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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Some questions are elegant in the author's own words.  Wife has systemic compromise but won't be sexual.
10/5/00 Q:
Hello Dr. Fitzgerald,

I would like to hear your thoughts regarding what my wife claims is a
medical condition which has caused her to have a lose of sexual desire.

My wife and I are in our early thirties.   We began dating about two years ago and last month
we were married. She has diabetis and an underactive thyroid. We both work
and have agreed not to have children. (Her request, my agreement)

Until we were married we maintained seperate homes and it was only during
the last year that we became sexually active. Because we lived about an
hour apart we only saw each other once a week.

Anyway I learned then that she was not very active in bed.... basically
she filled an obligation only when she felt she had to.

Now that we are married I have tried to talk to her about it. It's not
that I want olyimpic style sex... I'd just like to see some passion on her
part. It really does feel like I'm putting her out expecting sex and she
just lays there.

So I suggested we explore different methods of foreplay, everything from
romantic dinners, to massage. I even sent her an on-line survey of what
men like in bed. As you might guess she was quite upset. She said that she
has had a very fulfilling sex life and doesn't need a survey to help her.
As for foreplay, given that she has had a very full sex life she knows
what turns her on and what doesn't... and basically there is nothing I can
do to improve our sex life.

Her claim is this is all medical related and that she and her doctor are
working to correct the situation as best they can. The most recent change
was a differnet birth control pill that would increase her estrogen level.

While I understand that there likely is a medical related problem... I
wonder why she is so life less in bed. I think if it were me... I'd fake
it. I'd try to do something to make sex fun.

I just don't know what to do. Should I refrain from sex and let her make
the move when she feels comfortable? Should continue to try and do things
that I think will make it more fun?

From my position I'm a little frustrated to think at age 32 I may be
entering a downhill slide in my sex life. If by age 40 sex is non
existant... I don't think I will be able to continue in the relationship.

If you have any wisdom to share with me, I'd love to hear.

Thanks for volunteering.

A:  Run, do not walk, to the nearest sex therapist.  Many people who are somehow medically compromised just settle for a diminished sex life.  I have had couples where one has multiple sclerosis or advanced diabetes or other physical impediments, and there are ways to help them deal with their limitations and find creative alternative ways to behave.  But she would have to be willing to consider doing that.

Everyone has a preferred pace -- frequency -- of sex, and when they are out of synch with their partner, there are things they can do.  On my web page it's called the Sexual Desire Discrepancy protocol.

Her lack of willingness to even accommodate you is very threatening to your marital quality of life, and in my experience, will only get worse if she does not make some positive changes.  UNTIL there is some amelioration medically, she needs to provide at least a form of intimate physical therapy or you are going to progressively resent her.

Please do not wait until you are 40.  If things go downhill, the handwriting is on the wall in blinking neon lights, so why wait for it to get "bad enough?"  Face the problem now, and if, through any mechanism, things sexually don't get better, I suggest that you acknowledge that you two are incompatible and each find someone with whom you are more compatible.

I hope this helps.

By the way, you are the FIRST person in the 3 years I have been answering questions on, to thank me for volunteering in the question e-mail.  A few e-mail later and thank me for the answer.

Oral sex technique (female receiving) breakthrough.  Read only if you want to receive or give better oral sex
10/4/00 Dr. Fitzgerald,

I know you must get 1000 emails a day, so I don't expect you
to remember me. However, I just wanted to thank you for your
advice on oral sex. Like I told you I'm a 30 year old woman who
enjoys sex and don't consider my self inhibited. But when I started
to think of the norm for women having orgasm through oral, I though
I was abnormal. Although I was able to reach orgasm several times through
penetration, I felt a little inadequate not being able to achieve orgasm
through oral. Well my new boyfriend was able to go where no other man
has gone before (and I tell you he feels like a CHAMP), and I just have
to say It was "AMAZING". I now feel free in every way possible and finally
feel "NORMAL". I really don't think many men out there really "KNOW"
what they are doing when it comes to oral sex. My boyfriend uses the
term "Pop the Hood" where you FULLY expose the clitoris and let me tell
you, if more men knew that, women would be floating around with huge
smiles on their faces, like me! :)

Once again, thank you for your advice, and your time!



10/02/00  A writer contacted Dr. Fitzgerald with some medical questions, and Dr. Chance Fisher was kind to answer.  I thought some readers would also be interested in the answers although they are fairly technical medically.  Dr. Fisher's comments are flagged by @@@@.

What is the female equivalent of Viagra?

@@@@ Pharmaceutical companies are working to supply a female version, but to
date have not.  Viagra is prescribed to women as same as men, but is only
effective for some.

What are doctors prescribing to women who don't feel enough sensation?

@@@@ Actually, we prescribe more sex.  The more stimulation you get, the
more developed and responsive the nerves become.  There is no magic pill to
increase sensation alone.  If you have never had an orgasm before, you are
not going to automatically take a pill and "presto".  Peppermint oil seems
to help a great deal.

 I have heard Apomorphine mentioned, and a variety of herbal remedies
(Yohimbe, MACA, ginseng), and there's a new product called FemProx that is
due out soon,
and sometimes even Viagra is used or testosterone and other hormones.

@@@@ The reality is that these products work on the sex desire or libido,
not the sensation or gratification itself.  Yohimbe and Apomorphine work on
the same basis.  They are dopamine receptor agonist.  They actually work on
the brain to mechanically tell you that you crave sex.  They do not act on
the tissue of the genitalia like most people think. Secondly, most herbs
carry the "If you think they are working they are" guarantee.  Some herbs do
work, but most play on your mind.    Researchers have found that Apomorphine
and Yohimbe together can be used to restore a lagging libido.

Do you think topical creams work?

@@@@ Yes, they have been found to improve libido greatly.

Do you ever prescribe these creams?

@@@@ Yes, the most common creams prescribed for sexual problems is a
combination of Estrogen and male androgens or a 2% testosterone cream.

Do they actually activate the cells below?  Do they bring blood and heat to
the vaginal area?

@@@@ Well, sort of.  Estrogen is the source of nourishment for the female
tissues, so any estrogen taken in by the body keeps the elasticity in the
tissues by feeding the cells.  Hormones work by pushing positive and
negative feedback on the pituitary gland and brain.  So basically, the
hormones (creams) are a catalysts.  They may bring some initial heat or
blood engorging to the area due solely to the application.  But, it is a
complex chain of chemical reactions that the hormones jump start that end up
with the result being sexual excitement  thus, blood and heat in the vaginal

When you start fooling with Viagra you are taking a drug that works directly
on the blood vessels and their contraction and dilation ability.  Thus, when
the drug works on the vessels, more blood will pool in the genitals  and
allow a more sensitive sensation (heat).  Testosterone, Estrogen, etc...
work on a little different basis, not directly on the blood vessels.  That
is why Viagra has more rapid results, where hormones in creams or such need
a more extended time table to show any results.

10/02/00  And in the "I couldn't say it better" category, I received an e-mail from a man that is so articulate in emotions and thoughts regarding psychotherapy, that I want to share it with you.  He said that he would be flattered if I published it, after removing personal data.

BACKGROUND:  I do not recall the exact dates of the first 2 e-mails, but around 9/6 he sent a fairly long e-mail, to which I responded including the encouragement that he find a local herapist.  About a week later he sent another quite long one, and I said that I did not have time to respond adequately (extensively) because I am a slow typist and want to answer as many e-mails as possible, but that I could talk with him on KEEN.COM if he acknowledged that a telephone conversation is not therapy; I again indicated that his needs would be better met by a local therapist, face to face.  He opted for the Keen call.

On Wednesday, 9/20 I had a cancellation, and he called and we spoke for 50 minutes.  When I retreived e-mail on arrival on Friday 9/29/00 (a few days ago as I write this) I found the following from him.  At the end of his e-mail I will describe what happened next.

############  His e-mail starts here:

Dear Dr. Fitzgerald,

OK, you were right. I surrender to the inevitable and bow to your superior
knowledge. :) Having sessions available as life goes on would be very nice.
Perhaps it's just coincidence that I have more questions already, but I
really didn't expect this. But this woman Sally (not her real name) drives me to distraction.
I'm kidding a little bit. I know, I know, she's bad news. Don't start
rolling your eyes yet. ;) She is a therapist's dream, because she has the
power to drive everyone whose life she touches to seek professional help.
:)) I know long term we are totally incompatible, we've been over that, and
I'm even more sure of that than I was when we spoke, if that's possible.
But she isn't some woman I met in a bar, we've traveled in the same circles
for a long time, and I actually like her, nutjob though she is. She and I
both know she's a nutjob about relationships, in fact I convinced her to
start seeing her therapist again. But she is very intriguing for a number
of reasons. Believe me I'm getting a lot of "data" from it, in fact I can't
analyze it all myself. I could just run away and pick somebody "easier",
but because of the experience and whole spectrum of issues she brings up I
don't think she is a complete waste of time. I need to understand these
things now. It's tough dealing with so much in one package, but if I
survive I should be ready for anything. ;) Seriously, things that dealing
with her bring up in me will be applicable to any woman I date because how
I react is based on me, the other person just pushes the various buttons.
She's efficient, because she pushes so many buttons all at once. :) If not
Sally, then the next one will drive me nuts, I have to face these issues
sooner or later, and I prefer to tackle things head on.

The reason I am contacting you again so soon is quite simple. I had a
detailed conversation with Sally about our differences in the bedroom, and
some of her issues, and while the talk was very beneficial for both of us,
it brought up other issues that I know I need to address. That woman
triggers spots in my brain I didn't even know I had. When I can't sort
these things out to my satisfaction, it stresses me no end. That has a
dramatic impact on how well I eat, how well I sleep, how well I can do my
job, etc. Just the way my mind is these days being so bombarded all at
once. Needless to say I want that to go away ASAP! It just doesn't feel
healthy. In fact I think studies show that severe mental stress can cause
brain changes, possibly leading to increased susceptibility to depression
in the future. I don't want that! ;) But whether that's true or not,
talking with you before was hugely beneficial, and I know you can help.
That leaves several choices:

1), which I thought was actually pretty neat. I know how you feel
about phone therapy, and I don't disagree with you at all.  Believe me, I'm
convinced the face to face talk would be great, I would like nothing
better. If I could snap my fingers and be in San Jose I would, but
obviously that could take quite some time to arrange, I suspect you would
able to do a phone consultation much more easily. Lord help me I sound like
a junkie needing a fix. ;) Is there such a thing as a psych emergency? ;))

2) As much as I detest airports and traveling, like I said you've convinced
me. After the last few days I'm saying Uncle. ;) I would do the day trip to
San Jose in a heartbeat if that offer is still good, but I suspect that
would take time, and of course I don't know if you feel it is still
advisable. I think I could probably come up with enough new material to
make it worthwhile. ;)

3) Find a local therapist.  Nice if I can do it, and this has to be the
preferred long term solution, since I have to expect the unexpected will
happen again. But it will also probably be the most difficult to
accomplish.  Especially if it takes me a while to find one I like. Don't
know how much of my brain will be left by then, it feels like its shrinking
fast. ;)

You know, I really have to say I never thought I would ever consider
therapy. Personal bias I suppose, thinking I should be able to handle
things on my own. But, I've never confronted so many deep issues in such a
short time frame, what with the recent breakup and dealing with Sally at
the same time. But I go to the doctor to take care of a pain in my body,
and dammit this stuff can hurt so much more it's not even funny! I'd rather
get kicked in the nuts at 3 in the morning every day than have some of
these feelings. I'm not a fool though, why suffer more than I need to?
Talking to you helps tremendously, and who am I to argue with success? It's
really been quite a revelation. I believe I understand how rewarding your
profession must be to you at times. I have to say it sounds rather
appealing. I really find it hard to describe what a revelation this whole
field and aspect of life is. It *is* life, day to day, and I've never
really noticed or understood that, or examined it. Recognizing that these
things are always bubbling under the surface is like seeing in color for
the first time. Anyway, let me know what you think.

#############  End of his e-mail

So on Friday I e-mailed and said that I could pick him up at San Jose Airport at 1 pm on Sunday and we could go to my office, turn on the cost of therapy clock on arrival, talk until one of us said to stop, then I'd drive him back to the airport (15 minutes from my office).  He was highly motivated, we spent an intense 2 hours (we call that a "marathon"), we recapped at the end, ate snacks, talked about our mutual hobby of bicycling, he gave me great tips about pulse monitors, and drove back to the airport.

I was, and still am, in awe of his last paragraph.  I am reminded to not take this process for granted and to always be ready to walk a mile in someone else's shoes and to try to see the world through someone else's eyes.

10/05/00 He sent another e-mail after returning to his home town.  Part of it is reproduced here:

##############  His e-mail starts here:

I fully realize I will run into situations that will be difficult, and I
will know when I am in a position where more counseling will be beneficial.
I don't think that's a problem, I think that's great.

Although I fancy that I have good writing skills, I still find it difficult
to convey what a completely life-changing revelation this has all been. I
regret that I had to wait until 34 instead of coming to this much earlier,
but better now than never, and I won't waste energy on regrets. I feel like
someone must feel who has a revelation and is called to the ministry. I can
say with some degree of certainty that had I had this experience earlier I
would very likely have given a hard look to this field as a career choice,
that's how completely shocked I am. I imagine there must be times when you
have to deal with people who have undergone horrible traumas, that may be
difficult on a personal level to deal with as a profession. Every job has a
grind aspect. If yours doesn't I'm switching now. ;) But the ability to
have such dramatic impacts on people's lives like what I have experienced
myself after a few short hours must be incredibly rewarding. I would love
to be able to do that for people, it's difficult to imagine many things
more fulfilling in this life.

I'm convinced of a number of things. Getting married without going through
intensive values/compatibility counseling first is insane. Sex and
relationships are so intertwined that it's a shame that such a small
fraction of therapists have advanced training in this area. Not seeing a
professional when you are feeling emotionally traumatized, or feel you are
dealing with issues you can't easily resolve, only prolongs your suffering
and is foolish. The price of the flight and the session was some of the
best money I've ever spent, in fact I would have to think long and hard to
come up with a better thing to buy than an investment in happiness in the
only life you will ever have. If anyone has any doubts about that, they
shouldn't. Take it from someone who would never have considered therapy in
his life. If you even begin to suspect it might help, find a good therapist
in a hurry, you won't regret it.

I want to learn as much about this topic as I can. I can't seriously say I
will attempt a new career, but the more understanding and communication
skills and tools I can learn to put to work in my own life the better.
Feels like reading the life manual for the first time. :) If nothing else I
will know when to seek the services of a professional, and will feel damn
good about doing it, and that alone is worth it. If you ever open a school
for apprentices, you know where to find me. ;)

Very sincerely,

A grateful patient, and a willing disciple :)

My boyfriend wants me to "jump him."
10/02/00 Q:  Dear Doc,
  I was talking to my boyfriend the other night and he told me he wouldn't mind it if i were to "jump him"...only cause he teases me all the time, and i enjoy it. Now for me to "jump him" what could i do to catch him off gard? What can i do to "jump him"? please help!!! Thanks


A:  All that "jump him" means is catch him off guard.  At the beginning of an event you can't leave, like a class or dinner with his parents, whisper in his ear "I'm not wearing any panties," and place his hand where there is no panty line.  And if he likes to perform oral sex on you, anywhere where you can get away with it, go to the bathroom, insert 2 fingers into your vagina, getting them wet with vaginal fluids, approach him without washing your hands and if you have enough wetness, tell him to hold still and smear the liquid on  his upper lip, under his nose (and tell him he is not allowed to wipe it off).  If not wet enough, just hold your fingers under his nose or tell him to open his mouth and "wipe" your fingers on his tongue.  Be prepared, however, that he will have steam coming out of his ears, and you can expect fast sex as soon as you are alone.

The most dramatic way to "jump him," though, is in privacy for you to attack him, unbuttoning his shirt, unzipping his pants, etc., while in a throaty voice telling him that you are overcome with sudden passion and you just HAVE to have his cock in you NOW!

Questions about performing oral sex on  man
10/2/00 Q:   Dear Dr Fitz,

 I have never performed fellatio on a guy and was wondering how to perform this in order to give him maximum pleasure, also would it be better if I told him beforehand that I had never done oral before or should I just not tell him, ask him what he likes, experiment and improvise as I go ? Well thanks for your help,

Yours thankfully, B

A:  First, see a link to "How to give oral sex..." on my home page

Second, there is no one "perfect technique."  And different guys like oral sex in different ways.  Ask him what feels better and what doesn't.

Third,  Not all women will give their guy a blow job, so being willing is a huge asset

Fourth,  Many guys would be thrilled to know that they are taking the "virginity of your mouth."  Make sure you let him know how special he is that you are wanting to do this WITH HIM.

Fifth, if you find semen in your mouth distasteful, refuse to give oral sex if your lover demands that he come in your mouth or that you  swallow it.

Sixth,  don't worry if it is not enough stimulation to bring him to orgasm using your mouth alone.  Many men and women enjoy fellatio in which she uses her hand for most stimultion of the shaft, using her lips and tongue for stimulation of the tip of the penis.

Have Fun!


Psychogenic erection dysfunction
10/02/00 Q:  I am a 51 year old male who has been married to the same woman for 31 years.
The first few years were good, but then it has been downhill since then.  My
complaint with her through the years has been her lack of interest in sex.
She has never been the one to initiate sex.  She has made me feel like the
agressor.  She does not orgasm, give blow jobs, and is always in a hurry for
me to "get it over with. When I would try to talk to her about it, she would
clam up.  We do not communicate well at all.  Because of this, have cheated
frequently..  I would have left her but I felt an obligation to stay and
support our child who had health problems.  Now my child is 21, and I see no
improvement with my marriage, in fact we have not slept in the same bed for
1 year.  I am more then ready to get out!   I have met a wonderful woman who
makes me very happy.  She is 40, mother of 3 children and getting a divorce.
She is the total opposite of my wife!  She loves sex and is not afraid to
show it.  We are hoping for a life together.  But here is the problem--I
cannot get an erection!  She touches me in all the right places, loves to
give oral sex, and gets very aroused.  I feel turned on, but I just can't
get it up.  It is driving me crazy.  I can be alone and thinking of her and
get a hard on.  We are both very much in love, but I am afraid I am going to
blow it.  I have been seeing her for 3 months now.  Will I ever be able to
perform with her?

A: RELAX!  Thank Heavens you get erections by yourself!  Because of that situationality, yes, you do have psychogenic ED.

You are consciously or unconsciously too nervous.

Get a scrip for Viagra -- or if it doesn't work on you or if the side effects are too noxious -- or penile injections of Prostaglandin E1, and have only attempts at intercourse after the medicine has caused a chemical erection.  Do that 10 times and on the eleventh opportunity, say out loud:  "We're going to be playful and have fun.  We're going to take this slow and enjoy it.  If we decide that we're going to have intercourse, we will, because if I don't get a biological erection, I'll just use the medicine."

That works for about 80% of guys.  If you then need the med for the next three events, do NOT attempt intercourse and see a sex therapist.


Don't feel much when I put a finger in my vagina
9/28/00 Q:  Dear Dr. Fitz,

   People have probably asked you this a hundred times by now, but this is
something that has really been bothering me. Is it usual for a girl to not
feel stimulated around the vaginal area? My clitoris responds loud and clear
and I sometimes feel it may be too sensitive but when it comes to my vagina,
even if I insert a finger (I've never tried two), I don't feel the least bit
stimulated. Is this normal?

A:  In the pelvic region, the rank order, most to least, of nerve endings, is the clitoris, the anus, the labia, and way down the list, the vagina.  The reason that 40% of women have an orgasm from penile thrusting alone is that the penis  dragging on the labia causes enough tissue pulling on the clitoral hood, which rubs the clitoris enough to produce enough stimulation to trigger an orgasm.

The inner 2/3 of the vagina is so INsensitive that minor surgery can be performed on it without an anesthetic.  Most of the sensation at the introitus (opening of the vagina) is pressure.  I'm not surprised that you don't feel mich when you insert a finger, but you should have some pleasurable sensations from touching your labia.

AND, please feel OK about trying to insert two or three fingers.  The sooner you gradually stretch any remnants of hymen you have, the more comfortably you will be able to use tampons (and when you are mature enough, intercourse).

Conception from wet humping?
9/28/00 Q:  Dear Dr Fitz,

You get this all the time, but your site is really great.  I have three
questions that I would like answered so I can convince my roommate to be
safer.  The first two are mine, the third is hers, so if Q3 doesn't make
sense it is because this is my interpretation of my friend's question.  I
don't really understand how she can't know (or can't ask), but I already
tried to play 'sexdoc' with her and my suggestions were obviously
insufficient. I'm sure you can help.

1) What are the chances of getting pregnant from 'wet humping'--that is
front-to-front penis-to-vaginal-area contact with no penetration?

I know it is dependent on cycle, so assuming it is the day of ovulation
(or whenever most fertile, if I'm confused), what is the chance if 1)
ejaculation occurs and 2) if it does not occur?

Is there reason to take the morning-after pill if the worst-case scenario
occurs?  Or is it better to wait and know for sure about the status of

2) Is condom-protected sex safer than 'wet humping'?  (I always thought
so, but I want your expert opinion.)

3) How can the woman tell if her male partner ejaculates while they are
engaging in 'wet humping'?

(I'm really only concerned about pregnancy, not STDs for the above


Just sign me,

A:  Dear Concerned,

The essence -- the underlying principle -- of contraception you need to understand to answer your questions has to do with understanding conception.  In order for pregnancy to occur, one or more sperm must penetrate the egg, and that must attach somewhere in the woman's body.  Sperm exist in the clear fluid ("pre-cum" in the slang) that comes out of a penis when a man is aroused (about 80,000), and in the whitish semen when he ejaculates (usually between 200 million and 400 million).  If you MAKE SURE that none of the fluid that comes out of a man's penis gets into the vagina, you cannot get pregnant.

More than one woman has become pregnant, however, by having semen-coated fingers shoved into her.  There is no need to incur the cost of a condom for wet-humping if you control the liquid.  And your third question will cause many readers to chuckle.  Believe me, when that load of semen comes out, she'll know by the liquid and by the behavior of the guy!

The "morning after" pills are absolutely advisable if you get raped, but their use should be considered an emergency.  If you are between 10 and 18 days after your most recent menstrual flow started, and the condom (which you ALWAYS use, right?) tears or slips off inside you, that warrants the morning after pills.  But DO NOT be lazy and just think you can use that as birth control.  It is NOT 100% effective!  If RU-486 gets approved, that will be a relief to millions of women.

So, even if ejaculation doesn't occur, you can get pregnant from the sperm in the clear fluid.

Women ovulate irregularly, so using the "rhythm method" of birth control (unprotected sex avoiding days 10-18) is unreliable.  Some people practice withdrawal of the penis at the last minute (before ejaculation).  That is called "Coitus Interruptus."  The Scientific term for people who use coitus interruptus and/or the rhythm method for contraception is "PARENTS."

Guy worried about the amount of penile secretion during arousal
9/28/00 Q:  Dear SexDoc,
     I hope this email question in detailed enough because I really need a answer to this question. I am a male adult 25 years of age, and I am concerned about the amount of premature ejuculation I produce when I am sexually aroused by either my girlfriend or pourn film. My girlfriend says I'm the only guy she has been with that prejectulates as much as I do. Sometimes it's excessive to the point that when were intimate. I will produce enough preejeculation to have a wet spot show through my paints. The fluid is clear, slimy, and sticky. No discoloration, just clear.Please help me!! I need to know if this excessive amount is normal, or if I am suffering from a STD. I mean I remember in highschool I use to have this happen during arousal, but I never remember it being this excessive. Is there something I can do to stop this?? Is there something causing this I'm un aware of??? Please I need your expertiece

A:  Premature ejaculation is when a guy "comes" (ejaculates) too soon -- 5-20 seconds.

The clear sticky liquid you describe (called "pre-cum" in slang) is produced by the Cowper's gland and it neutralizes traces of uric acid in the urethra and lubricates the way so fewer sperm will be damaged during the explosion (or so it seems to sperm) from the seminal vesicles.

It is perfectly normal and does not indicate an STD, and is just a nuisance.  It will sometimes be more than other times, and you just need to deal with it.

If it is unmanageable with kleenex, you can wear a condom to catch it.

34 year old male virgin unable to maintain erection
9/27/00 Q:  Hello Sex Doc,

My question is this, I am a 31 yr old female who is dating a wonderful,
but VERY shy 34 yr old male. We just became sexually active together,
before this he was still a virgin. He however is not able to maintain an
erection during foreplay. I can get him erect with stimulation (oral, and
tactile), but that is only for a brief time and he loses his erect status.
If I am not performing oral sex and tactile stimulation, it disappears
almost instantly. There has never been vaginal penetration due to this.
I am not sure what I can do to help this. I am willing to be patient and
make things more comfortable for him and not focus on this issue, but I do
want to enjoy him "fully" at some point in time. He states he is just
He is not on any medication to cause this, nor anything physical that I
know of. What can I do, and can this be changed?

Please help with some advice.

Thank you

A:  What usually works is Viagra ten times, then attempting intercourse without it.

Men who do this conclude "I'm not nervous because if I can't maintain the erection, I'll just use Viagra." and that "confidence in a pill bottle" is their sky hook.

Viagra works best on an empty stomach.  If the side effects are too distressing, he can use penile injections of Prostaglandin E1.

Minister can't keep an erection; wife considers her options
9/26/00 Q:  Dear DrDoc,
My husband and I have been married almost 5 years.  He has never been able to keep an erection when he penetrates, and therefore I cannot have an orgasm because it just doesn't give me enough time.  He just wants to  fondle me, look at me and admire me without my clothes, and then masturbate with me watching.  He can keep an erection this way just fine.  He masturbates every day, I'm sure, because I go into his bathroom after he leaves in the morning and I smell semen on the washcloth that he has used.  He wants to have anal sex and oral sex but that is something I just can't do.  So for the past 4 years we have gradually just quit having sex of any kind and he never touches me or makes love to me.  I know he loves me.  He tells me very often, and is so loving and kind.  But when we go to bed he turns his back and doesn't even touch me or kiss me goodnight.  It's frustrating, and the only thing I can do is masturbate when he's gone.  It's not the same, and it is terrible to love him so much and want him so badly and not be able to have him.  I've thought of having an affair, or trying lesbian love.  I have had some contact with lesbians and have had sex with 2 of them.  I was younger then and it was very exciting.  However, I don't want to live like a lesbian.  I want to be faithful to my husband.  He is a minister and I am well known in my community.  I wouldn't know where to start or how to find someone.  Also I would feel guilty and if he found it out where would I be in his sight.  I'm just at the end of my rope.  Can you help me?

A:  Because he keeps the erection just fine while masturbating, but cannot during intercourse, the problem is psychological (unless he can stay erect in the female superior position, in which case it could be a rare circulatory disorder).  Rather than putting any effort into an affair with either gender, I encourage you to put energy into sex therapy to help him deal with whatever is inhibiting his ability to engage in intercourse.  That holds the fastest and least conflicting promise.  In the meantime make sure you continue to have orgasms at least every three or four days, to keep your plumbing in good working order.

Anxiety over producing a sperm (semen) sample at the infertility clinic.  Great reading!
9/26/00 Q:  My wife of 11 years and I are having trouble conceiving, and have
initiated treatment with her physician.  The first step, of course, was
to test me via semen analysis.  Since the Doctor's office is close by, I
was able to produce a sample at home, and subsequent analysis revealed
no abnormalities.  We went through several iui cycles, without success,
and have since been referred to a clinic that specializes in fertility.
The clinic is too far away for me to produce the required samples at
home.  This is my problem: I am absolutely horrified about doing this in
what to me, is a public place.  (I know...private rooms, perfectly
normal, healthy, natural..blah, blah, blah...I'm still horrified.).
I don't know why I have these feelings.  They don't make any logical
sense, but they are there none the less.  I was not brought up in a
religious household, not overtly taught to be ashamed in any way,
(society has succeeded in this matter, I suppose), and generally
consider myself to be a "liberal thinker" as these sorts of things go,
but  there is something so desperately private about this , I fear that
I will be unable to perform at the office. I don't have any problems
doing this at home, and as my wife will attest, it takes me no time at
all to rise to any occasion.   I've tried to explain my reservations to
my Wife, and that what she sees at home for performance stats won't
necessarily apply elsewhere, especially when there is a staff of trained
professionals waiting behind the door for me to finish.  (hey, there's
someone else that needs the room at 3:00, after all.  Can't this guy
hurry it up?  .....).   as understanding as she has tried to be, it
hasn't helped much.  I have literally worried myself sick over this
(threw-up twice in the last 2 days after discussions of this with the
Mrs...).  I wasn't this anxious about going off to Army Basic Training.
So now, my understanding Wife wants to call the whole thing off, knowing
the grief that it is causing me.  Great.  Now I'm going to be  the sole
reason that she is going to remain childless for the rest of her life.
What kind of heal does that make me?
Almost worse than the prospect of doing it in the office is the prospect
of expressing my reservations to the staff.  Again, I know consciously
that they are professionals, etc, etc, but In my warped little mind,
they're going to think, "what's the matter, Jack?  everyone else does
it.  just suck it up and get over it.  Are you really serious about this
or not?  If you were truly serious about conceiving, you'd whip it out
right here in the lobby.......".  We, as men, are not allowed to show
weakness;  we are to always do what is expected of us, without complaint
or reservation.  Certainly not any display of emotion.
I suppose that there is the possibility of renting a local hotel room,
but they would really prefer to have it done "on the spot", as it were,
and there's the same question of explaining my renting a flea-bag room
for an hour to the hotel clerk.....I guess I'm really hung up on what
others think.  So, I've worked myself into a no-win situation in my own
mind.  From your "positive suggestions" page: ...."please, overcome
embarrassment".  That is essentially my problem.  I can't seem to
overcome the embarrassment, or anxiety, of producing a sperm sample on
cue in a public place, after passing through a waiting room full of
people who know damn well what I'm there to do, while a bunch of techs
stand by waiting for the results.  And if I don't come through, we have
to wait 'till next month to try again, as the timing is so crucial....
It doesn't seem that anyone really wants to talk about this, (or I'm the
only one with this problem..), as I could find very little reference to
this subject while searching the web.  A few fertility clinics have web
sites that describe the process: "..husband provides a sample".
period.  If there's some "problem", (right, I have a "problem" that
needs to be discussed with strangers..), the sample can be produced at
home, provided that it can arrive at the lab within  "x" minutes.  That
seems to be all anyone wants to say.  (I did find this article: .  Its obviously
a joke, but if you have a minute, it pretty much summarizes what's going
on in my mind...)
So, after this long recitation, I ask, doc: Do you have any words of
wisdom that might help me to overcome this particular brand of
performance anxiety?  I would like to be able to just go into this
place, do what I have to do, and get on with things with as little
friction as possible.
Thanks so much for taking the time to read this.  Just writing out my
thoughts makes me feel alot better.

A:   I hear you, I hear you, I hear you!

First, let me reassure you that you are not the first man to whom this has happened.  But that does not make the experience any easier.

If you are going to produce the sample in the infertility clinic itself, and not in just any old medical lab, you can pre-alert your contact there and ask what solutions have been offered in the past.  Some have a side door; some will allow you to bring your wife if that helps (many men are well conditioned to their wife, either for her to use her hand or her mouth to assist in the erection, or to rub against a part of her body, having the specimen cup ready when they ejaculate).

All the ones I have known about have had many copies of Playboy, Hustler, Penthouse, etc. available in the "sample rooms."   And, if you have a favorite erotic story, bring it in a briefcase.

Some men have obtained a sample cup in advance, and masturbated while parked in their car, but beware:  If you are seen, you will likely be arrested for indecent exposure.

Because more than one man has said this, I will also add that NEVER, NEVER ask or joke about having a female staff member (the youngest one, with the large breasts) "assist" you.  It has been proposed too many times (seriously) and it is seriously offensive to the office personnel.

To a large extent, it is anticipatory anxiety like stage fright, and some men respond by learning how to hypnotize themselves, and actually going through the experience with no sample 2 or 3 times before they decondition from the nervousness.  After a couple of times it becomes a "been there, done that" thing, and the problem converts from anxiety to boredom -- lack of excitement.

I suggest that you speak with your contact at the clinic, communicate your concerns, and get a mental picture of what happens if you don't "produce."  And, because of the cathartic value of getting this off your chest, it would help to talk about it with a psychologist.  Especially one trained in cognitive-behavioral behavior modification techniques.

9/28/00 He writes again:
I just thought I would write back once more to thank you again
for your help.  You're doing a great service for people like myself who can't
even bring themselves to talk about this sort of thing.  I don't know if its the
response, or just the act of organizing my own thoughts and applying them to
this electronic paper that's helping, but as I said earlier, I feel much better
about all this.  Maybe I'll give you a call;  I'm curious about what you meant
about the "self hypnosis" and "going through the experience with no sample".
(hey, doesn't it say on the "tips" page not to ask questions in euphemism
because you might not know what we're asking? ;-)  Anyway, go ahead and delete
the rest of this...I expect no further response.  I'm just going to keep on
writing for my own benefit.. (the flood gates have opened).
So, "going through the experience with no sample":  you don't mean actually
going to the clinic in advance to take "batting practice", do you? (there we go
with the euphemisms...)  To me, that would seem like treating fear of heights by
jumping off a tall building.  I was a music performance major in college, and as
such, I studied a bit about performance anxiety.  Slightly different version,
though....perhaps some of the same basic skills can be used in this situation,
as well.  I remember blocking out the audience, not acknowledging them at all so
that I could concentrate completely on the task at hand.  There were relaxation
exercises, meditation, and so forth.  I'm sure it couldn't hurt to reach into my
old bag of tricks.  But, there are a couple of differences, though.  I spent
hours per day, every day, for years, with expert guidance, practicing my
instrument so that I could stand in front of a large crowd and perform
routinely.  Along the same lines, it was actually considered in these circles,
an admirable thing to lock oneself in a small room, alone for hours on end in a
seemingly endless and repetitive activity.  ("wow, he's always in that practice
room.  no wonder he's so good...I wish I were that dedicated...", is what the
other students would think.).  Not quite so with my current challenge.
Well, I was able to laugh and joke about it with my wife tonight.  As I said,
its getting easier.  I still don't think they (women) quite get it, though:
After long, drawn out discussions over the past few weeks, my wife asked me
tonight, " it because you have to go in there and masturbate, and they'll
know that that's what your doing?"

"uh....yeah.....what did you think?  I'm afraid I might spill on my new
shoes???".   Geez..

She spoke to the folks at the clinic today, (also all women.), and mentioned
that I might  have some difficulty....They were sympathetic, and offered a
couple of alternatives:  bad and worse.  (I suppose their hearts are in the
right place.  no slight against them- I couldn't think up anything better .).
One was for my wife to join me and help.  As I said before, it wouldn't.  The
other was to actually have intercourse in the room with a special condom.
(yeah, right. like handing them a cup isn't bad enough..).  This is just want I
don't want to ask for: help.  ("gee, I wonder if she cuts his meat for him,
too...").  As for the "what if I can't" question, the answer is' "come back
later and try again".  ( "fail a second time in the same day" is what that
sounds like to me.  "what makes you think that if I can't do it now, I will ,for
some reason, be able to do it later? ).

My wife said to me, giggling, "gosh, I wouldn't want them to see any traces of
saliva mixed in with the sample..."
"Ah-HA!!" I said.  "Now I think you're starting to get it!"

Well, I think that's the way I'm going to go.  I'll have to learn how to "just
do it".  Nothing else will be any easier.  Even if we lived close by, they want
it done "on the spot", if at all possible.  That will be the easiest for them,
and the most effective for us.  Maybe I'll give you a call and get some expert
coaching, like I had in college;-))   Thanks again for listening.

A:   Hypnosis is really teaching someone to hypnotize himself.  That is great for reducing anxiety.

Going through the experience with no sample means going there, getting the cup, going into the room, stimulating yourself, giving up, and leaving.  It's a way of dealing with being overwhelmed by everything all at once.

Some men one day go to the front door of the clinic, the next day into the waiting room, the next day into the sample room, the next day stimulate themselves with no ejaculation, and on the fifth day "produce."   Each day they practice deep breathing anxiety reducing relaxation.  It's behavior modification of breaking things down into small steps and pushing the envelope.  It works.

New boyfriend's penis doesn't get hard enough
9/26/00 Q:  Dear Dr. Fitz,
My new boyfriend and I have been dating about 2 months and I think he thinks his
penis works just fine.  I do not. I am usually one to discuss problems, but I'm
afraid discussing could make this one worse and I was hoping it would get better
on its own.  His penis just never gets completely hard.  It's hard enough to
penetrate and can usually do the job, but i'm constantly worried it's just going
to squish out (which it has done a couple times).  He seems to be very attracted
to me and says he loves sex with me.  It MIGHT be a little harder in the
morning, but still not what I consider completely right.  He always comes even
though it's not all that hard.
I'm curious what the causes could be and if you have any suggestions for how to
bring it up.  I've thought of phrasing it like he might not be totally attracted
to ME (so it's more of a my problem than a his problem).  I really want to know
if this is normal for him, but if i make him worry about his ability to please
me, it might make it worse.
Thank you for your help.

A:  In the sex therapy business we arbitrarily say that the buckle point -- during intercourse, when the penis slides in and out, if at some poing the in-thrust results in the penis doubling over, buckling, instead of penetrating -- is "85%" erect.

A man can compromise the rigidity of his penis with tobacco, drinking, and having such a terrible diet that he develops adult onset diabetes.  Poor exercise habits and high cholesterol and high blood pressure causing him to take blood pressure pills to lower it all can affect the rigidity of the penis.

If he is past 40, lowered serum testosterone could also be a factor.

If he has not had a complete physical recently, this would be an excellent time for him to have one, because insufficient penile rigidity could be an early symptom of the above or other systemic compromises.

9/25/00 Q:  Dear Doctor,

I have read all the questions you've replied to on vaginismus but none of the
situations were really applicable or helpful to me. I understand you must be
extremely busy but I would really appreciate it if you could find the time to
reply to my Email as I am desperate for some help.

Basically, I grew up in a household where there was a strict Catholic and
very negative approach to sex. My mother told me how unpleasant she found sex
and I have to say, I felt very repulsed by her mentioning sex with my father
to me at all. I don't remember it being specifically said, but I always had
the strong impression that sex was wrong/something I would get in trouble for
etc. etc.

As a teenager I was very apprehensive at the thoughts of kissing my first
boyfriend, but eventually did, and I loved it. I have since really enjoyed
dating, kissing, sexual intimacy and various forms of foreplay. The problem
is, I have never had penetrative sex and am totally unable to. On the one
occassion I tried it before I experienced extreme pain and stopped almost
immediately. I thought this was largely due to the fact that the man I was
with was extremely well endowed/ I was not 100% comfortable with him/ he was
really pushing the issue of having sex with me, and I just panicked.

Since then I have become involved in a very happy, really loving and
generally great relationship. I have been with my boyfriend 9 months but it
was serious from the beginning as we just "clicked". Sexually, things are in
some ways great. We are both very orgasmic and often spend whole days in bed
just playing with each other, doing '69' and other things (handjobs, touching
each others genitals whilst talking dirty, looking at mild porn). However,
penetrative sex is impossible. We have tried and the pain for me was
unbearable. We purchased a small vibrator (4.5" I think) and he has inserted
that in me on occassion, which I have sometimes liked a little and which has
sometimes caused me some discomfort. I know he is also now wary of hurting me
because of the pain I have experienced when we have tried previously.

I really love him and I really want sex. He is 23 and had slept with 3 people
before me and I want us to have that level of intimacy also. For his part, he
says that the amount of pleasure he gets from the other things we do is
greater than the pleasure he had from sex with other people and he would
never end the relationship because of the one missing component when
everything else is so right.

I want to overcome this though. I believe I have vaginismus and have been
looking at various information searching for a way to "cure" it. I registered
with a vaginismus website where other sufferers shared their experiences and
more than anything else I felt frightened. These people were in their 30s and
40s, had been married for 10 and 15 years and never had sex. I don't want
that to be my life.

I understand that therapy is recommended for a lot of people but I don't feel
that I'm the sort of person therapy works for. I have dealt with other issues
raised by my toxic upbringing on my own, by sorting their place in my head
out over time, and a Dr. who is aware of my upbringing and my method of
dealing with it has commented on how well I've done. I have recently
graduated from University as the youngest ever law graduate in my City, (I'm
20 years of age), and seem to have a very promising career ahead. I want to
make this area of my life equally happy and was basically hoping you could
advise me on a way of beginning to work with myself to overcome it.

Thank you very much for taking the time to read such a long letter and I
eagerly await your reply.

A:  Dear Reader,  I am including this letter mostly to illustrate that there are excellent reasons why there is a need for face to face therapy.  She starts off with a religious negative family life, clearly articulates vaginismus, says she doesn't want to end up older and unable to engage in penile-vaginal intercourse, then slams the door shut with "I don't feel that I'm the sort of person therapy works for.

Women have tried self-help approaches to all kinds of sexual problems for years, and none has emerged for the vast majority of vaginismus sufferers.  Weekly psychotherapy along with gradual dilation, breathing, and Kegel exercises is quite effective, but I have had many women present for the psychotherapy discouraged that the homework will do any good because they tried it on their own.

Alas, she eagerly awaits my reply to advise her of a way to work with herself to overcome it, and I cannot for I have no magic bullet.

Please notice that for things that can be fixed by doing exercises at home, like premature ejaculation, for example, I am delighted to publish the entire self-help protocol on the internet (link from my home page).

Embarrassment about initiating sex threatens relationship
9/25/00 Q:  Dear Dr. Fitz:
I have been involved in a lesbian relationship for quite some time now. Since
the start of our relationship (almost 4 yrs. ago), my lover has been the one
to always initiate sex.  She is sick and tired of doing so and refuses to do
anything sexual unless I take the initiative. (It's been over 2 months since
we had sex.) The problem is that I won't.  In my past relationships, my
partners have always been the ones to initiate the sex. 'Til this day, I have
never seduced anyone I have been intimate with.  I don't know if my problem
is fear of being rejected (although I don't think it is because this is what
she has told me she wants me to do -- so why reject me)? Or is it plainly
that I am too shy, embarrassed or inexperienced to take charge?  I can't even
see myself telling her to make love to me or that I'm "horny" for that
matter.  Instead, I prefer to go to sleep all hot and bothered which is what
I have being doing for the past couple of months.  She has been with a whole
lot more women compared to my few encounters.  She has expressed to a mutual
friend of ours that she feels "unwanted and unloved" as a result of my
inability to initiate.  Furthermore, she believes that I hate having sex
(totally untrue).  I have expressed to her that I have a problem with the
initiation but that I do love her and would love so much to have a "normal"
sex life.  My fear right now is losing her on account of this.  I don't turn
to books because I don't want her to know how much of a problem this is for
me.  I guess this is where the word "embarrassment" comes in ... after all,
I'm 35 yrs. old.  I've been searching the Internet on the sneak for some type
of help and that's how I came across your site.  I would love to know what
your advice is and/or can you tell me where on the Internet I can find sites
that would help me overcome all this....maybe on seduction, setting the mood,
etc.  By the way, I have never been sexually abused nor have I experienced
anything negative that would make this such a problem for me.  I look forward
to your response.  Signed DESPERATE!!!!!

A:  Here is another case of a person frozen in her own difficulty.  "I don't turn to books because I don't want her to know how much of a problem this is for me."  I suggest that the same amount of time she is willing to spend on the internet, be spent in the local library or in a sex therapist's office!  Help is available, but the internet is not the answer to everything!

I am reminded of the oriental saying "When the student is ready, the master will appear."  Necessity being the mother of invention, when she is desparate enough (as she signs her e-mail), she will search for effective help.

What sexual activity to surprise my boyfriend with a night of passion?
9/22/00 Q:  Dear Doc,
  You have helped me with many questions I have asked in the past and hope this one will be just as easy. Now when my boyfriend and i have sex he wants to please me as much as possible. Which i dont mind. Now i want to please him really good.But want to surprise him with a really good night of passion, just to let him know that im falling in love with him, without exactly saying it. I want him to have an experience he'll never forget.The only problem is i want it to be perfect.So what kinds of sexual activity can i do for him to get him arroused and have the time of his life?Like i said id ask him but i want him to be surprised and blowen away.
Thanks for your time and hope this question wasnt too hard to answer as it was to word it.

A:  That's difficult to answer because different men like different things.  When it comes to "peak" experiences, what one man says blew the top of his head off, another will say is disgusting and perverted!

The common denominator is novelty -- something different, and often "naughty."  Couples who have done only "straight" sex often graduate to anal sex play as the next "level."  But you need to be cautious, because some unsophisticated, sexually insecure, and/or relatively ignorant guys think that any touch on their ass is a homosexual thing.  Then again, some guys, and some women, just don't like their ass touched.

Men identify as peak experiences things like:

 "She said she got 'all cleaned up' and wanted me to take the virginity of her ass."

 "She was giving me a blowjob and all of a sudden she slipped a slim well-lubricated dildo in my ass."

 "She said she had a surprise, blindfolded me, tied me spread-eagle on the bed, washed my anus with a warm soapy washcloth, wiped it with a warm wet washcloth, dried it -- I was dying of curiosity to know what she was going to do -- then she smeared what I later  found out was creamy peanut butter on and around my anus, then called in her dog to lick it off."

Other unusual and passionate things include a role reversal, where you tie him spread-eagle face up, making him necessarily passive, then drip chocolate sauce on his nipples and penis, lick and suck and use your hands on various parts of his body, with the goal of getting him erect and keeping him on the verge of climax for a long time.  To be ultimately passionate, culminate the experience (bring him to orgasm) in the woman on top intercourse position.

And some guys get totally turned on by watching their woman masturbate; some like it when she uses a dildo; some get off big time if she has a larger dildo in her vagina and a smaller one in her rectum (see my pages on anal sex on the home page for hygiene requirements).  In general, the common themes on the porno web sites are what sell because guys like to see them.

Some guys would consider it extremely erotic for the two of you to watch a porno video together.

Please tell me what you think, what you do, and how he reacted.


READERS are invited to e-mail their peak experiences.

42 year old man discovered anal auto-eroticism
9/22/00 Q:  I am a male of 42 years old heterosexual and would love to have a man penetrating me for the sake of experience.I sometime insert a cucumber of 7 inches long and 2 1/2 inch diameter with ease after massaging the anus with the well lubricated cucumber.Is it safe to be penetrated with a cucumber or dildo.First I tried a small cucumber of only 5 inches long and 1 1/2 diameter for 5 minutes and then get to the bigger one which fit easily when I am aroused.I would like to insert a bigger one but would like some advice first.I am sure I can fit a 3 inches wide or slightly bigger.
Best regards

A:   Anal eroticism is common in both genders, but anal sex received from a gay man is risky because of AIDS.

I suggest that it is safer to do it to yourself or to have your lover do it to you.  The video available from good vibrations, "Bend Over, Boyfriend" is a step by step illustration of how to do this with a strap on dildo.

I suggest that you discontinue the use of cucumbers.  A rough part can scratch your rather delicate anus.  Get dildos of various diameters and be sure to wash them with Lever 2000 or Safeguard or any other soap that is bactericidal and not scented (some people react to Dial).  ALSO:  IF you dilate to the point of tearing the tissue, this could result in fecal incontinence.  Use pain and resistance as your guide and do not dilate too much.

See preparation and hygiene instructions on my home page.


p.s.  In the October, 2000 Playboy, in the Playboy Advisor, there is a question that starts:

    "My husband and I have been married for 31 years but until six months ago had never tried anal sex.  What a mistake. ... It's the only way my husband can get off more than twice in a night, and I lose count of how many orgasms I've had."

Can too much anal sex harm me?
9/22/00 Q:  Can too much anal sex harm me? My boyfriend turned me onto anal and I like
it almost as much as vaginal. Many times we only do it anal when we're

A:  To the contrary, frequent dilation and relaxation of the anus, along with the motion and the excitement of sex, promotes blood flow and oxygenation of tissue which are good for the body.  The greatest dangers you run are tissue irritation if there is not enough lubrication, and contracting a disease if he has one.  Also, you should know that if you are allergic to any medicine, such as penicillin, you can irritate your bowel if he is taking it because it will be voided in his semen (so use a condom in that case).

Is oral sex between cousins incest?
9/21/00 Q:  Dear Sex Doc,
My Cousin and I are very close to each other even though we live 2,00
miles from each other ( Ilive in California, and she lives in Pennsylvania).
Anyway, she just loves giving oral sex, to guys and girls as she is a
bisexual. Anyway, three years ago she was visting me here in California when
we were talking about sex, and said how much she loved giving oral sex.
She then suggested that she perform oral sex on me, by putting my penis in
her mouth, and sucking it. I had herad about this before, and how good it was
supposed to feel but didn't think that it would, and that it would be gross
because she is my cousin. I told her jsut that, and she said don't worry,
we're cousins and cousins should make each other feel good.
So, I let her do it, and while it felt extremmely good, and I do mean
extrememly good, I now wonder if that was normal, to expierence the pleasure
of it, even though she was my cousin, as well as know if it was incest or
not. What do you think?

Regretful in California

A:  Incest is a Judeo-Christian concept and is culturally bound by the times.

For over 300 years the ancient Egyptians were ruled by successions of brother-sister marriages!  And that was totally accepted as appropriate (conserved the royal blood line).

In the United States, yes, that was legally sodomy in 11 states but it was not technically incest because penile-vaginal intercourse did not take place.

A South Carolina virgin is a woman who can run faster than her brothers and father.

Sexual experimentation between relatives is extremely common.  I suggest that you just chalk it up to experience.  If you are distressed about it, though, see a therapist before this interferes with your ability to develop a trust relationship.


From a 21 year-old:  How to spice up a 4 year-old sexual relationship
9/21/00 Q:  I know that this is a very broad question, but I would really like some
help...  I am 21, have been in a relationship for 4 1/2 years with the
same girl, lost our virginities to eachother 4 years ago and the sex was
great, exciting, new, adventerous and everything great that you can think
of, but it has faded over time, and quite a bit I might add.  We have
talked quite a bit and some of it had to do with her being comfortable
with herself again and she is a lot better now, and the rest was just us
being too comfortable with eachother.  Well we recently talked and would
really like to get things back on track the way they used to be, but we
have tried all kinds of things in the past so there isn't all that much
that is new.  I would like to know anything that I can do to spice it up,
it has basicaly come down to the fact that we need to be adventerous and
try out new exciting things again to excite ourselvs/eachother.  Please
help me out any way you can, I will gladly answer any questions that you
might have further, any more info that you might need, anything.  Please
help me/us out here.  She doesn't know about this, I am going to try to
supprise her with something if possible.  Thank you very much, and I look
foreward to hearing back from you soon.

A:  There are entire books on sexual enhancement and role-playing, etc., and e-mail is an inappropriate medium for trying to duplicate that.

ALL relationships between humans take on a "been there, done that" overtone over time, and you cannot regain the stimulation of novelty from the early experiences in a relationship.  You need to calibrate your expectations on that one.

All people have some inhibitions, and seeing a sex therapist for enhancement is an excellent and efficient route to bring them to the surface and dispel them.

All of that having been said, many committed couples spice up their sex life with sex toys (see links on my home page) and different sex acts, like oral sex and anal intercourse.   But there is no magic bullet here.


Married 4 years, no sex for the last 2, husband downloading gay porn.  What's a girl to do?
9/21/00 Q:  Dear Doc,
    I have been scrolling through your Q&A's but haven't found one that
applies to my situation.  I am in my 30s and have been married for 4 years.
For most of our marriage, I have lost interest in sex because of my concerns
that my husband may be gay or bisexual.  For the last 2 years, we have not
had sex.  On more than one occasion, I discovered that he had downloaded gay
porn from the internet, and had been in chat rooms.  At one point, this
activity seemed to be compulsive, with him having missed time from work to go
home and log on.  He also did this when I was out of town.
     We went to a sex counselor once, but after making assurances to me that
he was not gay and promises not to look at the porn again, he did, and I have
since told him that I would not have sex with him unless he sees a therapist.
 That was 2 years ago.
     We get along well and we are affectionate with each other, but this
subject has remained a "closed door" for so long now that I doubt I will ever
feel the same way about him.  His unwillingness to talk about it or do
anything about it makes me feel like I don't really know him.  One night I
said to him, "Are we ever going to have a normal marriage?"  He said he would
do something about it, but he hasn't, and it seems like he's just playing a
waiting game with me to see if I forget about all of  this and resume
relations with him.  Any advice you can give me would really help.  Thanks so

A:  Women who have gone through this before describe it almost word for word as you do, and universally, their lament is that they waited too long before voting with their feet.  Clearly, you are not getting your needs met, he is lying to you, you two are prima faciae sexually incompatible, and you are not getting any younger (a commodity necessary for connecting with another mate).  I suggest that you bottom line him with the confrontation that each of you would be predictably happier in a different circumstance, and that each of you is entitled to choose sexual behavior and fulfillment, and that each of you clearly prefers something different from the other.  I think he is giving you a clear message that he likes what he does and doesn't want to change.  Any questions?

Young woman concerned that 15 year-old boyfriend's former gf trying to touch him
9/21/00 Q:  Dear Dr. Fitz:

Hi!  I am 15 year old girl.  I am going out with 15 year old boy for the past 7 months.   We love each other very much.  I am having a problem with another girl.  His ex-girlfriend  She likes him again.   I don't know what to do??   He is the one who told me she has been trying to touch him and he's been backing off. I don't go to the same school.

Should I approach her.  What can I do or say to have her back off.

I need your help.

Thank you
Angela (not her real name)

A:  Dear Angela,

FIRST you did the best thing by asking someone.

Think of people's behavior like driving a car.  The only car you can control is the one you are driving.  You watch for brake lights, turn signals, and direction in other cars, but those things only influence the behavior of other drivers, they don't control it.

I suggest that you NOT confront his former girlfriend.  That could result in her thinking of it as a challenge if she is competitive.  I suggest that you have a heart to heart talk with your boyfriend and ask for his confirmation that YOU are his girlfriend now, and that he will not touch her.   Make it clear that you cannot control his behavior, and that if he wishes to reconnect with her, you will be sad, but you will accept that reality.  But that it is NOT acceptable to you for him to tell you that you are his girlfriend and still have affectionate touching with his former girlfriend.

And, dear Ashley, calibrate your expectation model to include lies and heartbreak.  Many teenagers have to learn the hard way.

If you appreciate this advice, please let me know what happens.


23 year old woman achieves orgasm in only one way.
9/21/00 Q:  Dr Fitz,

I'm a 23 year old female who has never reached orgasim.  I can make myself
orgasim only by crossing my leggs and applying finger stimulation.  I've
tried doing this on many occasions with men, but it's never worked.  Oral
stimualtion from men never seems to make me orgasim, neither does
stimulation from their touch.

I'm currently in a very important relationship although we have not had
intercourse yet.  I want to orgasim so badly with my boyfriend and
experience this with him, but I'm fearful that it won't happen.. as usual.

I've tried other ways to make me orgasim however nothing works.  The ONLY
way I've been able to give myself pleasure is when I cross my legs and apply
finger stimulation.

My question:  Is there ANYTHING humanly possible I can do to orgasim with my
boyfriend?  Maybe I'm missing something?  Or am I just one of those
unfortunate people who will never be able to reach an orgasim?


A:  First, I have cited in several locations that only about 40% of women achieve orgasm from penile thrusting alone.  The others have one before or after or never, OR "help themselves" with additional clitoral stimulation during intercourse.

Please note that NOT ONLY is the desirability of simultaneous orgasm a debilitating myth, but (are you ready for this?) the idea that both partners "have to" have an orgasm from intercourse is an outgrowth implication of Judeo-Christian concepts.  If you are trying to make a baby, yes, the most efficient "lay" delivery system is an erect penis in the vagina.  BUT, dear reader, if you are pleasuring each other, what is wrong with each person achieving orgasm in a different way?  The emphasis on both people having orgasms during intercourse is a derivative of "The only purpose of sex is to make babies," and "the only REAL sex is penile-vaginal intercourse."  "Spilling seed" outside of the vagina was a sin because it didn't promote pregnancy.  Back then, every religion wanted to control the masses and have the greatest number of followers.  Today, most of us can read and write and study and decide on our own situational ethics, and we have too many people on earth!  You can believe that everything else besides penile-vaginal intercourse is necessarily either immature or perverted if you wish, but by buying into the intercourse-only idea you are giving up lots of other fun activities.

The part of your brain responsible for orgasm is the same that learns how to ride a bicycle.
Unfortunately, some women and some men have done the same exact thing to their body to achieve orgasm to the point that the brain interprets only that set of circumstances as the "correct template" to trigger orgasm.

I cannot tell if you are one of those women or that you are unfortunately on the low end of the sexual response normal curve.

You didn't mention a vibrator.  I suggest that you buy one (the vibrators in all major drug store chains are perfectly adequate) and see if you can lie flat on your back, legs spread apart, and take your time to explore what it feels like around and/or on your clitoris.  DO NOT place it right on your clitoris and hold it in the same spot for a long time.  That causes "sensory acclimation" and can make your clitoris go numb (or if you really mash it, you can cause nerve damage that takes months to regenerate).

Take your time, avoid a sense of rushing or urgency, notice the feelings.  What you need to do is re-train your reptilian brain to interpret these different sensations as sufficiently pleasurable to trigger orgasm.

If you are able to achieve orgasms that way, strive to bring yourself to orgasm in different positions like on your knees and standing up.  When you then have intercourse with your new boyfriend, try doggy style using the vibrator, and during each successive event, strive to use the vibrator less and less.  You are "pairing"  the vibrator sensation with the sensation of his penis.

ALSO:  Obtain a copy of "For Yourself" by Lonnie Barbach, Ph.D., and read it page by page without skipping ahead, and do every exercise no matter how easy it sounds.

And in the final analysis, if nothing except crossing your legs and using your fingers works for you, I suggest that you abandon the "need" to validate sexual activity by having an orgasm during intercourse. Have fun, do what he wants to achieve orgasm, have him pleasure you as you wish, and when you want an orgasm, cross your legs!

If you appreciate this advice, please send me an update and remind me that this is published on page 26 at 9/21/00


Left eye closes and stays closed upon orgasm
9/21/00 Q:  I'm going to do my best to jump right in here and ask my question.  I do hope I don't fail in that attempt.  I'm a 51 year old woman and I have been married twice.  I'm divorced now, and have been in a relationship with a wonderful man for just short of two years.  I'm only telling you that part so you will understand I'm not a "newbie" at this.  Now for the question.  When my lover brings me to organism my left eye closes on it's own and stays that way for several minutes.  I have never had this experience before (well I have been having it for two years), and this is the only time it happens.  I have to actually force my eye to open, and then most of the time it closes again right away.  I have talked to my doctor about it, but all he told me was I was supposed to have my eyes closed during intercourse.  I'm not going to go into what I told him, but needless to say I came away with less than the answer I was seeking.  Have you heard of this before, and is it OK?  Thank you in advance for any information you can give me on this.  L.

Dr. Chance Fisher answers:  Everything is fine.  Sometimes when the orgasm is powerful the endorphins will have an anethesic effect on nerves in the entire body.  Since the optic nerve is buried in close capacity to the brain where the endorphins bind to receptors, this causes the eyes to flutter or roll or in your case, close completely.  There is no serious problem to worry about.

How to put on a condom
9/20/00 Q:
Hello Sex Doc,
              Well, I'm kind of embarassed to ask this. I'm a young male,
20...I have had sex a few times before, but I have NEVER used a condom. I
HAVE NO IDEA HOW TO PUT ONE ON OR WHAT! I just got some, but foolishly threw
away the box, and i just got the condoms left.

1.) I have no idea as to WHEN you put the condom on (before or after

2.) How you flip it on?

3.) And how much area it should cover??

My main one is #1. Like when me and my gf are planning on having sex, when
should I put it on?? and heck how?? but i'm not sure about any of them...

If you can PLEASE help me out here I would appreciate it SO much...
I'm very embarassed, I hope you can help me...

Thank You SO Much

A:  It's easiest to put a condom on when the penis is erect.  Carefully tear the edge of the individual condom wrapper so as to avoid tearing the condom, determine which side is "up" by how it is rolled up, place the center of the condom on the tip of your penis, unroll about an inch, then with your other hand pull up about a half inch and SQUEEZE ANY AIR OUT to make an empty pouch to hold your semen, then making sure that pouch stays there, unroll the rest of the condom down to where the base  of your penis meets your abdominal wall.

I STRONGLY urge you to practice this by yourself so you are not nervous and fumbling when it is needed.

It is surprising to me that I get many e-mails from men who complain that they don't like to wear a condom because it feels like the blood supply to their penis is cut off because the ring of rubber at the base is so tight.  Try Trojan Large!  And the other embarrassed questions are from guys who say that their erection is so small that standard condoms fall off.  In that case, get one of those wide but small rubber bands often used to hold bunches of broccoli together in the grocery store, install the condom, then put the rubber band near the base of the penis and FOLD the base of the condom around and under that rubber band (but do this only if you wish to avoid pulling out your lover's pubic hair at the worst possible moment).

9/25/00 He writes back:
Dear Doctor,
             I thank you very very much for answering my question. Hopefully
all this will work!! But it would be so differnt while actually performing
sex. I mean, what am I supposed to do, hold it in my hand, or keep the
condom on a bed post or something! What would you recomend, cause i'm
guessing it'll take some sponintuity and momentum away if i stop to put it
on, so how should i deal with that? Well, thanks for the reply, please write
me back again if you can. By the way, what is page 26?? A friend of mine
referred me to your mail if i needed help with this stuff. Do you have a

Thanks So Much,

A:  Ah, the age-old question of how to have it ready.  If you whip it out before she has agreed, she can be offended that you took her for granted.  If you have to get up and run across the room for it, you both could cool down too much.  The BEST way is for you two to agree (otherwise it is date rape), for you to have it a reach away (that's why bedside tables have drawers and some guys ALWAYS have an extra Altoids [breath mint] tin box on their bedside table), and for you to tear open the package and have her install it (after a playful lick if you're lucky).

Yes, it does break the mood somewhat.  That's why incorporating installation of the condom as part of your playful foreplay is best.  And, if she puts it on you, she can't later claim she wasn't cooperating!

How effective is the birth control pill?
9/20/00 Q:  For the past two years, my girlfriend and I have been in a monogamous
relationship and having protected sex.  She's on the pill (takes it
faithfully), I use condoms, and I withdraw before I ejaculate.  However, she
feels that it's time for us to abandon the condom altogether.  Yet, I'm
apprehensive or really over cautious.  How safe is sex on the pill in
avoiding pregnancy?  I'm pretty sure you've answered this before, but I
couldn't find a question like mine.  Thank you for your help.

A:  Dr. Fisher replies:  The pill is 97% effective when used faithfully.  It is one of the most
reliable methods of birth control methods.  It is good to remember that some
birth control pills can be affected when a woman takes antibiotics and
certain other medications.  So, be careful to check with the health care
provider when starting a new medication in terms of it affecting the birth
control method.  If it is found that there may be a possibility of it
decreasing the effectiveness of the pill, a condom can be used during this
time to protect against pregnancy.

Anxiety about first time intercourse
9/18/00 Q:  Hi,

I'll be married in six months time and I feel a little anxious about
having sex for the first time with my husband.

Although I do know the biological details of sex, I'm still afraid that
our first experience will be a bad one.

I have a couple of questions
1. Is it normal for first encounters to be bad?
2. What can I do to relieve the anxiety. I've known my husband-to-be for
more than five years and I feel really close to him but I just cannot help
but feel afraid.

Please help.

A:  A couple's first experience of penile-vaginal intercourse can be heaven or hell.  It can set the tone of the relationship and yield great joy and intimacy or it can be the start of the slippery slope to divorce.

You, the woman, need to determine if you have much if any tissue at the opening of the vagina, and if you have enough to interfere with the introduction of something the size of your husband's penis, you need to stretch it until it no longer blocks the entrance.  That is called the hymen, and some women are almost completely blocked, and other women have no hymen.  If sharp fingernails are not a problem, wash your hands and gently insert two fingers (index and middle).  Spread them as far apart as you can and rotating them, see if you can remove them very slowly and gradually, making sure you make a complete circle of rotation every half inch they are removed.  If you feel something blocking the fingers, you need to stretch that every 2 or 3 days until there is no more blockage.  Some women have told me that they used a wine bottle that has a neck that gets progressively wider.  That way they can stretch a little bit more every 2-3 days.  ALSO:  Learn how to do Kegel exercises.  I have published the complete protocol within the "excerpts" section of my book -- see that near the top of my home page.  If you know how to tense the pc muscle, you will then know how to relax it.  That's your pre-marital homework.

When you and he are going to have intercourse for the first time, take it sloooooooooowwwww and avoid the mistake of believing that you must achieve the goal of complete penetration with vigorous stroking on the first attempt.  Be affectionate and playful and be pleasure, as opposed to goal, oriented.  Learn how to bring each other to orgasm by giving precise feedback as to what feels good to you as a unique individual.  Some women are tall, some short, and some like vigorous nipple stimulation, and others want very gentle nipple contact.  The preference of clitoral stimulation is also remarkably different from woman to woman.  Some say that they have to have a jackhammer on their clitoris for half an hour, others find anything more than a feather touch to be painful.

Be OK with the idea that the first time you might just bring each other to orgasm, and with each event maybe go a little further, like just rubbing the tip of the penis on your labia, then 2 days later having it penetrate your vagina an inch, then 2-3 days later maybe penetrating deeper.  When the penis is inside you, do the Kegel exercise and feel what it is like to relax.  If you relax when the penis is going in, you will avoid developing vaginismus.

If he ejaculates too soon, or if you need to touch your clitoris during intercourse, don't worry about it!  Those things are common.

Your key elements are to avoid rushing, to communicate and give feedback or demonstrate how you like to be touched, stop immediately if you feel any pain, and be respectful of each other's wishes.  EVERYBODY is somewhat nervous during their first event of intercourse.  It would be quite bizarre if you (and he, if this is his first time) were not.  And don't be afraid to ask someone older and more experienced about things sexual!

Virgin just got married and is now experiencing constant pain.
9/17/00 Q:  When I got married last Saturday I was a virgin.  I was expecting some
blood and some pain the first few times my husband & I had sex.  There was
a whole lot more blood than I thought there would be, but apparently my
husband sort of jump started my period.  My only conscern is that I still
experience so much pain, and not only during intercourse.  It's to the
point now that it hurts to sit down.  My husband has been so sweet and
kind, but no matter what we try it is excruciating to let him get inside.
Once he's inside, it's not too bad, but it takes quite a while to get him
in.  Is there anything that I (or he, or we) can do to make this less
painful and to make sex more enjoyable for both he & I?

A:  I strongly suggest that you NOT attempt penetration until you ask your GYN if you have vaginismus or some definitive differential diagnosis is obtained.  The sooner you start treatment for whatever is causing the pain, the sooner you can make progress on it, but IF YOU CONTINUE to repeat the pain episodes, it WILL take longer to reverse.

Please make it OK between you and your husband to do non-penetrating sexual things.  It ain't intercourse, but it's better than nothing.


You should NOT be experiencing pain.  Something is wrong.

Too much lubrication!
9/17/00 Q:  Hi there, i was just wondering if you could help me out with a problem i've
been having lately concerning my sex life.  I have been with the same
boyfriend for 2 years and we have been having some sexual frustrations over
the last year.  It seems like whenever we have sex, i tend to get too
lubricated, and it is not as enjoyable.  I'm worried that i am not pleasing
my boyfriend, therefore i cannot enjoy myself.  He assures me it feels just
as good as it ever did, but i know he is lying.  I can't remember the last
time he had an orgasm having sex, or actually iniated sex.  My boyfriends
penis is an average size, and i've never had a problem with this before with
previous boyfriends.  Is there anything i can do to decrease the
lubrication?  Can you help me out?  I'd greatly appreciate it if you could!

A:  The ONLY things you can do are 1) insert a tampon for an hour before intercourse to absorb as much fluid before sex as possible; 2) get him closer to orgasm by hand or mouth before vaginal penetration, 3) during intercourse angle your pelvis to cause more friction,  4) some couples have him pull out and quickly wipe his penis and her labia with a soft cloth, then re-insert,  and 5) some women become skilled at oral or anal sex to compensate.

Worry about bent penis and masturbation
9/15/00 Q:  hi I'm a 20 year old male and I masturbate on regular basis( at least once a
day).  my penis is bent to the right. I am a right hended person and I
masturbate only with my right hand. My penis is bent not only to the right
but down as well. could the rfrequent masturbation be the reason for this
deformity? and what can I do to straighten my penis?

A:  Please RELAX!

Masturbation is GOOD for you.  It promotes blood flow to the penis and pelvis and the endorphins released into your blood stream strengthen your immune system by increasing your white blood cell count (among other things).

Your handedness has nothing to do with the shape of your erection.  Some curvature is perfectly normal and may change over time.  Please continue to do healthy things without worry.


Anguish over a fantasy
9/15/00 Q:
A few months ago, my girl-friend decided to get her
legs waxed so went to this lady who was to do it for
her. Well, she also decided to get her panty-line
waxed so the lady asked my girl-friend to strip to her
underwear & then slipped her panties up from the
crotch so she exposed her entire pubic region. Then
she applied wax over my girl-friend's pubic region w.
her bear hand & waxed off most of her pubic hair so
she could see the entirty of my girl-friend's clit and
everything else. Then she used her bare hand to wipe
it all off & then used some tissue. I loved looking at
my girl-friend down there thereafter & have lost count
of the number of times I've masturbated over it both
in her presence & afterward. Well, that's where my
problem comes in cause I also have repeatedly
fantasised & masturbated to orgasm over the idea of
another woman touching & seeing my girl-friend's
privates exposed! Is this a bad thing which I should
be ashamed of & stop immidiately? Please tell me cause
the mere thought of it has turned me on repeatedly & I
have masturbated to orgasm over it many times. Please
tell me if its unnatural & should stop immidiately or
if it is a common occourance in men. Hopeing you help
me fast with
the truth.

A:  Whenever I get any e-mail communicating anxiety over the content of a fantasy, I shake my head slowly and wonder how people got beaten up so badly.  Where does the message come from that says that you should question the validity of "naughty" thoughts?  In e-mails and in face to face therapy, people relate ideas that the average person would think are psychotic!  But HEY, if it gets you off and it is not injurious, and it is not just a rehearsal for a crime, where is the problem?  Nancy Friday made a fortune compiling fantasies, and if you want to curl your nostril hairs, read "Women on Top" and "Men in Love."

BETTER YET:  Some couples, asking how to spice up their sex life, find it very arousing to once in a while pull out one of those books and read it aloud to the partner while the partner is fondling the reader (and him or herself).  If SOMETHING in those two books doesn't turn you on, you need to see a sex therapist for disinhibition!

So if you have a particular thought that gets you off, enjoy it!  But be careful who you tell it to.  Just making it "public" can destroy the fantasy.

9/17/00 he writes back:  Dear Doctor,
Thanks a lot for the advice - that re-assured me a lot
& yes, I will continue to do it & enjoy it! But what
did you mean by saying "but don't do it unless your gf
wants you to?" Did you mean not to masturbate over
that woman touching my gf's privates or not to
masturbate while looking at my gf's privates exposed
unless she wants me to? Pl enlighten me on this cause
I don't want to make a wrong move. But incase you're
wondering, my girl-friend has told me that she loves
it when I fansatise over her "pussy" & masturbate  to
orgasm, in her own words. She loves it when I just
keep touching her there & masturbating while looking
at her exposed.
Pl tell me what you mean by that doctor. Thanks so
much, I'm v. grateful for the advice given.
Best regards,

The sexdoc was in a hurry and said also to him:  "Just don't do it unless your girlfriend wants to."  What I meant was "It's OK to fantasize about a woman touching and looking at your girlfriend's genitals, but don't arrange the actual thing -- bringing a woman into your bedroom to touch and look at her genitals -- unless she, your girlfriend, wants to do that."  Clear now?

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