Sex and Relationships

Sexual Dysfunction


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Answers to questions about sex therapy and sexuality

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6/8/98 Q: Hi,

Let me just tell you that I think it is wonderful that you offer your time to help those with problems that are so scary for them they don't know who to turn to. It is much appreciated!!

I am an 18 year old female. I have been with the same guy for about a year now. I haven't had sex with him. During our encounters he rubs my clitoris repeatedly. Normally I have great pleasure, but lately it seems to be more painful than anything. My clit almost seems to be swollen. I am a virgin, so STDs are out of the question. Is this normal because of agitation, or do you think I may have a real problem. I am kind of scared. I would really appreciate it if you would get back to me a soon as you can. Thank you for your time. C.

Dear C.: The question is whether it's behavioral or medical. If "lately" means that your clitoris gets stimulated vigorously more often than usual, I wouldn't be a bit surprised if it gets irritated and swollen. Avoid stimulation for several days, and when you resume, be ultra-aware of the skin irritation possibility. If you are using sufficient lubrication and there has been enough time for the tissue to "settle down" from the last time it was irritated, you should experience no discomfort. If under "reasonably gentle" stimulation it gets irritated and swollen (more than usual from stimulation), then check with a medical doctor. Were you having orgasms before? When excited enough, the clitoris does become erect and appears swollen. Be sure that what you are feeling is not just more intense sexual excitement than you have ever felt before. p.s. I hate to tell you, but STDs are not out of the question because you are a virgin. If he were to rub your clitoris with a body part that just touched an oozing herpes lesion, for example, there is the possibility of contracting the herpes virus. Please review STD material carefully. That having been said, I have never heard of an STD of which the first symptom was a sore clitoris (but I'm not an M.D., so such a case might exist).

6/8/98 Q: I am 34 year old woman on birth control. I have been married for 7 years and have sex less than 12 times a year because it is not pleasurable to me and my husband even says it hurts him. We had sex nightly our first year together, but our relationship became very stressful with arguments and that's when the sex stopped. We started working together which ended some of the stressful arguements, but came with its own problems, like we are together every day 24 hours. Every year, we said it was just because our business was new and took a lot of our energy and once we got more profitable and stable, we would work on our relationship. The business is over 5 years old now and we are becoming more and more successful, but I feel like we can't get our relaitonship back together after all these years of not being intimate. I've gone to a GYN and he referred me to a physical therapist who has used an electric probe with biofeedback and said my muscles seemed to fine. She has poked at the internal muscles of the vagina and I have proclaimed it painful. She said in healthy tissue, it wouldn't hurt, so she has been internally masssaging the painful spots once a week for about 4 weeks. She says they feel more normal, I think I agree they're less painful. But, when I try to use a small diameter probe, I can get it in, but if I try anything larger, with lubrication, it just doesn't want to fit. I can force it in, but that's the whole problem of sex not being pleasurable. Even if my husband and I take 5 minutes to slowly force his lubricated penis in me, the vagina still doesn't loosen up. He says it feels sharp and painful to him, and of course it hurts me. We did have "normal pleasurable sex" before in our relationship, but he has always been a little larger than I feel comfortable with. Several times I have gotten a bruised urethra from sex and had spasms with the muscle which was extremely uncomfortable. My husband says even when we were having regular sex I always felt tighter than any other girl he had ever been with. And I do remember (before we had problems) many times after sex, having a burning sensation that felt like maybe I had torn skin and the semen was making it burn. Is there any operation that can make sex more comfortable for me? I also feel like I don't even feel any interest in sex anymore, but I think that has just come over time from knowing that it won't be an enjoyable experience. I feel like either I have a medical condition, which makes me too small for him to begin with, or that maybe if I could just get aroused and have pleasurable sex without pain just a few times in a row, I feel like I could get back to normal. I can't convince him to see a sex therapist, but I don't know if I should be wasting money trying to get blood tests run to see if I have hormonal problems, etc. if all I need is a therapist. Also, is it possible for an undetected std to cause these problems? My doctors have never tested me for any. Seven years is a long time for a married couple to go without sex and being intimate. I'm lucky we have any relationship left- but I know time is running out. If we don't start having a reasonably satisfactory sex life soon, neither one of us is going to want to stay together. >If you could give me any possible medical reasons for this problem, I could at least ask my doctor about those possibilities. >Thank you for any help.

A: One of the most challenging aspects of sex therapy is the differential diagnosis. Because you had sex nightly during your first year together we can infer that there was no medical or psychological complication then. When you started having arguments the sex stopped. You say that you were checked by a GYN and that he referred you to a physical therapist. I am presuming that the GYN would not have made such a referral if there were any medical condition he should be treating.

Therefore in the absence of an intervening medical complication, I would entertain the idea of functional vaginismus -- that is, you can accept a probe smaller in diameter than your husband's penis, but anything bigger hurts. If every time you attempt intercourse it hurts, I would expect anticipatory anxiety and protective clenching of the introitus (the opening into the vagina). I suggest that you satisfy any lingering curiosity you have about medical conditions by again reviewing the matter with your GYN or internist, and if none emerges, I suggest sex therapy. There are behavioral protocols for dealing successfully with vaginismus, but they take time, patience, and work best if both partners are engaged in the process. If your husband won't accept sex therapy, you have a choice of perpetuating your asexual and painfully sexual experience, or of doing something different. The longer this continues, the more time it will take to reverse it. You are 34 years old. Please don't wake up at 44 and ask where the last ten years went. Any questions?

I am the 34 year old married 7 years who just sent email a few minutes ago. I wanted to add that even when I am enjoying sex, I have to spread my legs wide open and preferably in the air to comfortably accomodate my husband. When we've tried to do it doggie style it is just too tight. Or any time my legs aren't wide open. I just wanted to add that because I know that my vaginal opening is smaller than average and my husband has a larger than average penis. Can this be causing my problem?

This would support the idea that it is not a medical problem but a muscular clenching -- which is partially ameliorated by spreading your legs as wide as possible.

6/8/98 Q:  Dar Doctor,

One day, I happened upon my fiance's pornography collection. It was some pretty hardcore stuff but rather than immediately put them back, I let myself go through the pictures, perhaps to satisfy my curiosity as to why men buy these magazines.

After that first time, I found myself looking at the magazines on occassion (not frequently), and, to be frank, became fascinated by the vaginas of the women in the magazines. I would look closely at their stretched-out pussies with hanging lips and all and think of my own one, which didn't really resemble theirs, being much more tame-looking, I suppose.

About a month ago, my fiance actually caught me reading these magazines but he didn't have an idea of how closely I was examining. I get quite excited looking at the pictures and the sex that followed his finding me reading was particularly good.

The next week, I made a decision that I would like my own pussy to be similar to the women in the magazines and told my fiance about my secret fetish. He said that it was fine by him and that he figured since we're planning to be together and having sex for the rest of our lives, my vagina would end up looking that way anyway. Plus, he admitted that my transparency was surprising but turned him on all the more. He had a brief question on whether I was turning lesbian or something but I had thought about that myself and I told him confidently that that wasn't the case since I had considered that possibility earlier and dismissed it after some time thinking about it. I told him that I've just really latched on to my first real (and personally, rather kinky) fetish.

Problem is, we have no idea what to do now. We've been having sex for four years now, about four to seven times a week, but I don't have vaginal folds anywhere close to what I see in the magazines. Do you have any idea what we, as a couple, or I, by myself, might be able to do so that my vagina might more closely approximate those that I look at in the magazines?

Very truly yours,

C. D.

A:  Dear C.D.

I'm not sure what you saw, but if I put together "pretty hardcore" with "stretched-out pussies with hanging lips" I suspect that these are women who were selected for the appearance of their genitals or who have had a great deal of sexual excitement without resolution. Anatomical studies of prostitutes indicate that some of them have enlarged labia and an enlarged clitoris, and the inference is that they repeatedly became sexually aroused without orgasm, resulting in tissues engorged with blood that were not resolved rapidly (orgasm causes vasodilation [enlargement of the blood vessels] allowing such tissues to "deflate" quickly).

So the answer of how to look that way is to get sexually excited over and over and over again without having an orgasm. Doesn't sound like fun to me even if you get paid a lot for it.

Dear Doctor,

Thank you very much for your advice. You're right, it doesn't sound like a lot of fun.

What was fun though is that my fiance discovered my email. He read my mail and your reply and said that even if we don't exactly know how it's done, we're going to keep trying -- our way (which means vigorous sex at least 4x/week), which IS a lot of fun and certainly turns me on.

Thanks for your quick reply. You provide a fantastic service. I wish you all the best.


6/8/98 Q: Dear Doc, My question is concerning premature ejeculation. I have read your page on the technique in postponing PE but it doesn't seem to work for me. After practicing the technique posted in your page, I can lengthen intercourse for a longer time. But its only when my girlfriend and I speed up our love making movement, faster strokes, that I immediately reach ejeculate. This pose as a problem for us since after experience many positions with my girlfriend we only found one position in which she can reach orgasm. And this position require fast strokes, which causes me to ejeculate immediately leaving her unhappy. Is there something that I can do such as taking pills such as prozac, anafril. paxil and etc or perhaps one of those desensilizing sprays. during the times which I know I am going to have intercourse. I am afriad my PE problem happends because I am not circumsized. Is there another alternate solution for me. Your expertise adivise is greatly appreciated. Thank you.

A: The solution to what you are experiencing is not drugs or anesthetic sprays -- it is in better understanding how intercourse works. Only about 40% of women experience orgasm during intercourse, and that is often in only one position -- the one where she gets enough clitoral stimulation (which varies from woman to woman -- the position, not the clitoris). I suggest that the two of you negotiate how long you want to be coupled, and when and how she is going to get clitoral stimulation enough for her orgasm, and then what position is mutually comfortable for you to achieve orgasm. If you reach orgasm first, figure out how she is going to get enough clitoral stimulation second. Yes, the bias is in favor of a woman reaching orgasm before the man because she doesn't lose an erection, and her orgasm feels better when she has something providing resistance to those luscious squeezes her vaginal muscles give to the penis. The uncircumsized status of your penis has only a mental effect on what's happening.

Dear Will,

Thanks for the suggestion. You are right this is something that I need to work out with my girlfriend. Its probably going to take alot of discussion between her and I. Since this topic always comes up and I quess she is in a way frustrated and angry at me for reaching an orgasm early. Since she has to wait a while before I erect again, so that we can resume intercourse. At some point she believes it will be better having sex with another person. Since she can't take this agony. That's why I am searching very hard for alt. to our difficulties, because I don't want her to find sex else where. This is why I tried searching many alt. way such as anafril pills or spray to temporarily relieve this agony. So I can gain control on a as need bases when she wants an orgasm. Once again I would like to thank you very much for your time in helping and responding.

Sincerely, J.

Dear "J": Your comments suggest that you believe some Great American Myths. In your case, the first is "The only 'REAL' sex is penile-vaginal intercourse." WRONG! Many people, both men and women with sexual experience, report that oral sex to orgasm is wonderful sex (very, very REAL) along with other sexual activities I will not enumerate. The second is that "The man is responsible for his partner's orgasm." WRONG! Each person is responsible for his or her orgasm -- whether by telling the other person what he or she wants or by making it happen! I suggest that you and your girlfriend talk about your sexual options and variety and being boxed in to "just" penile-vaginal intercourse. After you do some wild and crazy things other than penile-vaginal intercourse -- then assess the flexibility and choose whether you then want to restrict yourselves to the same-old same-old. p.s. Tell me what happens, please.

6/8/98 Q: My wife and I have been married for 5 years. We are both about 30. We have two children. When we have intercourse, her vagina gets sore after 3-4 minutes. We have forplay, where I stimulate her on her clitoris for 10-20 minutes. She also uses my penis to simulate herself. We have tried using Astroglide, but she still gets sore. She describes it as a burning sensation that can last for a few hours or most of the day. It usually causes her to ask me to hurry up...which can mentally slow me down. (Neither of us have any STDs.) She feels that I should ejaculate within that 3-4 minutes ("I take too long"), but I feel that she should not get sore, even if we had intercourse for 20-30 minutes (as long as she is still lubricated). Where should we go from here? It is greatly reducing her desire to make love (and mine since I don't like her to feel pain). --

A: I have stated in numerous locations that I am not a medical doctor, but when patients tell me about a physical ailment, and it doesn't sound like it's caused by psychological factors, I urge them to get it checked by their MD, and I hear about the follow-up and catalog the symptoms and medical diagnosis.

The most common diagnosis I have heard from what you describe is that it is a UTI - Urinary Tract Infection -- that is getting provoked by tissue movement around the urethra. The "burning sensation that can last a few hours or most of the day" is totally consistent with this. Another possibility worth checking is scar tissue at or near the opening to the vagina, probably caused by either tearing or an epesiotomy during vaginal delivery.

So "Where should we go from here?" is to her OB-GYN with the symptoms.

6/8/98 Q: I am a pedophile. I know this because I fit the definition (sexual >desires and fantasies of children). I've had such desires and fantasies >(for boys exclusively) since my teenage years. Except for some sexual >encounters as a teenager with other teenage boys who were consenting, I >have never acted on any fantasy or desire. I'd like to be clear about >that. I have never sought out or engaged in sexual behavior with a >child. And I have never had a homosexual encounter with an adult male. >Hard to believe, but true. I have always controlled my sexual desires >and fantasy through masterbation. It has been very unfulfilling, but >necessary for me. Though I have had these desires for my whole life, I >have felt extreme guilt and shame because of them. Actually, the guilt >and shame have helped keep them in control. But more recently, I have >discovered internet pornography and I have gravitated towards like a bug >to light. And this scares me. I don't think I can overcome my shame >enough to seek help. I've even hoped for psychotherapy or some kind of >help annymously over the internet. That is why I've decided to write to >you. Is there any advice you can offer to me? I am so tired of the >guilt and shame. And I am worried about my inability to control access >to the internet pornography. Thanks for your advice. >

A: If you don't bring this under control by yourself, it will be done for you by the authorities. The public hue and cry about pornography in general, and pedophilic material in particular, on the internet, has resulted in tons of governmental resources to catch pedophiles. If you continue to pursue this seriously and repeatedly, it is only a matter of time before you're going to hear a knock on your door.

If you can't control your internet searches, please, for your sake, muster the strength to seek psychotherapeutic intervention. If you can't control your behavior through whatever mechanism (self-control or psychotherapy, etc.) it will be controlled for you by incarceration.

For Your Information, you need a sex therapist's sex therapist. That is, 2% of the mental health care community has received sufficient advanced training to qualify as "sex therapists", and probably fewer than 5% of them have undertaken specialty training to deal with sex offenders. You're not a "sex offender" at the moment, but dealing with your problem requires someone who knows the progression from thought to impulse to action to getting caught for most effective intervention. Screen on at least A) experience dealing with sex offenders on probation, or at most B) a therapist who has been accepted as an expert witness in matters like these.

Those of us who do this kind of work would much rather deal with prevention than rehabilitation. While such patients have less motivation, presenting for therapy to keep themselves from trouble, rather than being court-ordered, they also have less guilt over having disturbed a child (or children) in the process.

6/8/98 Q: >i think that my boyfriend would like me to give him a blowjob and i just want >to know the exact way to do it > >

A: Just as each woman likes her clitoris and her breasts touched in a certain way, and that varies from woman to woman, so men have individual preferences about how they like to have their penis stimulated. Please abandon your search for the "exact" way -- read about it on the web or watch a porno flick, then ask your boyfriend what feels better to him while you're experimenting. Enjoy. And remember this advice if and when you give another man a blowjob -- what works for this man might and probably will, be different with the next one.

6/5/98 Q: Hello Doctor Fitz, I am a 19 years old male and somewhat confused. I am attracted to both men and women and have acted on both. When I have had sex with a man I feel guilty afterwards and want to get away as quickly as possible. Also I can't see myself in a deep relationship with another man. But with women I feel none of that, and a deep relationship is not a problem. What do you think of this, and what can I do to get less "confused." Thank You for any help you can give.

A:  Dear Confused: There are millions of people like you, but what sets you apart is having the guts to volunteer this and to ask for a reaction. After more than 30 years of talking with men and women of all ages about what you describe, I am comfortable with the observation that Freud was right: Most people are born "pan sexual" -- that is, able to engage sexually and emotionally with both genders. Some people are born homosexual and once they have experienced gay emotional and sexual contact they are totally "left cold" by heterosexuality. Similarly, some people are born hetero, and are totally unmoved by their own gender. In a sense, your question is akin to "who should I love more, my Mother or my Father?" The answer is that these are different experiences, not a forced choice. Sex with a man is a different experience from sex with a woman. Many happily married men are able to function quite satisfactorily sexually with another man, and during World War II many women had lesbian relationships of convenience which lasted until their man came home from the war.

I suspect that it is socialized homophobia that accounts for your guilt feelings after sex with a man. For better or for worse, you have a choice, with consequences. You can pursue behaving gay, with social difficulties, or you can pursue behaving heterosexual, with greater social acceptance (so long as age, race, deformities, etc., are within bounds). Considering your age, I classify what you are doing as "experimentation". I expect you to look back on these experiences in 5-10 years and conclude that you were glad that you checked things out. If you continue to be in some degree of duress about this matter, for, say, more than another year, please, for your sake talk to a competent relationship therapist. p.s. Homophobes will consider this an outrageous opinion. Be cautious about reactions you get about this, from gay or straight men or women.

6/5/98 Q: Hello Dr. Fitz,

I saw your website and hope you could answer a couple of questions for me. My first question is in regards to my testicles. When I masturbate my testicles go from a "hanging" position and seem to move up closer to the base of my penis and a little to the side. Sometimes they feel like they are going to slip out of my sack and into my stomach. I feel the need to hold them down at times to prevent this feeling. I have not had intercourse yet and feel that i will not be able to prevent this from happening while having sex with a partener.

As for my second question, my penis when not erect sometimes seems "bent or twisted". It is not always like that, sometimes it hangs very straight, but I do notice it more after leaving the pool, if it's cold outside, or when I'm very nervous. I don't know if it's related in any way to my first question, but any help you have to give would be most appreciated. Thank you for your time.


Dear "Mr. X": What you describe is NORMAL!!!!! High School or College Biology or Human Sexuality ought to address this! In case you haven't taken those subjects yet, it is normal for the scrotum to pull up to the body during sexual excitement. Please don't hold them down!!!!! They go "slightly to the side" because one testicle is larger than the other (in all normal men). And when your penis is cold, it shrivels (to conserve body heat). Ignore its shape in the unerect state. If it really bends a lot when fully erect, get that checked out by a Urologist (it could be Peyronie's disease). If it bends a little up, down, left, or right, enjoy your idiosyncrasy (and tell all naive lovers that it's the sign of a good lover). p.s. Can I call you "CJ"?

6/4/98 Q: Dear Sex Doc,

I have been dating my best friend for a year and a half now. We are both 28. I am self employed and do very well and she has a good job that she enjoys. We were friends for about two years before dating. We have had problems since after the first six months with frequency and overall enjoyment of sex. She does not enjoy sex as much as I do. We went to a therapist last May and decided that a compromise would be the best thing. We decided to try having sex every other day. She also told me after a session that she did not want to talk about sex with anyone. Our problem is that many times when it is "my" night, she says she doesn't feel well, but we can tomorrow, which doesn't happen. By about the fourth day I start to get a bit upset, OK, real upset and it shows. We usually have a big blowout about this time. She has promised me that she will try things like surprise sex or maybe have sex two days in a row after she chooses to go three days, but never does. I have never asked her to have sex on "her" night until last night, which caused a huge argument. She is totally unwilling to try new things. She doesn't even like foreplay, just get it over with. We have never had sex anywhere in the house but the bedroom. We have never even had sex when we weren't in a bed. My problem with this is that I have asked her to try things I read in Men's Health or other magazines. She won't do it. It really gets me when she says "I have tried that (I.e. sex on the beach, sex on the couch) but I don't want to again." I always take this as "I would do that with others, but not you." We have finally agreed to talk to a sex therapist after what we both called the last time to argue about this. She still says that if I don't hassle her she will have sex more, but she is not willing to do that until after I have done that for a while. This girl is the most wonderful girl. We both want this to work out and both realize if it doesn't we can not be together. I know I am making mistakes with these actions and would like to change that, but the attitude I get from her is that I need to change so how she acts, or doesn't act will be alright. I do not want the same sexlife she is demanding.

Any suggestions? P.

Neurologically, anatomically, physiologically, biologically, endocrinologically, physically, and for most folks, psychologically, sex feels good. Some people feel absolutely wonderful while they're doing it, but but guilty, depressed, lonely, scared, etc., afterwards. Some mis-interpret the soporific, anesthetic feelings from the morphine-like endorphin release from the pituitary during sexual excitement and on orgasm as a "sign" that sex is somehow "bad". Everybody has a preferred frequency of being sexual and/or having an orgasm. Admittedly, I see a skewed segment of the population as a sex therapist (well, marital and sexual, to be precise), but about 95% of the folks I see deal with their inhibitions and end up, from the inside out, wanting to be, and being, sexual more often than when they first walked in the door. 5% have been "forcing it" and come to grips with the preference for sex less often. At the risk of being misleadingly brief, the differential diagnosis hinges on whether myths, ignorance, or self-concept distortions account for diminished sexual behavior, or whether it's just plain "how much that person likes".

With that preface, the questions are what is motivating your sex drive and what motivates hers. If you're both doing what feels "right" for you, and you're not striving to meet some male-myth quota, and she's not sub-vocally rehearsing "Nice girls don't enjoy ... ", but is doing what feels "right" for her, then you're simply mis-matched in your desire for sexual contact.

That having been said, there is a message embedded in her not being willing to try new things, to want no foreplay, just to get it over, and the rigidity (my imposed label) of sex only in the bedroom and in a bed. There is the joke about the minister who comes out of the bathroom on his wedding night to find his blushing bride spread-eagle on the bed touching herself. Startled, he proclaimed "Why, my dear, I thought I would find you on your knees" (he was thinking of praying), to which she replied "We can do it that way if you like, but it gives me the hiccups". The point being that even if she has done things with others (on the beach, on the couch), if they aren't painful or humiliating, you have a right to expect that she would be willing to do them with you because it pleases you!

You say that you have finally agreed to talk to a sex therapist. If you haven't yet, then you're on the right track: professional intervention. If you have, and the outcome was that she'll have more sex if you hassle her less, you've got the formula, and you can see if that turns out to be true. But from what you've said, you have more psychological work to do. In the final analysis, if it turns out that the two of you are sexually incompatible, please search for other partners with whom you are more compatible. Life is too short ....

6/4/98 Q: I had sex with my girlfriend and she told me that I was the first she had ever had, but she did not bleed. Do all virgins bleed their first time and if not, what percentage do? A response would be greatly appreciated. thank you for your time P.

A:  Not all virgins bleed as a result of first intercourse -- many have either no appreciable hymeneal tissue or it has been sufficiently stretched by tampons, self-exploration, horse-back riding, sports, etc. The percentage is unknown because there is no central data clearinghouse to which such events are reported.

6/3/98 Q: Dear Sex Doc,

I accidentally found my girlfriend's diary and against better judgement, read a few pages. She wrote that she fucked another guy while we were presumably monogamous with each other. I didn't read any more. We still have great sex, but I suppose there has been a slight decline in frequency. She is pissed at me about something. It's very complicated and I have no idea how to proceed, i.e., whether to tell her what I know. If I tell her she will of course be angry and lose trust in me, but if I don't say anything I'm just silently furious at her but can't tell her why. Should I tell her everything and send her on her way, should I break up with her for some vague reason, or should I just enjoy our time together and start seeing other women?


A:  In considering how to comment on this I am reminded of the aphorism "You can please some of the people all the time, and all the people some of the time, but you can't ...". No matter what I say most people will have an opinion. I come from the "school" of honesty, assertiveness, scientific inquiry, making mistakes but learning from them, forgiving other's mistakes where possible (it's not always possible) and progressive refinement of one's values toward the goal of finding someone with whom to bond for life. Whew! Easy for me to say.

Evidence in fact: let the readers and I accept the fact that you read her diary. Acknowledging that you shouldn't have, that moral judgment is beside the fact. You read it. You say that you "accidentally" found it. Is it possible that she left it out for you to find? Is it possible that she didn't fuck another guy -- just wrote that in the diary for you to "accidentally" find? If she is really pissed at you , what better way to inject a smoldering seed (you're "silently furious")? Part of the consideration of how to handle this is where you want this relationship to go. If this is not the love of your life who you are imploring to consider becoming engaged to you, is this relationship going to end with "Have a nice life -- it's been nice knowing you"? There is something to the expression that if things don't go the way you wanted them to that it's been a learning experience.

I suggest that you learn as much as possible from this circumstance, and let the proverbial chips fall where they may. Go for a walk in the woods or any place where neither of you can escape. Tell her that you "accidentally" found her diary (avoid "you" statements, like "If you didn't want me to find it you should have hidden it better"). Tell her that you shouldn't have invaded her privacy by reading it, and that you feel bad for having done it, but that you did it and you're sorry. Role model the honest admission of a mistake with apology so she can do the same. Tell her that you stopped reading at the point where she wrote that she fucked another guy. Ask if that was true, and if so, ask what her motives were. Tell her that you would appreciate an apology for breaching your agreement of monogamy -- then ask if she engaged in safe sex, or whether you should be concerned about a sexually transmitted disease.

At this point you'll have to do some soul searching to decide how to proceed. For example you can tell her that you are so wounded by her infidelity that you can no longer be open intellectually, emotionally, and physically (sexually) with her. You are doing her the "kindness" of illustrating that there are consequences to her actions and that one is your withdrawal. Or you can say that if the circumstance were reversed that you would want her to forgive you your indiscretion, and so you forgive her, but want an ironclad agreement that it will not happen again while the two of you are intimate. In short, figure out what YOU want, how you want to handle it, and how it gets bench-marked against the principles you believe in, then execute it. If you're in a quandry, use two "tie breakers": 1) If a good buddy approached you with this circumstance, what would you advise him to do? and 2) If you were relating this to someone you respected, and the confrontation with her happened three months ago, what would you say that you did that you were proud of? I am stacking the cards in favor of maturity -- that is, I hope you wouldn't be "proud" to tell someone "The bitch fucked around on me, so I fucked around with other women 'on her'". That's childish tit for tat.

If you appreciate this advice, please show that by e-mailing a description of what you did and how it turned out. A few loose ends: You say that if you tell her that you read her diary she will of course be angry and lose trust in you. Because you seem to believe that she did, in fact, fuck some other guy, aren't you of course angry and have lost trust in her? Unbundle your options: "Tell her everything and send her on her way?" How about "We both tell everything, forgive each other, and enjoy our time together"? Do NOT "break up for some vague reason". That is validating her dishonesty with your own! ("To thine own self be true"). I expect to hear from you regarding how you handled this and what the outcome was.

6/3/98 Q: So you know of any good reliable products that are able to increase the sex drive of women? Thanks

I LOVE THIS QUESTION !!! Let's see now, let's start with diamonds, then add pearls, gold, fancy cars, a mink coat if she doesn't object to animal pelts, flowers, candy ...

6/3/98 Q: Dear Doc, I am 22 and my boyfriend and I have been living together for a little over 2 years now. I've never thought we had the perfect sex life but there are many other great aspects of our relationship that I would never want to lose. He is 24 and we are both intellegent, responsible adults. The problem, we have sex once a week and he seems to think that is fine and I've also come to terms with how often we are having sex, is this the norm? Should I let friends and family members who say it isn't upset me? Do I have a self esteem problem for thinking he should want me more? Please offer me some advice I would hate for this dispute to destroy or relationship. thank you, Amy

A: Dear Amy: If I asked you the question "Is a height of 5 feet 5 inches the norm" could you answer it? If the question is "What height is normal", an endocrinologist would probably say that anything between 4'10" and 7'6" is normal -- taller or shorter should get a growth hormone check. I have had couples in therapy who had sex once every 6 weeks, and couples who had sex twice per day Monday to Friday and three times each on Saturday and Sunday. All of that is the "norm" because it is not pathological and it is compatible for consenting adults. The only signal of distress I hear is that you have "come to terms with how often ...". Non-injurious sex between consenting adults is a private matter -- if friends and family members comment on your sex life, how do they know? Do you ask them what's "normal"? How much sex your boyfriend wants is not a function of how much he wants YOU. It's a reflection of how often he wants to be sexual! The self-esteem issue I see is whether you are willing to be with someone who wants to be sexual less often than you do. You're never going to have a mate who is 100% compatible intellectually, emotionally, or physically. The question is whether it's close enough. If he wanted to make love every other day, and you wanted to make love every third day, would it make sense for him to ask if he has a self-esteem problem for thinking that you should want him more? If anyone asks how often you make love, the answer could be "Often enough". If it isn't acceptable to you, then you need to decide if you want to find another mate with whom you have many fine compatibilities -- including greater sexual compatibility. In summary I suggest that you decide what you want, and if it isn't illegal, immoral, or fattening, do it in the privacy of your home regardless of what the average (or "norm") is. Any questions?

Dear Doc,

Thank you so much for your advice. I had to laugh while reading your response, you really opened my eyes at how silly my fears can be sometimes. I would also like to say that I think you give great advice I agree with everything you had said. I hope you help others as much as you've helped me! You've really put my mind at ease. I hope you're around for future reference and I will definitely refer you to friends and family the next time they want to snoop!! Thanks again, Amy

Embarrassing Noises During Intercourse (female) (8/8/97)

Dear Sexdoc: I am thanking you in advance for taking the time to read and to respond to this question. I do know that I am not the only one to experience embarrassing noises while engaged in intercourse. Certain positions, e.g., on my hands and knees, cause what I assume to be an intake of air into my vagina which makes an embarrassing sound when it expels. I have noticed that this occurs more often when I tighten the muscles inside my vagina, and I am wondering if there is any way to avoid this happening, and if this is in any way harmful.

Dear Embarrassed: What you are experiencing is called "vaginal farts" and it means that your pelvic muscles are in GREAT SHAPE! It is not harmful unless you are swimming in toxic waste, and the only way to avoid it during intercourse is to lie flat on your back and refuse to become even the slightest bit sexually excited. Educate your lovers, preferably before intercourse. Explain that the same well-toned pelvic muscles that so wonderfully drive the penis into heights of rapture when it is intra-vaginal are responsible for the air in and out. If it happens only when you are very sexually excited, tell your lover that that is the confirmation of how incredibly turned on you are (implying that he is a good lover ...). If you're with a real Freshmen (sexually speaking at least) you might have to get more graphic and explain that "real" farts are gasses that are chemically produced in the lower intestine. Vaginal farts, in contrast, really are composed of air sucked in and out. The converse is not true, by the way. That is, if you don't experience vaginal farts it doesn't mean that you have to go back to the gym. Most women with excellent pelvic muscle tone do not experience vaginal farts; others are blessed with an auditory announcement of that state.

HEALTHNOTE: Never, ever, allow anyone to blow air into your vagina!!!!! It can cause serious problems ranging from Toxic Shock Syndrome to an air embolism in your blood stream that can KILL YOU! I am adding this because it occurs to me that someone might say "Gee, honey, let's see what it would sound like if you did have air in your vagina (and then blow into it).

P.S. I was especially delighted to receive, and to respond to, this question, because it illustrates clearly that your relationship with your sex therapist must be so open and trusting that you can ask absolutely any question whatsoever, regardless of how embarrassing you might think it is, or how "stupid" or "dumb" you think it is.

Panic Attempting Penetration (female) (8/5/97)

Dear Sexdoc: I am a virgin in my 20's and for the past year whenever my boyfriend and I attempt penile-vaginal penetration I always just freeze up and panic. I want to have a happy sex life with my boyfriend, but I just get so scared when we try. I haven't experienced any traumatic events in my life. I am able to achieve orgasm both by myself and with my boyfriend. Please help us to nurture our sex life. Thanks so much for your time and attention. (signed: Frustrated With Myself).

Dear Frustrated: A significant number of your sisters are thanking you right now for asking that question. In the absence of sexual trauma at any age (and psychological problems that interfere with sexual functioning) I blame this on the negative messages in American Society ranging from "Nice Girls Don't" and "If you're not a virgin on your wedding night you're spoiled goods" to labelling your period "the curse". When I hear " ... freeze and panic ... " I usually hear messages from childhood or adolescence like those above plus "If you ever get pregnant you're not welcome in this house" and "The pain of losing your virginity is excruciating" and "Be prepared for blood all over the place" and other variations on the theme designed to control people by scaring them. Guys will tell you: they didn't grow hair on the palm of their hand, go blind or crazy, etc., from masturbating.

The Good News is that regardless of the cause of your freeze and panic, that behavior modification using successive approximations is a solution in a high percentage of the cases! If you treat penetration as many shades of gray, not black or white, you can coax your body and mind into being relaxed in small increments. Freeze and panic comes from your reptilian brain stem, which is pretty dumb. So you have to teach it in slow, repetitive steps making progress very slowly. You have to have a lot of trust in your lover, and be very explicit about what you're feeling and how your body likes to be touched. Because I cannot modify and tailor the experience for you on a weekly basis, as I do with patients in therapy, I will describe the general protocol. Find your baseline. What can happen now without too much anxiety? Can you "only" touch the outside of your vagina? Can you insert one of your fingers in your vagina during sexual excitement? Can you have your lover insert one finger? Progress from outside touch to the insertion and in and out movement of one finger to two fingers to three fingers. You do it first, than have your lover do it. Each time strive to make some progress, whether it is in number of fingers, depth of insertion, in and out motion, or duration of insertion. WHEN you feel anxiety, try to maintain the status quo, take deep breaths, tell yourself to relax, feel the anxiety "melt away", and when you are sufficiently calm, resume what you were doing. During each session relax, take your time, get sexually excited, and progress from baseline to the point where you are OK with your lover repeatedly inserting and withdrawing half-way three of his fingers, simulating intercourse. When you have trained your reptilian brain to recognize that as pleasure, gradually transition from three fingers to a protected penis (after, say, a minute of slow stroking with three fingers, have your lover withdraw the fingers and insert his penis two inches. When you're OK, then have him stroke in and out an inch. Each event have him insert deeper and deeper. You might need, during each event, to repeat the entire process: outside touch, one finger in and out, two fingers, three fingers, etc. Strive to insert the penis sooner and sooner after you achieve three fingers.

NOTE:  Always make sure you both have an orgasm during each session (reward the reptilian brain). Don't be surprised if your lover has an orgasm sooner than either of you would want -- this could get him pretty worked up. Always make sure you are copiously lubricated vaginally. If you don't have a lot of natural lubrication try KY liquid, Astroglide, or KY jelly. Know that YOU CAN GET PREGNANT if your lover gets semen on his fingers and then puts that finger in your vagina. It's an inefficient sperm delivery system but it has happened! If you get to an impasse that you cannot get beyond -- say, five events with no progress -- then you need professional intervention (sex therapist). Last but not least: Remember that this is FUN and pleasureable. Please let me know how it goes.

Trouble Achieving Orgasm (female) (7/21/97)

Dear "Sex Doc" I have a question for you. I'm 23 years old and have never had an orgasm. It never worried me until now. My boyfriend is doing all kinds of interesting things to me to make me have an orgasm. Many of my friends are having the same problem. I thought that I was alone in this dilemma. All information is greatly appreciated. Worried

Dear Worried: Unfortunately, you are one of MANY women who have trouble achieving orgasm. Fortunately, an articulate female therapist, Lonnie Garfield Barbach, Ph.D. wrote the best book about that:  FOR YOURSELF:  The fulfillment of female sexuality.(1975) It's available in paperback. I suggest that you obtain your very own copy and that you read the book from start to finish; that you NOT skip ahead; that you DO EVERY EXERCISE even if you say "...that's easy -- I can do that!" and that when your body teaches you what it needs to be orgasmic (that's right), that you then teach your boyfriend.

Many women have deeply internalized fears of pregnancy, religious messages, uncomfortability with menstruation, or a myriad of other impediments to enjoying great sex. I have had a woman in her sixties, mother of four grown children, have her first orgasm under therapeutic direction (in her home, not in my office, in case you were wondering). The majority of women become much more sexually responsive as a result of structured sex therapy -- all I have to do is help them unlock their natural sexuality by peeling away the layers of inhibiting factors! It's a beautiful sight!

And "WORRIED:" Please tell your friends; spread the word. And ask your boyfriend to be patient while you learn what your body has to say. GOOD LUCK (if you remember, please send me an e-mail WHEN you become orgasmic). With Pleasure, The Sexdoc.

One-Sided Sex (7/27/97)

Dear Sex Doc: My fiance and I are both in our 40's, have lived together for a year, and have had a problem from day one:  He says he desires me but his actions don't support this. When we get in bed, if I stroke him like I'm just going to masturbate him, he's fine. But if I show any excitement like I want him to reciprocate, he comes up with an exzcuse to not proceed. He uses fear of pregnancy to avoid intercourse, but won't buy condoms or suggest that I use my birth control. Some nights, after he thinks I'm asleep, he sneaks out of the bedroom to search for women on TV and masturbate. He masturbates all the time. I give him oral sex almost every day. He gives me oral sex only when I beg for it, and that has happened 7-8 times in the past year. He only touches my genitals when I put his hand there, and then he is sometimes rough and it feels cold and mechanical. When we have intercourse -- I always have to initiate -- his penis is never as erect as when he is masturbating himself or when I am masturbating him or giving him oral sex.

When we're in public he stares women down; does the same thing to women on TV. It doesn't matter how gentle and loving I am when I talk to him, he still blows up, makes me wrong for wanting sex all the time (I'm lucky if it's once a week). It's painful to lie in bed next to him when he masturbates, wanting him and him not wanting me, but when I suggest separate bedrooms he gets angry. We met online, then did phone sex. He says he needs a lot of sex but it only seems to be with himself. He refuses counseling and makes everything my problem. Help! One-sided sex giver.

DEAR ONE-SIDED SEX GIVER:  The bottom line is that before this gets worse or you get older, immediately present him with an ultimatum:  Intensive psychotherapy, a radical change in his behavior (of which I am confident he is incapable without help and/or for more than two months), or the termination of your relationship. I am sorry to let you know that the behavior you describe is deeply entrenched and seriously resistant to sufficient genuine change until he gets the message in a big way (see below). His behavior might be the result of numerous reasons, and is likely a complex combination of many things. I have had couples like the two of you in treatment, and as soon as one insight and resolution is reached, another reason or excuse emerges. At a minimum my reaction is for you to embrace the fact that the two of you are incredibly incompatible in your sexual preferences. Cut him loose to find a woman (if any) who might enjoy that protocol. At a maximum, my advice and counsel is that the prognosis is poor and that you could end up investing a lot of time, emotion, money, and hope into his behavior change. If you invested 18 months, your share of competent therapy at $550 (plus or minus $100) per month, plus a predictable emotional roller coaster, all with a low probability of success, and if it didn't change enough, how would you feel then?

Two additional notes for you and all other readers: 1) I have had better success working with men alone who have had three or four one-year relationships like this terminate. If fewer than three relationships die it's too easy for the guy to conclude that he just chose the wrong mate. If he goes on to the fifth relationship after four die the same way, it's a public announcement that he really, really doesn't want to change. So encouraging a woman to give the ultimatum and leave if that's what happens is really the best thing for the guy. Note that the WORST thing that can happen is to perpetuate this dysfunctionality, tacitly ratifying the guy's behavior, and prolonging the pergatory she is in!

AND 2) Precious few therapists have sufficient training and experience to deal with a problem this intense in both relationship matters and sexual matters. I have had other sex therapists refer cases like this to me. They can handle the sex part but the relationship intensity is often very difficult to manage. More often, I have had good relationship therapists refer a case to me after most of the relationship stuff was resolved, but there was a sexual component left over (that they had not had the training to deal with). SO:  BE SURE to identify someone who is clear about the dual intensity and if you think you're going nowhere, find a new therapist!

Monday, 7/28/97 UPDATE: She e-mails back: Dear Sexdoc, thanks for responding. After I wrote to you, my fiance and I did sit down and talk. He was actually sweet and listened; didn't get angry for once. It was really nice for a change. But, he did still deny the masturbation thing. I have never felt that masturbation is wrong. It's when it takes the place of intimacy with me that I object. Hopefully he and I can keep communicating in an adult and loving way. It's our only hope, especially since he won't agree to counseling. Thank you again.

AND, TEN MINUTES LATER:  Dear Doctor, I was wondering if my fiances behavior could be attributed to stress?

The SEXDOC Responds: Dear gentle reader (now I feel like Miss Manners) A powerful principle in Applied Clinical Psychology: The person with the greater need always loses. Your fiance must be fulfilling a lot of your needs or you would not be putting up with his selfish behavior. I suspect that your e-mail to me gave you the courage to do something different, that that was sensed by your fiance, and that his fear of losing you pushed him over the edge to be nice. Remember what you wrote: "... didn't get angry FOR ONCE." (emphasis mine) Childhood parental, societal, and religious messages about masturbation have instilled substantial privacy in many people. There is nothing dysfunctional about masturbating unless it interferes with other committed obligations and activities, such as sleep, studying, going to work or school, and making love with your significant other. KEEP ON OBJECTING WHEN  (and in my opinion, not "if") he masturbates and it takes the place of intimacy with you!!!!!

STRESS? For most people the endorphins released during sexual activity and especially at the moment of orgasm are immensely pleasureable and rewarding. That can also combat stress. But at the risk of being brutally honest for your sake, I think you're trying to rationalize his behavior. There is no excuse for anyone over the age of 12 being selfish and as inconsiderate and manipulative as he is! Protect your self esteem and your dignity. Politely but firmly inform him of what is reasonable, and if he wants to masturbate after that, fine. But not at your expense (which is what is happening now). Thanks for the feedback and please let me know how it is progressing.


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