Sex and Relationships

Sexual Dysfunction


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Answers to questions about sex therapy and sexuality

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6/2/98 Q: My husband and i have been "married" for three years. Unfortunately, I think he spent the first 1 1/2 yrs cheating. I do know of and confronted him on one. Ignorantly, staying with him, I know that he is no longer having any affairs. (The cat doesn't get let out to roam the neighborhood anymore...just an occational adventure to the backyard.) The deal is his sex drive STILL hasn't picked back up. We as a couple are doing better than we have in years. We are actually friends again. Unfortunately, the cycle continues....we have sex 2-3 times in a two week span and then its NOTHING for a couple of months. I am going crazy and he won't admit there is a problem so I can't get him to seek help! AAAAAAAAHHHHH! Besides frustration, it doesn't help on the rebuilding trust issue. I am going crazy! I know you can't give me a "Professional diagnosis" or anything, but a few ideas couldn't hurt. Unforunately, I think I have tried everthing. ANY suggestions? Sincerely, A.

A:  Dear A:  There is something going on here that neither of you seems to be at least communicating, and possibly he doesn't understand. The "self-help" solution is assertive communication and productive confrontation, with goals, milestones, and assessment with "plan 'B'" as a back-up if things aren't progressing. If he won't seek professional help because he thinks that would require him to admit that there is a problem (or worse that HE has a problem, God forbid), you have three choices: A) tell him that YOU have a problem and that you need his help to achieve a satisfactory solution, and invite him to help you by going with you to see a competent therapist (works with some men and women); B) lower your standards for what you deserve in life (bad choice); or C) vote with your feet: give him an ultimatum and if he does not respond satisfactorily (note that "doesn't is the operative word here, not "can't" or "won't"), assess what you have learned (if it doesn't turn out the way you wanted it's a "learning experience"), dust yourself off, salvage what you can of your self-esteem, remind yourself that you deserve better than this shoddy treatment, recite over and over again "I have too much to offer to put up with this poor quality of life" and MOVE ON! In any of these three scenarios you would benefit from the values clarification of a competent relationship therapist. This is not an "infomercial" for therapy -- there are excellent reasons why psychotherapy exists. Your circumstance proves my point! For your sake, do SOMETHING! The longer you perpetuate the status quo the older you get and the more "accepted" it becomes. Best wishes.

6/2/98 Q: My fiance and I have had a sexual relationship for the past six months. He has no problem getting and maintaining an erection, but he cannot seem to reach the point of ejaculation through intercourse. We have been using condoms and he says that the problem is that the condoms reduce the feeling too much. He is able to ejaculate when he masturbates, but I don't know if he would feel comfortable masturbating in front of me. I am able to orgasm very quickly and he wants to have sex for extended periods and I am not able enjoy intercourse for that long without getting tired and losing my interest. I have been able to bring him to the point of ejaculation through oral sex, but only on three occasions and it took at least thirty minutes. This situation is very frustrating. I am very sexually satisfied, but I feel that he is not. He doesn't complain about it or express that it frustrates him, but I wish to alleviate the problem. I don't know what to do about it or how to talk to him about it without hurting his feelings or giving him further anxiety about the issue. Is it possible that there are some underlying psychological issues that I don't know about or could it just be technique and comfort level? What do you suggest?

A:  Inability to ejaculate during intercourse is identified in the professional literature as "Male Orgasmic Disorder". The cause, as a practical matter, can range from simple neurological conditioning, through frustration and irritation at "having to" wear a condom, to control and anger issues. There are plenty of other sample points along the way but I wanted to present a thumbnail sketch. I prefer to exhaust simpler possible explanantions and interventions before appealing to anything more complicated. In the absence of medications, fatigue, or other immediately possible contaminating factors, I suggest experimenting with added stimulation. Engage in a number of "clinical trials" that are NOT ROMANTIC -- they are sexual "homework". Have either of you stroke his penis with lubricant before installing the condom. Keep the stroking going while you and he "get into position" for intercourse, and segue smoothly from the hand to the vagina, maintaining the motion. If you can time this so he is about to ejaculate just before he enters you, and he ejaculates inside you, strive from trial to trial to increase the length of time his penis is in you before he ejaculates. This "re-programs" his brain's interpretation of the sensations. If this doesn't do it, get help from a sex therapist sooner rather than later -- the longer you rehearse and repeat his inability to ejaculate during intercourse the more "chiseled" it gets in his brain. Please let me know what happens.

6/2/98 Q: Hello Sex Doc,

After procrastinating a few weeks I got around to calling a few clinics in search of an experienced sex therapist. I had tried the one internet source you advise with little success in the Milwaukee area. The receptionists at the local clinics said I would receive a call tomorrow from a therapist for an appointment or referal. In the meantime I thought I'd check for internet information again and also went to your site for new postings of Q and A. To my suprise your response to the first question in week #9 dealt with the Madonna Whore complex and fear of committment.

I am familiar with the Madonna Whore complex and recognize that I have a fear of commiitment. I'm 29 and single. I emailed you a few weeks ago about what I consider a very strong sex drive and fear that I wont stay excited with the same person in the event I ever get married. I've been in a few 1-3 year relationships that, although sex was good or great, I eventually started to lose interest in the relationship(s) for one reason or another. I usually embrace the freedom I get when I am single again, primarily because it opens the door for sexual encounters of a new and fantasized type. However within a few weeks or months I usually start to miss my ex girlfriend a lot and look back upon sex as something that was very good. My last relationship was especially nice but she was 8 years older and this made me especially concerned that I may lose sexual interest in her down the road. I enjoy pornography and am sure I make mental comparisons even though I feel I understand the difference between acting and what one can expect in a monogomous relationship.

I let this last relationship come to an end on the grounds that I wasn't ready for children and she being 37 would need and want to start a family sometime in the next couple of years. To me marriage will be a very big step and the short time allowance between marriage and kids felt like a recipe for disaster. I miss her now and am wondering if I did the right thing. I've enjoyed my sexual freedom or at least that I can call local chat/dating lines and have relatively inexpensive phone sex without feeling guilty as often and as much as I'd like. I've met one girl for a blowjob which was great at the time but pretty empty afterwards because she wasn't the kind of person I'd consider a relationship with. I also have been watching more pornography and feel pretty perverted a large part of the time. I scared myself a few days ago because I was masturbating while driving down the highway. I realized I could be viewed by vans and trucks on my right. I got very excited when I saw a female driver and got into position so she could see if she looked. She didn't and I quickly finished and then felt bad that I did what could get me in trouble or offend someone else. Everybody: Please see the Caution note, below

I know you can only gather so much info from emails. I would like to know if you think the Madonna Whore complex and fear of committment are applicable to my situation and if they are areas I need to learn more about. I'm feeling scared and worry that someday I might be that 50 year old described in the posting. Still I wonder if maybe I'm just a healthy single 29 year old male that hasn't found the right person and gets a little sexually frustrated after being single for a few weeks without sex. I feel very mixed up. Any further thoughts or suggestions? Thanks, M.

A:  I could write a whole book on this topic, and what I will take the time to write here will be necessarily incomplete. I endorse being pretty certain about who you want to spend the rest of your life with, and I think that means having experience intellectually, emotionally, and physically with numerous partners. No long-term partner can provide the thrill of being with a new partner, by definition. The information -- the data if you were running an experiment -- that is not available to those who have not committed to a long-term relationship has to do with the transition from the thrill of "getting to know all about you" to the security of acceptance, deeper love, companionship, and being there for each other through good times and bad.

One of the disadvantages of the Whore-Madonna complex (from "have sex with everyone you can but marry a virgin" to "sex before marriage is OK but after marriage it defiles your perfect wife") is that it interferes with the quality of sex after marriage. You could get stuck with a wife who doesn't want to be sexual as often as you do, or you would be inhibited from being sexual with her after marriage. Don't confuse a "fear of commitment" with a healthy concern about making a mistake by marrying someone with whom you have doubts. And, don't confuse a reduction in the thrill of getting to know a new lover with "losing interest in the relationship after a few weeks". Men want novelty, freedom, and flexible stimulation, but obtaining that into "middle age" comes at the price of a long-term stable secure relationship. Clarify your values until you're "pretty sure" then make a commitment. If you expect to be 100% positive, forget it -- this is an imprecise science, and there are no life-long guarantees.

CAUTION: Most states have serious consequences for sex crimes, and exhibitionism (masturbating in your car while viewable by anyone else) is dealt with HARSHLY! It's a thrill but please weigh the benefit against the possible consequences!

6/1/98 Q: dear doctor, I am a 18 year old girl and my boy friend refuses to have sex, cos either of us are virgins. So i tend to masturbate and i do it almost daily, now my clitoris has slightly loosened, i am scared that this would make it difficult to later have sex with my boy friend. i want to know if masturbation bad for the health and do males masturbate? awaiting your reply

A:  I applaud your boyfriend: You are both physiologically ready for intercourse but not yet emotionally prepared for the consequences. I don't know what you mean by your clitoris is "loosened". Sexual behavior that is not bad for you (rape, incest, or otherwise inappropriate) is good for you -- it strengthens the immune system and is an anti-depressant. Yes, most males masturbate.

6/1/98 Q: Dr. Fitz, I am a 16 year old male who has never been in a real relationship before. My neighbour, who is also 16, who i have known of for 5 years, but really only known her for the past few months. I cut their (the neighbour's) lawn, and for the past three weeks, she has invited me in for something to drink, and we end up talking for about 30 minutes. Today, she was the only one home, and she wanted to go swimming, but didn't want to go by herself (in case she hit her head...). She came over, and i answered the door. She asked if my sister was home. She was, but she was with her Tutor. I said that, and without missing a beat, she asked is i wanted to go swimming. I said sure, and we were swimming and talking for over 2 hours. When she came to our door, it is impossible to not see the dining room, where my sister was with her Tutor. When we did go swimming, she came out in a bikini (i know she has one piece suits from when she swam with my sister two weeks ago). What i am asking is from the info i have given you, do you think that she (neighbour) is being friendly, or trying to "hit on me"? Thanks a lot.

A:  If by "hit on me" you mean get you in bed for sex, I think the probability is low. It sounds to me like she is spreading her wings and exploring the world of social interaction with the opposite sex. I suggest that you respond as you wish -- "yes" if you have the time; "no" if you're on deadline for your homework, chores, etc. -- and gain some experience is getting to know someone and relating as a person before you entertain sexual activity. Plus, I suggest that you feel flattered that she is showing an interest in you. But that alone does not constitute "hitting on you". In a few years when you have had some sexual experience, and someone "hits on you", you'll know it! Enjoy!

6/1/98 Q: Dear Doc My wife and i have been married for a year but up till now we still are not able to have proper sex due to difficulties of entry into her vagina. Everytime when i attempt to enter her she will experience a gruesome pain which halt the whole process. I have to admit that i too feel the great pain in the penis which prompt me to suspect that i may not have targetting the "correct" hole. However, this is unlikely because if that is not the hole, then where can it be??? Could it be something is wrong with her opening? If this is the case, what can we do to solve this problem and end this nightmare of ours which has been impairing the quality of our marriage life up to a significant extent for a year. Thanks very much.

A:  It's the hole between where the liquid waste comes out and the solid waste comes out. When she's having her period, it's where the bloody tissue comes out. I suggest gentle experimentation with a well washed, well lubricated little finger. If she can't tolerate gradual dilation of that center hole with one, two or three fingers without pain, start with a gynecologist, and expect that you might be referred to a sex therapist. "Discomfort" is tolerable -- the stretching of the opening is sometimes uncomfortable at first. But it should never be "gruesome". Get help before repeating the same experience.

6/1/98 Q: Someone told me that when sperm goes through the air toward the woman's vagina, the sperm becomes dead due to the air around it. Is this true?

A:  NO! Sperm are surrounded by the jelly-like liquid from the prostate gland that keeps it wet, warm, and well fed in preparation for the marathon swim up into the woman's body. Air is not a contraceptive!

6/1/98 Q: Hi- I am a 18 year old female and my boyfriend (22) have been going out for a year now and just recently have started having intercourse but I seem to cum right when we get started or a short time after we have started with the fore play so my question to you is: Is there any way I can keep control of myself and kinda hold it in until we are a little more in the mood? I am aware that this question was kinda asked in the week number nine by a woman named Heather but you never really refered to this question you really focused on her first question. I would really appreciate a response to my inquiry and thank you for your time.

A:  What makes anyone have an orgasm ("cum" in slang) is neurological stimulation -- contact with nerve endings. It is COMMON  for people with modest sexual experience to have quick orgasms -- men and women! Some guys will ejaculate the second a hand or a woman's other body part(s) (ahem) come in touch with the tip of the penis. Some women have an orgasm from ear, neck, nipple, or thigh stimulation alone! It takes experience and if you want to prolong the event, avoid contact with your erogenous zones. Does this answer it for you?

6/1/98 Q: Dear Dr. Sex Doc, I'm an 18 year old female who has just recently lost her virginity about 2 weeks ago. Since that time, I have had sex a total of 4 times. The first time, was just as i expected, painfull as hell. I bled a little and he barely got the tip of his penis in. The next day i was a little sore. The next 2 times we had sex, we got it in a little farther, I was still in very much pain and recieved no enjoyment what so ever. He on the other hand, had a fine time having his orgasm. Still, he felt as if I had to be stretched out farther, so he continued to pull out and insert again. We did this a total of about 10 times. By that point, I was numb and felt little pain. He was concerned by the third separate day we did this that I would never enjoy sex. We took a week and a half break and tried again. This time, I felt little pain and he was able to fully penetrate. I still recieved no enjoyment from the sex. I have never been able to reach orgasm or even come close. I feel pleasure but not very intensly. I have tried masturbation both by him and myself and oral sex and none have gotten me near orgasm. I really want to feel the pleasure that he feels and share it with him buit right now it's impossible. Help! upset and worried

A:  First time intercourse doesn't have to be traumatic! Please do not draw any conclusions about your sexual response until you have had more experience! I suggest that you suspend repeating your attempts at orgasmic intercourse until you have been able to determine what your body wants and needs to achieve orgasm. Please read Lonnie Barbach's book "For Yourself" and no matter how simple you think the exercises are, please do them one after the other. When you are able to reliably bring yourself to orgasm, then teach your then-current lover what works for you. Because only about 40% of women experience orgasm during penile-vaginal thrusting, you might find it more enjoyable to touch your clitoris before, during, or after your lover's orgasm. If you can muster the courage, talk to other women about this. If you still can't achieve orgasm, contact the professionals around you. There are women's group therapy and support groups focused on this topic.

6/1/98 Q: Hello. I have a question for you. My girlfriend and I have started to have sex and we've tried maybe 8 times now. I'm having a really hard time ejaculating inside of her. I'm 21 years old and I don't think this should be a problem. We use condoms and I think that maybe I'm just not use to them yet. It just doesn't feel that good. Can you recommend something? A good brand of condoms? I don't know.... This is really frustrating for me. My girlfriend going on the pill is not an option. Thank you for your time. I look forward to your reply. Signed, Frustrated

A:  Dear Frustrated: It might be anxiety or fear of pregnancy. Are you cool, calm, relaxed, and comfortable? Try "Lambskin" or other ultra-thin "natural" condoms -- or try Trojan-enz Large -- but note: the former stop sperm but not viruses, so they are not "safe sex". Otherwise, try re-conditioning your sexual response by stroking your penis before penetration, to see if being closer to ejaculation can help. A few "clinical trials" that are educational and not romantic might set you off in the right direction. Let me know what happens.

6/1/98 Q: Dear Doc. I really hope you can help me. I have been with my fiance for 2 1/2 years. We are both madly in love with, and attracted to, each other. We also enjoy sex immensely, but I have never achieved orgasm. I guess this is a common problem for women, however, all the advice I get is to explore myself and learn to orgasm through masturbation. I am very familiar with my body and although I masturbate (and enjoy it!) I can't make myself orgasm. I realise orgasm is not the goal of sex, but I am starting to get very depressed about this. Both my fiance and I are 20, I have no real stress other than my University degree, and we are both very happy. Please can you help?? P.

Dear P. I am tempted to publish on the web only questions to which I have insightful and informative answers, but alas, I hope the following will make it clear that this cannot always be the case. Female orgasm problems are complicated matters. If you are positive that there are no hormonal or other medically-related circumstances that should be addressed first, then you can focus on assessing the psychological factors. But don't go there until the medical possibilities haver been ruled out -- you'll only frustrate yourself trying something behavioral if what you need is medical! My standard advice is to encourage you to do all you can on your own before seeking help from a sex therapist. If you haven't gone page by page through Lonnie Barbach's book "For Yourself", start there, but DON'T SKIP  AHEAD. I have had too many women go back and start over after skipping ahead to find that the key to their progress came from something in the basics. If proceeding slowly and methodically through that book doesn't do it for you, I suggest talking with as many girlfriends as you can get to volunteer time with you. A vibrator can produce diagnostically interesting information, so long as you don't hold it in one place too long and go numb. There is group therapy for women who are pre-orgasmic (the glass is half full, thank you), and if all else fails, then consult a sex therapist. Please let me know if (and when) something along this stream results in an orgasm.

6/1/98 Q: I sometimes have lessbian thoughts, I am married, and do not want to actually be with a women. But an am curious about this sometimes. I recently made a friend on the internet, and she is bi, and she tells me that basically i am just holding it in cause i am scared, and that i need to talk to my husband and do something about. I alawys figured it was just a fantacy, people have thoes but dont need to act on them do they? she got me so confused, I no that i am not homosexual. But if i have thoughts like that does it automaticallly meen that i am bisexual? I dont think so but now she has me wondering. Please help i am sooo mixed up

A:  For both women and men one of the earliest symbols of peace, security, and fulfillment of needs is "mother". Being held in mommy's arms, with our face nestled between her warm, supple breasts is a primordial concept that creates a sense of well-being in most people. For heterosexual men, the re-creation of this is easy -- suckling at the breast is both a form of foreplay and a symbolic return to infancy. For heterosexual women, however, it introduces confusion between wanting to regress to infancy and wanting a lesbian sexual experience. If you want to be held tenderly and just cuddled, communicate this precisely to your husband. If you want a currently age-appropriate (grown-up) sexual experience with a woman, discuss this with your husband. If you are having trouble deciding between the two, consult someone who is neutral -- a competent relationship therapist. Not only do people NOT NEED to act on their fantasies, often, reality is overwhelmingly less thrilling than the fantasy itself, and after acting it out, the fantasy loses its stimulation value. I suggest that you take a conservative approach: get your head straight before acting on impulse. Once done, you can never go back.

6/1/98 Q: My wife and I have been married for 4 years and our sexual relationship has progressively gotten worse. I enjoy sex and could have it daily. My wife, however, does not have the same sexual appetite. We have sexual intercourse about 3 times a month and we both agree a change is necessary to save our marriage. My wife can't explain her decreasing sexual interest. When we have sex it is brief and my wife often complains about it being uncomfortable. I have noticed when she is really sexually aroused she has no discomfort. The times she does experience discomfort seems to be the times when she really isn't into the sexual intercourse. Because of this I have ruled out the possibility of some medical reason. Her OB-GYN has also been unable to find a medical reason for her discomfort. I believe it is a result of her decreasing interest in sex. We both would like some suggestions to increase her desire for sex. Thanks, B.

A:  What jumps right off the page (OK, screen) at me is "When we have sex it is brief ..." and " ... when she is really sexually aroused she has no discomfort." How brief is brief, and how aroused is she when you attempt intercourse? If 3 of every 4 times you had sex it hurt, you'd want sex less often or you'd figure out the difference between the painful and the pleasureable times, right? If she is not aroused enough, and you attempt intercourse, and it hurts, I would expect her to want to have sex less and less often. It seems to me that if you wish to have sex more often, the prescription is in your question: make sure she is really sexually aroused so that she does not experience discomfort. P.S.: When is a woman ready to be penetrated? 99/100 men and 97/100 women will answer "When she lubricates". Wrong. After she lubricates, the vagina "tents" -- that is, it creates space internally. A small number of women can feel the internal shift. So, to increase her desire for sex, make it as pleasureable as possible, and as discomfort-free as possible. Tell me if (and when?) this works.

6/1/98 Q: Please help, my husband and i like to play around with toys, but when >we use dildoes, I have a problem. I get a rash, and get really >sore, cant pee for like a week. not really but i think you get the >point it burns. We wash it with antibacterial soap after each use, and >we use lubrication, so could i just be alergic to the material? Does >that ever happen? Please let me know, it kindof makes it hard to play >around. Thanks > > >

A: My first thought is that maybe you're not rinsing all the soap off. My second is that the dildo is subtly abrasive to your labia and the tissue around your urinary opening. The burning so you can't pee for a week (exaggerated, you say) suggests a UTI (urinary tract infection), which can occur if too much rubbing around your urethra (the tube where the pee comes out) massages "stuff" from outside the urethra up it, irritating the inside of the urethra (which is what feels like burning when the acidic urine flows out).

Do an experiment: Cover the dildo with a condom. Lubricate it thoroughly with a water soluable lubricant (KY, for example). Make sure that whatever hands (and whatever else) touch(es) the condom-covered dildo is (are) clean and well rinsed. Use the dildo like you always do. If you don't have the burning after-effect after using the condom-covered dildo the cause of the burning was probably chemical or bacterial. If you still get the burning sensation, the cause could be mechanical -- massaging stuff up your urethra -- OR still chemical or bacterial if the outside of the condom-covered dildo is getting contaminated AFTER you put the condom on that sweet thing.

NOTE: If you're moving the dildo straight in and out, the chance that you are massaging your urethra is less. If you are angling the handle of the dildo "up" so the tip points more toward your anus, causing the handle to rub against the upper part of your labia, this is likely causing both more stimulation to the clitoris AND more stimulation (and likely, irritation) to your urethra. If you're angling the handle of the dildo "down" so the tip points more to your head, the tip could be internally rubbing against the root of your clitoris (see a diagram in a sex ed book for this) AND rubbing internally against your urethra (through vaginal tissue). Experiment with the mechanics. Let me know what works.

She has stopped having orgasms (7/21/97)

Dear sexdoc: My partner and I both left long standing relationships to start ours. Neither of us has had any history of sexual problems. For the first two months she was always able -- and fairly quickly -- to reach her climax. Now (our relationship is four months old) she never makes it or does so partially, in a way that is not at all satisfying to her. This problem started when we started having emotional doubts (we came close to breaking up). She likes to be on top because she can make my penis touch a particularly sensitive area that helps her orgasm. She says that I no longer touch that area. And because she's frustrated, she's not receptive to me bringing her to orgasm in other ways. MY QUESTIONS:  1) Is it possible that my penis is too small (and that initial success was due simply to the excitement of a new relationship? 2) This problem is now affecting my ability to attain or maintain an erection. Should I use an erection cream? 3) She has suggested having sex with a former boyfriend to see if this problem is hers or mine; what do you think? and 4) Do you think this could be the result of the emotional doubts we had two months ago? David.

Dear David: Thank you for the question! I am pleased to answer it publicly because I know from professional experience that there are lots of readers who can identify with this. Because of the coincidence of the emotional doubts with the onset of the problem, and because you mention no other systemic (body) complication, this really sounds like psychogenic (mind-emotionally caused) anorgasmia (inability to orgasm). To provoke everyone's thinking: Do you think your partner would be equally eager to have YOU have sex with a former lover to see if you have the problem? Your biggest sex organ is between your ears (not between your big toes). Feeling safe, comfortable, secure, and affectionate make for the best sex, and if you're having doubts and are frustrated and worried that there might be a problem, you've got a great set of ingredients for guaranteeing that there will be a problem!

I doubt that your penis is too small (female readers note one of the first male concerns!); if she's on top she controls where the tip of your penis rubs her internally. Erection creams are topical anesthetics and simply diminish neurological sensation. If used without a condom they also anesthetize your partners labia and you both end up feeling like you're having intercourse with a cadaver! PROACTIVE SUGGESTIONS:   Show your partner your question and my answer. Talk with each other intensely about what your doubts are and what you each need to hear from the other person to help you feel more secure. Don't fall for the myth that "The only real sex is penile-vaginal intercourse". Using your fingers, tongue, or any other body parts, have her tell you exactly what to do to bring her to orgasm without using your penis. After you have done this a few times, get her excited so she is very close to orgasm, then penetrate her vagina with your penis and use her or your fingers on her clitoris to guarantee an orgasm. Recondition your bodies to expect reward instead of doubt and frustration. Gradually transition from 95% non-penis stimulation with 5% penile thrusting to 50% - 50%. By the way: turn about is fair play -- during the "training" sessions when you're bringing her to orgasm, after she has caught her breath after her orgasm, have her touch you with you giving her precise instructions! If that doesn't work, you have three choices: 1) seek professional therapy; 2) terminate the relationship; or 3) perpetuate an incomplete and frustrating relationship. p.s. I'd love to hear how things progress!

Short Penis (7/18/97)

Dear Sexdoc: HELP!  I am a 32 year-old virgin with an extremely short penis, even when erect. I am terrified to be with a woman sexually for fear that she will laugh at me! Are there sex clinics I can go to to be with a woman?

Dear Terrified:  Because you make no mention of medical evaluation, I suggest that you start with a Urologist. As far as sex clinics, I discourage using professional sex workers for sex problems because the results often do not carry over to an affectionate relationship that has emotional importance to you. If you are destined to spend the rest of your life with a penis so short that it cannot penetrate a woman vaginally, I suggest that you link up with a partner who appreciates the broad array of sexual behaviors you can provide to her, and, best of all worlds, find a woman who would enjoy the never-ending erection that could be provided by a dildo you could strap on and engage in intercourse with until she begged you to stop. Such women do exist!

Penile Lengthening (7/17/97)

Dear Sexdoc: How effective are techniques to lengthen the penis? I have heard good things about surgery. What about vacuum pumps?

Dear Wannbe Longer: WAIT!!!!!! Current techniques for surgically increasing the length or girth (circumference) of the penis are CRUDE and full of subsequent complications. Here in the U.S. there are horror stories of plastic surgeons creating ugly results with unforeseen complications, and malpractice lawsuits. Until the surgical technology gets perfected you are at great risk to go under the knife for your penis. VACUUM PUMPS:  I will be unpopular with manufacturers of expensive pumps saying the following, but in my experience with patients, the penis is obliviously ignorant of the cost to produce the vacuum it finds itself in! Vacuum pumps are available from most mail order houses (see on my homepage links to Good Vibrations and Adam and Eve). Expect to pay around $19 to $45 U.S. I have seen the exact same pump for sale for $19.95 one place, and $49.95 in an advertisement appealing to older men who want absolute confidentiality for the humiliating problem .... etc. In other words, if they're selling the "scare" of "fix the problem" the price will probably be higher. So, buy one, try it, BEWARE over-inflating -- you could cause tissue and blood vessel and nerve damage -- and BEWARE leaving a constricting device at the base of the penis on too long. By preventing blood trapped inside the penis from escaping, which produces the erection, you are also cutting the penile tissue off from its supply of OXYGEN.

CONFLICTING TESTIMONY: While I have heard men complain that using a vacuum pump achieves only temporary results, I have also read accounts of some men who claim to have added 1-2 inches on the length. How many times they had to use the pump, I do not know. But it's no panacea. My encouragement is for you to focus more on the broad spectrum of sexual technique than worry about the length of your penis. Best Wishes!

Too Many Movies (7/17/97)

Dear Sexdoc: For three years my only sexual release was masturbating while watching pornographic movies. I now have a girlfriend, and I'm very aroused and attracted to her sexually but the last few times of intimacy I've been unable to achieve orgasm. Because of our work schedules it's sometimes only possible for us to make love on Friday evenings. How can I break my reliance on adult movies and maintain a healthy sex life with my girlfriend?

Dear Moviewatcher: Your biggest sex organ is your brain, and while watching movies, you can achieve a state of fantasized perfection that can never be topped by reality. I suspect that you have conditioned your reptilian brain (the part that makes you lust even after sex partners you can't or "shouldn't" be sexual with) to be spoiled by the novelty and the unexpected events in adult movies, coupled with the "perfection" of stroking yourself with exactly the tempo and pressure and location that feels best. I suggest that you spend 30-60 minutes in foreplay and that you and your girlfriend take turns dictating what you want the other to do to you. How about her giving you explicit instructions for ten minutes, then you giving her precise commands for 10 minutes. After 40 minutes (Her, you, her, you, for 10 minutes each), if she isn't very lubricated, and if you don't have an orgasm within a few minutes after penetration, something else is going on and you would be well advised to ABSTAIN from further attempts until you get professional help. If you DON'T ABSTAIN you can further condition your sexual neurology to be insufficiently aroused by your girlfriend. P.S.: If it's any consolation to her, please reassure your girlfriend that it's not her -- I speculate that you would have this problem with any woman you intended to be sexual with.

P.S.: GORDON:  when I attempted to send an e-mail to you my mail server reported "unable to deliver". I hope you see this (and if you do, please send me a note letting me know that you got the answer).

Low Sexual Desire -- with Complications (7/10/97)

Dear Sexdoc: What do you recommend as the best course of action to enhance one's sex drive? I had a traumatic introduction to sex over 20 years ago, but am now married to a wonderful man. I enjoy sex with him but am frustrated that I don't have more desire for him. Unfortunately, part of me is extremely resistant to any kind of coercion to change, even if that coercion comes from myself. Should I see a therapist?

Dear frustrated: WOW!  There are numerous points here. Your "lovemap" (essentially what turns you on and determines how often you want to be sexual) is created by complex forces some of which are quite obvious, but some of which are elegantly subtle. While there are lots of pop psych books on how to enhance your (monogamous) sex life, no book can assess the extent to which your traumatic introduction to sex is now influencing your ability to give yourself more often to your husband (which you feel as "desire"). If you see change as resulting only from coercion, I urge you to resist it. But if you contemplate that a different reward incentive can be put in place for you to want more reward -- at the cost of changing for the better -- then I would expect you to make the change to get the reward.

It might be that your lovemap calls for having desire for your husband exactly as frequently as you now feel that desire. But in over 30 years of working in this field I have found that over 90% of men and women harbor inhibitions that interfere with being sexual more often than they are when they walk in to sex therapy. I SUGGEST that you do consult a competent sex therapist to sort out your traumatic introduction and your current state of desire. Your question also inspires me to add to the "sex therapy" section information about what you can expect from sex therapy. Thanks for your question. I hope this helps.

Intercourse painful for the woman (7/3/97)

Dear Sexdoc: My wife and I are 28 years old and we have been married for 5 years. We were both virgins when we married. Since day one intercourse has been painful for my wife. She has consulted 7 doctors and had two surgeries but nothing has eliminated the pain. We have had intercourse maybe 20 times in five years. We now have a beautiful 8 month old daughter. The doctors said that a vaginal delivery would help stretch her out and solve the pain problem but she had a C section. Can anything be done?

Dear Almost-still-a-virgin: The tip off is "The doctors said that a vaginal delivery would help stretch her out ...". Several years ago I had a patient with exactly those symptoms. Herself a health care professional, she did an exhaustive medical literature search and found a then-recent article on "Non-specific Dyspareunia" cataloging only 10 known cases in the Gynecological literature. All were mysterious to the doctors, but it was noted that 6 of the 10 had subsequently given birth vaginally, and all 6 reported no pain during intercourse after their vaginal deliveries. Stretching does seem to play a key role. I suggest that you ask her OB-GYN if some other stretching could now be done.

ALTERNATIVELY:  You make no mention of a psychological work-up. If we keep an open mind and entertain the possibility that this is in whole or in part psychosomatic, then you might have more to work with. Because you both were virgins when married, I infer that your initial sexual encounter was not as polished, suave, and sensitive as it could be -- you are not to blame for having no prior experience. If the first encounter was painful for her, such as from the tearing of the hymen or from penile penetration prior to sufficient lubrication and introital (entrance to the vagina) relaxation, then she might have anticipated pain during the second encounter, which could have encouraged a form of vaginismus (painful spasm of the vagina). If the self-fulfilling prophecy of expecting pain, clenching the vaginal muscles, and experiencing pain, is repeated over and over, it becomes almost guaranteed. Don't overlook the psychological possibility.

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