Q&As

Q: I am a 25-year-old female. I am manic-depressive and have also had a
total hysterectomy after having two children. My doctor has put me on
different kinds of hormones but I still do not have any kind of sex
drive. I have two small boys and work full time so I am always stressed
out. This problem only causes more stress by creating problems with my
husband. Is there any medicine that I could take to increase my sex drive
or do you have any advice.

A: Unfortunately, there is no magic pill to increase your sex drive, and it will take some effort from both you and your husband. But there definitely is a lot of hope for you!

You are under a lot of pressure with two young children, a full time job, friction between you and your husband, and the pressure coming from yourself about wanting sex. Sexual desire is a delicate feeling that needs the right circumstances to flourish. This normally does not work well if you are under a lot of pressure. I recommend to try to reflect on your present situation and see what you can change in order to relieve some of the pressure you are currently experiencing. Also, it is very important to talk to your husband about this. He needs to understand that your feelings are not directed against him, but that you simply are under too much stress. It would be best for you and your husband to seek professional help with this and have a counselor or therapist help you to sort out your relationship and your present situation. A third person often will see things from a different perspective and could possibly give you very valuable advice. If you are interested in finding a sex therapist in your area, you can contact The American Association of Sex Educators, Counselors, and Therapists at www.aasect.org.

What was the reason for your hysterectomy? With “total hysterectomy” I suppose you mean that your ovaries also were removed? Your doctor has prescribed hormone replacement therapy, so I assume that that the fact that your decreased desire could be due to a hormone imbalance has been addressed.

Are you taking any medication for manic-depression? The depressed phase is often associated with decreased sexual desire, but if you for example are taking lithium, your low desire could also be related to the medicine, which in some people has a negative side effect on sexual function. It is very important to discuss this with your doctor. For your own and your doctor’s information I recommend a book called “Sexual Pharmacology. Drugs that affect sexual function” by Theresa Crenshaw and James Goldberg (1996) ISBN: 0-393-70144-1, which addresses this fact. There are some possible alternative medications (Bupropion/Wellbutrin and Valproic Acid/Depakene), which your doctor may want to consider. But that of course all depends on your situation.

I encourage you to read the piece on “Child Birth” in the “Essay” section on this website. Even though your last child is probably no longer a newborn, you may find some valuable information. The key point for you is to collaborate with your husband. Try to work together in a constructive way and see whether you together can rearrange your priorities and your daily life in order to relieve some of the pressure. Try to get a baby-sitter as often as possible, allowing you to create some special time for each other. Begin by getting re-connected on a non-sexual level first. Go out for dinner, watch a movie together, or simply go somewhere where you can communicate in piece and without interruptions. Once you create more room for and start feeling better about your relationship in general, your sexual desire may improve. But it is necessary to create the right environment first.

What may cause my husband to nearly faint during lovemaking?

Q: What does it mean when you and your husband are making love and he almost blacks out or almost falls unconscious?

A: I recommend that your husband go to his doctor for a check-up. He needs to have his blood pressure checked, and undergo a general physical exam. The fact that he almost blacks out during sex suggests that his blood pressure is too low.

Does your husband take any medication? And does this only happen during lovemaking, or also in other situations? One scenario, which I can think of, would be if he was taking nitrates for a heart condition, and used Viagra. This could cause a dangerous lowering of his blood pressure, which is the reason why doctors do not prescribe Viagra to men taking nitrates. Other medications or conditions could cause this as well, and your husband needs to be seen by a physician.

Why do I get tingly all over during sex?

Q: I have a question about a sex problem I have with my boyfriend. Every time we have sex I become numb and tingly all over. Could it have something to do with the fact that we put a pillow under me for better entry? Please help. Am I just weird?

A: Anytime you feel tingly somewhere in your body it is either caused by

The blood supply to that body part having been reduced or cut off
A nerve supplying the body part having been affected somehow, for example through temporary pressure
If you hyperventilate (breathe too fast).

So to answer your question: Yes, the sensation you are experiencing could be related to the fact that you are in a position where either the blood supply to your legs is reduced, or you are applying pressure on a nerve. Try to change your position and see whether this changes anything.

Are you nervous during sex? Do you feel a little bit dizzy and/or lightheaded when this happens? Sometimes, people hyperventilate (breathe faster) when they get nervous, and this causes a normal reaction in the body, which includes tingly sensations, feeling dizzy and lightheaded. If you feel that this could be the case, try to relax. I have no idea how old or sexually experienced you are, but try to go slow, get comfortable with your partner, and do a lot of hugging, kissing and foreplay before you move on to intercourse. You do not even have to go all the way to intercourse every time. Too many people in this world think that sex HAS to include erections, penetration, and orgasm every single time. In my opinion what really counts is that you feel comfortable, close and connected with your partner, whatever route your lovemaking may take. And it may vary from time to time. But try to not look at sex as a goal oriented activity with the end goal of penetration and orgasm in mind, but rather as a fun, enjoyable activity that brings you closer to your partner.

If your sensation does not change after you alter your position, or become more relaxed I would recommend asking a doctor who can examine you.

Will masturbation help me to reach orgasm faster?

Q: What kind of effects would masturbating regularly have on a woman? My boyfriend says it helps a woman reach orgasm quicker. I do not masturbate often, and I do not really enjoy it that much. He tells me that it could fix our problems with him coming too soon and me not being satisfied. I really enjoy being with him but I have not been too near to orgasm and when I am he finishes too soon.
What can I do?

A: Please look at some of the questions about masturbation on this page or in the Q & A archive. Basically, in my opinion masturbation is a very healthy activity for men and women. For either sex, masturbation increases the blood-flow, thereby supplying fresh blood to the genitals, which can be beneficial. Just like cardiovascular exercise is good for your heart. The person masturbating also does become more aware of his/her body and about what feels good. Often, that person will have an easier time reaching orgasm, simply because he/she knows what kind of stimulation feels best at a particular moment.

But you should not masturbate only because your partner wants you to. I think it is important that the urge comes from you and not him. It sounds as if he has a problem with premature ejaculation (PE), which is the most common sexual problem for men. I do recommend for both of you to read the book “The New Male Sexuality” by Bernie Zilbergeld, and/or the book “PE, How to overcome premature ejaculation” by Helen Singer Kaplan. Both books will give you and your partner exercises to do, which may enhance his ejaculatory control.

You mentioned that you do not have time to reach orgasm, because he ejaculates too fast for you. This is a very common problem. Women often need a long time of direct stimulation of their clitoris, or of vaginal stimulation in order to reach orgasm. There is nothing wrong with that and it is completely normal. Men who ejaculate before their partner is satisfied can continue to stimulate her manually, orally, or with a vibrator as long as she wishes. This will often allow her to reach orgasm after all.

Where could the pain during intercourse be coming from?

Q: While having intercourse with my fiancé I got a sharp pain in my lower stomach on my right side. So bad I could not continue. This has occurred before but I’ve continued. I thought it was because of his penis size. Maybe I can’t handle the rough sex. I'm a little worried about damage that might have been done to my insides. Is this possible?

I’ve made arrangements to consult with my doctor but wanted a few ideas before hand. Thanks for your help.

A: I am glad that you are going to see your doctor, since he or she will be able to perform a gynecological exam and ask you a number of questions, which will hopefully lead to a diagnosis.

I believe that is unlikely that your insides have been injured during sex. But that depends on what you mean with “rough sex.” It takes a lot of force and penetration by large or rough objects to cause damage. This certainly does happen in some abusive situations.

Consenting adults can have “rough sex” including forceful thrusting without any injury, but with one or both partners being a little sore the next day.

The pain could be coming from any of your pelvic organs. It could be a benign ovarian cyst on your right side. Or your uterus, bladder or intestine (much less likely your kidney) can produce the pain. Your doctor will be able to palpate your ovaries, and maybe find out from where the pain originates. Have you had your period recently? I’m thinking of the possibility of an ectopic pregnancy (pregnancy outside the uterus).

Be sure to give your doctor all the facts you can think of, including things that may seem embarrassing to you.

Are inherited diseases transmitted during sex?

Q: I’m 18 years old. My girlfriend is on birth control pills. Can I get any diseases such as STDs if we do not use condoms? What about inherited diseases like multiple sclerosis?

A: If your girlfriend is on birth control pills there is only a very small chance that she will get pregnant. If you do not use condoms, you can contract sexually transmitted diseases (STDs) such as gonorrhea, chlamydia, herpes, genital warts, HIV, hepatitis, etc. from her, in case she has any of those diseases.

You cannot contract any inherited diseases such as multiple sclerosis through sexual contact with her. Inherited diseases are passed on to the next generation through chromosomes, which contain all the genetic information. Also, diseases such as cancer are NOT transmitted through sexual contact.

Why do I lubricate so little?

Q: I am 19 years old and have been in a sexual relationship for almost a year now. However, whenever we have sex I do not produce any natural juices. We have used KY jelly from the beginning of the relationship, but it seems to go dry quickly even using this. My boyfriend has recently become discouraged during foreplay, as he does not feel like it is doing any good because I am producing nothing. Why is this? And what can I do about it?

I look forward to your reply and hope you can help me.

A: It is not unusual for some women to lubricate very little, and it can vary from time to time how much a woman lubricates. KY jelly and other lubricants need to be re-applied several times, so keep the bottle handy, and do not worry if you need to use it several times during lovemaking.

Try not to focus so much on your lubrication or rather lack of it, since being tense about it may cause you to dry up even more. Your amount of lubrication is not a measure for how much you love your boyfriend. He and you both need to understand that.

You are young and sex may still be relatively new for you. Instead of concentrating on goals such as erections, ejaculation, and orgasms, try to focus on different sensations: How does your boyfriend’s touch feel. What would you like him to do different, what could he do to make it continue feeling good or better? Communicate these messages to him. It takes a lifetime to get to know your own body, and you may encounter pleasant surprises along the way. Take your time to find out what feels good, and enjoy the journey.

A lot of women enjoy nipple stimulation (either manually, orally or otherwise), and this will often have a direct effect on your genitals. This is actually caused by a physiological reflex between your nipples, the brain and your genitals. Why don’t you experiment with nipple stimulation to see whether this will increase your lubrication?

If you are really concerned, I recommend consulting with a gynecologist, who can prescribe medication for you.

What can we do about different desire levels?

Q: I am in a loving relationship, but my sex drive seems much higher than my partner's. This is very frustrating for me, to the point where I can become quite depressed. Is there any way of reducing my sex drive so that it becomes more compatible with my partner's (e.g. drugs or herbal remedies - didn't they give troops bromide in WWI?)?

My partner's sex drive is too low. I make sex and sexual play as enjoyable for her as I know how, and she can become very aroused and orgasms every time, but she never initiates anything. She can get very annoyed at me for always pestering her for sex, and I can sometimes become angry with her for not wanting to ever talk about it. I have no trouble with premature ejaculation or similar sexual dysfunctions, and I don't want to leave my partner just because of sex.

A: Neither is your sex drive too high, nor is your partner’s sex drive too low. You just happen to have different but normal desire levels. Let me give both of you some numbers from a recent study, “The Social Organization of Sexuality. Sexual Practices in the United States” (1994) by Lauman, E.O. et al.; University of Chicago Press. A more popular version of this book is called “Sex in America. A Definitive Study” (1994) by Michael, R.T. et al.; Warner Books.

The study involved 3,432 men and women from all social, educational, cultural, and religious backgrounds, and living all over the USA. Since a computer program chose participants in the study randomly, the study population is highly representative of the entire nation. Following are the numbers of how often 18-24 year old Americans have sex:

	4 or more times per week: men 12%, women 12%;
	2 or 3 times a week: men 28%, women 29 %;
	A few times per month: men 24%, women 32%;
	A few times per year: men 21%, women 16%;
	Not at all: men 15%, women 11%.

As you can see, 12% of American men and women in your age group have sex 4 or more times per week. You are both normal. You for wanting sex often, and she for not wanting it as frequently.

Here is what I recommend to you: You are doing great by showing your partner affection, and trying to make foreplay enjoyable. But try to accept the fact that she wants sex less frequently right now. Enjoy it when it happens. One possible reason for why she never initiates sex may be that she anticipates it to happen sooner than she wants to, since your desire is so much stronger than hers.

I think there is a lot of hope for you two. You describe your relationship as loving. She can become very aroused and reach orgasm, and you do not seem to have any other problems than worrying about your sexual desire. That is all good news. Try to compromise on less frequent sex for a while. And when it happens, enjoy it!

Finally, a few words about masturbation: In my opinion it is a good thing to masturbate when you have so much sexual desire. It is perfectly normal to masturbate on days where you want sex but your partner does not. Many young men in steady relationships masturbate regularly. It is a good way to release sexual tension. Only if you masturbate excessively and this activity influences other daily activities in negative ways it may turn into a problem.

How can I say No to sex?

Q: I am 18 years old and I recently got back my HIV test and discovered that I am clean. I feel like God has given me a second chance at life to be more careful. I am currently seeing a guy who is 27 years old and obviously interested in sex. He wants to have sex but now I do not. The only problem is that I fear telling him. I know he will not stay with me, and that is not the sign of a healthy relationship. However I really like him. I was wondering if you had any advice on how to be strong in my morals and not give in to sexual temptation.

A: Good for you for taking a HIV test, and yes, you have a second chance to be more careful about sex. I believe that a woman should only have sex if she wants to and feels ready and not out of feeling pressure to do so. Do not fear telling your boyfriend that you are not ready for sex at this time. If he is a good guy, he will respect your wishes and you for being straightforward with him.

If you feel tempted to have sex, think about that sex is a very special moment between two people, and that both should be equally consenting to this activity. I can recommend a brand new book to you. It is called “Women’s Sexualities” and it is written by Carol Rinkleib Ellison, New Harbinger Publications, ISBN: 1-57224-196-9. You can read my review about this book in the “News” section on this website.

Dr. Ellison has interviewed 2,632 women between the ages of twenty-three and ninety. These women have shared intimate details about their sex-lives and women as well as men can learn from the tales told. I think what you especially might benefit from is reading the chapter “The First Time.” Dr. Ellison also mentions the fact that many young girls give in to older boy friends. It may help you to read about what other women have done in the same situation, their possible regrets and their comments about what they might have done different if they had had a second chance.

After my brain surgery how can I get my sex drive back?

Q: I am a 56-year-old male who had a menigioma located at the base of the brain removed 4 years ago. Since then I have lost my sex drive completely. I went to an urologist who prescribed caverject injections, which work as far as erections are concerned. Viagra does not work, since I have no sex drive. No climax for 4 years is a long time. Surely there is something I can do to get my sex drive back?

A: Your question is hard to answer by e-mail. I would advise you to find a sex therapist who can possibly help you. You can contact The American Association of Sex Educators, Counselors, and Therapists at www.aasect.org to provide you with names of therapists in your area.

What are your circumstances? Are you currently in a relationship? If so, how is your relationship working out? Do you have any stresses in your life? How was your sexual drive before your operation 4 years ago? How would you describe the level of your self-esteem? Has anything changed since your operation? Are you feeling depressed? Are you taking any medications? All these factors can influence sexual desire, and it will be easier to have professional help in finding the root of your problem and trying to resolve it.

Viagra only works if you have a sexual desire. It enhances the physiological reactions in your body and allows more blood to flow into your penis during erections. But only if your sex drive is active.

If you do have a partner try to focus less on erections, intercourse and orgasm and spend a lot of time on non-sexual touching. Give each other massages and caress each other’s bodies. You do not need a sexual desire in order to enjoy these activities. Take a bath together and enjoy each other without necessarily engaging in intercourse. By being able to enjoy intimacy and caressing of your body your sexual desire may slowly return.

Even though the book does not specifically address the effects of brain surgery on sexual desire I recommend reading “The New Male Sexuality” by Bernie Zilbergeld. It does cover a lot of general topics and is worthwhile reading for men and women.

Good luck, and let me know if I can be of further help to you.

Is swallowing sperm good for you?

Q: I am writing regarding "SPERM" that I cannot find any information about through your site. my Question is what is the advantage and disadvantage of getting some sperm in the mouth through the sexual relationship and if get some of it in the stomach by swallowing it.... if husband asks for it for an enjoyment, as he heard as well and read that
the sperm is even good for women's hormone. I will appreciate if you could email me back with your answer to what I inquire and want to know what is the danger if swallowed some of it.
I am looking forward to hearing from you as soon as possible with many thanks.

A: I have never heard about the fact that swallowed sperm should be good for
women's hormones.

Many women and men enjoy oral sex. Some like to get sperm into their mouth
or even to swallow it. Some do not like the man to ejaculate inside of their
mouth even though they enjoy sucking on the man's penis until before
ejaculation.

You should do what YOU like and not what your husband wants you to do.

You asked about the advantages and disadvantages of getting sperm in your
mouth: The advantage is if you both enjoy it. The disadvantage is if you do
not like to get sperm in your mouth, or if your husband has a sexually
transmitted disease as for example chlamydia, syphilis or HIV.

Many couples use condoms for oral sex. You can even get some that have a
pleasant taste. Check out the Good Vibration website at www.goodvibes.com
for more information.

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What can I do about dryness of my vagina?

Q: I seem to have a problem. When ever I have intercourse my vagina dries up and it gets painful. Is there something I can do?

A: How old are you? If you are past your menopause it may be that you would benefit from hormone replacement therapy. Check with a doctor to see whether you are a candidate for this type of treatment.

If you are younger, I would suggest to start out using personal lubricants, which you can get over the counter at any pharmacy (KY jelly, Astroglide, etc.). If this does not help, I would see a doctor who can prescribe a vaginal cream or suppository which will enhance the lubrication of your vagina.

What about my premature ejaculation?

Q: I am 33 , I used to masturbate in a strange manner, I tried to forcedly ejaculate without erection while watching TV, for several years. Now I am going to marry and I am having a problem to ejaculate prematurely with or without erection. I tried squeeze technique but it would not help as something triggers ejaculation from inside and orgasm is completed even if I don't let sperm to get out. I am not married and never did intercourse, I tried several times with some prostitutes but failed to penetrate due to premature ejaculation.

A: It sounds to me as if you are having two problems: 1) Premature ejaculation and 2) guilt feelings about masturbation.

1) “Premature” or “rapid ejaculation” is probably the most common male sexual problem. In most cases it can be treated. I encourage you to read chapter 22: “Developing Ejaculatory Control” in the book “The New Male Sexuality” by Bernie Zilbergeld. You can buy the book from the Amazon.com website, but I am not sure whether this also applies to your part of the world. You may get enough insights and help from reading that particular chapter in order to lengthen the time period before you ejaculate. Dr. Zilbergeld describes several exercises that you should follow, including the squeeze technique which you have already tried. Try the exercise again following his instructions.

2) About masturbation: Over centuries and in many different cultures, masturbation has been viewed as a sinful practice. Not too long ago, masturbation was associated with medical or even mental illness. For many individuals, it is difficult to escape these myths.

I believe that masturbation is a healthy act of self-pleasuring. It is O.K. to masturbate. I share this view with many doctors and health professionals in the Western world.

To give you an idea about how frequently people in the USA masturbate, I will cite a few numbers from a recent study, “The Social Organization of Sexuality. Sexual Practices in the United States” (1994) by Lauman, E.O. et al.; University of Chicago Press. A more popular version of this book is called “Sex in America. A Definitive Study” (1994) by Michael, R.T. et al.; Warner Books. The study involved 3,432 men and women from all social, educational, cultural, and religious backgrounds, and living all over the USA. Since participants in the study were chosen randomly by a computer program, the study population is highly representative of the entire nation. Following are the numbers of people who masturbate once a week or more: men 26.7%, women 7.6%; numbers of people who masturbate not at all: men 36.7%, women 58.3%. These numbers clearly show that masturbation is a common practice in our culture. However, it is interesting to note that 54.0% of men and 46.8% of women do feel guilty after masturbation.

Finally, some advice for having intercourse when you are getting married: Do not only focus on intercourse, this will only make you nervous and make it difficult for you to perform the way you would like to. Take some time to get to know your wife’s body, give each other massages and just enjoy touching each other. You can probably stimulate your wife to orgasm orally or manually, you do not need an erect penis for her to enjoy sex with you. Once you are less nervous about the novelty of being with a partner, you may find it easier to control your ejaculation and have satisfying sex.

What can I do about my low desire for sex?

Q: I`m a 19yr old female, with a small amount of sexual experience in my lifetime. I`m happily engaged to a great guy I`ve been with for 2yrs. One problem though, I have no desire what-so-ever for sex. This is causing great difficulties in my relationship. Is this a mental, physical problem? How do I know? please help me, I`m on a very tight budget and cannot afford personal psychiatric help. But value my relationship with him very much.

A: There is a lot of hope for you. Your low sexual desire is very likely related to your relatively small amount of sexual experience. Many young women find themselves in the dilemma of thinking that they should want sex and be able to “do everything right” from the beginning even though the truth is that it just takes quite a while to become comfortable with sex.

It is very positive that you seem to have a good relationship, and are committed to each other. I would recommend for the two of you to do some exercises called “sensate focus exercises.” They are best done in several steps following detailed instructions from a sex therapist. But you can also try to do them on your own: Make an agreement with your fiancée that you will not have any intercourse and not achieve orgasms for a while. Get some nice massage oils, and try to arrange a time, where you both are rested and relaxed. Try to arrange a nice setting for both of you. Undress as much as you feel comfortable and take turns giving each other a massage of all areas of your body except the genitals and your breasts/nipples. Start out lying on your back, and then turn over. Try to spend at least 1/2 hour on each other, and enjoy caressing different areas of your bodies. The person who is receiving the massage, should try to let the other person know what feels good and what doesn’t.

It is the idea to take small steps every time and after a while to also include the genital areas. You both may find these exercises very pleasurable, and you may get a different attitude towards sex, which not necessarily has to include intercourse, but can involve giving each other pleasure simply by exploring and caressing each other’s bodies.

Do you have regular gynecological exams? Most likely, any physical reasons - if there are any - for your problem would be discovered this way.

One important final question I have to ask you is whether you have ever experienced any unwanted sexual advances from someone. If this is the case it could play into your situation, and it would be an issue to work on. Even though you cannot afford any counseling you would very likely benefit from reading some self-help books which I could recommend to you. Please let me know if this is the case and I will e-mail you a few book-titles. In any case, please do not hesitate to contact me if I can be of further assistance to you.

Is there anything I can do in order to last longer than one minute?

Q: I'm 20 and when I have sex with my girl friend I ejaculate at a very fast rate I should say. It's not like it my first time this have been a long term thing. I have tried different thing such as relaxing, getting off beforehand, thinking of other thing. I want to know is that what can I do to make it longer then that 1 old minute.

A: It sounds as if you are having what is called “premature” or “rapid ejaculation.” This is probably the most common male sexual problem. In most cases it can be treated. I encourage you to read chapter 22: “Developing Ejaculatory Control” in the book “The New Male Sexuality” by Bernie Zilbergeld. This book is listed in the “Reference“ section of this website, and you can buy it on-line by clicking on the author’s name when you are on the “Reference” page. This will link you to this specific book on the Amazon.com website. Or your local bookstore may have it in stock. You may get enough insights and help from reading that particular chapter in order to lengthen the time period before you ejaculate. Dr. Zilbergeld describes several exercises that you should follow.

You can also try to find a sex therapist, who can coach you and your girl friend about doing these exercises right. If you live in the United States or Canada you can contact AASECT (The American Association of Sex Educators, Counselors, and Therapists) at www.aasect.org about a list of sex therapists in your area. Finally, there are medications available to treat this problem. But there is a good chance that you will not have to go this far, and that you will be able to achieve ejaculatory control by doing the described exercises.

Good luck with everything!

Why can I no longer ejaculate?

Q: I have been consulting with doctors but since I had a sigmoid resection done on my colon and since then march 98- I am able to maintain an erection although not able to have a climax. This is very discouraging to me. If you can offer any suggestions besides checking with the doctors- I would be grateful.

A: Under which circumstances can you not ejaculate/climax? When you masturbate or when you are with a partner or both? Have you had a colostomy after your operation? Has anything else been going on in your life?

I am trying to determine whether your problem has 1) physical/organic (related to body function) or 2) psychological roots (the way you perceive yourself and possibly a relationship that you may be in).

1) Physical/organic roots:

One organic cause can be related to changes in hormone levels (androgen deficiency), which can be assessed by lab-testing at your doctor’s office.

Another organic cause could be if some of the nerves important for the ejaculation process have been severed during your operation. Since your erectile function is unaffected, it is clear that many of your nerves are still working fine, and I assume that this is only a remote explanation.

Are you currently taking any medications? Some drugs can cause so called “dry orgasms.” If so, check with the doctor who prescribed the medication to you.

2) Psychological roots:

Psychological factors can often affect ejaculation in various ways: early/fast/premature ejaculation or delayed ejaculation as in your case. I recommend reading “The New Male Sexuality” by Bernie Zilbergeld for more information on this subject. You may get some important insights from this book.

Finally, a sex therapist can specifically deal with your ejaculation problems. You can contact The American Association of Sex Educators, Counselors, and Therapists (AASECT) at www.aasect.org for a list of sex therapists in your area. They have a good on-line listing of therapists in different states.

Good luck, and let me know if I can be of further help to you.

Why can I only ejaculate when I masturbate and not with my partner?

Q: I'm a 24 year old man. I have a sexual problem. I always have had problems getting an orgasm when having sex with a partner. When I have sex with a partner nothing happens. I have no problems getting an erection. I try to relax and enjoy the act, and I feel relaxed but nothing happens. When I satisfy my self on my own I have no problems getting an orgasm. I guess my problem is mental, but I just don't know what to do. Do you have any advice?

A: You have a very common problem and there is a good chance that it can be solved. The good news is that you do not have a problem getting an erection, and that you have no problems ejaculating during masturbation. Remember these positive factors.

With respect to ejaculating when you are with your partner you are already doing something very important: You are trying to relax and to enjoy the act, and you actually feel relaxed. This is also good and important.

Is your current relationship a relatively new one? It sometimes takes men quite a while to become comfortable enough with a new partner before they can ejaculate in her or his presence. One thing you could try is to masturbate in your partner’s presence. Couples sometimes include individual or mutual masturbation in their lovemaking. Once you feel comfortable ejaculating in your partner’s presence, you can try to let your partner masturbate you until orgasm. You can give instructions about how you like to be caressed. If you can become comfortable with this practice you may be able to progress to ejaculation during intercourse. During this whole process you will most likely become even more relaxed than you are at present, which would facilitate ejaculation.

Some men have a problem to ejaculate during intercourse since they find themselves in a different position than when they masturbate. If this is the case for you it may be a good idea to expand your way of masturbation. Masturbation is good under all circumstances, it is a good and healthy sexual practice.

Try to be patient and become more secure in your relationship.

Why can I only achieve orgasm if I tense all my muscles?

Q: I am a healthy male, 25 years of age, and have really never had any sexual relations until recently. I now am with a wonderful girl, but find I can not orgasm during intercourse, I can orgasm only if I tense nearly all the muscles in my body, and masturbate vigorously.. is there a medical problem I may have that causes this? the only thing I can think of that I have ever been diagnosed with is colitis, about 5 years ago. could that have an effect? when I was 19 I had a short term relationship and could not orgasm with her either. I can maintain an erection during intercourse for hours, although there is really very little sensation that is noticeable. is there a possibility that this is a mental problem? it makes me a little concerned not only about my health, but my confidence in myself as well. the Girl I'm with now is wonderfully patient and understanding, so it doesn't seem to yet be affecting my relationship. all I can tell you is that I have had very little experience in the world of sex, I'm 25 and this is only my 2nd partner ever. when I was 20 I was diagnosed with colitis, and aside from that I know of nothing useful to tell you.

A: I think your problem is related to your limited experience and I think there is a good chance that it will resolve over time. Many men have the same problem as you do. It sometimes takes men quite a while to become comfortable enough with a new partner before they can ejaculate in her or his presence. So to answer your question whether your problem could be mental the answer is yes.

Make sure that you are using effective birth control which you feel comfortable with. Fear of pregnancy can influence the ability to ejaculate.

The most important thing for you is to try to relax and not have the goal of ejaculating in mind when you are with your partner. Try to enjoy the intimacy and be assured that sex does not have to include orgasm or ejaculation or intercourse. Sex can include so many other things as massages, foot-rubs, oral stimulation of the genitals, etc. It is very important that you both are enjoying what you are doing. I would encourage you to work on forgetting your goal of ejaculation for a while when you are with your partner. Tell her about my answer. She sounds like a wonderful and understanding woman.

Can you ejaculate when you masturbate on your own? One thing you could try after a while when you feel ready and comfortable, is to masturbate in your partner’s presence. Couples sometimes include individual or mutual masturbation in their lovemaking. Once you feel comfortable ejaculating in your partner’s presence, you can try to let your partner masturbate you until orgasm. You can give instructions about how you like to be caressed. If you can become comfortable with this practice you may be able to progress to ejaculation during intercourse. During this whole process you will most likely become even more relaxed than you are at present, which would facilitate ejaculation.

It is often easier to reach orgasm if you tense your muscles especially in your buttocks. As you get more comfortable with sex you may not have to tense your muscles as much anymore.

Unless you are on medication that inhibits ejaculation - and there are some drugs which do (especially antidepressants) I do not think that having colitis has anything to do with your problem.

Could a threesome harm our relationship?

Q: My husband and I have a good sexual relationship, in general. He has expressed a desire to have a threesome with another woman, though not involving intercourse with the third party, just me.
Most of the time, the thought of this excites me (not in a bi curious way, but for two of us to please him). Sometimes I worry if it will have a harmful effect on our relationship. Any thoughts you might have on this matter would be very much appreciated.

A: I am glad you are giving the possibility of having a threesome a lot of thought. It can work very well, if ALL parties involved have clearly defined boundaries (emotional as well as physical) and expectations, and no reservations. I always recommend to follow your gut-feelings. If you have any hesitation about a threesome, do not do it at this point in your relationship. You worry about a harmful effect on your relationship. Have a candid conversation with your husband about what a threesome would mean to him, to you, and what impact you would expect it to have on your relationship. Do not do it simply because of pressure from your husband. But if you wholeheartedly want to do it, go for it. In my opinion it is OK to do whatever brings you pleasure, as long as it does not cause anybody involved emotional or physical harm.

It can sometimes be difficult to decide which fantasies can be successfully carried out and which ones should remain fantasies. If you decide not to have a threesome at this time in your relationship, there are other ways to add some spice to your sex life. Check out the Good Vibrations web site at www.goodvibes.com. They offer a large selection of sex toys, erotic videos, books, etc.

Good luck!

Why can I not reach orgasm anymore?

Q: I am a 37 yr old woman - with no past problem with orgasm. I recently had my second child via a rather difficult vaginal birth. Since the birth of my child I cannot reach orgasm. My doctor has prescribed testosterone cream which seemed to help in the beginning - but no longer does. I was switched from Levothroid to Synthroid shortly before the problem surfaced - my doctor suspects no link. I had problems with memory and confusion just prior to this orgasm difficulty and I wonder if I could have suffered a stroke injuring a portion of the brain pertinent to sexual function. I have suffered two years with this situation and am losing confidence in finding a solution. Intercourse and manual stimulation have both been tried as a means to what was previously an easilly attainable orgasm - nothing works at this point. I have no clitoral stimulation, no breast stimulation, no engorging of external genitals... please help if you can. Thanks.

A: There may not be a link between switching your thyroid medications, but any disturbance in thyroid hormone level (Hypothyroidism as well as Hyperthyroidism) can affect your sexual response. Your problems with memory and confusion also may have been related to a low thyroid hormone level, but this is only a suggestion. It is impossible for me to say more on the base of the limited information I have. How well is your thyroid hormone level controlled? Are you having regular check-ups? This is an important factor to focus on.

A stroke seems less likely to me since you probably would have experienced other deficiencies, such as speech difficulties and/or problems with some movements. But of course, it is a possibility.

Previously you had no problems achieving orgasm. Were you able to have vaginal orgasms as well as orgasms through clitorial stimulation? What happened during the delivery of your second child? Did you have any tissue injuries? Did you have any surgical repairs done? If so, this could be an explanation for altered sensations in your genital area.

In addition to making sure that you are not hypothyroid, I suggest that you try to create special time and to arrange a nice setting for you and your partner. This can be a challenge with two children, but it is possible. For a while, just explore each other’s bodies, without focusing on intercourse and orgasm. Get some nice massage oils, and try to arrange a time, where you both are rested and relaxed. Undress as much as you feel comfortable and take turns giving each other a massage of all areas of your body, not necessarily including the genitals and your breasts/nipples. Start out lying on your back, and then turn over. Try to spend at least 1/2 hour on each other, and enjoy caressing different areas of your bodies. The person who is receiving the massage, should try to let the other person know what feels good and what doesn’t. This is a nice way to learn more about each other’s bodies without focusing on intercourse and genital areas. You both may find this interaction very pleasurable, and you may learn more about sensations in different parts of your body. Your body has a great potential for developing new areas for sensation. Just think about the spinal cord injured individuals who may have no sensations in their genital area, but who can learn to achieve orgasm from being touched in other areas where sensation is still intact. Why don’t you give this a try?

Even though you have not had difficulties achieving orgasm before, you may benefit from reading: "Becoming orgasmic. A sexual and personal growth program for women." by Julia Heiman, PhD and Joseph LoPiccolo, PhD; published in 1992 by Fireside Book, Simon & Schuster. You can find the book on the page References and order it from Amazon.com by clicking on the author's name.

Good luck!

Why do I not want sex anymore?

Q: I am 20 years old and I have a 2 year old and a 1 year old. I was depressed through both of my babies and for 4 months after my last child. I would like to know why I do not want to have sex anymore. This is causing major problems for me and my husband even to the point that we are fighting about this every night now. I have been to the doctor and they always say the same thing, it has not been that long since you had your child it will come back, but I feel like they are just brushing me off. Please help me before I go crazy.

A: I think you can be helped, but I cannot give you a magic pill, and it will take some effort from both you and your husband. You are under a lot of pressure with two young children, friction between you and your husband, and the pressure coming from yourself about wanting sex. Sexual desire is a delicate feeling that needs the right circumstances to flourish. This normally does not work well if you are under a lot of pressure. I recommend to try to reflect on your present situation and see what you can change in order to relieve some of the pressure you are currently experiencing. It would be best for you and your husband to seek professional help with this and have a counselor or therapist help you to sort out your relationship and your present situation. A third person often will see things from a different angle and could possibly give you very valuable advice.

A very important factor not to forget is to evaluate whether you are depressed. You have been to the doctor recently. Did he or she address the possibility of you having a depression that may need medical treatment?

I encourage you to read the piece on Child Birth in the "Article" section on this web site. Even though your last child is already 1 year old, you may find some valuable information. The key point for you is to work together with your husband. Stop fighting about the issue, this will only make matters worse. Instead, try to work together in a constructive way and see whether you together can rearrange your priorities and your daily life in order to relieve some of the pressure. Try to get a baby-sitter as often as possible, allowing you to create some special time for each other. Begin by getting re-connected on a non-sexual level first. Go out for dinner, watch a movie together, or simply go somewhere where you can communicate in piece and without interruptions. Once you start feeling better about your relationship in general, your sexual desire may return. But it is necessary to create the right environment first.

Good luck!

Why is my semen very watery?

Q: I am a 21-year old male and I am very concerned about how my semen looks. Rather than a thick, creamy white fluid, my semen is more of a semi-translucent - sometimes almost clear - liquid that is very watery (runny). What does this imply? Does it have any affect on my sexual health/fertility/etc at all?

A: Let me ask you a number of questions: Has the way your semen looks changed recently, or has it always looked this way? Could it be that you have a sexually transmitted disease? Do you have any other symptoms as pain when urinating, or fewer?

Have you had any problems with your testicles during childhood or later, for example undescended testes or an infection like mumps that may have involved your testicles? In either case the production of your sperm may have been affected, ultimately affecting your fertility.

However, it is very likely that you simply secrete an excessive amount of fluid. The fluid contained in the ejaculate comes from different sources: Sperm is produced in the testes and transported through the vas deferens to a storage chamber located behind the bladder. Neighboring glands (the seminal vesicles) produce and secrete a significant volume of fluid. Even more fluid is produced in the prostate, and finally, several glands along the urethra also secrete fluids. The latter fluids are clear and viscous and vary considerably in amount between men. All these different fluids together make up the ejaculate.

It may well be that your production of sperm is normal (your fertility is normal) but that you simply produce excessive amounts of fluids from some of the other sources I have mentioned. This is not unusual, and some men have discharge of fluid at an early stage of arousal and before ejaculation. In some cases the secretion can be so excessive that it drips from the penis.

To answer your final question, there is a good chance that your sexual health and fertility is perfectly normal. However, if you are still concerned, I would recommend seeing your doctor about this issue.

What can be done about my bent penis?

Q: I'm having a problem. My penis is bent towards left due to lots of
masturbation. Can I bring it into its original shape? Is it possible for me to engage in intercourse with a female with a bent penis?

A: I am not sure that your penis is bent because of masturbation. It is not uncommon for some men to have a bent penis when erect. In some cases intercourse can be difficult, but this entirely depends on the angle. If necessary, it can be fixed by a small operation that often can be performed under local anesthesia.

There is one condition which is possibly caused by trauma to the penis, called Peyronie’s disease. In this case there is scar formation in parts of the penis causing it to bend. Treatment options vary depending on the individual situation.

I recommend that you visit a doctor, who can help you to correct the shape of your penis. There are a few things you can do prior to the doctor’s visit: Obtain a Polaroid camera or another type of camera. Take at least one picture of your erect penis from the side, and one picture from above and looking down on your erect penis. If you can use a background with squares as for example grid paper, the doctor will be able to determine the angle with which your penis bends. This information is very important for your doctor, even though you may find it embarrassing.

Good luck with everything.

How frequently do people have sex?

Q: I'm 27 years old married for seven months now, my wife is 25 years old, healthy and young, however she is not sexually active, she doesn't like sex as I do, she can't offer me more than one time a day or in two days although I do my best I do everything you can expect.

Also her period is irregular. So what can you advice me to solve out this
problem?

A: I am not sure in which part of the world you live, but I would like to give you an idea about how frequently people in the USA have sex. I will cite a few numbers from a recent study, "The Social Organization of Sexuality. Sexual Practices in the United States" (1994) by Lauman, E.O. et al.; University of Chicago Press. A more popular version of this book is called "Sex in America. A Definitive Study" (1994) by Michael, R.T. et al.; Warner Books. The study involved 3,432 men and women from all social, educational, cultural, and religious backgrounds, and living all over the USA. Since participants in the study were chosen randomly by a computer program, the study population is highly representative of the entire nation. Following are the numbers of how often 25-29 year old Americans have sex: 4 or more times per week: men 11%, women 10%; 2 or 3 times a week: men 36%, women 37 %; a few times per month: men 31%, women 38%; a few times per year: men 15%, women 10%; not at all: men 7%, women 5%. As you can see only 11% of American men and 10% of American women in your age group have sex 4 or more times per week.

You are young, newly married and have a high level of sexual desire. That is entirely normal! But it sounds to me that sex every or every other day is too much for your wife. This is also normal! I suggest that you try to have intercourse less often, your wife may enjoy it much more this way. It is like having a good meal - it tastes much better if you do not get it every single day.

It is OK for you to masturbate if you like. That is a very good way to relieve sexual tension, and you can do that on the days were you and your wife are not having sex.

You said that your wife’s periods are irregular. How irregular are they? If it bothers her too much she should see a doctor who can determine the reason, and probably treat her. Irregular periods can be a problem if you want to become pregnant.

Let me know if you have further questions.

Is it normal to bleed after sex?

Q: I would be grateful if you could explain: Recently I have started my first sexual relationship and am on the pill. After sex I sometimes experience some bleeding and period-like pains, is this normal?

A: It is not unusual to have a little bleeding and period-like pain after the first few times you have intercourse. But if this persists I would recommend to see a doctor.

Do you lubricate well enough? If not, increased friction may contribute to the bleeding. Make sure that you spend enough time before actual intercourse to get excited and lubricated. You can also buy a personal lubricant (K-Y jelly, Astroglide, etc.) over the counter at any pharmacy.

Even though you are on the pill which is good and very responsible of you, do not forget condoms unless you are 100% sure that your partner is not HIV-positive or has another sexually transmitted disease. Contraction of any of these diseases can be prevented or at least very much reduced by using condoms.

Please do not hesitate to ask any further questions.

Why do I have a heavy vaginal discharge?

Q: I am a 19 year old college student and I am concerned about my vaginal discharge. It is very heavy lately. There is no itching and not really any bad smell, but it is rather embarrassing. At first I thought it could be signs of a yeast infection, but besides the heavy cottage cheese discharge, there are no other sings. Please help.

A: I think you may be having vaginal thrush (a fungal infection), which is not dangerous and can be treated with medicine. If you have not already done so, you should see your doctor immediately in order to get treatment. Have you recently been taking antibiotics? This sometimes can cause thrush.

Besides routinely checking for other vaginal infections, your doctor may also test you for chlamydia which sometimes can be present without giving symptoms. It is important to treat chlamydia in order to prevent that your fertility may get negatively affected.

Why do I ejaculate so fast?

Q: I just turned 30 and have noticed in recent months that I am having trouble with ejaculating too fast and maintaining an erection. It really has my whole self esteem shot, I used to be able to maintain even after I ejaculated. Now I about to go through a divorce and will be dating and I don't know what to do. Of course I want to be able to have sex like I used to!

A: It sounds as if you have some emotional turmoil happening at this time in your life, since you are about to go through a divorce. This may explain that you are ejaculating faster than usually, and that your erections are not maintained as well as normally. There is a very good chance that you will return to your usual level of performance once your emotional issues are resolved.

Take your time. Do not worry about dating at this time, worrying may only make things worse. Also, your first dates do not have to include intercourse right away. Once you feel ready to date again, enjoy getting to know a new person and spend some time simply adjusting to your new life. This will hopefully make you more relaxed once you resume sexual activity with a new partner.

Meanwhile you can masturbate, if you want to. This is a very good way of improving your erections, and there are several exercises you can do in order to lengthen the time before you ejaculate. You can read about these exercises in the chapter called "Developing Ejaculatory Control" in the book "The New Male Sexuality" by Bernie Zilbergeld. I can highly recommend this book to you.

I wish you all the best and good luck with everything.

Why am I coming so quickly and how can I change this?

Q: I have no problem with getting hard right away with my wife before sex but little time after I come and nothing happens for my wife. Why am I coming so quickly and how can I change this? We are talking about 30 seconds.

A: It sounds as if you are having what is called "premature" or "rapid ejaculation." This is probably the most common male sexual problem. In most cases it can be treated. I encourage you to read chapter 22: "Developing Ejaculatory Control" in the book "The New Male Sexuality" by Bernie Zilbergeld. You may get enough insights and help from reading that particular chapter in order to lengthen the time period before you ejaculate. Dr. Zilbergeld describes several exercises that you should follow.

You can also try to find a sex therapist, who can coach you and your wife about doing these exercises right. You can contact AASECT (The American Association of Sex Educators, Counselors, and Therapists) at www.aasect.org about a list of sex therapists in your area. Finally, there are medications available to treat this problem. But there is a good chance that you will not have to go this far, and that you will be able to achieve ejaculatory control by doing the described exercises.

Can ejaculating many times be harmful?

Q: My husband & I have a wonderful relationship. Our intimate times tops everything. I'm a little concerned about something that I'm embarrassed to ask my doctor. Both my husband & I are 30 years old, young. About once a week in the weekend, we bond by spending the whole day making love, fall asleep at night, and the next day continues until like noon. What I'm concerned about is his health. I of course have a wonderful loving time, and I know he is too. But within 24-hours, he will ejaculate from 5-7 times. Of course this is not everyday but once a week, but I'm just wondering if this is healthy for him in the long run. Could you kindly advice? Thank you so much.

A: What a wonderful way to spend your week-end! Ejaculating numerous times within a 24-hour period will not hurt your husband. Unless of course he somehow suffers physical distress during or following your activities. If you both enjoy what you are doing, there is no reason to stop. I find it very positive that you both are willing to spend so much intimate time together.

The old saying "use it or lose it" also seems to apply to sex. Some researchers claim that frequent erections are beneficial, since the penis is perfused with more oxygen-rich blood than in the flaccid state.

The only negative thing I can think of with respect to your frequent lovemaking could happen if you at some point wish to become pregnant. Sperm-cells are continuously produced, and by ejaculating 5-7 times within 24-hours the sperm gets diluted, and it may become more difficult to get pregnant. This should not stop you from what you are doing now. But if you ever are having a hard time getting pregnant, make sure that your husband does not ejaculate as often during your fertile period (the time period when you ovulate).

I am only mentioning this so that you are aware of this possibility. By all means continue what you are doing, and enjoy each other!

How can we get my boyfriend to ejaculate inside of me?

Q: Help! My boyfriend and I have a very wonderful and caring relationship. He is a very considerate lover and always is concerned that I have an orgasm. We have wonderful sex but he cannot have and orgasm or ejaculation by any other means than masturbation. And nothing I have tried and done has helped. I cannot make him come, only he can. He is 26 years old and started having intercourse when he was nine. we are worried this might have something to do with it. We've discussed the situation openly and tried a lot of things, but don't know what to do. Please help us if you can.

A: It sounds as if you and your boyfriend are getting along very well and that you are having wonderful sex despite his inability to ejaculate during intercourse. This is very positive.

Your boyfriend’s problem (called "retarded ejaculation" which has nothing to do with mental retardation) has a very good prognosis with sex-therapy. It is caused by a reflex that can be learned to be controlled. It is a similar situation as when someone has difficulty with starting the stream of urine. Sometimes, by turning on the water-faucet or by thinking of something else, one starts to urinate. I really recommend finding a sex-therapist since the treatment involves several steps that have to be carefully choreographed. You can contact AASECT (The American Association of Sex Educators, Counselors, and Therapists) at www.aasect.org. They can help you locate a sex therapist in your area.

If you for any reason are unable to find a sex-therapist near you, here are a few suggestions: Can he ejaculate when you masturbate him? If no, this is something you should work on. Have him fantasize as if he were masturbating by himself while you stimulate his penis. He can guide you how he wants you to caress him. If the answer to the above question is yes, you already are a big step ahead, and here is the next step: You masturbate his penis until orgasm and each time you arrange yourself in such a way that his penis gets progressively nearer your vagina. Once he is comfortable ejaculating close to your vagina while you masturbate him, you are ready for the next step: You stimulate him until he is near orgasm. Then he inserts his penis partly into your vagina. You continue to stimulate his penis while he thrusts. Once he is close to orgasm he signals to you and you remove your hand. The coital thrusting will hopefully bring about the actual orgasm.

It could very well be that your boyfriend’s problem is related to his early onset of having intercourse. What were the circumstances at that time? Was he in any way forced? Was it a positive or a negative experience for him? I am glad that you are openly discussing his past, and trying to resolve his problem together. A sex-therapist would also focus on this issue in an attempt to help you resolve it.

Is my difficulty in achieving orgasm related to an inherited disease?

Q: I am a 49 year old male. I have always had difficulty in achieving an orgasm. Lately, I have begun to wonder whether an inherited disease is a factor. I inherited Charcot-Marie-Tooth (CMT) disease from my mother. I hope this is a false fear, but this is my first step towards finding a cause. Next would you recommend a trip to a urologist? At any rate, whether CMT effects sensation in the penis is my primary question.

A: Since I do not have much experience with patients with Charcot-Marie-Tooth (CMT) syndrome, I checked with a neurologist who treats patients with this disease. He has never encountered problems with sexual dysfunction among his patients with CMT. He passed the following reference on to me: Bird TD, Lipe HP, Crabtree LD: Impotence associated with the Charcot-Marie-Tooth syndrome. European Neurology; 1994; 34, 155-157. If you do not have a medical library near you, a public library can most likely get you a copy of this article, if you are interested.

The lack of information about sexual problems related to CMT does not necessarily imply that these problems do not exist in that particular patient population. It may be that patients hesitate to mention sexual concerns at their check-ups. Do you have the possibility to meet with a sex therapist? A sexuality specialist would be able to inquire about the nature of your problem achieving orgasm. On the basis of a detailed history, the sexual health professional would then be able to guide you with respect to which treatment would be best for you, and whether a trip to a urologist is recommended or not. You can contact www.aasect.org for information about how to find a sex therapist near you.

Do you have a sexual partner, or are you single? How do you masturbate? I do encourage you to explore your own sexuality, and find out what feels good to you. It may be that you need more stimulation, and that using vibrating sex toys would provide the necessary amount of stimulation in order to reach orgasm. Check out the Good Vibrations web site at www.goodvibes.com for ideas and suggestions. They also carry a book called "The new Good Vibrations guide to sex" which I can recommend reading.

Could you give me guidance about my masturbation problem?

The following question was asked by a 26 year old, unmarried man from Asia:

Q: I have problem about my sex. In my whole life I have not made any sexual relation with any female but when I was 15 year old I involved in
masturbation (sexuality due to hand practice). I have been involved very much in this habit. Now I have almost given up this habit but I feel that whenever I go to this practice the sperms come out just in one minute.

Previously, I have this habit of taking tea too much; I usually took hot tea more than 10 times. But now I have given up this habit, I take tea just one or two times a day.

Also, I have this problem that sperms come out form penis whenever I have toilet; usually in ordinary routine of urinating, sperms do not come out from the penis.

I have not taken any drug or medicine yet to remove this problem. Its first time that I am telling this problem to a doctor.

I would be very thankful to you if you give me the necessary guidance about this problem.

A: Thank you for writing me about your concern. Over centuries and in many different cultures, masturbation has been viewed as a sinful practice. Not too long ago, masturbation was associated with medical or even mental illness. For many individuals, it is difficult to escape these myths.

I believe that masturbation is a healthy act of self-pleasuring. It is O.K. to masturbate. As we move into a new millennium, I share this view with many doctors and health professionals in the Western world.

To give you an idea about how frequently people in the USA masturbate, I will cite a few numbers from a recent study, "The Social Organization of Sexuality. Sexual Practices in the United States" (1994) by Lauman, E.O. et al.; University of Chicago Press. A more popular version of this book is called "Sex in America. A Definitive Study" (1994) by Michael, R.T. et al.; Warner Books. The study involved 3,432 men and women from all social, educational, cultural, and religious backgrounds, and living all over the USA. Since participants in the study were chosen randomly by a computer program, the study population is highly representative of the entire nation. Following are the numbers of people who masturbate once a week or more: men 26.7%, women 7.6%; numbers of people who masturbate not at all: men 36.7%, women 58.3%. These numbers clearly show that masturbation is a common practice in our culture. However, it is interesting to note that 54.0% of men and 46.8% of women do feel guilty after masturbation.

I think it is OK for you to masturbate. However, if you feel that this activity is taking so much of your time that your life is negatively affected by it, you may have a problem. It seems from your letter that you have been able to cut down on your tea drinking habit as well as on the frequency of what may have been excessive masturbation. Alone from a practical point of view, this will allow you more time to concentrate on other aspects of your daily life. Now, whenever you do drink tea or masturbate, I suggest that you enjoy it and be proud about the fact that you were able to cut down on excessive habits. Does this all make sense to you? Otherwise please write again, and I will try to clarify my answer to you.

Finally, I am not quite sure what you mean by your sperm coming out when you go to the toilet. Do you ejaculate without masturbation? If you, after reading this answer, still think that you have a problem which I have not addressed, please let me know.

Should my boyfriend be thinking about me most of the time when he masturbates?

The following question was asked by a woman who discovered that her boyfriend masturbated while looking at a girl in tight jeans on the Internet. He also sent her a brief e-mail. The question is abbreviated considerably for privacy reasons. The final question was:

Q:.....Should my boyfriend be thinking of me most of the time when he masturbates? I am looking for answers to feel more settled. Any help is appreciated.

A: I do understand your disappointment when you found out about your boyfriend’s e-mail. It is always hard to accept that you may not be the only one that your partner finds attractive.

First of all, let me assure you that his behavior was not abnormal. Masturbation is very normal, and having fantasies at the same time also. The internet gives people a lot of opportunities, one of them being to engage in cyber-sex. If I were you, I would not put too much into this incident. Your boyfriend clearly was embarrassed when you confronted him. I do give him credit for being honest with you when he said that he does not always think about you when he masturbates. It is absolutely OK to have fantasies involving other people than the partner you are with. What kind of fantasies do you have?

Your boyfriend probably has masturbated for a number of years, which is absolutely normal. He may have a number of different fantasies he likes to focus on, and there is nothing wrong with him doing this at this point in your relationship. Fantasies are very private, and do not always need to be shared. Some people like to act out their fantasies, sometimes together with a partner, others prefer to keep them for themselves.

You asked whether he should think about you most of the time when he masturbates. I do not think so. You cannot and should not attempt to control what is going on in his mind. Give him some freedom to have fantasies, and maybe try to enjoy some of your own.

What really is important is how he treats you in "real life." Is he respectful, sincere, faithful, loving? In my opinion, those are really qualities that count and contribute to making a relationship a solid one.

Would a hysterectomy be of relief to my abdomen?

Q: I had a appendicitis, ruptured, and I have also had 2 surgeries for cyst removals on my right ovary. All three surgeries I was opened from above belly button to pelvic area. Now, with all the adhesions, I am wondering if a hysterectomy would be of relief to my abdomen? I am not able to have children, as a result of my tubes being bound up by the adhesions, I am 28 years old, married for 10 years. Is there a way to open the tubes?? Thank you.

A: Prior to your question, you list the following key words: decreased vaginal lubrication, painful intercourse, low sex drive, lack of sexual desire, not feeling like a sexual person anymore.

I suggest that you have your hormone levels (estrogen, testosterone) checked. The function of your ovaries may have been affected by the cysts and surgeries you have had. Many of the symptoms you mention could well be related to low hormone levels, and you may benefit from hormone replacement therapy. Both vaginal dryness and sexual interest can improve from estrogen treatment. Once lubrication is better, intercourse may be less painful. Your doctor or gynecologist can determine whether you are a candidate for this treatment. Also, in order to relieve decreased lubrication you can use lubricants (Astroglide, K-Y jelly, or other types) sold over the counter in most pharmacies.

Reasons for painful intercourse include vaginal dryness and adhesions from surgery. It is hard for me to answer whether a hysterectomy would give you relieve. I would start out by trying to relieve your vaginal dryness first before you advance to more drastic measures. Have a candid conversation with your gynecologist about different possibilities. He or she also most likely will be able to give you a better answer than I am able to (due to the limited information I have) about whether it is possible to open your tubes up. This will depend much on the amount of adhesions you have and the surgical interventions you have had.

Just for your information, you could check out the following two web sites about vulvodynia (pain related to the vulva): Dr. Glazer’s Vulvodynia website www.vulvodynia.com; National Vulvodynia Association www.nva.org.

What can I do about my voyeurism?

Q: I mostly can only get a full erection on when I watch my wife having sex with other men. Is there any thing that I can do about this? I cant take the new drug because of blood pressure. This has greatly affected our sex life

A: It is hard to answer this question on the basis of the limited information you have given me. A sex therapist or other mental health professional will be able to guide you better following a detailed interview, ideally together with your wife.

First of all, there is nothing wrong with voyeurism (the practice of obtaining sexual gratification by looking at sexual objects or acts), if it happens with the consent of all participants. Many people have voyeuristic fantasies, however, not everybody acts on them.

In order to clarify your particular situation, I would like to ask a number of questions: How old are you? How long have you been married? Is this a new practice of watching your wife having sex with other men? How long have you engaged in it? Have you ever wanted to secretly peek in on strangers having sex? Have you ever done so? Have you ever had or been interested in having sex with men? Has anything else happened in your relationship to your wife? How are your erections otherwise (at night, in the morning, during masturbation)? What do you fantasize about when you masturbate? Answers to these questions would make it a little easier for me to give you specific suggestions.

Sometimes, in a situation like yours, it may be helpful to focus on fantasies during intercourse. It is OK to do this. You could maybe try to fantasize that your wife is with another man while you are having sex with her. Imagine that you are watching from a distance. Why don’t you give this a try and see whether it woks for you?

Since this may be a complex issue and your sex life already has been affected greatly, I recommend finding a therapist who can help you resolve it.

How will sex after hysterectomy feel?

Q1: What about sex after hysterectomy? Will it feel the same? Will HE feel the same? I am very worried, the time has come to resume. Please help! By the way, ovaries are in tact, and I want it just as much as ever, but I am scared.

A1: It is hard to predict whether it will feel the same for you or not. Let me assure you that the majority of women following hysterectomy experience either an unchanged or even improved (due to beneficial effects on health and pelvic symptoms) sex life. Some women feel that their sex life has deteriorated, but this is often due to loss of ovaries and consequently a decrease in libido. Since your ovaries are intact, and your sexual desire appears unchanged I think you have a very good chance to be able to resume a very satisfying sex life.

It is likely that your vagina initially may seem somewhat shrunken or shortened. However, during careful initial intercourse the vaginal tissues will most likely eventually stretch. I suggest starting out slowly, and allowing each other much time to become reacquainted sexually. Once you are ready for penetration, it may be easier for you to be sitting on top of your partner, facing him. In the superior position you will be able to control the level of penetration and the amount of thrusting. Be sure to have some lubricant handy if you should need it.

Q2: Thank you very much! One more question. When we have intercourse, it is almost impossible for him to ejaculate inside of me. He almost always finishes with masturbation. We don't have a major problem with this, but I would like it to happen naturally. After his divorce, he was without sex for about 2 years, so of course masturbation was his outlet, does this have anything to do with him not ejaculating in me?

A2: Yes, this could be related.

Here are a few suggestions: Can he ejaculate when you masturbate him? If no, this is something you should work on. Have him fantasize as if he were masturbating by himself while you stimulate his penis. He can guide you how he wants you to caress him.

If the answer to the above question is yes, you already are a big step ahead, and here is the next step: You masturbate his penis until orgasm and each time you arrange yourself in such a way that his penis gets progressively nearer your vagina. Once he is comfortable ejaculating close to your vagina while you masturbate him, you are ready for the next step: You stimulate him until he is near orgasm. Then he inserts his penis partly into your vagina. You continue to stimulate his penis while he thrusts. Once he is close to orgasm he signals to you and you remove your hand. The coital thrusting will hopefully bring about the actual orgasm inside of you. It may be helpful for him to focus on fantasies that he usually has while masturbating. There is nothing wrong with having fantasies during intercourse and this could be a good way for your partner to distract himself.

This is a very technical description of events. It will take a while to get through the individual steps. Take your time. First of all, I would focus on having intercourse again, and then later on to work on his ejaculation problem.

Why does my partner's semen have an odor?

Q1: I recently started seeing a new man. We corresponded for a while before we met. Recently, we spent a weekend together and we slept together for the first time. My question is: Why would a man's semen have a rather unusually "pungent" odor. I have never encountered this before and I am in my mid-30's and usually enjoy oral sex, but can not bring myself to do this because of the odor of his semen. Please give advice...I really love this man and would like to build a long-term sexually healthy relationship. Thank you for the service.

A1: First of all, everyone is different and has different body odors. I do not know of any specific reason for why your boyfriend’s semen has a pungent odor. It may be related to his diet, but several other unknown causes related to his body chemistry may play a role.

Here are a few ideas for you: Get nice smelling soaps, a soft sponge, and whatever "bath-tools" you can think of. Make a mutual bath a fun and initial part of your lovemaking. Some of the odor may be reduced or overshadowed by more appealing odors.

You could experiment having oral sex with condoms, which is a good idea under all circumstances since he is a new partner. There are even flavored condoms for oral sex. Check out the Good Vibration’s website at www.goodvibes.com for ideas. I know that they carry one kind called "Kiss of Mint."

Any strong odor can always be caused by an infection. However, your boyfriend would most likely experience other symptoms as vaginal discharge, pain in the testicles or when urinating, and possibly fever.

One thing that is important to remember is, that his odor may change over time. For example, some people who eat raw garlic on a daily base for health reasons perspire the odor of garlic through their entire body. Once they stop eating garlic, the odor stops after a while.

Q2: Thank you so much for your response. I was concerned also because he is a gulf war veteran and I have read so much concerning the medications they were given that is causing all kinds of problems and also the chemicals they were exposed to. He was in the Army and was deep into Iraqi territory...

A2: You are welcome.
I do not know anything about those nasty chemicals. Under all circumstances, condoms should allow you to have safe sex.

How can I improve my erections?

Q: I have had several prostate surgeries, and also several hernia repairs. During the last hernia repair the cord going to my right testicle got in the mesh and cut the circulation off. I have had another surgery to remove the right testicle. I sometimes have an erection that will stay, and at other times it does not stay but a minute or so. And when I do have sex I have this burning affect in my right groin area. I would like to see what can be done to help me out. I am 50 years old and too young to give up on sex.

A: The burning sensation in your right side groin area may be related to the surgeries you have had. Maybe a nerve got injured or the problem is related to the complications you had during surgery on that side. Is there any way to check back with the surgeon who performed your hernia repair? He or she may be able to help you with that problem.

About your erectile problem: How were your erections prior to surgery? Did you then have erections at night and/or in the morning? Do you have morning erections now? Are your erections different when you masturbate than if you are with a partner?

If the answer to these questions is that your erections in general (in ALL situations) have become less strong, this may be related to the prostate surgeries you have had. Even though surgeons do their best to preserve nerves important for the erectile mechanism, it is not always possible.

However, there are several ways for you to improve your erections:

There are vacuum devices available, which will create a vacuum around your penis. This way blood enters the penis. By applying a tight ring at the bottom of the penis it remains erect for a while which enables you to have intercourse.
You can learn to inject a special drug into your penis. This will cause an erection sufficient for intercourse.
There are medications available to insert into the tip of your urethra. This could work for you.
Have you tried Viagra? I would recommend giving it a try.

An urologist will be able to assess your situation and give you specific advice and information.

Q2: Before I had the surgeries my erections were strong and lasted until the sexual relation was finished. Now I might have an erection and it stay for awhile and then it might be gone just as quick as it came. I have tried the Vigara and it doesn't help either. And there is always the burning
sensation in the right groin area.

A2: You may also try out a "cock ring" which is an adjustable ring that you place at the root of your erect penis. The ring will prevent the blood from leaving the penis, which may stay erect longer.

Rings can be ordered from www.goodvibes.com.

Can I get a safe penis enlargement?

Q: Please Help. This is not a joke. Is there anything you can really do. I’m looking for any (safe) form of penis enlargement. I’ve every great insurance and will listen to all comments and suggestions.

A: I am afraid that you will have to ask a plastic surgeon who performs sexual reassignment surgery. The reconstructive possibilities and outcome will depend on your individual case. I am no expert in this field. In general, it may be very hard to preserve sensory nerves during surgery. You may end up with a larger penis but with a glans that is insensitive to touch. Also, surgery can involve complications (including scar formation) that may affect the result. Risk versus benefit from the surgery has to be carefully assessed. A plastic surgeon will be able to provide you with more information.

I know very little about you, but you seem very distressed about the size of your penis. If this is of any help to you (and assuming that you are having sex with women), I have heard many women say that they have wonderful sex with partners equipped with small penises. Sex involves more than just intercourse. Most women enjoy the intimacy, the caressing, and the emotional contact to their partner. This is something you may want to focus on.

Have you ever considered including sex toys in your sex life? Check out the Good Vibrations web site at www.goodvibes.com for ideas and suggestions. It can be very pleasurable for both partners to use sex toys and it may distract you from the size of your penis.

I'm 22 and a virgin. Am I just too small and there is no hope for me?

Q1: I'm 22 and a virgin. I tried to have sex on several occasions, with the same person, but no penetration occurred. Is it possible that I am just too small and there is no hope for me, or what can be done??

A1: There is lots of hope for you, and a lot can be done.

First of all, it is not uncommon to be 22 and a virgin. It does not take a lot to be tense, and tense muscles can make penetration very difficult. Try to find out why you may be tense: You have tried several times with the same person. How do you feel about this person? Why exactly do you wish to have intercourse? Is it because everybody else does it (supposedly) or because you are madly in love? Under which circumstances have you tried? Did you have enough privacy? Did you feel relaxed and comfortable? Did you use birth-control? These are just a few questions you may want to think about in order to try to understand your body’s reactions.

Can you insert your own finger or a tampon into your vagina? If not, you may suffer from vaginismus, which can be cured with the help of a sex therapist.

If you have no problems inserting your finger, this is a good beginning. Explore your own anatomy while holding a mirror and try to become comfortable touching different areas around your vagina. Find out how different areas respond to touch and gentle caressing.

When you first attempt intercourse, try to be as relaxed and comfortable as possible. Take your time. Begin by focusing on other body parts than the genital areas. Massage each other and play around with each other for a while. If this arouses you, your vagina will probably start to get wet. If not, you can use some water based lubricant (K-Y jelly, Astroglide, etc.) sold over the counter in most pharmacies. It is important to be well lubricated when you attempt penetration. Also, it may be easier for you to control the amount of penetration if you are sitting on top and your partner is lying down on his back.

Q2: I thank you for the information, I do want to add, however that I do have problems wearing a tampon, and it is very painful to remove it.
Also is it possible that being molested as a child is having an affect on me now??
Thank you for your input...

A2:I think there is a lot of hope for you. But it will take some time. I think you are suffering from vaginismus, which can very well be related to having been molested as a child. It can be treated!

I recommend getting in touch with a sex-therapist. Your boyfriend could be a help during the process.

Don't rush anything. Here is an additional suggestion for you: Try to get
familiar with your own genital anatomy. You may already have done this, but nevertheless: Make sure that you are comfortable and relaxed. Hold a mirror in one hand and use the other hand to explore your genital area. Feel around while you look and concentrate on what feels good and where. Try to insert a finger into your vagina. It is a good idea to use some lubricant which you can buy over the counter at a pharmacy. Take your time. Over the next few
times, try to insert more fingers if you can. It is not going to hurt, since
you are in full control. You can also do this while relaxed in a warm bath.

Once you feel comfortable doing this, you can involve your boyfriend and you can insert one of his fingers into your vagina. Again, you are the one controlling the movement, so it will not hurt you. Take your time getting comfortable with this. After a while you may be able to fit more and more fingers into your vagina, and eventually have intercourse.

Is sexuality a basic human need?

Q: As a clinical psychotherapist, I recently got into an argument with a colleague of mine over the NEED for sexuality. Need is defined here as something required to sustain and maintain life. I contend that sex is a basic need; my colleague does not. Are you aware of any research done in this area? Can you guide me in any way in my pursuit to "prove" my position?

A: You are raising an interesting question that is hard to answer. This coming spring (May 2000) the Society for the Scientific Study of Sexuality is having a meeting titled "What is Sex?" It could be that the issue you are addressing, whether sexuality is a basic human need or not, may be on the list of topics to be discussed.

Personally, I believe that sexuality is a basic human need. I would argue that without sexuality life would not be maintained. This fact in my opinion places the need for sexuality at the same level of other life-sustaining needs.

It has been argued that the reason that most men and women experience orgasms (which certainly are not necessary for procreation) is to make intercourse more likely to happen, and consequently allow life to be maintained.

After our new baby, what can I do to bring the spark back?

Q: My husband and I had a baby nine months ago and our relationship seems to be on a down hill slide. We have had sex no more than once a week after she turned three months old. Sometimes we can go for several weeks and not have sex. I don't have any desire much of the time. There also seems to be a new component that has arisen in the fact that he seems very unsatisfied with my performance. At this point I feel frigid and cannot do anything right to please him. Desire has welled up inside of me but I fear not pleasing him or initiating foreplay correctly, it has become too scary to try. He says frequently that he feels like he is punching a time clock now or that I am too preoccupied. He also says another person cannot make you feel a certain way, only you can allow that, so it's all my fault. Our sex life previous to the baby was not great but we did seem to connect and have much more fun. What can I do to bring the spark back? I feel the depression and despair around our relationship as a whole increasing. I am getting desparate and scared of our future. What can I do? Please help me.

A: First of all, congratulations on your baby! These little individuals tend to change people’s lives, sometimes dramatically. I encourage you to read my article on child birth.

It sounds as if you have gotten into a bad circle, where you now are afraid of doing things wrong. You are asking what you can do about getting the spark back and you are scared for the future.</