen,making them physically and sexually weak and utimately dead.in South China and in south asian and Africa and even in India where this disease is prevalent,people have strong belief in such stories and play. Mass hysteria that Contaminated pork with swine fever cause epidemic of Koro in singapore in 1967.In Africa,Black magic was behind this and in Nigeria and ghana,there was panic that penis has disappeared by touch of a stranger.

But in isolated 03 cases in America, patients suffering from anxiety and worries about Penis suffered it after smoking Cannabis which may increase worries and anxiety as its side effect.In Britian and other western part it was due to depression resulting from psychological disorder,phobia for AIDS,brain tumor,schizophrenia etc.,but never a social or folk beliefs based on prevalent ancient stories and dramas.Ethnographic psychologist (who study different cultures) consider koro to be closely related to panic attacks caused by either social belief based on prevalent stories or myth or rumors of food poisioning or evil doers or as punishment to evil doing in form of self perceived or believed sexual offence resulting in retraction or shrinkage of genitialia with or without fear of death.Attacks of koro are often set off when men are in situations that would normally cause the male genitals to shrink slightly,such as emotional distress or cold temperatures.as Scrotum and penis more responds for shrinkage on exposure to mental stress and cold temperature they affect more than female.But tensed and psychological disturbed or introverted sexually freezed or tense female may suffer too complaining of retraction of Nipples and of vulva or disappearance of vulva under tight thighes under severe stress and strain.

SIGN & SYMPTOMS: Koro exist in two forms.Classical or True or Primary Koro where patients under a social belif or rumor or myth complains of shrinkage of Penis or testicles or both in Male and of Vulva or Nipples of breast / breast or both in female folowed by retraction of them in abdomen with physical and sexual weakness with or without fear of death.Mostly present as acute attack lasting for hours to maximum duration of 02 days.But some may show symptoms for years as chronic cases or recurrent cases ,some instead of shrinkage of genitilia complain genital shortening,alteration of penis size,loss of muscular strength,genital paraesthesia with no complain of retraction or breast mass in female with altered breast size and hidden or distorted nipples.Feature of sexual dissolution,loss of sexual or physical power,weakness,urinary obstruction,sterility may be seen.Psychologically Pateint suffer from anxiety neurosis may include fear of death,non specific physical danger,impending madness,spirit possession and feeling of being bewithched or under cover of black magic with feeling to sex change to eother female or vice versa or turning Enuch.

But in secondary or unclassical form of Koro as seen in western world only retraction of penis or loss of penile strength is coplained where person has got intense anxiety for penis with a strong psychosocial disease or under any organic brain disease or under influence of drug or intoxication.

While there are no substantiated reports of the condition itself resulting in any physical damage to the individual, many sufferers have unfortunately inflicted harm upon themselves or physical damage in frantic attempts to stretch the penis or Breast to prevent further shrinkage. It is not unusual for those with koro themselves or wthrough their family members and social sympathisers to resort to using devices such as clamps or weights or pegs or by aloop of string for retraction of penis as mechanical traction device.female either herself or ladies around her grab breast,pull nipples out or insert iron pins in nipple so that it cannot go inside.

Chanting of local religious songs and puja or religious celebration to please God/Goddess through local preachers and pandits or programmes for their blessing or correct any unknown mistake conducted in their past celebration or work out by local witch hunters by putting wood fire and smoking to remove bad blessing or evils or black witch from society or beating or killing of socalled wrong or evildoers suspected in society or villages is done.In North bengal people are putting lime water over both ears and nose ,keep Kush grass or pure water of a temple or river to keep these bad evils from them .some also cover their genitilia and breast so much under clothe as nothing happens to these organs.

DIAGNOSIS: it is easily done when epidemics occur as strong social belief or myth or rumor based on past prevalent stories and drama of witch hunt or as a punishment of some sexual wrong doing or intake of contaminated food or prsence of some diseases with typical full blown symptoms of penile/Testicle shrinkage or retraction in abdomen in patient of introversion suffering from anxiety or psychological disorder or under religiuos and social belifs and faith in myths or evil doers with or without sexual and physical weakness and fear of death.Injuries are secondary to measures taken by patients or relatives to prevent injuries.

TREATMENT:---

As the disease involves social beliefs and psychological insult so both Medical and Indigenous treatment should be given otherwise complete eradication may not be possible.As no defect is found in genitilia and breast to nothing is done for this if injuries inflicted by patient or relatives as mechanical manipulation to prevent retraction of genitilia or nipples then local injuries are dealt both surgically and medically.

in Cultural bound cases,lectures should be organised through healers of society by educating them with anatomy and physiology of Genitilia with audio visual or practical demonstration either as alone or to whole society utilising local media,radio /Tv/poster/leaflets and picturing small booklets,Individualy affect person psychosocial analysis is done and therapy for underlying disease is started.Inwestern type sexual conflict is identified and patient treated for any psychological or organic disease diagnosed.

indigenous medicines by local healers may be also advised to win the belief of people,praying to Gods and submitting to socalled social healers and witch hunters may be allowed to control epidemic spread but side to side strong counselling and health education should be provided individually ,by NGO or by Government health agency and social reforming departments.In china people hit gongs or bells to drive out witches .They use chinese a yang or yin augmenting medicine including herbs,animal penises (of tiger,deer,and fur seal )pilose anter(stag of deer) or deer tail.Pepper soup ,ginger soup,Louki or cucumber soup or liquor is also drunk to cure the diesease,in north Bengal people are using lime water application over both ears and nose and kush grass and holy water keeping to keep awya bad evils.

Dr.D.R.Nakipuria



09434143550

**Author is a naco trained HIV and sex specialist

This less invasive surgical technique has generated excitement, criticism and a great deal of discussion since surgeons first started doing them few years ago. It is a challenging approach and still is performed by relatively few surgeons. Clinically, this surgery has yet to show any advantage over traditional laparoscopy in terms of pain or patient recovery. Even the cosmetic appeal - which leaves one scar neatly hidden in the navel is questioned by some because even the scars left by traditional laparoscopy are hard to detect a year after the surgery. So then , where does it stand and where is it headed to? Is it a fad that will fall by the wayside or will it be a progression to Natural Orifice Translumenal Endoscopic surgery? (NOTES)? Will it be embraced by the patients, surgeons and the health industry to become the standard of care?
Although there is an improved cosmetic result from this surgery ,there are not a whole lot of patients who are asking for it. It is mainly driven in part, by the industry and in part by the desire of doing less invasive operations and the surgeons wanting to keep their skills on the cutting edge. Less invasive surgeries require unique and high skill set and it should be attempted only by surgeons who have tremendous experience. It should be done on educated patient population who can understand that there are almost no proven benefits. The good part of it is , if you cant get it perfect you can always add another port and fall back on the standard technique, so that the surgery is not compromised in anyway.
Limitations of instrumentation like internal retracting system, scopes with flexible tips etc are still not widely available. Visualization is a problem. Since it is parellel with the working instruments, the field of view is limited in relationship to where the instruments are and where the target tissue is. Specialy surgeries on the foregut requires a good liver retracting system and it becomes difficult with a single incision technique. Gall bladder, appendectomies and colectemies are best for this approach. Also sleeve gastrectomies and gastric banding. Technologies such as robotics have the opportunity to take away some of the technical dfficulties of single incision laparoscopic surgery.
The reality is, although time consuming and difficult , Single Small Incision Laparoscopic surgery is here and some motivated surgeons are utilizng this on selected patients and the skills developed may enable them to bridge to the next technique ! With new techniques and surgeons not having to touch their patients during surgery, we hope the healing and anointing will still be there flowing through these instruments !

SEX PERFORMANCE FAILURE IN MALE OR IMPOTENCE-TYPE & REMEDIES
SEX performance failure is a matter of great concern for A male person as he thinks himself as active partner and so wants always to be best strong sustained performer in Sex which is considered as sign or exhibition of his musculanity or his existence in as boss in Male dominant society,if this sexperformance is disturbed or fails he starts thinking that every thing has been lost .This Sex performance is always so much in mind of a common person that many starts assuming as some defect in it although they are normal because there is always a will to achieve perfection and superiority in it and such idea becomes more If they are exposed to sexual stimulation through talk,stories or video shows where Sex is depicted as most form of pleasure and enjoyment.
For this defective Sex performance, a word IMPOTENT has been coined on broad base where a man cannot perform sex with a partner .It simple meaning is a failure, weakness inability lack of interest in Sex performance. A man may start feeling that he is impotent but actually he is normal or may start that he has lost dignity, masculinity, wholeness and every thing of his life submitting himself to extreme psychosocial insult. But broadly Impotence in man means that even after proper stimulation(what to talk of normal self stimulation as self stimulation is common in adult male and male unlike female becomes stimulated or erection of penis occurs on mild exciting exposures as remembering,talking,watching listening of opposite partner or her activities dress,eye contact,voluntary or involuntary touch of normal body part,sexual organs or sexual act of another) stimulated by talking exhibition,touch or sexual excitation by opposite partner or sexual activities through book,videos,internet or mms etc man does not achieve proper erection or straightening,thickening ,hardening and tightening of Penis with or wthout secretion of small seminal fluid .But There are many degrees of erectile difficulties too. 1.Some men may be able to achieve an erection, but are not able to maintain it. 2.others become erect, but not extremely rigid. 3. Many others only have problems when they are with a new partner or with a long-time partner. And in last 4., there are those who cannot achieve an erection at all even after stimulation by an opposite sex partner to the extent of heating and touching G-spots. Although these problems has been categorises as stated above but still in most of them psychosocial disturbance remains the core factor.
Person may be suffering from a physical or emotional problem (or both) for which there are definite solutions. If problem is of an emotional nature, the following tips may help. If erectile problem arises from a medical condition, there are now many new medicines, surgeries and therapies that can help restore sexual health. What ever the nature of problem may be,but rule of its correction lies in the fact that almost every man has difficulties with erection at some time in his life and everybody feels some time in himself at least that he suffers from erectile dysfunction(ED). Therefore affected person is not abnormal only , nor he is alone affected by this non performance of Sex.There is no need to suffer in silence. Don't let once embarrassed in alone or silence and let this embrassment of self realisation of less or non-performance or less or no erection keep one from sexual health and happiness.Following type of disturbances of erectile dysfuctions are seen.
1.Low Performance Anxiety :It's not unusual for a man to have an occasional episode of impotence in form of less performance , after drinking alcohol or after a particularly stressful day. However, if he places too much emphasis on the incident and harbors fear that it may happen again, the anxiety itself may become a cause of erectile difficulties. Some men engage in thinking that distracts them or take away from their sexual performance. One should try to take over such low performance incidence and relieve the anxiety about having to get an erection.For such anxiety if no heed is paid to it or a good stimulation is kept such beliefs goes away and man resume strength again.
2.Stereo type Performance: One problem in people's sex lives is that many perform it through certain ruts and routines and they don't have much novelty. For example they always have sex at 11:30 at night with the lights off, with the same foreplay, and so on. Their sex lives are relatively invariant. Soon,their partner becomes about as exciting to them as a flounder. They can change their sex lives by incorporating some variety- go to another place or a different setting. Vary the routine. Buy wife some new night dresses or change sleeping room ,decorate with flowers,perfumes music or change stye of four play or coitus . one shoul spice up sex life.
3.Stress and Strain: Stress and Strain arising either from performance anxiety or from other life situations, can also be a culprit in erectile problems. Relaxation exercises are helpful. Deep breathe or progressive muscle relaxing, where the person consciously tenses and relaxes each part of the body in sequence. In and of itself, as a treatment for impotence, relaxation is not effective but it may be a good first step for someone trying to improve their own functioning.
4.Tension with partner: Marital or relationship difficulties are notorious contributors to sexual problems. Anger, resentment, and hurt feelings often spill into the couple's sex life, turning the bedroom into a battlefield. This situation is especially likely to develop if partners are non communicative ,communication of personal or familial matters and forgetting them during performance is the key for good sexual performance and isappearance of this Impotence.Familial tension,children problems or any other social disturbances or a bad environment will spoil a good Sex completely labelling it charge on male partner mostly as Impotence.
5.Walk,talk and Eat Sex: During Sex it is a rule that one should walk or prepares one self and partner in the way that Sex is only focus in mind.all narrations should be on this topic to increase libido and bring good orgasm and once achieved than one should enjoy in the way as Sex has been served as food. and only r expression of each other sex difficulties ,demanding sex or informing one’s failure or goodness clearly and methodology to get it corrected by showing action as to cover partner’s fault will bring forth good performance.
6.Be ware of intoxication:Now a days Alcohol intake is rampant in society and many think that after intoxication with Alcohol (both Partners) stimulat sex and performance but it is untrue as Alcohol causes uncoordination and synerigism leading to less performance.Similiary smoking,drugs or medicines neither can arouse or contemplate sex .so always avoid them before sex.Bear bars,dancing girls,nudity,aphrodisiac medicines and alluring music and robust lightening etc may bring orgasm but have got no relation with better performance as man gets easy and early excitement so until very experienced usually not able to sustain erection for long time and a second arousal and action is mandatory to satisfy the partner.Aphordisiac medicines and intake of Hasis or cocaine or Ganza or any opoid is habit forming and durg dendance can destroy life completely so never bring it in Sex which can be conducted normally between two willing partner in a lucid environment,time and place.
7.Positivity is the rule:So many fearful history/story or activity or imprint of past experience may surround a new comer or less performer or person suffering from some diseases or in older age as they cannot perform or make partner irritated,please donot think negative,please fullfil good hope aspiration and confidence with very positivity in mind ,a self determined confident can break any stone.many person think that they are not performer and many partner feel that they are not good looking or physique or age wise difference or married un married status to stimulate another partner or of not that status by education,position or economically to suit the partner but this doesnot have any place in Sex performance.As you meet with partner with zeal and positive energy and once sex is started ,sex itself is so inductive that such feelings goes away once orgasm is aroused by touching G spots or Clitors or by shacking and masturbating penis every thing is forgotten and a good performance comes so be remain positive,Every body some time feels that he is impotent as has either got slight erection with immediate discharge or late erection with no discharge or for female pain ,bleeding and loss of virginity or exposure of bad name and reputation all want to inhibit sex but good and strong determination overtake it immediately.
8.Win partner’s confidence: as stated in my article “Sex in recent perspective and modern definition”Partner is very important,now a days both partners are called active in SEX.a lazy partner can damage an active sex and a superactive cooperative partner cam make a sluggish boring sex into a dynamic charming sex.interaction,coordination,co-operation,harmony and synerigm is the backbone of good Sex.so always inuce partner bring eachother by stimulation Gspot of each other and start Sex with full orgasm and then perform all 04 stages of Sex taking and giving pleasure giving time to sex,simple rapid erction,penetration and ejaculation is a dry sex as we take food in hurry without any spice and taste to calm hunger but a good cuisine by a good cook with good presentation and slowly eating taking time provides us really interest pleasure and satisfication of food.
9.Read sex and know Sex: sex is so much important method of mental and physical relaxation in the life of an individual and its important in familial life is very strong as it brig better adhesion,cohesion,understanding,bondage liking and love that it canot be taken as a very light just to perform activities as we have modernised and cultured are food taking habit ,same way good,better and best Sex is very important so to know about Sex is mandatory ,how to bring good arousal or orgasm,increase intimacy and cooperation in performance and then sustaining the act.Now a days many formulas,medicines,mantras and tabeez and therapy are sold by socalled sex specialist to enlarge Penis size(most of the time Penis size is normal as first 2 inch of Vagina is only sensitive sexually for penetration so a normal 4-6 inch of Penis is enough for good Sex and no medicine can enlarge the penis except Sidlefinal(vigra) or tadalafil help some patients really suffering from Erectile Dysfunction(ED) in male patients only or testosterone only in castrated or otherwise Addison or any other hormnone disease) or to bring sex arousal,desire or bring Orgasmor increase sustainability ,to icrease power and duration of strokes and delayed ejaculations etc,But most of them are bogus ,only good practise under guidance of expert counselling bring forth good result,understand that sexual organs are as good parts of Body as other parts any abnormal behaviour with them as sex with children or mentally retarded persons may cause much harm bleeding,tear etc leading to death of child.similiarly to sex with animals or introducing different electrical devices and toy ,stimulation by binding with chains ,rods etc is unwanted and regarded as perversion and abnormal sex.
10.Good advise and expert counselling:Sex is so less discussed and expressed in personal life that a affected person remain under quota of days and years under depression and anxiety leading to irreversible stage of Impotence.if a good advise is sought such fear and apprehension goes immediately and rejuvenate the person.some time person is suffering from infections of genitilia as in Female and it remains cause of pain and bleeding during Sex which makes many female a freezed female or male is suffering from phimosis,hypospadius or epispadius or infection of glans or herpes or other infection of genitilia or tight and short frenulum or hydrocoele,spermatocoele,varicocoele or hernia or systemic disease of metabolic disorder as diabetes or protein loosing enteropathy or any systemic cardiovascular or renal or hepatic or hormonal abnormality that sex will remain low until root cause is treated and corrected,.In our country in middle aged person most of doctors donot ask about sex performance nor patient states it but diabete mellitus do affect sex performance too and actual attention should be paid to it ,same after menopause most female donot like to state any thing about sexual life but here Sex is not important to maintain good bondage and relations by relaxation but also helps us to burn good amount of calorie.
Therefore,IMPOTENCE is not necessarily a sex performance failure but lack of better understanding coordination and cooperation between partners because of their covered and hidden beliefs and lack of knowledge of Sex leading to somany psychological disturbance.
Dr.d.r.nakipuria

** author is a HIV & Sex Specialist
0943434143550
http://drnakipuria.jivisha.com

NEW RESEARCH IN MICE SHOWS AGEING CAN BE REVERSED BY STEM CELLS;-----
Ageing is the process which cannot be reversed as the man or animal who has taken birth has to die one day,maximum age for human being is 100 yrs.Our skin ,nerves,hear lung,intestines,bones ,muscles every part starts showing feature of old age and we becomes older and older these tissue becomes mor older and show signs of decaying and loss in structure,function and minor intracellular biochemical activities and ultimately one has to die.
man has conqured the world by reseach of Dolly by producing a replica of a person 100% by on cells without needing fetilisation from oppisite partner egg by establishing and harvesting stem cells or embroyinc cells of primitive or primodial cells which is the mother cells of every thing.As blood and skin and endothelium of intestines are rapidly replaced every day so here Stem cells does a remarable work ,they remain exist here even in old age and Bone marrow which forms all type of blood cells is the store house of these blood stem cells which produce different type of Blood cells.Bone marrow produce myeloid and lymphoid type of blood cells,Myeloid is concerned for producing immune cells resulting in productions of fighting blood cells which helps us o prevent inflammation by infection and cancer.But some lymphoid cells help our body to repair or rejuvenate old cells or tissue.In young mice Myeloid cells are produced in less number than Lymphoid cells but in old Mice Lymphoid are in less number produced,so repair work in not done properly but after injecting stem cells (or blood )from young Mice is injected in to old Mice it travels to Bone Marrow of old Mice and stimulate it to produce lympoid cells so that repair of old tissue being undertaken very rapidly as old Tissue are repaired Ageing Process is being reversed.
This study has been done in Mice only but not in Human Being but as more research will further clear the picture,Man will be immortal as only limitation OF IMMORTALITY is the fact that all body tissue usually becomes old and self decay and destruction is the cause of death of tissue or human being as Man has conquered over diseases and infections but cannot control self dying process and by such invention the last hurdle of Man Being Immortal will be also removed.
By mixing blood of old people with the blood of young people ,these young bllod cells rejuvenate old blood cells .This has been demonstrated by THE HAVARD STEM CELL INSTITUTE by a recent published study on Mice.When blood from young mice bone marrow injected in old mice,these blood cells after entering into Bone Marow of Old mice revitalise these Blod Stem Cells present in Bone Marrow.Reseacher concluded that usually in old Mice Bone marrow produce that type of Blood stem cells which generate more Myeloid series blood cells which control infection or tumors but less amount of Blood stem cells whch produce Lymphoid series cells that orchestrate or regenerate tissue Repair as seen in young Mice but after the injectionof young blood cells even old Mice started producing stem cells that is doing tissue repair.The study is yet to be done in Human being.
hence such study is most important mile stone in life of Human being as now man can produce own replica by oneself,can kill any infection ,defeat any metabolic,cardivasular,immunological or herditory disese but now by this study old age will be turned into young age and Man will live for years as he wants to live or he will be IMMORTAL.
Dr.D.R.Nakipuria

-HOW TO PERFORM ? A MODERN PERSPECTIVE & DEFINITION
---DR.D.R.NAKIPURIA
SEX although cannot be discussed or expressed openly in our society as it is a topic of intense personal matter and allowed to discuss by grown up or adults or matured in personal couple group or an advice by seniors to upcoming matured adults to practise it as per their experience.Beside this our society think its discussion may destroy social fabric as may stimulate youngster in early sexuality or indulgence of adults and old in abnormal sexuality beside legal partner.SEX has been broadly defined as meeting of two partners of opposite sex or meeting two external genital organs of opposite sex whether any pleasure or satisfication is achieved by this or not.As man has got Penis and it is penetrated in to vagina through introitus by man so he is called active partner and as female simply receives Penis so is called Passive partner but modern detail analysis of patients achieving full satisfication and pleasure by Sex and persons remaining unsatisfied and psychosocially disturbed after Sex has redefined this definition of SEX.
it is very important for a man being active partner realise very much,any defect in performance of Sex either of arousal or desire or LIBIDO or lack of excitement on stimulation by seeing or reading sexual activities or seeing or touching opposite sex partner or her activity or by stimulation through eyes,talk,exhibition or touch of partner or self induced involuntary erection( under influence of body hormones) i.e.,tightening,straightening,thickening and hardening of penis with slight secretion of seminal fluid over glans region with easy slipping of foreskin over it or called as ERECTION or it may be failure of pushing this erect penis in partner’s vagina through introitus or Ext.Genitilia Vulva or discharge of Seminal fluid into vagina immediately after penetration i.e.,EARLY EJACULATION resulting in loss of satisfication and pleasure as strokes gives more and more pleasure which reaches to peak slowly keeping pace with speed and force applied for stroke.by penis.The force is more applied by a thickened, tightened and straight erected penis ,that is why a good erection is mandatory for a good performance of sex.lack of such erection is called Erectile Dysfunction(ED).This enjoyment becomes more excited as partner’ vagina contracts involuntary or by active contraction of Pelvic muscles by partner is increased.Therefore ,apathy of partner,less excitement or lack of attention in sex by partner or deficiency of active cooperation and actions in Sex also result in getting good satisfication and pleasure.Female although by misnomer called as inactive partner but actually her cooperation from the stage of getting desire,attention,environment of Sex to getting aroused or ORGASM either by self excitement or by stimulation by partner by look,touch or reading books or watching video etc.,or after fourplay by partner which is very important in Female as they are less easily excited or reach peak to Orgasm and without her active cooperation Sex remains less pleasant and unfulfilled in satisfication.Role of Accessory or additional Genital organs like Body contour,Pubic Hairs,Moustache,hairs over chest/limbs(in Male),Face color of Body,color of Iris of eye ,shape,size of Eyes,Placement of Eyebrows,straight beak like nose,mouth opening,lips ,fore head,style of hairs over scalp,and contour,fullness,bogginess tightening,size ,shape resistance,compressibility of breast with coloring of areola and stargtening of nipples with shape of belly being scaphoid and centrally placed elliptical umbilicus ,proturbance of buttocks,broadening of Hips with slender slim straight fingers,toes limbs, soft palm and sole with absent of hairs over any part of body except straight small shiny pubic hairs with thickened puffy Labial folds is very important as they play indirect role to either initiate Sex or Libido or later to maintain Sex or good performance or more sustainable play.Early Ejaculation leads to flaccid ,small ,shrunken Penis which freezes immediately a Male partner as female is either at peak of orgasm or getting arousal for orgasm ,such sudden discharge makes her completely dissatisfied and uncomfortable as shrunken flaccid penis cause no dilatation of strchable compressed thickened roomy vagina or touching of cervix of Uterus or deep pockets of vagina around cervix or fournix .So either expressed by modern educated Female partner voluntarily or involuntarily expressed by face or body activities immediately or on subsequent occasion of Sex initiation by male partner who realises this as his biggest failure and suffer from self realised Gilty consciousness leading to Psychosocial disbalance leading to further damage in getting arousal or erection or performance of sex and vice versa.
Therefore,we have realised that sex is no more confined to one partner ,one partner may be less active but other partner can make him co active similiarly an uninterested or freezed partner can freeze or dissatisfy another partner.Previously if one partner is not performing particularly a male doesnot get erection or arousal to perform sex we called it IMPOTENCE and similiary a female doesnot get pregnancy after intercourse we called IMPOTENCE but it should be better termed as INFERTILITY but now a days sex has been better defined as stated above in following stages.
StgageI: Self or stimulated Aroursal and arousal of partner with full Orgasm.
Stage II:Erection of penis with penetration and reception of such erected penis by an active partner.
Stage III;-Mantenance of coital activites by cooperation of both partner ( both are as active no active or passive nomenclature).
StageIV;-Discharge or Ejaculation of Seminal fluid in vagina or condom or ouside gradually allowing partner to cool gradually and slowly.
Sex in different positions or in different openings beside vagina as Anal or oral or Arm pit sex is not called perversion but resource to achieve more pleasure and satisfication in which any of these four stage is fortified depending on which separate methodology we adopt like kissing or messaging of Breast increase stage I and III ,oral ,armpit and anal sex improves stage II,III and IV.Sex with children or old people or desibilated or mentally retarded people or against will of partner forcefully or under intoxification with alcohol ,drugs or sleeping pills is a crime and this needs no discussion as it is always painful .SEX IS A RESOURCE TO BRING JOY, HAPPINESS , SATISFICATION,LIKENESS,ADHERANCHE AND MORE HUMAN BONDAGE WITH LOVE IN LIFE IF IT PAINS EITHER PARTNER DURING OR AFTER PERFORMANCE IT SHOULD NOT BE CALLED SEX.Sex ,how much discarded for discussion openly in society is need of human being to mantain its progeny in universe but Sex is the only simple natural method of producing future generation but every act of Sex is not necessarily mean production as Human has reached highest growth in Animal Kingdom,he has to restrict the number of his progeny,that is why he has learned to enjoy Sex without production by developing so many methods of contraception like Condom,spermicidal jelly tablets,foams ,vaginal condom,pessary jellies,IUCDs ,oral contraceptive pills/injections/patches for female and male,sex during safe period,external ejaculation etc.,
Lack of availability of partner in war time battalions leads to sex with same sex partner and gradually a class of people called as GAY or LESBIANS has evolved in society in good number across the globe,they are perfect Humanbeings with good mental and social judgement but they got enjoyment with same sex or HOMOSEXUAL.They are no more defined as perverted or sexually abnormal persons ,many countries provide their activity as normal as Sex among HETROSEXUAL exist.even in India,their such act is now not under any screeing of unlawful activity.gradual wecome and accept of these Homosexual have added further definition of SEX where in Stage II erection of penis or penetration of Penis may or may not present and partner may utilise aroused finger /hand /toe or any soft compressible toy/instrument after excitement for penetration or simply with external genitilia or with accessory Genital organs as mentioned above completes further stages of SEX where Ejaculation may or may not come avoiding need of any contraception to avoid pregnancy but needed to arrest spread of sexual transmitted disease like HIV,Syphlis,Gonorrhoea,Herpes,Hepatitis B & C ,etc.But in this Homosexual activity which is regarded as abnormal activity by many as it turned very purpose of SEX and human existence of Love for man and woman keeping our social fabrics intact also involves very intimate cooperation of both partners,here both partners are highly active members as lethargy or apathy of one partner cannot initiate this at all and this strong love,affection,intimacy,bondage and physical contact has lead to more increase in their numbers in society .
In modern time if SEX is not performed keeping intact all 04 stages of SEX with strong bondage affinity and adherence of both partners leads to breaking in relations or crimes where SEX is performed by male as simple formality of penetration after slight or full erection knowing nothing about arousal of opposite partner and ejaculation ,satisfication,pleasure,enjoyment is left behind or never asked or taken care of where female is always acts as passive receiver and Male as dominant partner serve as active partner without any question or liking of opposite partner or self realisation of failure covered under social dominance of male over female or a female even unsatisfied either gets satisfication by illegal means or remain unsatisfied but never asks or challenge male partner under social obligation of male dominance and even pay price of Infertility (being discarded by family or divorced ) even having her no fault.Sex can be performed in many style and ways with use of fragrance,sweet smelling scents,powders,lotions,jeelies,perfumes wearing alluring clothes or creating inductive environment like rose petal bathing,swimming or candle light meetings under flower shade ,exorbiant seducing music and video shows,dance with slight intake of stimulants and usual duration of 10-20 minutes(which may be increased in some one who practise its regularly) for stage II-IV performance is regarded as normal Sex ,regarding frequency 1-5 times a day to once a week or month is regarded as normal sex but if its frequency reached more or filthy means of using electric vibrators,binding partner with rods,chains or belts or stimulation by smoking ,alcohol or drugs or burning partners body parts or genitilia or Accessory Genitilia by cigratte butts or by pin pricks or electric or thermal currents is perversion and abnormal sex which comes as obesity hypertension,heart disease comes after over eating.Sex under intoxication of excessive cigarette,alcohol or drug is always perfomed of low category as performance is mostly un coordinated and incomplete,so it is better to avoid it.Enviornment personal privacy and isolation is important for good Sex performance as Sex is always a private personal matter in our society,no body wants its open and frank exhibition and show.and we have been matured in this way through our culture and social rules that sex has been always a private matter of a couple through which person and society both grow,sharing and swaping of partners or multiple partners or prostitutions or Jigglos cannot be termed as normal lawful practice of society and has been regarded as offence in Sex.In no way Sex promotes separations,loneliness ,breaking and divorces and it is not limited to simple enjoyment and satisfication burning and destroying our social fabrics involving two willingful compatible and legal partners .simple meeting and performance of these IV stages where social fabrics is destroyed canot be termed as normal sex.hence sex with animals like horse,dogs,cattles canot be termed as normal Sex,these should be avoided as damage to our external genitilia or body parts may occur as animals are not trained to perform sex with human beings and many sexual transmitted disease can spread through it.As in our many acivities like eating ,reading,sleeping,playing etc we do some time nothing ,some time excess and these are termed abnormal activities ,same way in Sex if we either do apathy or doesnot involve our partner or do which should not be done or praticed or do excess then it is called abnormal sex or perversion which brings many diseases as obesity after excessive eating and Anxiety nervosa after no eating.Sex with children,mentally retarded persons or under pressure against will of even a partner is termed rape and regarded as unabailable offence in our system.

Hence sex requires two active willing legal partners for its true performance,if partners are either excited by oneself or by simple stimulation of each other and a private suitable place and time is selected,Sex can be performed excellently without need of any counselling, advice ,medicine or artificial allurement environmental things as mentioned above.In society so many quack doctors or self styled sex specialist doctors or therapy are advertised in print,electronic and internet media claiming better and best Sex.Nothing like this actually exist,if both partners are really happy and pleasant a good sex has been performed irrespective of its total duration and duration of any stage mentioned above or overlapping of stages,it is a continous live processnot a machnary computer which will always move through stages by giving every stage a good time ,these stages has ben enumerated to uderstnd Sex in better way .if intimacy,adherence and closeness achieved in partners with Conception(reproduction) then Sex has fulfilled its target(reproduction is not necessary as mentioned above) and there is no role of any thing ,instrument,medicine,doctor,counselling or therapy .A rumor is spread regarding penis size,so many instruments,medicines or message oil or sold to increase its size but for a better performance of sex only 2-4 inch penis is enough as only outer 2inch of vagina is sensitive to penetration so such size odf penis will give pleasure to both man and woman and till today no convincing scientific medicines has been discovered which can increase penis size,thickness or tightening.No medicine or therapy has come which increase arousal or libido in male or female (Testosterone helps only those male who have got less its amount in Blood not in normal male where if it used may cause prostatic cancer or toother virilising effect)but so amny are sold in market for increasing desireness or lure for sex .Sex is a totally personal psychological matter which can be easily controlled and maintained by psychological counselling removing childhood fear,apprehension or any doubt about Sex as sex is painful,sex is crime,sex is abnormality,sex always result in pregnancy,sex is discarded things and sex is a formality to be performed after marriage in first night only and after that on demand by husband (wife has go no right to ask sex or question sex),limited sex after child births,no sex after menopause,no sex during menstruation ,no sexual discussion among family or with children or in school ,our external genitilia are dirty parts of waste disposable only so should be never cleaned or cared for.A good development has taken place in some patients of actual Erectile Dysfunction (ED) where Sildefinal or tadalfil gives good result but it has got no effect on many patients of ED too and in normal persons it never increases size or erection of penis but sold like anything and even female takes it where it has got no role ,same way for delayed ejaculation so many medicines and creams and injections are marketed which is better controlled by psychological counselling and gradual practise and learning style of performing sex under guidance of an expert.After unprotected sex to avoid pregnancy I-pill or unwanted 72 are sold openly in market which are nothing but high doses of oestrogen and progesterone which completely disturb a woman’s menstrual cycle and in many woman as suffering from migraine,thrombosis,hypertension,jaundice etc., they are contraindicated so government should ban selling of these drugs with harmful side effects by advertising in TV and printed media as youngsters are now developing live in relations and sexual activities openly with removal of fear of getting pregnancy but risk of developing sexual transmitted diseases like HIV,Gonorrhoea,herpes ,septic abortions and infertility.
DR.D.R.NAKIPURIA

09434143550
***Author is an expert Sex and HIV practitioner