Sex and Relationships

Sexual Dysfunction

Answers to questions about sex therapy and sexuality

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

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Answer page #23

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Retarded ejaculation:  "All's well that ends well" or "The value of honesty and catharsis"
6/9/00 Q:  Hi Doctor,

I'll dispense with the pleasantries and get right to the point.  I'm a 42 year old male in excellent health that is involved in a committed relationship with a 36 year old woman (I'll call her Jane).  The relationship is normal and healthy.  We plan to marry in a year or so.  But there seems to be a problem with me and I hope you can provide some advice.

I was first married 15 years ago and went through a bitter divorce after returning from Desert Storm.  I was suicidal and required hospitalization (don't worry, I'm OK now).  Since then I've had 2 meaningful relationships (to me anyway) that ended due to the women "changing they're mind", probably because I was looking for commitment.  This left me feeling very bitter about women in general.

I took on the attitude that women were all basically worthless and the woman of my dreams did not exist.  So I started to "whore around"  I would disrespect the women I met and only used them for my personal sexual gratification.  (The interesting thing during this time was that the less I respected women, the more of them I would attract).  I had many sexual partners and always performed admirably.  My staying power almost perfectly matched my limit of endurance and orgasms were never a problem.  I consider myself a virile man, and have always seemed to satisfy my partners (at least I never got any complaints, even though I am aware that women can sometimes be overly careful with a mans ego and not communicate truthfully).

Fast forward to the present.  4 months ago I met Jane, the woman of my dreams (go figure!).  It may also be important to mention that she is the most physically attractive woman I have ever been with.  I would even go so far as to say that she is intimidatingly beautiful.  One of those women that a man will look at sometimes and say to himself, "My God, what does she see in me?"  This type of comment, in one form or another, has even been voiced by some of my male friends, and I get a distinct feeling of envy from female friends.  Don't get me wrong, I am a sharp looking man, but it would seem that I have chosen to be with less attractive females in the past.  Perhaps because I wanted the women to think they were "lucky" to have such a good looking guy, or something like that, and this seems to contribute to my "problem".

After we got to know each other and decided to make love, the trouble started.  I was unable to perform at all during the first 4 or 5 attempts.  Total impotence!  I wish I could explain the trauma we shared during that time!  I was considering all kinds of "fixes" - Viagra, doctors, hypnotherapy, acupuncture, aroma therapy, you name it.  Then all of a sudden it went away.  Yet one issue remains...

We can make love for an hour at a time a couple of times a day two or three times a week.  We make love in many different places and utilize many different positions acceptable to us both.  I will make love until I am dripping sweat from every pour and to the point of utter exhaustion.  Then I rest and do it again.  I'll repeat this until my body simply runs out of gas.  Yet I won't orgasm.  I do eventually have a teeth-rattling orgasm, most times I have to wait for another day.  I'll make love one day, but not orgasm until the next encounter.  Sometimes not until the third.

The results of this are two-fold.  First, Jane is beginning to suffer from emotional strain because she thinks that she ''can't please her man".  And two, I feel that I am contributing to a negative self-esteem issue with her, I wonder if there is something "wrong" with me, and sex is difficult emotionally for me also because I do not get the release and feeling of internal balance that comes from an orgasm.  This lack of an internal balance can contribute to my being less than understanding with her issues (which I feel are more important than mine) and end up having a "pity party".

Hence, I would like to ask your advice.  Do you think this will all just work itself out?  Should I seek further counseling or therapy?  Might I have a physical problem?  Do I love making love to her so much that my body just doesn't want it to end?  Or am I just having too much sex (if there is such a thing)?

Any help or advice would be appreciated.  Thanks.

Mike in Albany (not)

P.S.  This may be important to mention.  During the times I have "between women"  I would masturbate about every other day, as I have been since I was 12.  Masturbation never seemed to complicate my lovemaking abilities but since seeing Jane and having this "problem" I have almost completely stopped.  When I do, however, my body seems to react normally.  This leads me to believe that the issue with Jane is psychological and will eventually pass once I get used to having such a beautiful sexual partner.

A:  Dear Mike,

Your p.s. is the most important part!  If you can pleasure yourself to orgasm in a comfortable length of time -- whatever you want to invest or have time for -- AND in the same positions your body is in when you are having penetration with "Jane,"  the problem IS  psychogenic.  That (what we call) situationality rules out a systemic compromise.

In rare cases men can have penile stimulation to orgasm in every physical position except when they are on their knees -- either missionary or doggy style -- and that is a circulatory problem (pelvic blood steal).

I strongly urge you and Jane to get into sex therapy soon because the longer you repeat this delayed orgasm the more entrenched it will become.  If you noted progress -- i.e., the 3-event moving average length of time to orgasm getting briefer and briefer, you wouldn't need sex therapy.  If it is stable, as it sounds to me, you need to break this.

The self-help approach is when she has had all the orgasms she wants (and before she gets sore or too tired) and you then want one, withdraw, stroke with your hand vigorously, then re-insert just as you are having an orgasm.  If that results in your having orgasms intravaginally sooner and more predictably, you also don't need therapy.

Hypnotherapy, acupuncture, etc., are at best placebo effects.  I suggest a cognitive-behavioral therapist who reports that he uses Master's and Johnson's "Sensate Focus" all the time and has seen plenty of guys with this behavior.


If you appreciate this advice I would appreciate a follow-up of what happened.

And, THANK YOU for such an articulate and appropriately detailed question.  I have received this kind of question in 13 words and cannot provide an articulate answer.   Your presentation motivated me to reply with an answer of this detail.

Best wishes and I look forward to hearing from you.  Please reassure Jane that while she is NOT the cause of the problem she can be part of the solution (doing sensate focus with you).

He writes again:  Hello there again doctor,

Thank you so much for the rapid response to my inquiry.  Luckily I can already report some progress is being made and I have high hopes for the future.  I would like to share these in the way of a "follow-up".

Yesterday after writing my letter to you, I spoke in detail with "Jane" about it, relaying exactly what I told you.  It turned out to be one of the most productive conversations we have ever had on the subject of sex.  Previous discussions had always taken place in bed immediately following an "incident" when emotions where running high, precluding any truly effective resolutions.

It would seem that the fact of writing my problem down in detail AND discussing it in a calm and rational manner with Jane, a "weight' of sorts had been lifted.  As a matter-of-fact we had a "normal'' session of love making last night! (Actually her name is Mary (not), I mention this because it seems the more truthful I am, the more benefits I receive).

I may even be a step ahead of the game because I am aware of some of the techniques used in Sensate Focus.  During the "rough times" I poured over everything I could get my hands on.  When Mary and I were talking about my letter to you yesterday afternoon, she asked if there were anything SHE could do to help.  This is the first time she had been far enough away from her own issues to consider that option.  A MAJOR breakthrough!  She has not, up until now, been very interested in  foreplay.  She would just ask if I wanted to make love, strip, and expect instant penetration.  I'm sure this contributed some to my problem because I'm a big fan of foreplay.

I told her about some of the ideas presented in Sensate Focus and our lovemaking last night included some of them.  We gave each other a full body lotion massage with the understanding that it would not lead to intercourse.  She did me first then I did her.  I was about ½  way through when she said she couldn't stand it any more and we made love.  We also "talked dirty" to each other (something new we both thought would be interesting) during the hottest parts.  I'm pleased to report it was a complete success!  My erection was complete and I orgasmed at my previously normal time.  It was the first time I was able to make love to her like I knew I could.

In conclusion I wanted to recognize the help I believe just writing you contributed to this.  I wanted to thank you for making your services available (and free!).  Also I wanted to assure you that I do not consider one victory the end of the war.  I will continue to monitor this issue and consider further therapy if self-help methods dwindle in effectiveness or fail completely. Now I can do so from a much more stable platform without so much of the stress I was feeling before.

Thank you for being there.


Does this give you a better idea of why we do this pro bono? And, I thanked him for his role in Desert Storm.

It's not just deers at night, looking at headlights ...
6/9/00 Q:  I am a 31 year old male.  I have found the woman I would like to spend the
rest of my life with, but, there is one aspect of our relationship that I am
not particularly fond of.  She is 27, beautiful and athletic.  She also has
a low sexual drive.  When we do have sex, I try to everything to please her
and she is appreciative.  She would rather have intercourse than oral sex.
When she orgasms, it is usually accompanied by tears.  Then she does not
want to be touched at all immediately afterward.  We have set a date to be
married next June,  can I turn this behavior around?  We now have sex once
or twice every 4 to six weeks.  I have had an experienced past sexually and
enjoyed discovering my own sexuality as well as my partners.  My fiance gets
"grossed out" at a lot of normal sexual activity. i.e. particularly graphic
love scenes in movies, she begins to turn away from.  Let's not even mention
porn.  I truly love her and want to make her happy.  I would like to be
happier, and not fantasize as much as I have started to.  My imagination is
running the show lately, and I need a little advice.

A:  Run, do not walk, to your nearest experienced relationship therapist!  She is making a very clear statement that the two of you are incompatible sexually!  People divorce because of intellectual, emotional, and/or physical incompatibility! (Among other things.)

Unless she has a hormone imbalance you can't increase her interest in greater frequency.  And her psychological reaction is a HUGE WAVING RED FLAG!!!!!

You need to get a powerful professional reading on this.  You are blinded in the headlights and have unrealistic hopes.  (If this diplomatic approach isn't strong enough, I'll try to be more blunt.)

How much masturbation is too much?
6/7/00 Q:  Dear Dr.
I am 15 years old.  I have been jacking off since I was 10.  I am addicted.
I do not do it 24-7, but some times I do it 10 times in one day.  Most of
the time I do it 3-4.  So do I Jack off too much.

Please Help

A:  Instead of "masturbate" substitute any other time-consuming activity (watching TV, playing video games, etc.), and the answer is the same:  It's too much if it takes time away from other responsibilities, such as eating, sleeping, studying, sports, etc., OR if it causes tissue damage (in which case make sure you use a lubricant).  Aside from those two considerations, it's healthy and feels good.  Just don't make other people uncomfortable about it.


Too much vaginal lubrication
6/6/00 Q:  I have too much lubrication during sex to the point that I don't feel
anything.  My doctor has removed the estrogen from the pill, but with no
success.  What could be wrong?

Dr. Fisher answers:  The vagina is lined with a mucous membrane, there are no separate secretory
glands that are found in the vagina.  During sexual arousal there is an
increase in the blood flow to the genital region.  This causes
vasocongestion of the sexual organs and is responsible for producing vaginal
lubrication.  This increased blood flow causes fluid to seep across the
vaginal  lining in a process known as transudation....kind of like sweating.
Different women produce different amounts of fluid depending on age, degree
of arousal, medications and vascularization of the vagina.  This is a
natural process and there is no way to block the vasocongestion of the
genital organs during sexual arousal.  As you age you should see a decline
in the amount of fluid you produce.  In the meantime you might consider
keeping a small hand towel next to your bed so you can easily wipe away any
extra fluid that might be produced, especially right before penetration.

What happens during a Pap exam and can the doctor tell if I am sexually active?
6/6/00 Q:  I was put on the Birth Control Pill to regulate my period a year ago..and
since then I have become sexually active..They wont renew the pills unless i
go in for  PAP exam. My mom doesnt know that I am what exactly
will happen during the PAP exam? will they find out??

Dr. Fisher replies:  Pap smears and the exam that goes along with it are not as terrible as other
people make them out to be.  First, they will ask you a few questions about
your general health, your periods, etc... Then they will take your height,
weight, blood pressure.  Now, when you are up on the lube rack ( a slang term
for the  table) he or she will probably start out by giving you a breast
exam which is nothing major.  Then the doc will ask you to slide down to the
edge of the table and put your feet in the stirrups and ask you to spread
your legs.  He or she will take a speculum and slide it into your vagina.
Basically, this helps widen the opening so we can see better, it feels like
a little pressure.  After the speculum is in place, the doc will look around
at the tissue for any bumps, lumps, etc... Then he will take something that
will look like a long Q-tip or brush and swipe the vaginal/cervical  walls
to collect cells and place them on a slide to send them off to the'll get the results about a week or two later.  Now the speculum is
removed and he or she may take two fingers and insert them into the vagina
to feel the position of the pelvic floor, uterus, and other organs.

There will also be a nurse in the room during the exam.  They usually stand
up by your head and talk about subjects totally irrelevant to the exam to
keep your mind off of what is going on. The nurse usually hands things to
the doc too.

No, doctors cannot tell if you are sexually active unless you tell them.
And yes, they usually ask because they need to know this to in order to look
for diseases or conditions that may result from sexual activities.  Don't
lie, it defeats the purpose of going to the doctor.  The doctor will not
tell your mom that you are sexually active.

And by the way, nothing you can say, ask or do in the gyno's office will
embarrass the doc, we have seen and heard and been asked it all!

The effect of clitoral piercing on orgasm
6/2/00  I am having trouble achieving orgasms now -- could having my clitoris pierced be the problem?

Dr. Chance Fisher responds:  First, we need to narrow down what type of clitoral piercing you had.
Clitoris piercings are not performed as often as clitoral hood piercings
because few women are anatomically suited for the piercing.  The clitoris
piercing is not inherently dangerous as long as the clitoris is large enough
to support the piercing and the piercing is placed appropriately.  The
clitoris must be at least 1/4" wide and the hood must not constrict the
jewelry.  If the jewelry is constricted or twists under the hood the
piercing will migrate, reject, or scar.  The glans clitoris contains as many
nerve endings as the glans penis.  Nerve damage can result from piercing a
clitoris that is too small or from piercing through the shaft of the
clitoris and through the dorsal nerve.  Some women that have a clitoral
piercing lack sensitivity because the glans of the clitoris is exposed and
has become desensitized.  So, there might be a slight chance that there is
some nerve damage due to the piercing, but not to the extent that it should
cause a lack of orgasm altogether.

Question that opened the sexdoc's Pandora's Box of fidelity
5/30/00 Q:  Hi Dr. Fitz,

    I am a faithful reader of your website and have written to you a couple of times in the past and appreciated your insights. I think I finally have a handle on what my real  underlying question is and am hoping that you will consider giving me the benefit of your experience.

I have an ongoing challenge in my relationship with my partner who seems addicted to the personals sites and looking to find a cyber-mistress. He feels this is his personal business and none of my concern. Although I have told him this is intolerable for me, he continues to do it, so I know it won't change. I am in the position now of choosing to end the relationship because of it.

After many months of soul searching about this, I realize my question boils down to wondering whether there is such a thing as mental and emotional fidelity in men (and are women any different?),  or are these concepts just wishful thinking? Have men simply evolved from Australopithecus to the present state, still responding to every pretty face that walks by, making physical faithfulness simply an inconvenient  necessity based on practicality, and not on any inner sense of  fidelity? Is my partner an exception or are all men on the prowl emotionally and mentally?

Thanks for your input!!

The Hopeless Idealist

A:  Dear Hopeless,

What a wonderful question!  Because I am positive that other people (men as well as women) have this concern I am posting it.  There is an old saying that "the person with the greater need always loses."  What impacts me is the question of what else he will escalate to if you give in on something so obviously distressing as this?  His insistence that you bring a girlfriend into the bed with both of you?  His having sex with men with which you can't compete?  Exactly what you describe is why there are references to "starting down the slippery slope!"

I urge you strongly to reassess your self-esteem.  Do you really have trust and intimacy with a man who continues to engage in a discretionary behavior that you find intolerable?  You're not being "finnicky" or "prissy" here.  This is emotional commitment, and he is saying loud and clear "I am not willing to invest all my emotional needs in one woman."

Is there such a thing as mental and emotional fidelity in men?  I wish to expand that to include "physical" as well.  "Mental fidelity" is a curious oxymoron which implies that a man (read "person") can remain "faithful" to his woman by not fantasizing about having sex with other women.  Unattainable except in the brain compromised.  Please (everybody) embrace the old adage:  "I don't care where you get your appetite so long as you eat all your meals at home."  Please do not attempt to curtail any fantasy life.  It will fail, lead to lies and guilt, and suppress affection and creativity.

I define emotional fidelity in this context to mean that a person does not have a relationship in addition to his primary relationship, in which there is romantic love and a desire to be sexual with someone, in the absence of sexual contact.  This happens often in the workplace, especially if the people interact interdependently, and often under stress.  It is a form of getting one's affectionate and esteem needs met in a manner contradictory to an expressed or implied promise (monogamy).  The requirement of romantic love excludes lust.  If a guy lusts after a Playboy centerfold or an actress, don't worry.  If he lusts after a co-worker, that could develop into romantic affection through mutual flattery (among other avenues).

And finally, physical fidelity.  Every spouse is capable of providing variety in sexual activity, but no spouse is capable of providing variety from a different person.  Because mammals in general, primates, in particular, and humans in the extreme, are stimulated by novelty, it is irresistible to believe that the grass is always greener on the other side of the fence (especially if the "fence" demands mental fidelity!).  In days of old, when men owned their wife, children, livestock, and homestead, committing adultery was theft and banned strictly, to prevent social chaos.  When the only people who could read and write were religious leaders, and their role was to define contemporary morality (often by their own proclamation and for self-serving purposes), the ban on adultery kept the masses in line, and the ban on masturbation (but only for men, in the bible) and birth control forced the need for sexual release to make babies (read "a pissing contest to see which religion had more followers than another"), clearly defined needs, whether you agree with them or not, were met.  I respectfully suggest that if we ignore religious mandates, a big "if" I grant, that an occasional roll in the hay under certain circumstances is much less threatening to the sanctity and security -- thus, continuity -- of a marriage than emotional infidelity.  The executive of either gender who has some sexual contact (yes, Bill C., oral sex counts) with someone while at a business conference out of town has much less of a chance of disrupting his or her marriage than the person lusting after, flirting with, and often having lunch with, a co-worker.

If a person's needs for affection, self-esteem, variety and frequency of sex, etc., are being met, it is easier to forego the frosting of variety by person.  People who have an occasional sexual contact with someone other than their significant other ("SO") feel more alive, vibrant, desired, valued, thrilled by "getting away with" something naughty, independent, and rebellious to societal mandates.  I am not advocating open marriage.  The vast, vast majority of them fail for a variety of reasons.  What I am suggesting is that finding out that your SO had some sexual contact with someone besides you is not necessarily grounds for extreme emotional anguish and financially punitive legal proceedings.  Often, in marital therapy, I find that learning confidentially that one member of a marriage had sex with someone else is a magnificent opportunity to assess needs and to institute behavioral change so the marriage is more satisfying.  I must add that I get a kick out of the times when the monogamous spouse confides that she or he knows about what the other did, but that she or he pretends not to know.

Genetically we have been bred for men to diversify the gene pool (have sex with as many child-bearing age women as possible), and for women to select the alpha male for sex, then to keep him around to protect her from saber-toothed tigers and mastodons when she is waddling along 8 months pregnant.  So yes, men are hard-wired to be attracted to every pretty face that walks by (although most stare either 14 inches or 36 inches lower), but that doesn't mean that impulses to act on those thoughts cannot be controlled.

Socialization imposes rules of conduct, violation of which has consequences.  We eat with a fork and knife (and some have mastered chop sticks) instead of with our hands, we are taught not to go to the bathroom or pass gas in public, and if you want to get laid, to be perceived as having value.  Relationships are negotiated expressly or implicitly, and the rules often include "I won't have sex with anyone but you if you agree to the same thing.  If you break that rule there are consequences."

Is physical faithfulness simply an inconvenient  necessity based on practicality, and not on any inner sense of  fidelity?  Not quite.  Physical faithfulness is an intellectual decision that requires self-control because for men, it is contrary to what all the biological signals are screaming.  Hey, religion, many parents, and society said that if you masturbated, horrible things would happen.  You did, it felt wonderful, and nothing bad happened.  A lot of people say adultery is the work of the devil, but for those who do it, the internal chemical reward is extremely reinforcing.

I'm sorry it took so long to answer your e-mail (in days, not in words).  As you can see, I found it very provocative.

What do you think?


6/5/00 She writes again:

Hi Dr. Fitz,

    I want to thank you very much for your thoughtful and insightful
response to my question about the mechanisms of faithfulness. What I
understood you to be saying is that the biggest problem with my
partner's behavior is the fact that it contravenes clear boundaries set
by me in our relationship. That in another relationship this behavior
might be OK because both parties had agreed it was OK. Did I get that

Yes.  Couples make often complicated and often unspoken rules, the lines of which are drawn sometimes by body language (a dirty look when she flirts or he stares at boobs or ass), or orally (taking your SO aside at a party and saying something about his/her behavior).

You point out that men have to constantly curb their natural biological
inclinations. One is tempted to ask why they would be willing to do this
over a long period of time? Clearly, different men must deal with this
challenge differently. In my partner's case, I think he just feels
unnecessarily constrained and has found this particular way of meeting
this biological imperative: remain faithful in body only but the sky is
the limit otherwise.

Men and women are willing to remain monogamous so long as the scales of assets and liabilities (one of which is foregoing sex with someone else) stay in the positive.  If she "cuts him off" from sex because she's mad at him, he can rationalize that it's OK to get sex elsewhere.  If he fails to let her know how important and desirable she is, that can be taken as grounds for sex outside the relationship.  "Addicted" to the personals and searching for a cyber-mistress smacks of fear of intimacy or inability to commit, and if I saw the two of you in person, I would delve deeply into your emotional compatibility (which I strongly urge you to do with or without a good relationship therapist).  There is a very real sense in which he is saying, loud and clear: "Hey, if we get married or otherwise commit, you're on notice that I will probably continue to test limits and boundaries and 'slip."  I AM an addict, you know...."  I, the sexdoc, don't buy that.

You go on to say that it is imperative not to suppress fantasizing.
However, this is what he considers he is doing is fantasizing with no
intention of acting on any responses he might scare up through this
activity. I have told him that he has already contravened a monogamous
agreement  when he is having suggestive correspondence   with another
woman, and that his constant attempts to establish such relationships,
and his advertising that he is available for extramarital activities,
go way beyond the realm of fantasy. I tell him that these behaviors are
like someone walking around the house constantly waving a loaded gun,
looking at the gun and admiring the gun and imagining shooting the gun,
while saying they would never shoot it. The stress is constant.

So, this breeds another related question, when does fantasy cross the
line and creep into reality? I say the line is crossed when there is an
actual other human involved and communication occurs. Where do you draw
the line? I would be curious to know.

Fantasizing occurs without ANY interaction with the fantasized object.  You can lust after an actress, but if you attempt repeated contact that's called "Stalking!"  By his ACTIONS he is going beyond fantasizing.  It might be more easily understood sideways:  Thinking about sex with an animal is fantasy.  Sexual contact with an animal by a human is called bestiality.

You have made so many good points in your comprehensive response, thank
you for taking the time to go through the exercise and helping me to
clarify this very prickly issue.

You are welcome!  I have already heard from several people that this has caused a lively and provocative discussion, and helped them clarify their marital boundaries.  Thank you again for a great question.

The Idealist

When you give a guy a hand job, what do you do with the semen?
5/30/00 Q:              I want to give my boyfriend a hand job, but i am really confused about what to do with the cum afterwards, i want to ask him about it but i feel kinda stupid asking. I have started givign him one many times before but then i start thinking about when he cums  and i wont' know what to do. please help me.

A:  This is why God invented Kleenex!  She expected this!  There is no reason why you cannot have a facial (or toilet) tissue (hey, a Macdonald's napkin will work) handy -- even wrapped around the erection, if you wish.  Some people prefer to use one hand to stroke the penis, and have a tissue cupped in the other.  When he starts to come, simply cover the head of the penis with the tissue, hold it in place, and be prepared to mop up if there is a lot of fluid.

When you graduate from a hand job to a blow job (sucking his penis), remember that you don't have to swallow and you can quickly replace your mouth with the tissue when he comes.

WHAT CAN GO WRONG:  1) [major] women HAVE become pregnant by taking the "come-covered" fingers and, in their own sexual excitement, putting them into their vagina, essentially forcing seminal fluid up them; and 2) [minor] the ejaculate can quickly cause the tissue to disintegrate, resulting in what looks like a doily surrounding the tip of the penis.  Be prepared to ball the tissue up to catch all of the fluid.

p.s.  In the Coincidence department, the sexdoc does not recall receiving ONE question like this since starting the site in May, 1997, and the VERY NEXT e-mail after this question was on the same topic!

How to achieve better sex
5/25/00 Q:  My wife and I are in our late forties. She has agreed to sexual
counceling and I was wondering wheather there was concnetrated program
available to teach people to appreciate sex (be more relaxed, and have
fun). A weekend program or the like would be ideal as a beginning.

Suggestions would be appreciated

A:  Because sexual attitudes and behaviors evolve in each individual over a significant period of time, slowly, they are best changed that way.  The weekend sensory awareness sex retreats sometimes work for a few days or weeks, if at all, and rarely last.

What works for the rest of your life (in the therapy I do, at least) is a technique called Sensate Focus, assigned and monitored by an experienced sex therapist.

I have had patients who came in and asked not to be assigned sensate focus, claiming that they tried it for several months and it didn't work, to find that they failed to include an essential component:  review, reframing, and re-direction weekly by an experienced sex therapist.

I have had couples respond effectively in 8 weeks, and others that needed 20+

I hope this helps.


A sicko for watching husband masturbate in the shower?
5/23/00 Q:  Thank you for your wonderful service.  I've been reading you for some time now and I don't think I've ever seen anything quite like my situation before.

I'm a healthy, happily married (for 3 years)  27 year old female. Our sex life is good. I walked into the bathroom one morning and found my husband masturbating in the shower.  He didn't see me through the frosted glass and he didn't know I was there.  The strange thing is, is that I stood there and watched him!  I wanted to just walk out, but couldn't.  Now, I finding myself watching him in the shower all the time and wanting to 'catch' him again.  I can't help but think that I'm some kind of sicko for wanting to watch him do this.  I know masturbation is normal, and it really doesn't bother me that he does it.  It's not like he does it every day.  I just enjoy watching him when he does do it.  What's going on?

Thank you.

A:  Ah, the ravages of sexual repression take their toll!  Puhleeeze, "sicko" for watching your husband masturbate in the privacy of your bathroom?  What could be more intimate, respectful of monogamy, open of him, trusting that you would not be critical, and devoid of STD risk?  An essential component of voyeurism is that the observed party does not know that he or she is being watched.  Many couples spice up their sex life by playing voyeuristic games, with one hiding in the closet (open a crack) while the other does something "kinky."

It is perfectly normal to add the adrenaline rush of doing something "naughty" to something sexual, to turbocharge it!  That's why some couples have intercourse in a public place -- the possibility that they might get caught makes the sex explosive.

In the sense that the degree of difficulty is commensurate with the degree of reward, many couples find that one of the most difficult emotional challenges is to pleasure themselves to orgasm while their spouse watches intently, making mental notes.  Once they are able to do it, the sense of relief is absolutely immense!

Instead of loitering near the shower hoping he'll do it again, I suggest that you invite him to watch you while you're in the shower, because he'll get a surprise, making it clear that he is to stay 6 feet away (this time).  Your "job" is to be a porn star on live stage, bending your knees, pressing ham (your butt cheeks) against the frosted glass, and with fingers or shower massager on your clitoris, moan and groan and shriek when you have an orgasm.  Lots of slurping sounds of your fingers in your vagina are a bonus.  If you can observe him discreetly, I'll bet he is stroking himself (or mopping something off the bathroom floor).  Enjoy!  This is what a committed monogamous relationship is all about!

(Let me know what happens and let me know if I may post it here [and remind me it's posted on 5/23/00 so I can find it again].)

Guy takes 20 minutes to ejaculate during intercourse; it works only half the time
5/23/00 Q:  Hi,

When my girlfriend and I have sex, I only ejaculate about half the time and
it takes me about 20 mins most the time.  How can I do this every time and
maybe be able to control how long it takes.  Please help me, I know you are

A:  If you're nervous, etc., that can retard ejaculation.  If intercourse provides deficient stimulation, you can do the unromantic thing of stimulating manually either before insertion or mid-way (after she has an orgasm, if possible).  Aside from that, usually it either gets better because you learn how to angle your penis for more stimulation, or almost withdraw, stroking then rapidly, giving the head of the penis more attention.

Let me know what works for you.

That having been said, you need to know that there are men and women who would LOVE to be, or have a male lover who has, that problem.


Nervousness causing sexual problems three months into first sexual relationship
5/23/00 Q:  I have a problem; I have suddenly been unable to reach orgasm with my
partner. We have been going together for three months, and this is my
first sexual relationship. Up until a week ago things were going great,
until I mentioned to him that I only seem to have an orgasm when we are
alone at his house (I live in an apartment and feel self-conscious about
being vocal because of the people around me). He said he had noticed that
I was more tense at my place. So I recognized that I had a problem with it
and asked one of the volunteers on this web site about it, and she
suggested imagining that no one else was there. So I tried that, but
easier said than done. I get lubricated really well but then dry up fast
when he starts touching me. I even tried alone to get one, as I have been
able to in the past, with the same results; I could get aroused but could
not maintain the lubrication. How do I know if it is psychological or
physical? Could it have to do with the original problem, or even with
another problem - one of his friends who is out of a job, moved in a few
weeks ago, which did upset me as I was used to having the house to him and
myself, plus the fact that this guy has yet to start looking for a job and
has not been helping my boyfriend around the house on top of the fact that
he is letting him stay free? I did mention this to my boyfriend as a
possibility of why, and he did say he would address it with his friend
soon, but that‘s not what I‘m thinking about while we are having sex,and
after I talked to him about it on the phone I tried once again in vain to
arouse myself, and even when the other guy was not at the house yesterday
and we had sex, it still didn‘t happen. My last orgasm was a week ago; and
actually, I did think his roommate was in the house so I was quiet about
it but still able to have one. What do you think? What should I do about
it? Do you think my therapist (not a sex therapist, just for psychotherapy
off and on for the past 5 years) could help me? Thanks for your help!

A:  Because your biggest sex organ is your brain, the same thought processes that can make sex imaginative, fun, exciting, and meaningful (among many other things), can also make sex impossible due to stress, worry, fear, or sensitivity (among many other things).  Because this is your first sexual relationship, and it is in the early stages, I infer that you do not have personal experience with the fact that things vary.  Concern about being heard, or even remembering that you were worried about being heard, can dampen your libido.  Considering the circumstances, I think the chance that it is physical is essentially zero.

Focus on pleasure and fun, not on performance.  Take time to pleasure yourself with no particular goal of orgasm.  Just keep doing it and see what happens.  Time, experience, and learning what works and what doesn't is what you need.


Why does semen get runny?
5/23/00 Q:  Why does semen come out sort of like honey, then "melt" to make the wet spot on the bed?  Is it the oxygen in the air?

Dr. Fisher replies:  Well, oxygen does play a part in liquification, but the major players are
actually  proteolytic enzymes in the semen.  The constituents of the semen
responsible for coagulation originate in the seminal vesicles.  The seminal
vesicles contribute fructose and prostaglandins to the semen.  The
proteolytic enzymes that initiate liquification are found in the prostate.

After semen leaves a man's body it undergoes a lot of changes.  The
first step is called coagulation, during which it separates into protein and
water, forming a jelly like substance.  In the vagina, the elevated
temperature keeps the semen liquid for some time, but outside the body, it
can coagulate within minutes.  The coagulated semen remains this way for
about 15 - 30 minutes.  If it sits longer, it liquefies again, as the
enzymes in the semen break it back down to a liquid form.  This usually
happens within one hour of ejaculation.

Am I expecting too much from a relationship?
5/22/00 Q:  Hi.  I am a 26 year old woman and have been married for 5 years.  I have one child and an extremely demanding career as a state social worker.  My husband and I have certainly had our share of problems and have considered separating numerous times.  I have read many of your responses to questions, and I know this is not a case of sexual incompatibility because we used to have an incredible sex life.  For the past few years however, I can barely bring myself to have sex with my own husband.  I rarely have an orgasm, usually only if there is anal penetration.  I find myself imagining that my husband is someone else just to get me through it.  Basically, I love my life.  I have a great job, a beautiful daughter, and the home of my dreams.  Sometimes I think that I am just being greedy to expect more from our relationship and I should just count my blessings.  We have been through counseling twice and nothing seems to help.  I just don't know what to do anymore.  I hate to think of the pain I would cause my husband if I suggested separating, but do I have to accept that this just happens?  Please help.

A:  In response to the suspicion of some readers that I post only the most controversial or the "easiest to answer," or the most outrageous questions, here is one that is very difficult to address.  Part of what I can say will sound glib; part is unknown, and part accurately reflects the medium of e-mail -- one way, absent body language, and brief.  (Instead of "The good, the bad, and the ugly, this is the glib, the unknown, and the brief.

If you have selected each other based on all your filters, such as age, race, weight, height, education, social skills, respect, etc., and if you are intellectually as well as emotionally compatible (you say you are already sexually compatible), I would listen for one or more of sub-clinical depression, intimacy problems, one or both taking the other for granted, lack of rewarding behaviors, and/or unrealistic expectations.  For some couples everything is fine except a sense of "Is this all there is?  I thought marriage was much more than this!"

If I were seeing you professionally I would encourage substantial amplification on your reference to "... just being greedy to expect more."  I am distressed when I read the familiar reference to "been through counseling twice ..." and I encourage you to consider deep research for a therapist who is known to be really well trained in advanced relationship matters.  Alternatively, or additionally (try first) check out the books by Harville Hendricks, and take the time to go through every exercise.  I would really appreciate an update, reminding me that this is posted on 5/22/00.

No intercourse during 14 years of marriage
5/22/00:  Hello,
My wife and I have been married for 14 years and have never had intercourse.
We do everything else but always stop short of actual penile insertion. We
bring each other to orgasm orally. Not that we haven't tried but there's
always something. She seems to have a fear of pregnancy and I will lose my
erection due to performance anxiety (self-diagnosed). We have tried to talk
about these things but always end up arguing about it. I am literally at my
wits end and am quite depressed about this situation. Is sex therapy the
only solution for this?

Thank You

A:  This is a rare state of affairs.  Yes, sex therapy is appropriate, but be prepared for months of systematic desensitization.  For the two of you to have rehearsed this for 14 years it is chiseled in stone and will need lots of time and patience.

5/22/00  I e-mailed a woman the comment that "it is so much easier to be a man (biologically)."  She replies:  I found:

The male hormone testosterone affects both the way a man's body develops and the way his brain thinks. Compared to a woman, a man generally has a smaller stomach; larger lungs; 20 percent more red blood cells; 50 percent greater brute strength; a shorter lifespan; less ability to stand high temperatures; a lower heart rate; he has greater sensitivity to light but less sensitivity to sound; greater likelihood of being left-handed, dyslexic, or nearsighted; greater tendency to have allergies; greater aggressiveness; stronger sex drive; he is more easily stimulated sexually by sight; less aware of how to develop an interpersonal relationship; more logical and less intuitive.

5/18/00 Update from an appreciative visitor to


I wrote you an email about a month ago, about 6 pages or so of my life history and the history of my sex problem.  Since you may not (probably will not) be able to connect to my original letter, I will give you a brief summary.  I am 50 and had never been able to turn myself on by masturbation.  Results with a partner were not good either, and several nice relationships had ended because I was sexually unresponsive.  The few times I did respond were when I was "surprised" (or with my first husband, when he was partially asleep).  I had already tried everything I or several sex therapists could think of.  I am an intelligent, educated woman who grew up in an asexual family.  You assumed I had already read Lonnie Barbach's book ("For Yourself") and told me my problem was serious and you couldn't think of anything to help me.  Actually, I had not read the book, so I did.  At the age of 50 years, 3 months, 14 days, and 11 hours, on April 24, 2000, I got turned on for the first time by masturbation!  And again the 26th and 27th, and regularly since, and I am becoming more regularly orgasmic as time goes on. The two things that helped me the most were:

     1.  I had been told (by therapists) that I needed to develop a fantasy life because I am (definitely!) an observer, analyzer, etc. of my own performance.  This had not worked so I tried the suggestion in the book of watching "pornographic" (I wonder if they would still be classified as pornography) movies.  Yes, it worked for me.

     2.  Her suggestion of masturbating for an hour every night no matter what happens!  I had tried masturbating but the performance anxiety kicked in if I didn't respond right away.  Well, now I never respond right away but no longer have the anxiety about that, because I am doing it to fulfill assignment, not to get turned on, and now I almost always get turned on!  (I now am a firm believer in the "use it or lose it" theory).

Thank you so much for being on the internet to help people and for recommending Lonnie's book.  If you were here right now I would give you a big hug and probably start crying.  I had almost come to the decision that I shouldn't have any more relationships with men, which may not have mattered for all practical purposes, because by then I was actually afraid to get into a relationship, knowing it would come out sooner or later that I was sexually unresponsive, and the relationship would probably end, and badly.  I haven't found a new relationship yet, but now have the confidence to do so.

Thank you again.


Is there any way to reduce the size of the Labia Majora?
5/18/00 Q:  I was very overweight and I am losing it but I have noticed that my outer vaginal lips are still the same large size.  Are there any exercises or other ways to reduce their size?

Dr. Fisher replies:

Yes, there are cosmetic surgical procedures that can actually reduce the
fatty tissue of the Labia Majora.  As far as exercises go, there are not any
that will reduce the fatty tissue.  But, lets look at the facts, this is one
of the few places on a woman's body where fat can work to her advantage!

The Labia Majora, along with the Labia Minora, protect the urethra, clitoris
and vagina.  In the Labia Majora there are sweat and oil glands that
secrete a scent when sexually aroused....the same scent that makes many men
go crazy.  These "lips" are also very sensitive so, the bigger the better.
Besides, we're not all suppose to be the same....some pussies are tucked
nice and snug and some have lips that just stand out and say "Hello there
sailor."  If you find one man who likes a "dainty" one there are ten men
behind him saying "I'll have what he's having, but super size mine."  It's
all in what you like....and so far I haven't found a straight man who
doesn't like a pussy!

Menstrual irregularity after stopping birth control pills
5/18/00 Q:  Dear Dr. Fitz

Thank you very much for your guidence of my previous problem, that is of the
sperm falling out on the bed.  Now another thing has come up,
let me start from the begining, I was consuming pills since last 6 months
and I stoped taking it in march, then I had my periods on april
29th that too the flow was not proper and by the 5th day it almost
stopped,so we had intercourse on the same day,but the very next day I had a
heavy flow and it continued for another 5 days.  Thereafter this time only
17 days have passed and again I have my periods.  before marriage my cycle
was of 40 to 45 days and during consumption of pills it was 25-27 days.
could you help me in analysing my problem ? is it because of sex ? (I am 24
years old and got married six months back)
Thanking you once again

Dr. Fisher replies:

When you are on the pill your hormones are pretty much flat....not low or
not high.  When you go off of the pill, your hormones swing back to what
they were before you started taking the pill.  The pill regulates cycles by
releasing a hormone (different depending on the type your taking) which
usually keeps cycles down to 28 to 35 days for most women and also decreases
cramps and bleeding.  When you go off the pill it will take your body time
to readjust back to your normal cycle and hormone levels.  It usually takes
about three to four months for it to return to normal. Most of the time your
cycles/bleeding patterns will be exactly the same as they were before you
started the pill.

Sex has nothing to do with your cycle length.  But what can occur is that
when you "think" you have finished bleeding and you have sex, the
contraction of the uterus and other tissues, along with your sexual arousal,
can cause the uterus to expel or "push" out any extra blood that the vessels
in the uterus may contain.  There is no medical risks here and in fact a lot
of women have sex when they think they are finished to "get rid" of the
excess products of menstruation.

Odd smelling vaginal discharge
5/18/00 Q:  okay. So for about a week I've been having a very odd smelling vaginal
discharge. I dont know what it is. I mean, I have pretty regular discharges
normally, but they usually dont smell this bad?  Could there be anything
wrong with me? Or am I just over reacting to something natural?

Dr. Fisher replies:  The vagina does a pretty damn good job of cleaning itself.  Discharge should
not  be foul smelling.  The only time there should be an "off" odor that is
considered natural is during menstruation....and what you are smelling is the
iron from the blood.  Foul odors are caused by vaginal infections due to an
over abundance of bacteria that upset the pH levels.  Some times the odor is
coupled with an off color discharge (green, gray, yellow, or off white).

First, you probably have the start of a yeast infection or a minor bacterial
infection which can easily be cured with creams (over the counter) or now a
pill.  If you are sexually active and have had unprotected sex, make sure
you are not dealing with an STD, which could cause infertility down the road
if not treated.

If you find that it is a yeast infection and treat it as such, a good
prevention is to eat yogurt as well as lather the vaginal walls with the
yogurt directly.  And at night, sleep without underwear to air things out.
Keeping the moisture under control is important to prevent bacterial and
microbial growth.

Wife doesn't give oral sex often;  Why can't a woman be more like a gay guy?
5/18/00 Q:  My wife is not into giving me oral sex at all. She does it once in awhile
because she knows how much I enjoy it, but I know that she is not enjoying
it. It's an extra special turn on to see that a woman is turned on by
sucking on my penis - which my wife is not. Sometimes it's just the
mechanics of it that she can't master, and I know it takes time - we've
been together 3 yrs. Gays that I've talked to say they live to orally
service men???????????????? Why can't women be like that????? in addition
to intercourse?

A:  Some gays love to give oral sex because they know how good it feels.  Women, absent a penis, can only analogize.

Make sure that you are fresh, clean, and un-smelly in that entire region.  If she associates your penis in her mouth with the odor of a fart, I would expect her to be turned off.  On that topic, remember the old junior high school comment that "a rat smells his own hole first" if someone asked "who farted?"  It's actually the opposite.  People who walk into a bakery salivate at the delicious smell, but bakery workers don't smell it as strongly because of sensory acclimation.  You might not think you are smelly, either because your nose is accustomed to it or that you don't stick your own nose that close (unless you are capable of autofellatio).

And some neanderthals into control and insecure in their masculinity, demand that their lover take all the ejaculate in their mouth and swallow it.  WRONG!  If that is a problem for her, make it clear that it's OK if she replaces her mouth with her facial tissue covered  hand when you start to spurt.

And last but certainly not least, discuss this with her.  Remind her that you consider this one of the most loving things a woman can do for her husband and probe for something with which to reciprocate.  It doesn't have to be sexual.  I have had women in therapy whose negotiating trade was a back rub, thighs or buttocks rub, or being washed in a bubble bath or shower!

If you appreciate this advice, send me an update with the reminder that this e-mail date was 5/18/00.


p.s.  I am reminded of the song in My Fair Lady, "Why can't a woman be more like a man?"

Never horny 22-year old woman
5/18/00 Q:  Hi I am a 22 year old female that is just never horny. I have decided not to have sex till marriage, and my fiance is ok with that. But.. I can't bring myself to even mess around. I just don't care. I have been on birth control and I think my problem started not long after I started those. This problem is really starting to ruin our relationship and I don't want it too because I love him. But I also don't want to do it cause he wants it, I want to want it too. Do you have any suggestions? Thanx for your time. Confused

Dr. Fisher replies:  Certain birth control pills or contraceptives will cause a hormonal
imbalance and thus, cause a decreased sex drive.  You didn't state what type
of birth control you were taking, but most of the time, Estrogen based pills
will cause the most problems with libido.  It takes Estrogen and
Progesterone to make you feel normal and balance libido.  The two weeks
before you ovulate is regulated by Estrogen, while the two weeks after you
ovulate are regulated by Progesterone.  If you have a Estrogen dominance,
the Progesterone is overwhelmed and cannot do its job.  What you need to do
is go back to your doctor and tell him or her to prescribe a different
dosage or an all together different kind of birth control method.  There are
tons of different oral contraceptives, you may want to check into a
Progesterone based pill or a new one called the "mini pill" which is a low
Estrogen dose.

15-year old worrying about erections
5/18/00 Q:  Hi Doctor!
Where can I start... these past couple of days I've notest that I don't get
many erections no more even when I try to masturbate it doesn't grow as
quick. For example I'm only 15 and I had my first actual oral sex(head job)
with a partner where I didn't exactly go on a big erection it was more of a
floppy one, and today I had asked a female friend if she could masturbate me
to see if I could get an erection and she did but I didn't exaclty get one
there either like it was kind of growing after awhile but we got interupted
so we stopped about 2 mintues later. I'm really worried and I'm not sure
what to do I'm still virgin, and I do wake up with erections. Could be that
I masturbate too much? I don't really want to go see a doctor so is there
any kind of massages I could do or is it just some kind of phase? oh and I
recently picked up smoking so could it be because of that? if it is, is it
to late to quit? Please reply back thank you!

A:  STOP SMOKING IMMEDIATELY!  It can cause cardiovascular problems with sex besides having all kinds of negative health effects.  And, many self-respecting women will not kiss a smoker; they say it is like licking an ash tray.

Worry, fear of getting caught, etc., can interfere with erections.  If this has been only the last couple of days, relax.  It has nothing to do with masturbating.  And the only "too much" masturbation is if it interferes with school, sleep, homework, or any other "should" behavior.


Is female superior oral sex possible?
5/12/00 Q:  Can a woman have oral sex when she is on top?  How is that possible?

A:  Oh my, yes.   A man lies on the bed on his back, the woman either faces his head or his feet, plants her knees on either side of his shoulders or his head, goes down onto her hands or elbows, and positions her labia over the man's mouth.

A variation is for the man to hang his head, face up, over a corner of the bed, and for the woman to stand on the floor and squat, presenting her genitals to his lips and tongue.

A variation enjoyed by many people is for her to have had a bath or shower and to then  rotate her pelvis so the tongue is in contact with a route from her anus to her clitoris,  then back again.

Enjoy (and let me know your reaction to female superior oral sex).


Female version of Viagra
5/11/00 Q:  Did I hear right about a new drug that just came out that is the female
version of Viagra?  I took one of my husbands Viagra and it didn't do
anything for me.  What about the over the counter drugs that claim to enhance
orgasm etc.  Is there anything new on the market to enhance the libido for
women like myself, over 40???  It takes me longer to reach an orgasm then
when I was younger even though I am just as turned on.  Tell me please, I
want to get back some of my sex drive.


Dr. Fisher replies:  A:  Yes, the same company (Pfizer) that produced the male version of Viagra is
also in the works of producing a female version of the drug.  They estimate
that it will be on the market later this summer.  There was a study where
women were given the male Viagra.  90% of the trial members exhibited the
same physiological responses as men did when given the drug.  There was an
increased blood flow to the genitals and an increase in indicator
of lubrication. Viagra does not work for everybody, especially when other
medications, medical conditions or alcohol is involved.

Right now, there are also two other drugs being tested and studied for
female sexual dysfunction.  The Parkinson's disease drug Apomorphine.  The
second drug is a combination of the herb Yohimbe and an amino acid called

As far as over the counter careful.  I haven't heard of any
earth shattering results from these over the counter drugs that would
warrant a referral from me or any other doctor.  Most of these work on the
mind......kind of like giving a Tic Tac to a three year old when they kind
they are sick.....if you think you have been given a wonder drug, then
positive results surely follow.

Lover (allegedly) has fear of her extra weight
5/11/00 Q:  I have a bit of a dilemma and I'm hoping you can give suggestions.  I'm in a
relationship and we both do really love each other for reasons other than
sex.  I'm about 50 pounds overweight, but I was much more overweight.  I'm
currently losing 2-3 pounds a week and my partner sees it and is a big source
of encouragement for me.  The problem is that he won't have sex with me
because of it.  In his past, every girl he was with was super skinny - size 1
- 3's so my body type is not the kind that turns him on.  I perform fellatio
on him and he will just rub me and make me orgasm with his fingers.  Can you
give me any suggestions as to something that may help him get over his fear
of my extra weight?  Is there anything I could do other than wait til I'm
thin?  It's very frustrating to me because I have the same needs as a skinny
person.  I don't think he realizes that.  Also, I think his sexual drive is
minimal due to the amount of marijuana he smokes.  Any thoughts on this
subject would be appreciated.

Thank you for taking the time to read this.

A:  His FEAR of your weight?  That doesn't make sense.

These things are negotiated.  If you give him fellatio, what incentive does he have for intercourse?

I suggest confronting him, letting him know that you have needs, and making it clear that you will do to him what he likes in return for him doing to/with you what you like!  It ain't holding it for ransom, it's negotiation to get your needs met.

If he won't, then I suggest you re-appraise the relationship.  Besides, many women would love to be only 50 pounds overweight.  There are men who cherish "rubensesque" women, by the way, but for the sake of your health I encourage you to keep on losing (safely).

Sexually incompatible?
5/11/00 Q:  Dr. F,
  Hi!  I am a 23 year old woman and I have been dating my boyfriend (27
yrs old) for eight months now.  We waited almost 2 months to have sex for
the first time - it was my first time ever.  I waited for true love to
have sex.  He was GREAT and very patient with me.  Anyway, before me, he
had many sexual encounters with other women...he was very honest with me,
but he settled down about a year before he even met me.  Since I have now
had sex, I want it more...I want to experience and learn new things and I
want it more than once every two weeks (which is about all I get!!).  I've
talked to him about it...asked him why he doesn't want it all that much
and he gets upset that I bring it up because he says that all I want is
sex which is TOTALLY not true.  I just want to learn and experience new
things.  The majority of the time I try to start something, he turns me
down, so now I'm too scared to start something so it's like I have to wait
until he wants it.  That's not fair to me!  We've talked about it and
he'll have some excuse but I really think there's something deeper there.
When we do have's good.  He always has an orgasm and most of the
time I do.  He says it's great and he really enjoys it and I think he's
telling the truth.  I'm at wits end with this.  I would be happy if he
never wanted sex...or wanted to wait until we are married, but that's not
the problem!  We never had the "beginning relationship sex" - you
know..when you have sex all the time all over the place.  I've told him it
would be nice to be wanted at other places and other times then just at
night when we go to bed.  I just don't know what else to do anymore!
Please help me!!  Thanks!
- Sexually Frustrated

A:  ALARM BELLS should be going off right now.  It sounds like the two of you are basically sexually incompatible.  I strongly urge you to either realize that this will only become a worse problem or get into couples therapy to discuss this!  While it might be the Whore-Madonna Syndrome, it really doesn't sound like it.

Pain from rough sex
5/11/00 Q:  I've been sleeping with my curret boyfriend for approx. 7 months.
I would say we have rough sex (extremely fast penetration), but it has
ALWAYS been this way, and until 2 weeks ago, there has been no problem
(no pain). We don't do any weird or unusual positions (missionary,
doggy.... etc are the main ones).  However, now I find that the inside
of my vagina (approx.2-3 inches up on the frontal plane) is quite tender
whenever we have sex, and its becoming too painful to have intercourse.
This has never happened to me before.
Why am I so sore now, but was not prior?
Any suggestions as to what I can/should do?
Thank you for your time

Dr. Fisher replies:

You state that the location of the pain is about 2 or 3 inches on the
frontal plane of the vagina.  This is where the G-Spot is
named by the gynecologist Ernest Grafenburg for his "discovery" of it.
Basically it is a group of nerves that respond to pressure from a penis,
object, fingers, etc.....pushing on it. Most women experience pleasure from
pressure being applied, but some experience pain.  "Rough" sex as you stated
could cause the spot to become slightly irritated. When you have sex try
penetration a little slower and make sure there is enough lubrication....if
not, try a product called Albolene, available at most cosmetic counters or
drug stores.  You may also want to try different positions like "spooning"
or a side entrance.

You could also lay on your back and allow your boyfriend to insert two
fingers in your vagina and try to locate the spot and see if by applying
pressure it causes pain.  Usually, the spot is located about three inches on
the anterior wall of the vagina, about the size of a walnut and may have a
slightly different texture than the rest of the vagina.

IF you are still having pain after a month, go to the gynecologist to rule
out any infections or genital defects that may be causing the pain.

How to control sexual urges with all the odds stacked against us?
5/10/00 Q:  I have always said that I would wait until marriage. I got kinda close. I
am engaged, and most definately didn't wait. Well, we decided together
that now we are going to wait, but it is REALLY hard. Both of us are
extremely modest and conservative, so buying protection was something that
just wasn't going to happen. (Please don't lecture me on the importance of
it.) We always stopped before anything happened, but we both know the
"infallibility" of that method. After I thought that maybe I was pregnant
and had to buy a pregnancy test, we decided that we would never go through
that again. About 3 weeks later, the initial shock had worn off and we
were testing our boundaries, which apparently we had none of. Well, we got
the same scare again, and decided to stop for good (again). It is REALLY
hard, though. We share a one-bedroom apartment so it's not like we can
just go take a cold shower and be fine. We are both determined, but I can
see this time being just like the last. Can you offer any advice on how we
can live together and not have sex? Please don't just tell me to
masturbate when I feel the urge. That isn't what I am looking for. I want
to know how to handle it mentally and emotionally, not physically. Well,
thanks in advance.

A:  You paint me into a corner!  You have raging hormones, intense desire for each other, you share a one bedroom apartment, and you want to know how not to act on your passionate urges?  The only solution is a chastity belt with your father holding the only key.  Sexual urges are reduced by orgasm, however achieved, so if you don't want to masturbate, I suggest that you two do anything you want SO LONG AS NONE OF THE FLUID THAT COMES OUT OF HIS PENIS GETS INTO YOUR VAGINA (AND THIS INCLUDES "PRE-CUM" ALSO)!  Give him hand jobs and blow jobs, and let him rub his erection against your body parts, and let him touch you to orgasm, or straddle his leg and hump it until you have an orgasm.  That's it!

66 year old man lost interest in sex
5/10/00  Q:  I am a 66 year old who is losing the desire to
engage in sex with my wife.  She is the same
age but very receptive to regular sex.  To my
knowledge I have no physical impairment or
disease......just lack of libido.  Can you
suggest taking any remedy to help increase
libido.  I am of average weight and have no
problem with erection when there is interest
and stimulation.  Thanks for your help.

A:  Between the ages of forty and fifty five men will go through what is
commonly referred to as "male menopause" or Andropause. Though there is no
one sign that signals this, such as the end of menstruation, men go through
many of the same symptoms of women.   During a man's life, usually starting
around forty, testosterone will begin to drop in levels because the testes
slow in the production of the hormone.  This in turn can dramatically lower
sex drive.

You state that you are 66 and in good health.  First, review your current
situation.  Are you free of sexual boredom?  Are you under any major stress
or have you gone through a dramatic life change?  What medications do you
take....antidepressants are mean culprits. If you pass this test, go to your
practitioner and ask that your testosterone level be checked along with a
complete examination.  Many men can be given a small amount of testosterone
via creams or transdermal patches that can light that fire again.

There are hundreds of so called herbal remedies as you know.  Some studies
have shown that Korean Ginseng increases libido, but that is still in the
theoretical criticism box.

Dr. Fitzgerald comments:  Many men between the age of 40 and 65 report that their erection goes down after initial stimulation.  The typical scenario is foreplay during which the penis gets some direct contact and becomes erect, followed by continued focus on the partner, during which the penis does not receive direct contact, and the erection goes away.  The solution to this problem is to realize that starting somewhere between 40 and 65, the penis needs continuous stimulation at some level to maintain the erection.  For many men, who up until then have been accustomed to the erection staying there once attained, anxiety that they are developing an erection dysfunction hastens the loss of the erection.  Another illustration that knowledge is power!

If the self-help exercises for premature ejaculation don't work, what can a guy do?
5/3/00 Q:  hey doc i know that i have emailed u before and thank u for all the
help...but my problem has gotten worse...have a problem with premature
ejacualtion...and i have used the technices that you have on your web page
but they are not working for you know whats i am doing wrong or is
there anything else that i can do to solve my problem....i am really worried
about this....please help.


A:  The self-help procedures work for most men, but they are not 100% guaranteed.

Some men are helped by low doses of Prozac, and others need to see a psychotherapist to uncover and resolve the nervousness and/or anxiety that is causing the PE.  If you can last long enough by yourself, but experience this with a lover, it is psychogenic.  If you are unable to maintain an erection without ejaculation for 10 minutes, it could be systemic, in which case you need to see a urologist.

Man cannot orgasm during oral sex
5/2/00 Q:  I never had an orgasm when receiving oral sex.  I have
been several women in my adult life, strippers,
superfreaky, and semi-professionals girls that really
appreciate oral sex.  However, I want to learn to
relax, and create sensitivity to release my flow.
Yes, I am married and the initimacy and oral sex is
splend -- again we are lacking the one essential
element that is oral sex orgasm.

Please, help me!!!!


Wildchase (male first name in e-mail handle)

A:  I presume you left out the word "with" when you say (you) have been several women ...

For many men, there is not enough stimulation from oral sex alone, to achieve orgasm.  Some men cannot come unless their anus or testicles is/are stimulated simultaneously, and for others, simultaneous prostate massage is needed.

Others vary the action by alternating between stroking themselves and oral insertion, while some prefer to stroke the base half of the penis while the tip half is intra-oral, BUT care must be taken with this technique to assure that the lover's lips are not hit by the fist moving up and down around the penis.

Think of the trigger for the reflex we call orgasm as the product of nerve signals per unit of time impacting the brain.  If you don't fire off enough neurons per second, the brain doesn't reach a critical mass of stimulation.  Fire off more neurons from places in addition to the penis and you might get over the edge.  This "sum of stimulation" analogy, by the way, is also explanatory of spanking during genital stimulation.  Some women orgasm spontaneously if they are close and their lover slaps them on the butt (caution:  be very clear about this before doing it, because other women will be instantly angry and may terminate sexual contact with you).

Thanks and anal sex from a woman's perspective
5/1/00 A reader comments:  Dear Sexdoc,

    A few weeks ago I wrote you about resuming anal sex with my husband
after many years of abstinence (due to my unfounded fears that resuming would
cause a third bout of hemorrhoid surgery).

    Your prompt and professional response encouraged me to approach you
further about the sexual desire discrepancy between my husband and I during
our so far 26 years of marriage. Your kind and immediate responses helped a
lot, and considering how busy you must be, the individual attention you
provided was especially welcome and appreciated. Surely there is sex in
heaven, and if so, a special place is reserved for you! To others you are
The Sex Doc but to me you'll always be The Sex Angel.

     And since your site is a wealth of much-needed sexual knowledge for
both men and women--knowledge is, after all, power--I would like to take
this opportunity to share something with your readers about anal sex from a
woman’s perspective.

    When my first lover, a very loving, sexually experienced man, first
introduced the idea of anal sex to me over 30 years ago, my initial reaction
was probably like those of many women: that it was unnatural, perverted, and
not something normal two people in love did. How wrong I was! My lover
understood my reluctance was due to ignorance. He very gently introduced me
to the glorious experience of anal sex slowly, lovingly, and tenderly with
his finger, his tongue,  then two fingers, a condom-covered carrot and then
in gradual slow depths each time, his penis, and only after making sure that
we were both "squeaky clean."

    While I thoroughly enjoy vaginal intercourse, there is NOTHING that
makes me feel so possessed and taken and loved than to feel my lover deep
within my ass. Sweet surrender indeed! For women who have not allowed
themselves this pleasure because of any reticence or fears, they really
don’t know what they are missing. Or what their lover is missing. For me,
the word "rapture" is not too strong a word to use.

    Sex may be the cake, but anal sex or anal love as I like to call it, is
the delightful icing on that cake that is oh-so-sweet.

Please identify me as Janie

The sexdoc comments:  I never cease to be amazed by the percentage of women in sex therapy who "discover" that anal sex is a secret desire of the husband, and something immensely pleasurable when they learn how to let their anal sphincter relax (or at least not clench) and the simple procedure for rinsing the rectum.  Common comments include:

    "I was afraid to suggest it for fear that you would think I was 'kinky' and if you didn't want to do it, you'd know that I did, and that could put a strain on our relationship."  (spoken by either)

    "It's like having sex with a new partner!  But, without the guilt, worry about diseases, or complications for my marriage"

    "She is SO FUCKING TIGHT back there.  It's like taking a virgin!"

    "I feel soooooo possessed, dominated, controlled, literally out of control, not responsible, 'taken' and able to really enjoy myself with wild abandon.  And the last inch and a half of his cock must push the tip against my g-spot, because I just start to have orgasm after orgasm after orgasm.  I call it 'dieseling' like when you turn the car engine off and it just keeps on sputtering and kicking over all on its own.  I treat it like a rare cognac -- to be indulged in once every three to six weeks, like it's rationed."

    "It's OK.  I can take it or leave it, but I do it when he/she wants because the pleasure he/she gets from it is an aphrodisiac to me, and I love to please my honey."

    "Because I'm on my stomach or up on all fours, I feel it's OK to be incredibly passive.  It was a huge quantum leap of understanding for BOTH of us when we got the leather strap-on harness and a dildo that fits in it.  He had to learn how to let me take responsibility, and it was a major learning experience for me to appreciate that I had to make all the moves.  That if I stopped, all the action stopped.  Guys take on a lot.  They have to keep on doing to women where women can just lie there (unless they're giving head, of course).  And, he learned the difference between just right and too fast.  I am convinced that we are both better lovers because we experienced the role reversal.  Plus, he enjoys the prostate massage and I have a better idea of what it's like to have that thing sticking out of your body!"

    "I always thought that women were just being "gatekeepers" or playing hard to get when it came to anal sex, and then along came my dream woman.  When I proposed to take her ass virginity, she counter-offered that she would be delighted to if I understood what the recipient went through, from the inside out.  So over the course of several weeks we both learned to rinse the rectum, and to gradually accept dildos and butt plugs of progressively larger diameters.  I learned why some women 'yelped' when their anus was dilated too fast or too soon, and developed a healthy appreciation for patience and lubrication.  Now, if I propose butt fucking, we agreed that she can agree on the condition that we both experience the preparation requirements, and she can choose whether to massage my prostate from the inside or not.  What we did gave me a whole new understanding of the expression about 'walking a mile in someone else's shoes!'"

Thanks for the message, "Janie"

Sexdoc -- whoops, I mean Sex Angel

Another case of sexual incompatibility
5/1/00 Q:  I have been married for less then a year. Im a 22 year old, white,
otherwise normal person. My problem is that I love sex, masterbaton, porn,
anything and everything that my wife hates.I have a real hard time dealing
with our problems, We have tried reading sex books like Mars and Venus in
the Bedroom, and Seven Weeks To A Better Sex Life. Nothing seems to
matter. After thinking things are fine we both go back to "normal".If and
when we do "make love" it is almost like I have to rape her. I feel very
bad about this and think I should say sorry to her, but it only makes her
cry. So as we go to sleep mad at eachother I (almost always) think of
killing myself. I know that I'm too weak to really do anything but  it
pretty much scares the hell out of me. If you think you can help me
without inpatiant shock therapy. I would like to hear some pointers on how
to live another sixty-five years with the person I love. thanks

A:  You need out patient weekly psychosexual therapy.  Either your wife is seriously inhibited or you two are seriously incompatible.

Sex therapy CAN address both of those circumstances!  But e-mail won't cut it -- you need in person therapy.  What you describe highlights why there are people like me who see people like you in person!  Get help soon before this is more destructive on your relationship.


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