Copyright (C) 1998, 1999, 2000 William F. Fitzgerald, Ph.D.

Answer page #22

Link to the Home Page of ASK THE SEX DOC

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I am told it will be up during Thursday, Friday, and Saturday 4/27, 28, 29 only.

A:
It's a matter of pacing yourself.  Two things are major players:  1)  The protocol -- self-help exercises -- for premature ejaculation that help a guy get from 3 seconds to 3 minutes, also help a guy get from 3 minutes to 23 minutes.  The link to this is:

 http://www.sexdoc.com/quess3.html#premature

2) For some not precisely known reason, men whose pubococcygeus muscle is in good tone in general are better able to attain and maintain an erection.

That exercise is described at:  http://www.sexdoc.com/mql.html#Kegel

The minor players (major for some) are time since last ejaculation, nervousness, excitement for this particular lover, and drugs and alcohol.  Some men medicate themselves with two drinks before sex because it increases staying power while lowering libido.  But that seriously interferes with a morning romp before going to work.

Tantric sex -- having an erect penis in a vagina with minor movement, for 30 - 90 minutes -- is very real but requires great will power, patience, the epitome of deferred gratification, and significant partner cooperation.

All of this having been said, though, there are some women whose pubococcygeus muscle is in such wonderful tone that either by conscious control or the involuntary reflex of orgasm, their vagina can milk an erect penis to orgastic reflex no matter what the man wants.

Go for it!

sexdoc

I'm a 43 year old male that has a problem performing more than once.  I have
no problem getting an erection, but after ejaculation whether it be durning
sex or mastrabuation, I loose my erection and can't get it up again, or I
loose my sexual drive to continue.

Please let me know what I can do about this.  I'm tired to perfoming once and
that's it.

A:  It's called the "refractory" period and it varies dramatically from man to man.  For the vast majority of men that time just gets longer and longer, and some men in their late 60's report that they need a full day before being able to get an erection again.

If you are "demanding" that your penis get erect, that can guarantee that it won't!  I suggest experimenting with playful (read "non-demand")stimulation four hours after you ejaculate to see if you get another erection.  Plus, your serum testosterone (which plays a major role in erections) peaks in the morning and can be half when you go to bed, so your best chances of twice in one day are 8 am and noon (had a nooner lately?) or 10 pm and 7 am.

sexdoc

First of all I want to thank you for taking the time to review my questions
and problems.  I think that your site is absolutely great and that you are
truly a generous person for providing people with your helpful knowledge!

Well here's my problem:

I am a 19 year old female college student who is very much in love with her
18 year old boyfriend.  We have been going out for about a year and we both
love each other very much and are so serious that we would like to spend the
rest of our lives together.  He always compliments me and tells me that he
loves me.  We both love having sex with each other and do it as often as we
can (it's rather difficult to find the time since I live at school, which is
far away from where he lives).  I love pleasuring him and trying new things.
What seems to be the problem is that I have never achieved any type of orgasm
from him (or anyone for that matter)--not by his penis, orally, or by touch.
This is very devastating to me because I would also like to feel pleasured
during our special time together.  He doesn't particularly like giving me
oral sex so he lacks in that area (by the way I am a very clean individual so
hygiene or smell isn't the problem and I shave off all of my pubic hair).  He
also doesn't like the idea of using vibrators or dildos.  The only way I have
ever achieved an orgasm is through masturbation (my fingers rubbing my
clitoral area with my underwear on covering the area being rubbed) and I
don't always achieve one every time.  I have been masturbating when I didn't
even know what masturbating was (since like 7 years old).  As far as I know,
this is the only method that has worked for me.  I really want to be able to
achieve an orgasm from my boyfriend but I don't know how it could be done.
Even though I don't achieve an orgasm I still enjoy being intimate.  Might
there something wrong with me?  I would greatly appreciate all the help you
can provide.  I'll try any advice you give me.

Thank You,
April (not her real name)

PS.    You have probably received many e-mails concerning the same problems as
I have discussed.  I apologize if it is redundant.

A:  The most effective way to become orgasmic during intercourse is to learn what you have to do to yourself to achieve the orgasm, then teach your lover(s) what to do.  Also, somewhat to my surprise, a number of women do not know what an orgasm is.  The absolute sign of an orgasm in both genders is involuntary pelvic muscle contractions approximately eight tenths of a second apart.  There may be 3 or 30 and there could be some, then a pause, then more.   Most women can achieve orgasm from clitoral stimulation, by finger, tongue or vibrator.  You can feel these contractions with one or two fingers either in your vagina or in your rectum.  Only about 40% of women achieve orgasm from penile thrusting alone.  Others have an orgasm before penile penetration, after, never, OR they stimulate or their lover stimulates, their clitoris DURING intercourse.

If YOU can’t bring yourself to orgasm, don’t expect your lover to.

 For more commentary on this please go to

 http://www.faqtory.com/sexdoc

there click on the search tab in the upper-right corner, and in the text window type in

 Barbach

Barbach's book, For Yourself, is the best self-help book for women.  VERY IMPORTANT: Read it cover to cover, page by page, without skipping ahead, and do each and every exercise no matter how easy you think it is.  It directly addresses some inhibitions or "displeasure" some women have regarding their genitals and sexual self-image.  Many women are not consciously aware of thinking that their genitals are somehow gross or disgusting (and cosmetic, pharmaceutical, and advertising companies richly cash in on that).

If that doesn't result in your having orgasms you need professional help (start with your OB-GYN).

In your particular case, April, your boyfriend's "doesn't like the idea of using vibrators or dildos" is potentially problematic.  If you are significantly more sexually uninhibited and adventurous than he is, this could predict serious sexual incompatibility in a long-term relationship.  I strongly urge you two to address this before making a public commitment (such as engagement).

sexdoc

I wrote to you about a month ago
about the disappearance of my libido.
To refresh your memory, I'm a 25 year old
woman, graduate student, in a wonderful,
loving relationship.  I am not under any
unusual stress.  Everything about my life
seems to be going great.

About 3 months after
I started taking birth control pills, my
libido disappeared completely.  I have since
stopped the pills (2 months ago), hoping my
libido would return, but unfortunately, it has not.

My doctor ordered some blood tests, and said
he was going to look at my "male hormones",
which I assume mean testosterone.
He also wrote me a prescription for a
vaseline-based testosterone cream.
He advised me to rub this on my "vaginal area"
twice a day, and that I might see the
return of my libido in about a month.

I've done some research on testosterone
therapy for such applications, but everything
I have read has focused on post-menopausal women.
One article said they strongly advise AGAINST
this type of treatment for women of childbearing
age, but did not state why.

My question is, is this safe?
Would this affect my fertility in any way?
Do I run the risk of my voice deepening,
getting acne, and growing excessive
body/facial hair?

This is causing me (and my fiancé) a tremendous amount
of emotional stress.  I'm willing to try just about
anything to get my libido back, but I want to know what I'm getting into.  Any advice or information you have
on the subject would be greatly appreciated.

Thanks for your time.

m

Dr. Fisher replies  A:  Testosterone cream is made with a very low dose, about 2%.  At this amount, male secondary characteristics should not appear.  The reason some doctors
are against testosterone cream therapy for women of child bearing age is
because the testosterone can be stored in fatty tissues and if the woman
should happen to become pregnant, it might affect breast feeding.  There has
been some theories about testosterone competing with fetal hormones, but
nothing has been proven yet.  Again, the cream is such a low dose that if
you are deficient, your body is using it up as fast as possible. As far as
future fertility, it shouldn't cause any problems from the cream itself, but
you may have underlying issues that may cause problems.

You say that you began taking birth control pills and this is when the
decreased libido started.  Have you tried triphasic pills?  Tri-Levlen is a
type of birth control pill that actually has been found to increase libido
among women.

Not only do you need your "male" hormones checked, you also need to have
your progesterone, androgens, and estrogen levels checked.  Another thing
worth looking into is your thyroid.  An underactive thyroid can be a mean
culprit on the  sex drive.

Remember, you may not think that you are under stress, but your body knows
you are and sometimes, the ovaries become suppressed and thus, the decreased
libido.  Graduate school alone is a bitch, couple that with the life of a
twenty five year old and you got some stress even if you don't think so.

A:  It sounds like you are anxious and are unconsciously clenching the muscles around the vagina.  I am ruling out an intact hymen because the MD said everything was fine.

You need to learn what clenching and relaxation feels like.  Wash your hands, lube up 2 fingers, slide them into your vagina, and alternately squeeze and relax your pelvic muscles so you can feel the difference.  You'll feel it on your fingers.  Then remove the fingers and squeeze and relax several more times, then re-insert your fingers and do it some more.

When you can consciously relax those pelvic muscles as your boyfriend is pushing in with a well-lubricated condom on his penis, the penis should slip in UNLESS the largest comfortable diameter of your vaginal opening is smaller than his erect penis.

If you try this and it still squeezes tight, STOP before you develop a case of functional vaginismus.  You might just have to either then see a sex therapist or wait until you are older and less anxious about vaginal intercourse.

sexdoc

Sincerely,

A:  People, people, people, if you haven't taken Psych 101 in college, please get a college text and read it cover to cover!  You do, I do, your (the writer's) husband does, we all do, no, not ice cream, but what gets rewarded!  Why do we have sex?  It feels good.  Why do we do more of what people thank us for?  Because the thanks is a reward and we all want rewards.  It's called "positive reinforcement" in psych 101.  The hungry rat in the maze gets food at the end and learns to run the maze faster to get the food sooner.  He learns that the wrong turns in the maze don't get him what he wants, so he learns to avoid wrong turns and to remember correct turns.

You want him to kiss you passionately again?  Either wait, and the next time he does it, gush about how that turns you on and makes you soooooo wet (reward him).  Or, instead of waiting, the next time (soon) it's appropriate, TELL HIM: "Honey, you remember XYZABC?  Well that turned me on like crazy and I would LOVE to have you do that again.  Tell him this time (get over the "I don't want to tell him because then it would be something I asked for" dysfunction), and then make sure you reinforce - reward - every time he does it.  At the moment, he's totally justified in concluding "Well, I tried something different, and I guess she didn't especially like it because neither her words nor her body language signaled appreciation."  Right?

Tell me what happens!

                          Sincerely,
                             # 2
 

Dr. Fitzgerald's reply:  Pregnancy is a function of sperm entering the egg and that attaching to some internal tissue and growing.  Technically, the sperm can swim up into your uterus and fallopian tubes through the menstrual fluid, and wait for an egg, and if you ovulate early, the egg can make it to the sperm before the sperm die, thus making pregnancy POSSIBLE.

In the "normal" menstrual cycle if you count the first day of menstrual flow as day one, you will most probably ovulate -- release the egg -- on day 14.  However, many things advance or retard the release of the egg, and some studies have shown that some sperm can stay alive for as much as 8 days in a woman's body (although less than 4 days is more common).

The chances of pregnancy are a function of how long the sperm live and how soon you ovulate.

NOTE:  See Dr. Fitzgerald's comments after Dr. Fisher's comments

Dr. Fisher's reply:

Bill,

Sperm can survive in the female reproductive tract for about 72 hours, give
or take a few hours.  In the presence of spermicide via a condom or during
hostile vaginal pH levels (i.e. infections, non-ovulatory times during the
cycle) sperm survival time is drastically deminished to a few hours.  But as
far as the other information, you were correct.  Technically, there are only
two or three days during the month in which a woman can conceive.  If a
woman pays close attention she can detect the days by the "tact" of the
vaginal mucus.  During ovulation, most women's mucus can be stretched in a
rope like manner about two of three inches between two fingers.  This "rope"
enables the sperm to "climb" to the tubes and fertilize the egg.  Pregnancy
is highly unlikely for her in this situation because: 1) Hostile pH due to
the menstration fluids, 2) the condom probably was lubricated with
spermicide, and 3) she hadn't released an egg yet.  BUT there is a slim
chance (she has a better chance of being asked out by Brad Pitt) that a
fluke happened and she could have got pregnant, but I doubt it.  I think the
real issue you need to address here is proper condom usage.....when it's
your first time you're as nervous as a whore in church, so now would be a good
time to review how you used the condom and think of why it may have broke.

Dr. Fitzgerald's comments:  spermicides are chemicals that kill sperm.  A pH level relates to acid or alkaline degree (most people know what acid is;  alkalines are chemicals just as acids are chemicals).  The cervix secretes a slippery clear liquid which is runny, like water, most of the time, but which gets a bit like bubble gum when a woman is ovulating.  If someone sticks their finger(s) in the vagina and gets this liquid  on the finger tip, then withdraws the finger and touches that tip to the tip of the thumb, then slowly separates the thumb and finger, during non-ovulating time the liquid will "snap apart" in a short separation, whereas during ovulation, there will be a string of liquid adhering to both thumb and fingertip for a much wider separation (Dr. Fisher's aforementioned two to three inches) before it jumps to thumb or finger.  For the graduate students, this is called the Spinbarkeit Index.  At the risk of grossing you out, some similar liquids come out of your nose, but are UNRELATED to ovulation (related to cold, flu, or hydration).

A:  This needs face to face therapy and serious attention if you wish to overcome it.  There is nothing I can suggest by e-mail if you refuse to pleasure yourself or you are unable to get over that "feeling foolish" phase.

If you wish to address this, time is of the essence.  The longer you perpetuate this problem, the longer it will take to fix it.

I am so sorry that you embraced religion to your detriment.  I cannot believe that any benevolent God would want this for you.

By the way -- in talking to people about sexual problems since 1965, I have had two women in their sixties become orgasmic for the FIRST TIME -- both had several children.  Please get help before much longer!

sexdoc

However, in a 2 year relationship, I think it may have been compromised.  We
really cared about each other and that I didnt want to have sex until
marriage.

We loved being intimate and getting as much pleasure as possible doing
"everything but".  ...but, finally we found that sticking the head on the
vagina was highly pleasurable to both of us.  I would always feel his head
go in a little bit.  We both agreed that was fine.  But, what if it went a
little more than that small amount once?  I was always paranoid against it,
and would feel down there to make sure he was still just using the head.
Each time I checked, I could feel the head just inside as he moved up and
down.

I mean I am sure it feels different having more than the head.  I never
think that even half went in, but who am I to know since I haven't ever
tried to engage in full and consentual intercourse.  The toys we played
with...lol...that went fully in, you could sorta tell they were reaching
further.  How do I really know that it never went in much since right on the
surface hitting the pubic bone and clit and the bare inside stimulation
feels extraordinary itself.

To his credit, he said it was just the head and he said he REALLY could
tell...that guys feel the warmth and know exactly where it is.  Would that
be an accurate statement?

Do people practice what we did?...fine line close contact  I mean we
certainly envoked restraint...I think...cuz it wasn't like his balls hit up
against me or he laid his whole weight on me...but in the motions how far is
too far?
_______________________________________________________________

A:  FIRST:  If he ejaculates onto your labia and the fluid somehow gets transported into the vagina, you CAN get pregnant!  Make sure that none of the fluid that comes out of his penis gets up you there!

Back in the days when men owned their wife and children, a virgin was more valuable than a non-virgin (culturally imposed value), a big deal was made about the breaking/ripping/tearing of the hymen (so-called "popping the cherry.").  But because some women either had no hymen or it was inconsequentially small, a great show of fanfare was made on the wedding night by having the blushing bride cry out when she felt her husband's penis enter her, to signal relatives to rush into the room with a freshly beheaded chicken, to sprinkle blood on the sheets.  In my book I'd call that the epitome of a "mood breaker."

So from an archaic, historical point of view, a virgin is one no longer if the tip of the penis has passed past where the hymen is/was/ought to be (less than a half inch from the opening to the vagina).  So honey, if his penis has been in further than that, you ain't a virgin any more in that sense.  But wait!  Please consider the meaning of this.  If you want your husband to be confident that he is the first man with whom you have engaged in vaginal intercourse, stop focusing on the depth of the penis and focus on what you think you could tell your husband that he would not be upset by.

There are many young women who have engaged in anal intercourse numerous times, and with numerous lovers, who have never had a penis in their vagina, who consider themselves "virgins," but I am hard pressed to label them as such, from the standpoint of "purity."

All of that having been said, if you wish to avoid sexual incompatibility, you and your husband would be well advised to have had sexual experience, both with others before each other, and with each other.  Actually finding out is the only way to know that you and he enjoy approximately the same things and approximately the same frequency.  Mismatches in those areas very frequently cause marriage problems.

Read more about this in my book, available on Amazon.com.

sexdoc

I belong to the Vaginismus support group whom you've had some contact.  They speak very highly of you!

When should a woman with vaginismus see a gynecologist?  My psychotherapist does not recommend that I see a gynecologist at this time and I am not sure I am making progress with her.

Also, what do you think of alternative therapies such as EMDR, hypnosis and kinesiology in treating vaginismus?

A:  PLEASE post this on the vaginismus support room (and let  me know when it is up there).  Dr.  Chance Fisher first, then my comments.

Dr. Chance replies:  When should you see a gynecologist if you suffer from Vaginismus?  The
answer would be RIGHT AWAY!  Who is to say which came first...the emotional stress that causes pain or the medical condition that causes pain first and then increased pain with penetration?
Vaginismus can result from psychological issues, BUT many times when you visit a gynecologist it is found to be a result of a physical condition, such as ovarian suppression, endometriosis, vulvar skin damage, or Estrogen deficiency.  I have had patients who have been involved in therapy for
several years come in for a consultation and exam and say "I know you can't help me because I or my therapist knows that it is a result of psychological issues," only to leave the office with a
medical diagnosis that is sometimes easily treated.  If you suffer from Vaginismus do not be afraid to go to the gynecologist!  There are creams and other topical substances that we can apply to the
vagina to "numb" the entrance to the vagina in order to examine a patient.  Also, you can just go in for a consultation....no exam, just a talk...to alleviate your fears.  Gynecologists are trained in
medical school to deal with both medical and emotional needs of patients.  If you go and the gyno says there is nothing physically wrong with you and yes, it is a result of psychological issues, ask if he or she would be able to direct you to a therapist or other professional who deals with the
subject.  And for God's sake, if you don't like your therapist or care provider change it!

Dr. Fitzgerald replies:  I have been trained in EMDR and I have hypnotized hundreds of people and trained dozens of all kinds of doctors to be hypnotists, and I am proficient in Applied Kinesiology, but in my experience with vaginismus, the traditional, less "sexy" behavior modification and disinhibition techniques of Cognitive-Behavioral psychology work most efficiently -- successful results in the briefest period of time.

I am in professional conflict regarding the advice of your therapist in the timing to see a
gynecologist.  I have had women explain that I am the third, fifth, or seventh psychotherapist they have seen for their sexual dysfunction, and after I take a history, if I think there is any chance of systemic etiology, I refer them to a gynecologist I know to be absolutely thorough.  When something medical comes up to address all or part of the vaginismus, I sigh in relief that I didn't try to treat a systemic problem psychologically.  I say "all or part" because many women whose vaginismus is inspired by a medical condition need behavior modification after the medical condition is alleviated.  There is a learned response that continues even though there is no more need.

And I concur with Dr. Fisher:  If you do not feel that you can say absolutely ANYTHING to your
psychotherapist, or that there is a road map with a time/task schedule and milestones, with a
clearly stated behavioral goal of therapy, find another therapist!  Too many people stay in therapy
too long, partially out of respect for, or in deference to, the knowledge of the therapist, and
because they cannot see the forest for the trees and confuse the cathartic value of talk therapy with "therapeutic progress."

A therapist's FIRST job is to put himself or herself OUT OF A JOB by helping the patient acquire
skills to achieve a self-defined better quality of life.  Keeping someone in therapy too long
insidiously weakens the patient's ability to trust his or her own judgment.

Dr. Fitzgerald AKA The Sexdoc  (DrFitz@sexdoc.com)

I am an avid reader of your page, and I recommend it to everyone of my friends. You helped me out a couple of times before, so I figured I willl respond to one of your questions.
On several occasions you ask for female opinion on shaving pubic hair, so if you already got responces on that please just disregard this email.
The first time I shaved it I was about 19, and because my lover asked me to. I was very surprised on how much it increased the sensitivity. Oral sex was ... oh so much better. I know you'll write it off to novelty factor, but that is not it. I liked it so much I decided to keep it shaved. I am 22 now, so it's been a couple of years. Being shaved improves oral and vaginal sex at least for me.
For vaginal sex I think the reason is that the clit is in more direct contact with my lover than before, but I dont know for sure.
For oral sex however the reasons are clear to me.
1) Obviously licking/touching skin directly is more sensitive than hair.
2) Weirdly enough a lot of guys are very uncomfortable with hair, claiming it gets into the mouth, smells, limits them ( me and most of my girlfriends heard MULTIPLE reasons)
3) I feel cleaner somehow. And I know what you think, but I am pretty open minded about sex, and dont have a problem with it. It's just like feeling clean after a shower.

So that;s it for PRO's

As for CON's
1) used to itch when it grew back.
2) shaving there isnt the most comfortable thing, and I cant even imagine waxing it, and most chemicals... forget about it.

However I got used to shaving, it's really not that hard. And I don't know why but I stopped itching.
So now there are NO con's as far as I can see.
It's really worth while, at least for me.

Please feel free to email me if you want to ask any questions or clarifications.

Hope I helped a little bit, your faithful reader

4/24/00 Another reader contributes:          Dear Sex Doc,
This is  actually a comment not a question  in response to the reader
Contribution: Pros and Cons of shaving her pubic hair. I agree with her,
shaving makes me feel sexier and cleaner. I found this great product called
Sally Hanson's Lotion Hair Remover with Aloe. My skin is very sensitive and
it works great. And afterwards I put on some i guess you could call it a gel
called Bikini Zone. This prevents all the itching and bumps and it grows back
in smooth and comfortable.

We are currently separated, mainly due to unresolved
sexual differences, so any help would be appreciated.

Dr. Fisher replies:   Welcome to our world!  You say that your wife gets off easy and that she rolls over and wants to sleep, gee sounds like a man.  No, really, I'm just kidding.  There is no magic drug that can help this, but some techniques may be of some assistance.

When you begin foreplay try NOT  to stimulate her breasts, buttocks, clitoris, etc..., instead kiss, fondle and touch anywhere else on her body.  When You get aroused and you see that she is becoming aroused to the point of almost orgasm, STOP and start doing something else. Changing the pace and making her "wait" for the reward can sometimes help.  Or, have her start to stimulate you and when you almost get "there" start to do the same for her, then you may be able to sustain sexual  play.  And, who is to say that you cannot have her "get you off" and then you do the same for her afterwards.  A blowjob in trade for a little muff diving. A few patients have reported that the use of mint based gels found in the Kama Sutra product line have a numbing effect on skin and that it delays or changes how a person responds to sexual stimulation, you may want to check into this. There are several products like this that have a "heat" effect that when applied to the skin change how the body responds to touch.

A:  You are between the rock and hard place -- he won't be sexual and he won't go to therapy.  I suggest that you assess your self-esteem and quality of life and confront him with the ultimatum of change/therapy or divorce.

He sounds like he is terrified of intimacy, exemplified by the sex.

Please be clear that if this fails to improve, it WILL only get worse with more and more emotional damage to you and a greater sense of inability to compete in the relationship marketplace due to age and availability of appropriate men.

I am literally ignorant of this ever "working itself out" by itself, and I have had mixed success in therapy.  If he is inhibited about something there is a good chance that therapy will work,  If it is fear of true intimacy, risk, exposure, being sometimes out of control for him, the prognosis is poor.

Please let me know your reaction and send me an update.

we are newly married couple and do not have much knowledge about sex. Our
problem is: soon after the intercourse (or as soon as he takes out the
panies out of my body), some amoumt of sperm comes out on the bed.  dowes it
mean that the sperm does not reach the destination ? and does it effect
conceving ?
 

A:  Yes.  This is a problem if you are trying to get pregnant.

Put a pillow under the woman's butt to tilt her pelvis so gravity keeps the fluid in.

Or, have intercourse "doggy style" with the woman on her elbows and knees, the man penetrating from behind.  After his orgasm she stays this way with her butt up in the air.

sexdoc

A:  Why not be blunt?  Many guys are hesitant because they are not sure exactly what their lover wants and are afraid to offend or just plain make a mistake!  If you want a topical vibrator, I suggest that you go to any big drug store and that YOU select the vibrator you want.  Just to run the experiment I have selected a vibrator, asked the pharmacist clerk if I can plug it in to assess its strength, and found an AC outlet behind some chairs (for those who want to sit and wait for their prescription to be filled.

I recommend a vibrator that recharges by being plugged into the wall.  That gives you the flexibility of not having to be plugged in to use it, and the immense cost saving on batteries.

If you want an internal, dildo-shaped vibrator, I suggest that you go to a sex toy store and buy it.  Your lover wishes to avoid either ridicule over how small it is, or criticism that "that monster will split me in two and make me as big as barn doors!"

And some guys are worried that a dildo vibrator will replace them:  IT never goes soft and his penis can't vibrate.  How can he compete (guys are very competitive).

Once you have it, introduce the two of them -- your vibrator and your lover -- and be very explicit about how you want it to be in contact with you -- lightly around your clitoris, or thrust slowly in and out of whichever cavity you prefer (remember that nothing that enters your rectum may be inserted vaginally without killing all the bacteria on it.

Please e-mail an update telling me what you did and what happened -- his reaction especially.  (Other readers also?)

A:  This sounds more like a fear of true honest intimacy than disinterest in sex!  He's interested with a virtual (not in the computer or game sense) stranger, but uninterested with his loyal close and available partner.  My speculation is that he would need several years of therapy -- he is 36 so he's in the middle of it becoming concrete -- before dealing with this effectively.  His "indifference" is a defense, and I suspect that he experienced something emotionally traumatic, either acutely in formative years or chronically from his most impression-making female, his mother (sorry people, but sometimes this is the case).  You are only 28, and if he will not go to therapy, followed by at least several months of couples work, I estimate that the probability of you getting your needs met is very low.  AND, despite the over-generalizations, there are men out there who would cherish, adore, and appreciate your sex drive and flexibility.  Maybe you and this man would both have a more satisfactory quality of life if you each were with someone more compatible.  Best advice.  Sexdoc

Also, I want to start having sex with my bf but I am
really afraid to get pregnant. How safe is the condom
usage? what is possibility of it's breakage with a
proper use?

What is the whole point of having a sex through
vagina? I find it not sensitive at all. I can get an
orgasm only through direct stimulation of my clitoris.

Thank you,
 

A:  The hymen is tissue that gets in the way of something going into the vagina.  It is at the opening to the vagina, and it may be totally absent or partially or completely there.  If he can insert 2 or 3 fingers -- whatever is the same size as the diameter of his penis -- you have no hymen to worry about.  You can be physically a virgin without a hymen!  To not be a virgin you have to have a penis inside your vagina, regardless of how much or how little hymeneal tissue you have.

Condoms have a 2 to 10 percent failure rate.  If they are high quality, thus do not have holes or tear, the common fault is for it to slip off inside the woman, spilling the contents.

The labia are sensitive as is the outer third of the vagina (although not much).  Orgasms during intercourse come from the penis dragging on the labia, which pull on the clitoral hood, which rubs on the clitoris, which gets excited enough to trigger the reflex we call orgasm.  ALL orgasms are clitoral orgasms.  So-called "vaginal" orgasms are achieved through the above sequence.   Some women like the feeling of something "big" in them to squeeze against when their pelvic muscles contract.

The "big deal" is largely historical, when a virgin was considered to be more valuable than a non-virgin.  He who plows the field first, or something like that.

A:  Both have clothes on.  Usually the guy lies on top of the girl and rubs up and down (toward her head then her feet) while pushing his bulge -- from his erection in his underpants -- against her crotch.  Both can have orgasms -- she from the clitoral stimulation and he just from the rubbing.

It's called "dry" because her vaginal lubrication doesn't wet him, and his semen doesn't wet her.

Clear?

Dr. Fisher's reply:

Constipation after anal sex is not a common problem, but it is reported.  Most of the time constipation after anal sex is due to chronic anal tension.  If you try to actively avoid a bowel movement during anal sex, your digestive system will contract and obviously keep the fecal matter in the bowels for an extended period of time thus, allowing for the intestines to absorb more water and causing a hard, compacted waste.  The colon/rectum is highly sensitive (lots of nerves).  When a penis or other objects are inserted they go into "defense mode".  Nerves are affected during anal play (good and bad).  Sometimes there is a temp. nerve damage of sorts.  Two muscles called sphincters surround the anal opening.  Each function independently.  If you insert a finger about half an inch into your anus and press your fingertip against the side, you can feel the two muscles.  The external sphincter muscle is controlled by the central nervous system.  You can readily tense and relax this muscle whenever you want.  The internal sphincter is quite different.  This muscle is controlled by the involuntary nervous system.  The internal reflects and responds to fear and anxiety during anal sex.  It will cause the anus to tense up automatically even if the passive partner is relaxed, comfortable and willing.

Also note: Laxatives can actually CAUSE constipation.  The colon begins to rely on laxatives to bring on bowel movements.  Over time, laxatives can damage nerve cells in the colon and interfere with the natural ability to contract.  Regular use of enemas can also lead to a loss of normal bowel function.

What can you do?  Well, tension can be relieved by touching the anus (you or your partner).  An ideal time to explore the anal opening is while taking a shower or a bath.  Deep breathing also affects the anal muscles. Tensing the anus and then letting go is another way of learning.  Constipation itself can be helped by drinking lots of water.  Corn Syrup or Olive Oil taken orally has been know to prevent and rid one of constipation.  If you feel that you really need to use a laxative measure, try using Glycerin suppositories.  They work relatively fast and are pretty safe.

I've talked about it to him and he says the pictures do not give him sexual
gratification (ha!) and insists that the women are not old, but that they
are his age. These women are blue-haired grannies! I'm not saying that the
more mature woman cannot be sexy...I hope to be, myself! But being sexy at
that age to someone else that age or to one's husband is one thing, but for
my young husband, who has a young, beautiful wife who is willing to try
anything, to need to look at this makes him look like a pervert to me! It's
really taking a toll on my respect for him. I had to laugh this morning at
the pics he looked at today after turning down sex with me last night. It
just seemed so pathetic!

Really, it's not funny, though. Seeing that crap makes me nauseous. My hands
shake, I nearly throw up. My hair is falling out by the handful. It's really
a problem. I spent an hour last night making myself up like a whore (he
asked me to do that about a week ago, but I just got the intensely colored
make-up yesterday), did my hair up, dressed in some metallic blue hot-pants
with a tank top, and was completely ignored. He went to bed without a word
to me, but acted this morning like everything was O.K. Then looked at the
pics. He passed me up for those old women. Just pictures, at that. What can
they do?

He says that every woman (meaning breasts and pelvic area) looks different
and that looking at them is a hobby and that all men do it (look at porn). I
think they all look the same. There is very little variation, especially
when you only compare the attractive ones. I mean, they are either young and
perky and tight, or old, wrinkled, loose, and discolored. There is only so
much difference and after awhile, they do all look alike. I've always
believed that it is love, life experience, and experimentation that make sex
exciting, not a parade of different people's gentals.

On your porn advice page, your replies sound like you also think every man
looks at porn and that I should be glad, because that means he's interested
in women/sex and that he has an imagination. Am I interpreting this
correctly? I have no need to look at any other man. I tried it...to get
even, but, first of all, he says that it wouldn't bother him for me to look
at naked men, and, secondly, I can't do it. It turns my stomach as much as
the other. I don't want to see anyone but my husband in his birthday suit. I
have an imagination, too, but it includes only activities with my mate. I
know the whole thing about men and visual stimulus, but why does that have
to mean other women? I hold myself open for him, I've masterbated for him. I
show myself to him. Why isn't that enough? It seems to me that it is not a
desire for visual stimulus, but, rather, a flat-out desire for other women,
and that has no place in a marriage.

I think he's a pervert. Is this, in fact, a "normal" view for a mature,
married man? How can I be intimate with a man I'm losing respect for? If I
have to accept this, then how?
 

A:  Instead of the perspective that he looks at older women, etc., instead of you, I encourage you to look at the single dimension of whether your physical and emotional needs are being met.

If your needs were met I wager you wouldn't care if he were fishing or bowling, and if you and he had sex often, and with great variety, you might even conclude that his looking at porno got him all hot and bothered and interested in approaching you sexually, and under those circumstances you wouldn't object, would you?

Call him on the absence of meeting your needs, not on the presence of what he looks at.

If you two can't work it out, get therapy before it gets worse.

sexdoc

A:  Some couples/people are sexual several times a day for ten years, others have sex once in 6 weeks for ten years.  Both are "normal" and it is a question of compatibility.  (Optimum health is AT LEAST every 3-4 days -- more IS better.)

Guys are at their peak at 18 or 19  then go downhill until 80 or death.  Women are at about 80% of their sexual drive at 17 or 18 and go uphill.  Up until around 38 it is usually the guy who wants sex more often than a woman, and after 38 it's reversed.

But in your case, I think you two are sexually incompatible and that you each would probably be happier, sexually, at least, with a more compatible partner.

sexdoc

A:  This is tantamount to relationship bait and switch, BUT she has some powerful arguments in the meds.  For most folks, anti-depressants eliminate sexuality.  I suggest that you either see a sex therapist about it, or go to my answers page 20, find the 2/11/00 entry regarding sexual desire discrepancy, and read it with her.

Your message needs to be "I respect and acknowledge your diminished sexual desire, but part of marriage is filling each other's needs.  If you wish not to be penetrated, at least join me so I can be sexual with you while you are passive.  Otherwise, I will take your refusal to do even that as license to get my sexual needs fulfilled elsewhere."

Many women (and men) treat "sex" as an all or nothing proposition -- a myth inspired by the idea that the only real reason you do it is to make babies.  As President Clinton illustrated, "sex" can be a lot besides intercourse.

It's a negotiation.  You give up the pleasure of vaginal intercourse in return for some external rubbing; she gets the avoidance of vaginal penetration in return for being physically present for you to rub on.

If you appreciate this answer, please send an update on her and your reaction.  I encourage you to withhold judgment until you have tried some of the frottage techniques.  90% of men before trying it insist they won't like it, and 90% of them after the event acknowledge that it wasn't vaginal, but it was damn better than nothing!

If she wants a baby badly enough, she'll be asking YOU for vaginal intercourse.

sexdoc

Thank you

A:  Not only is that disrespectful, demeaning, and outrageous, in most states it is also illegal!  My suggestion is that you have a heart to heart talk with him, ask what your flashing does for him, and see if there is something else you two can do that achieves his objective while respecting your wishes.  If the two of you can't work it out between yourselves, consulting a therapist to help deal with it would be in order.

If it is a control, aging, and excitement matter, which I suspect, be prepared that he will likely demand other novelties.  I urge you to maintain your boundaries and avoid doing something that you would regret.  It is he who is trying to change the parameters of the relationship.  Bend if you can, but do not break!  (Do you shave your pubic hair?  Please e-mail the pros and cons.)

A:  Because I know that other readers will identify with what you wrote, I am posting this on page 22 without your name, of course.

PLEASE let me know the med you describe in the sentence:  "My doctor gave me some other pill to help get my sex drive back and it seems to be working; I'm hornier more often now.  BUT!  All these sex problems."

This is complicated, and I hope you appreciate that e-mail has severe limitations.  This really needs face to face sex therapy, but if you periodically have difficulty affording your meds, I infer that you can't afford sex therapy.

Other women like you, who have had sex with a former ex great lover- but abuser - have seriously regretted it!  The short term gain of great sex is weighed against the much heavier burden of a loss of self-esteem and serious regrets.

In the era of Christianity, monogamy, and AIDS, sex is a problem.

I encourage you to redefine "cheating" as physical contact -- thus the chat room exchanges are not a breach of monogamy.  And I encourage you to go wild in your fantasies.  If you don't already have them, I prescribe "Women on Top" by Nancy Friday, and "Erotic Fantasies" by Mrs. and Doctor Kronhausen -- both books are out in paperback.  Also I suspect you would enjoy "The Story of O" by Reage, and possibly, if you can find them, the "Beauty" trilogy -- The Claiming of Sleeping Beauty, Beauty's punishment, and Beauty's Release -- by Anne Rice who used the pseudonym A. N. Roquelaure when she wrote them.  All of those books contain some very strong erotic fantasy material.  Other readers take note:  These books contain material that is violent, sado-masochistic, and definitely not for the faint-at-heart or impressionable.  If you are unfamiliar with this kind of content you will never think of sex the same way again.  A milder compendium of all kinds of erotica can be found in "The Pearl" -- a paperback book compilation of a Victorian England underground erotic periodical.

So, get inspired by what you read, let it get you as steamed up as you wish.  Consider getting a dildo, because it will stay hard as long as you want it to, and pleasure yourself to orgasm as often as you would like.  Fantasize that the dildo is connected to whomever you wish.   That is safe sex and there is no contact with another person to regret.

Please let me know what you think of this, and if (hopefully, when) you read material from some of those books, please let me know what you think of that content.

sexdoc

A:  The most common method of masturbation is to provide stimulation to the penis, mostly the head, by contact with something -- hand, sheets lying on stomach, piece of liver (Portnoy's Complaint), someone's body part, etc.

Some guys have orgasms from prostate massage, rubbing something against the prostate by going in through the rectum.  If the object is at all sharp this can tear or rip the rectal wall, causing life-threatening internal contamination, so guys who practice this often use a latex or silicone dildo (artificial penis), or another guy's penis.

Some men and women experience orgasm from enemas; others can have an orgasm from stretching the anal sphincter, hence toys called "butt plugs."

And a few men experience orgasm from nipple stimulation alone.

Some women, but I have NEVER heard of a single man, can have an orgasm from thoughts alone.  No muscle squeezes, not clitoral contact, nada.  Just lie there, think special thoughts, and wham, have an orgasm.

That's about it.  Readers:  any  suggestions?  Special techniques you use?  E-mail DrFitz@sexdoc.com and I'll post the innovative ones.

sexdoc

Thanks for your help,
 

A:  Yes, some men do, from time to time, fake orgasms.  And it is usually for the same reason women do -- because they are unable to achieve orgasm and give up (or give out if tired or something hurts).  While there are individual differences among men, and, to a lesser degree, for one man from time to time, the resolution phase of the sex cycle is usually quite consistent.  I suggest that you observe the rate of detumescence and compare those times when you think he has had an orgasm with those times when you think he is faking it.  If the latter seem to happen when it has taken longer, or when you have no wet spot from his semen leaving your body, it could be faking.

I suggest gently inquiring while in the same breath reassuring him that it's perfectly OK if he can't achieve an orgasm vaginally.  If it is OK with you, I suggest volunteering to find an alternative method for him to then achieve orgasm, whether by your hand or mouth, or his hand, or rubbing against you, etc.  It is usually the case with men that prolonged sexual stimulation without orgasm results in pelvic discomfort (colloquially called "blue balls") -- and if it happens too often (depends on the man) it could cause prostatitis.

In general, people fake orgasms because they do not feel safe enough to disclose that fact to their partner.  It is up to the partner, then, to gently confront it and reassure the faker that as a team you two can work together to achieve a satisfactory solution.

Please let me know your (and his) thoughts on this.

sexdoc

Dr. Fisher comments:  Bill,

I thoroughly agree with your answer on page #22 regarding priapism in the 56 y/o male as reported by his 53 y/o girlfriend. It is common for the penis to stay erect for a short time after withdrawal if the ejaculatory fluids were not released via intercourse/sexual stimulation.  It is a medical problem (serious) if the penis stays erect for long periods of time in the absence of sexual stimulation.  Priapism, even in intermittent occurrences, can scar the penis and lead to impotence if not treated.  So, Please see a doctor immediately.

What causes intermittent priapism?  Many things.  Psychiatric medications (anti-depressants) are common culprits.  Even after withdraw of the medications it appears that it still has an effect on the penile function. Some injections to treat impotence can cause it. Diabetic and / or alcoholic neuropathy, kidney failure, etc....  Priapism occurs when the blood collected in the penile tissues becomes "stale".......Meaning, anything that causes the  blood to thicken, or cause red blood cells to lose their flexibility and mobility.  For example, I have a young gentleman patient (26 y/o) that suffers from intermittent priapism due to sickle cell anemia.  I also dealt with a gentleman that suffered from priapism from time to time.  I found that his blood was thick and with a low dose of blood thinners, it alleviated the priapism all together.  Please know, that it is perfectly fine for a man to have a bought of priapism a few times in his life.  Especially in younger men.  It is common for men that feel or fear that they will ejaculate prematurely to try to "hold out" and thus with the added stress not ejaculate at all or when they do, the blood has accumulated to the point (time wise) that it has trouble "leaving" the penile tissues.

A:  What he has is euphemistically called "retarded ejaculation."  The behavior modification approach is to have him masturbate until he is about to have an orgasm, then insert vaginally and thrust to orgasm.  Each successive training session requires that he insert sooner and sooner, taking more time intravaginally.  He might also have to withdraw, manually stimulate, and re-enter the vagina.

It takes the romance out of sex but works for SOME men.

Please be assured that it isn't you.

If that doesn't work he needs assessment by a sex therapist in person.  Some things we can do by e-mail; others require in-person treatment.

sexdoc

A:  You say "A lot of girls your age are curious about the differences between boys and girls (normalize the curiosity so as to minimize or avoid embarrassment).  But there are certain rules we have to follow and showing or touching the body parts, we call them "private parts," that are covered by a two-piece bathing suit for girls, and a one-piece bathing suit for boys, are OK only at certain times and with some people.  For example, it's OK for your parents, or a doctor or nurse to see you undressed, and it's OK for girls to see other girls, like in a locker room, but girls and boys aren't supposed to see each other's private parts.  Remember when you learned to go to the bathroom all by yourself?  You learned to close the bathroom door because going to the bathroom is a private thing.  And so is showing your private parts.  Because I would be uncomfortable if you saw me going to the bathroom, I would also be uncomfortable showing you my weenie.

Dr. Fisher replies:  This definitely needs to be assessed by a gynecologist on a face to face
basis.  The rear entry position allows for deeper penetration.  It is a very
good possibility that you may have  had a slightly intact hymen that was
fully torn or stretched by a deeper penetration by the penis at a different
angle, thus the reason for the pain and bleeding.  BUT you definitely need
to have a pelvic examination to rule out the possibility of any other
internal abnormalities that you are not aware of.    Also, a doctor does not
know if you are sexually active unless you tell them.  Years ago an intact
hymen was thought of as an indicator of virginity, but actually most women
tear the hymen by intense exercise, tampon use, or sports. Some women are
not even born with hymens.  Now, your mother doesn't know that you are
sexually active (or you "think" she doesn't know) and you want to know if
the doctor is going to rat you out.  Well, if you are under the age of
eighteen, your parents have a legal right in most states to discuss your
medical care with your provider.  But, if you explain to your mother that
you would like to take responsibility for your reproductive health and that
you feel that you can make informed decisions about such matters on your
own, I think she will respect your privacy.  And usually, gynecologists will
respect your right to medical privacy and not breach patient-doctor
confidentiality, unless they are dealing with an immature minor or very
serious matter (i.e. AIDS, pregnancy, abortion), in which excluding the
parents in their child's medical care and decisions would be
counterproductive. If a patient is under eighteen and she requests that her
care be confidential, I respect her wishes.  If I feel a situation warrants
parental notification, I ask if she would allow me to contact her parents.

Ah, the happiest place on earth for a woman...the gynecologist.  The golden rule for visiting the gynecologist used to be right after the onset of menses (period).  Over the years females have tended to start menstruating at an earlier age, thus the standard has changed.  Every woman should have an annual gynecological exam starting at the age of eighteen, earlier if she is sexually active or having problems such as irregular or painful periods, sexually transmitted diseases or other abnormal symptoms.  How long should you wait between visits?  I like to see my patients every six months, but a year is perfectly fine and is usually looked to as the standard.  If you are "medically clear", meaning the pap smear, pelvic and breast exam, and any lab tests are normal, an annual exam is acceptable.  But, if you are just starting birth control most gynecologists will place you on the contraception and then request that you make a follow up appointment in two to three months to see how the method is working.  Also, remember that if your method of birth control is Depo-Provera, a visit to the gynecologist is a must every three months in order to receive the injection, but a physical exam is not required at every three month interval.

For the gentleman that is worried about ejaculate draining back out of the female reproductive tract:  It is perfectly normal.  Some positions promote the expulsion of semen more freely than others( women on top for example).  All women are not "built" alike.  His girlfriend might have a "tilt" in her reproductive tract, but it sounds like mechanical body positioning.  Also, if they have always used condoms, and have just started practicing sex without them, it may seem like a dam wall has broke in terms of fluid release because the couple involved have always had the ejaculate collect in the confinements of a condom and haven't paid that much attention to the amount of semen expelled.  Try a rear entry position(dog style) with the female resting her elbows on the bed, thus having her butt angled up.  Also, you could try positioning her pelvis at an angle with pillows or throwing her legs over your shoulders while trying it in the missionary position.  As far as clean up....Sorry....place a towel underneath her or buy rubber sheets!

Now, for the "inappropriate" crying response at orgasm: Contrary to what many people think, the responses women exhibit at the peak of orgasm are varied and can often be misleading.  Women report to me that at their climax they explode with many varieties of emotional release.  Those expressions frequently involve laughter, sobbing and even sneezing.  Because the sexual response cycle is multiphasic, there are levels of energetic build up during the whole process.  At a woman's orgasm, she releases all the pent-up energy and blood engorgement that has accumulated.  All along this continuum are indicators, such as color change, increased breathing, swelling of genital tissue and wetness/hardness of sex organs.  Throughout this process of arousal through the "pop" of orgasm, energy is amassing and must be discharged.  That energy may take the form of whatever the body is capable of releasing....so that may show up as intense crying.  In American culture, tears and crying have received too much bad press, for both men and women. Know that this is a perfectly wonderful means for letting out both feelings and energy.  BUT, be sure that you have thoroughly checked inside to make sure that these tears are of joy, not sadness or something else that may stem from a past wound around relationships, sex or body image (religious guilt).  Also, remember that for many women orgasms that are achieved through penial/vaginal intercourse are quite different in terms of feelings compared to manual stimulation.

Considering the reference to sneezing, above, I must share with you:  A woman was referred by her gynecologist because she could find no medical reason why the woman had an orgasm whenever she sneezed, and I was asked to do a psychological work-up.  When I asked if she took anything for this condition, she replied:  "Yes -- pepper."  (Thanks for the joke, Kelly)

Now for hormone assays.  YES, hormone assays are extremely valuable.  To date, there are tons of different assays that can be performed. Most assays will test for a broad spectrum of hormones including, testosterone, prolactin, LSH and FSH levels. Some assays are hormone specific while others can scan almost every hormone in the body, rather it be a chronic or acute onset of decreased libido.  As far as time is concerned, some assays are taken every three days during a woman's cycle, some seven, and some assays are performed by intravenously pushing a dose of one reproductive hormone into the woman's bloodstream and recording at different time intervals (30, 60 and 90 minutes) how the others hormones react and how much or fast the body absorbs the compound.  The type of test that a physician would recommend would depend on the symptoms of the woman and if one hormone was suspected to be low or unbalanced.  Now, under what seemingly "normal" circumstances would a hormone assay be called for?  If it has been determined by the care provider that no external factors (kids, sexual boredom, abuse, antidepressants, abnormal stress, etc..) are involved, then it would be worth looking into an assay.  But you have to take each individual case to heart.  I have a guideline as a reproductive endocrinologist that I follow when a woman brings the problem of decreased libido to me.  I have her fill out a ten page questionnaire at the office.  The questions involve asking everything such as drug use (street and prescription), sexual history (rape, abuse, frequency), occupation, religious background, etc....  It may appear to be intrusive on my part, but 90% of the time I can identify the problem by the way the questions are answered.  If the questionnaire and physical exam come up negative, then I start with a COMPLETE endocrine work up.  This includes hormone assays for not only the reproductive system, but also the Thyroid, Pituitary, Adrenal and Hypothalamus glands.  These glands, especially the thyroid and pituitary, have direct feedback on gonadal control and function.  Diseases such as Cushing's Disease, Diabetes, high blood pressure or Thyroidism could actually affect sexual drive in both men and women.  If I can pin point or narrow the spectrum of possible problems down, I can then order a specific assay.  But, EVERY woman will go through a time of decreased libido at certain times in her life, as will men.  If a woman goes more than six months with decreased libido definitely seek help....medical or therapy route.

A:  If you can't raise the bridge, you'll have to lower the water.

Because there is no safe way to enlarge the penis, the only recourse is a cosmetic episiotomy, in which a surgeon cuts her introitus and sews it back up, only tighter.  You run all kinds of risks, anesthesia, infection, pain, scarring, etc.

It might just boil down to a realization that she has been literally spoiled by large penises and that you two are incompatible.

sexdoc

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