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 [premature ejaculation] 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.