Sex and Relationships

Sexual Dysfunction

Answers to questions about sex therapy and sexuality

Copyright (C) 1998, 1999, 2000, 2001 William F. Fitzgerald, Ph.D.

Welcome to ASK THE SEX DOC

Answer page #28

Link to the Home Page of ASK THE SEX DOC

It seems fitting to ring in the new millennium with a new answers page, so here it is!

New addition:   9:15 pm Wednesday 1/24/01 in Montreal, Canada on the Peter Anthony Holder show on CJAD 800 AM.  And yes, there is live audio internet streaming.  This was scheduled for 1/10 but Peter called 2 hours before the show to inform me that a politician had unexpectedly resigned and the broadcast was pre-empted by reporting on that.

NOTE:  New material has been added to the ED Q/A at 1/2/01, below

18 year old male claims to be unable to bring himself to orgasm; she can't come from oral sex
1/17/01 Q:  Dear Sexdoc,
    I am K, a 16 year old female. I just learned recently that my
boyfriend can not cum on his own. He is now 18 years old and has never been
able to masturbate to the point where he actually cums. He has had several
wet dreams and I am able to bring him to cum during oral sex. Other than than
though, hand stimulation from either him or me has never worked. Is there
something wrong with that? He is really concerned about it, but too
embarassed to ask ayone. So, what do you think?
    Also, I masturbate almost everyday in the bathtub. Positioning myself
underneath the running water faucet often brings me to orgasm.   The first
time i ever did orgasm was during this. Unfortunately, when my boyfriend
gives me oral sex it just isn't the same. It feels good, but I can't
getreallyt worked up over it. Am I too used to the bathtub? or is he just
doing someting wrong? I really need help with both of these questions.
Thankyou so much. You are truly a blessing.

Love always,

A:  Dear K,  It is rare that an 18-year old male cannot bring himself to orgasm but who does from oral sex.  My strongest hypothesis is that he is too embarrassed to admit to you that he masturbates.  If he truly cannot pleasure himself to orgasm he needs psychotherapy as soon as possible because I infer that he has a serious mental block.  At the risk of sounding cynical, if he asks for oral sex often because that is the only way he can have sexual relief, I would be suspicious.  What a great way to get blown often.  "Please, honey, go down on me.  You know that's the only way it can happen ... ."

Regarding your orgasms, the question is whether you can bring yourself to orgasm using your fingers.  If you can, do it while he watches and takes mental notes.  You probably need extra clitoral stimulation while he is using his tongue and mouth.

Will a woman with vaginismus have trouble delivering a baby?
1/16/01 Q:  I have been married for 3 years and was diagnosed with vaginismus.  Now I
am pregnant and am scared as I don't know what complications vaginismus
can cause during child birth. I could not find any related topics in any
book or online.  I would appreciate any information regarding that.

A:  (Chance Fisher, M.D. replies:)  A female who has vaginismus can make it through labor and delivery without problems and complications.  Your body will automatically prepare for the
presence of a baby traveling through the birth canal by producing hormones that dilate the cervix, pelvic girdle and other surrounding tissues.

Remember, women were known to deliver babies out in fields in the "old days" without assistance in pushing.  In fact, babies pretty much deliver themselves.  Women can deliver a baby without pushing.  Remember when they used to knock a woman completely out?  The pressure of the baby will force the muscles to stretch and allow room for the baby.  Rest with the knowledge that you will probably not have any problems associated with vaginismus.

Is yellowish semen anything to be concerned about?
1/16/01 Q:  At age 55 why is the color of semen different at times? Sometimes instead of being white and opaque in color, it has a yellowish look to it. Is this something to be concerned about?

A:  (Chance Fisher, M.D. replies:) Changes in semen color at any age is perfectly natural.  Semen is usually a milky white to gray, but yellow is also normal.  The yellow color is usually a result of the amount of time between ejaculations.  The longer you abstain from ejaculating, the more intense the yellow coloring.  This is nothing to worry about.  If the yellow coloring is coupled with pain, swelling or other symptoms, then you should be checked by a urologist.

Reducing the probability of bladder infections induced by intercourse
1/16/01 Q:  My boyfriend and I have been together for two months.  I am very petite 5"1 and he is about 6 feet  220 pounds and he has a very large penis.  When we have sex it puts pressure on my bladder and i have gotten about 3 bladder infections already. We have tried other positions like me being on top it helps a little but I would like to know if you had any suggestions or solutions.

A:  (Chance Fisher, M.D. replies:)  First, your bladder infections are not caused by the size of his penis. Bladder infections are caused by bacteria, virus or parasites.  The cause of your infections is most likely due to the presence of bacteria in your vagina after intercourse (very common).  Bacteria enter your urethra and cause the infection.  You can prevent this by going to the  bathroom before and right after intercourse and also wiping his penis clean before

For comforts sake, you can use a cock ring.  They are usually a rubbery ring that slides down on the shaft of the penis. This will allow only a certain amount of his penis to enter the vagina.  You can also try the spooning position.

1/17/01 she writes back:  Dear Dr. Fitzgerald,
Thank you kindly for answering my question however I am still a little
confused about why it hurts me to have sex with my boyfriend. The penis
because of the size does put pressure on my bladder I realize this is not
causing an infection but it is HURTING my bladder.  I have never ever had
this problem with my previous boyfriends and they were not as large!!!So I
will try your suggestions but I am just wondering if their is a physical
problem with me.  I have gone for tests for stds and I am fine.
Is there a book on this subjuect or any literature about this.  I know lots
about infections.It is the actual painful sex I am concerned about

Dr. Fisher replies:  Usually when pain of this nature takes place it is a result of the head of
the penis hitting the cervix.  This CAN feel like it is hurting your
bladder.  Your vagina is on the average of five inches long.  If a penis is
very large it will hit the opening to the cervix causing a slight
discomfort.   Another way to help this problem is to have an orgasm BEFORE
he actually inserts his penis.  The vaginal walls will tent and allow more
room.  Also, if you keep your legs closer together during intercourse, it
will help.

Now, you may have a tipped uterus or suffer from endometriosis.  Your
gynecologist should have informed you in such cases if they were a problem.

How to have comfortable anal intercourse with occasional pain and occasional hemorrhoids (an answer by Dr. Fisher and Dr. Fitzgerald)
1/16/01 Q:  Dear Sex Doc,

Thank you so much for having such a comprehensive site, and for your thorough and thoughtful responses to those who write to you.  I'm really glad to have stumbled upon your page!

My question has to do with finding a way to have comfortable, enjoyable anal intercourse given that I have a history of hemorrhoids.

I'm a 33 year old married, bisexual woman. I'm generally healthy and very comfortable with my body, my partner and my sexuality. I have a history of constipation and straining with defecation since I was about 12 years old, and at various times have had rectal bleeding and pain due to hemorrhoids.  I have largely remedied this issue with a regimen of exercise, getting enough fluids and fiber (fiber both in my diet and with a supplement), and paying attention to the urge to go to the bathroom when it comes up. Still though, I occasionally will have some rectal bleeding due to fissuring or hemorrhoids.  I had a colonoscopy about 15 years ago which found nothing wrong.

I *love* anal stimulation in many forms, whether it be external or internal, or with a finger, small vibe, beads, or my husband's cock.  My husband also really loves to fuck my ass.  So here's the deal:  I love anal penetration, except for when I *HATE* it, because it sometimes really hurts.  More often than not these days, it's been uncomfortable or painful.   We always use lots of lubricant and also try to take our time.  We have tried using small butt plugs and graduating up to larger ones.  I've worked on breathing, visualizing, and the holding in then pushing out technique you refer to in some of your other replies.  I feel like i'm gaining some control over getting the sphincters to relax. BUT...

...sometimes I feel like I'm being 'fucked a new asshole', especially during initial penetration, and regardless of the diameter of the object of insertion. It feels like whatever is being inserted isn't going in right.  Because of my history of hemorrhoids, I feel like I have a lot of redundant tissue or perhaps some prolapse at and between the sphincters, and I feel like unless I'm penetrated exactly the right way, I get a sensation that parts of me are stretching that really shouldn't be.  When this sensation happens, I become anxious and fearful, and then (as you know), sphincter relaxation becomes nearly impossible.  If we try to proceed at that point, which we've decided to on an occasion or two, we usually have a devastatingly disappointing experience.  I think that what I am afraid of is that somehow I'm going to harm my anus or rectum, that I'm going to weaken it further, or that the pressure on the redundant tissue will cause some kind of false tract or fistula.

Solutions we've tried thus far include wiggling the object of insertion gently side to side, or inserting only partially, pulling out, and starting again a few times.  This sometimes works, especially with smaller objects. But my husband's cock just seems to be too big and too scary sometimes.

Maybe it's unrealistic, but I'd really love to be a butt-slut for my husband.  I know that if we could get angles and insertion right, and if i could stay relaxed, it would be a great experience.  We've had at least two episodes of ass-fucking that *really* much so that I was begging him for more and deeper and harder penetration.  But we can't seem to figure out what made those two instances successful, and i'm starting to feel hopeless about it.

 I'd really like to hear that the fears I expressed above are unfounded, or at least unlikely.  I would welcome any advice on the matter you have.

P.S.. I've already read "Anal pleasure and health" and the Tristian Taormino book on women and anal sex.

Much thanks for your time and concern,

A:  (Chance Fisher, M.D.)  There are a few things to remember when attempting anal sex.  Too much lubricant is never enough!!  Water based lubricant is fine, a greasy lubricant lasts longer and tends to be more suited to this type of activity. Lubricated condoms do make it a little easier for insertion.  The best lubricant I have found for anal sex is a make up remover called Albolene.
It can be purchased at most drug stores.

The best way to get the anus prepared for penetration is by externally
stimulating the tissue, then inserting a well lubricated finger or object to
stimulate the sphincter muscles.  If you take a shower right before sexual
activity, this is a perfect time to stimulate the area.  Plus, every time you
take a shower regardless of sexual activity  you can massage the area and
condition yourself to certain stimuli.

Position wise, you don't have to be in the dog style position to receive
anal pleasure.  Try it on your side, standing up or while laying on your
back with your legs thrown over his shoulders.

As far as damage is concerned, it can happen but is very unlikely if you use
patience and lubricant.  As long as you do not have an active case of
hemorrhoids that are bleeding you can safely engage in anal sex.  Most
damage happens in the anal opening when stretching takes place.  Go in
slowly and damage should be minimal if at all.

Another trick some people do is to insert a butt plug and engage in sexual
activity that ends in an orgasm.  During orgasm the muscles will clinch the
plug and condition the anus and surrounding tissues to the presence of an
object thus making it easier for insertion when the plug is removed.

Relax. Damage is unlikely.  You run a greater risk of damage by having a
large bowel movement.

A:  (William Fitzgerald, Ph.D.)  Learning to relax the anal sphincters taps into the same part of the brain that learns to ride a bicycle.  The difference is that few people forget how to ride a bicycle, but if you don't dilate your sphincters often enough, the brain forgets how to relax them.  I suggest an experiment.  Have a bowel movement, flush your rectum with a rectal syringe (about a cup of water) until the water comes out clear and with no more fecal matter, then insert a well-lubricated (I agree with Dr. Fisher -- Albolene moisturizing makeup remover is perfect because it is NOT water soluble, BUT it cannot be used with latex condoms) butt plug the widest diameter of which matches or slightly exceeds the diameter of your husband's penis.  Note every time you insert the butt plug that if you slightly bear down like you are trying to pass gas, that your anal sphincters relax and the widest part of the butt plug slips up more easily.  Do a variation on the Kegel exercise by pulling the butt plug as high in your rectum as possible (think of "Oh my; I'm in a crowded elevator and it feels like I am about to pass gas -- and I have to stop it"), then relax so that your pelvic muscles are "neutral," then bear down slightly like you are trying to pass gas.  Practice this so you can do it 30 times without hurrying.  When your 30 are done, bear down and relax, bear down slightly harder and relax, bear down slightly harder still and relax, until the butt plug shoots from your rectum.  This will strengthen your pubococcygeus muscle  and more importantly, both condition your body to having something go into your rectum in the opposite direction as fecal matter (until it becomes a "been there, done that, ho-hum sort of thing) and sensitize you to what your brain has to "tell" your pelvic muscles to achieve anal sphincter relaxation.  Some of my patients do this exercise while in the shower while shampooing their hair and washing their face.  If you do this once per day or every time you have a bowel movement, whichever is greater, I expect that you will not experience discomfort or anxiety around penetration by his penis.

And, I will wager that what made those two ass-fucking sessions so heavenly was that you angled your pelvis so that at the point of deepest penetration, the tip of his penis was pushing on your g-spot through the tissue that separates the rectum from the vagina.

In return for Dr. Fisher's and my advice, please make some notes about trying these things and e-mail an update of what happens.  Please remind me that this is posted on 1/16/01 so I can find it easily.  Enjoy!

Teenager loses erection during intercourse but not during oral or manual pleasuring
1/15/01 Q:  Dr,
My boyfriend and I have been dating for almost a year.
 We've always been very sexually active as far as oral
and masturbation goes.  But just recently we started
having sex. Whenever we try to have sex he quickly
loses his erection and I have to masterbate him to get
him hard again. He said he doesn't feel anything when
we have sex? I however, do feel pleasure when he is
hard. Why is sex giving him such a problem?  Am I
possibaly doing something wrong? And how do we get
ourelves to both enjoy sex?


A:  If he is accustomed to the more vigorous touch of his hand, and/or if he is nervous or worried, I would expect him to lose his erection.  To overcome this, 1) make sure he is cool, calm, and relaxed, and 2) have him stroke his penis, insert into your vagina, remove and stroke, re-insert, etc., until he can stay hard by being in your vagina.  Be patient.  It's the way to recondition his brain to accept gentler touch as "stimulating enough" to maintain the erection.

Uninhibited questions from a 15 year old female
1/15/01  Q:   Dear Sex Doc.,
I am 15 years old.  I have just started masturbating and I had a few
questions for you.  First I would like to ask if all girls finger
themselves.  I know a few girls who do it, but I wanted to know if everyone
does it.

Second I would like to ask if it is normal to have fantasies about the same
sex or if this makes you homosexual?

And third I was wondering if you could give me some techniques on
masturbation, because I am getting bored with tickling my clit with my
finger, and humping a pillow.

And my last question is, is it normal to stick wierd objects (such as
popsickles, garden hoses, bannanas ext.) in my vagina, because my friend
S does this and really enjoys herself.

I would greatly appreciate it if you would answer these questions!

Thank You

A:  Nobody knows for sure how many young women "finger" themselves.  In surveys, while we presume that most people tell the truth, we know that some people who masturbate lie and say they don't and some who don't who lie and say they do.  One study of 18 to 36 year-old women indicated that 75% reported that they masturbated during adolescence.

The joke among men is that 99% masturbate and the remaining one percent lies.

While on this topic, I will add that depending on the survey, 32% to 40% of women report that they never or rarely experience orgasm during penile-vaginal thrusting (alone), and that 10% to 15% of women in America report that they have never had an orgasm (from any stimulation).

Many people have fantasies about same-gender sex and that does NOT make them homosexual.  Homosexuality is defined by a preference to be sexual with the same gender, to the exclusion of the opposite gender, and acting on it by physical erotic contact.  Many adolescent men and women have a "crush" on another person of the same gender, and some people (again, we do not have reliable data on this) engage in "sex play" with a same-sex friend.  Many males have had the experience of a "circle jerk" in which 3 or more young men will sit in a circle, each masturbating the man to his right (right-handed masturbaters).  Young women often report experimentation with sexual contact with another female while camping, in a dorm room, or as a result of hugging to console an upset friend.  Adolescent experimentation, even persisting for several months, does not make someone a homosexual.  Satisfying sexual contact with a member of both genders and then choosing one does not imply confusion, but rather a flexibility, curiosity, and what we shrinks call "ego strength" -- the ability to decide what is right for you then doing it after weighing the pros and cons.

Some sex therapists believe that we are all born bisexual but that the society in which we live channels -- molds -- our sexual expression.  Ancient Greeks accepted as "normal" that a successful businessman, statesman, or military leader would of course have a younger man as an apprentice, with whom the older man would be sexual when he felt like it.

As a student of formal academic human sexuality since 1965, my observation is that the majority of the population could enjoy homosexual stimulation; that a minority of the population is heterosexual and is so repulsed by homosexuality that they could not respond to it, and that the same goes for homosexuals.  In the dark, the penis or clitoris does not know the gender of the lips, tongue, and mouth caressing it (unless there is a beard, of course).

Techniques on masturbation:  HOW ABOUT if readers e-mail their masturbation techniques and I will post them on a unique link from the home page?  First I must emphasize that different women like different things.  Some women have extremely sensitive nipples or clitoris; others say they need a "jackhammer on the clitoris for half an hour, to reach orgasm."  What women tell me often is that the essence of reaching orgasm is stimulation of the clitoris by finger, tongue, pulsating shower massager, hot tub jet, vibrator, water straight out of the bath tub faucet, sitting on a motorcycle (especially if a golf ball was sewn into the seat -- I kid you not!), or anything else that vibrates.  Some women wrap their legs around a friends leg and push their labia and clitoris against it repeatedly.  Some put peanut butter on their clitoris and "let" the dog lick it off (be very careful of a nip!).  For some people, if they masturbate exactly the same way every single time, they condition their brain into that being the ONLY way they can achieve orgasm, so flexibility in a variety of masturbatory techniques is healthy and can prevent problems.

Regarding whether it is normal to stick weird objects in your vagina, there are several aspects of this to be considered.  The most common reason offered by women who like to have something in their vagina (like a cucumber -- that's not just a joke; it really happens) that is not moving is that "... it feels very different having something inside to squeeze against internally when I have an orgasm than when I am 'empty.'"  The most common reason offered by women who like to slide something in and out of their vagina is that like penile-vaginal intercourse, something (whether condom covered cucumber or penis) sliding back and forth pulls on the labia, which pull on the clitoral hood, which stimulates the clitoral shaft, which, when there is enough neurological stimulation, triggers the reflex we call "orgasm."  If you think of orgasm being triggered by enough nerve impulses to the brain, that might make it more understandable why some women like, along with clitoral stimulation, nipple stimulation, rubbing on their labia, anal stimulation, and, in the "right" sexual positions, a hard slap on the butt now and then.  Some porno videos will show a woman with a large candle (unlit, of course) in her vagina, and a smaller diameter candle in her rectum.  The rules of thumb regarding objects in either vagina or rectum:  If any part would snag and/or cause a run in a pair of nylon stockings, it is too sharp (including fingernails), and 2) when in doubt, cover it with a condom (most county health departments have a big bowl of free condoms in the lobby or in the STD clinic waiting room).

The internet porn sites have tons of pictures of women putting all kinds of things in their vagina and rectum so the public service announcement:  Never put anything in your vagina that was in your rectum (or otherwise had anything that came out of your rectum on it) until it is thoroughly disinfected.  AND:  Never let anyone blow air into your vagina.  That could (under the right circumstances) kill you.

18 year old woman wants first intercourse with man seeing someone else who will soon be geographically distant
1/15/01 Q:  Hi,
I am an 18 year old female, urgently seeking advice!I have very strong
feelings for a man I work with, however will soon be moving city and leaving
job next week. He knows how i feel for him,and has said that he feels the
same, and is very affectionate towards me, however is currently seeing
someone else. I am a virgin and would love him to be my first, however i
don't know if this would affect our relationship. Any advice would be
greatly appreciated!

Thanks, Puzzled.

A:  There is no doubt that it will change your relationship, but if you two will soon be geographically distant and he is currently not emotionally available to you, I encourage you to consider how you might feel after the move.  While your first lover -- the first with whom you have penile-vaginal intercourse -- is someone you will likely never forget, this is not the be-all end-all event in your life.

Some men and women have erred on the side of conservatism and later regretted that they didn't act on their feelings of affection with that special person, and others were liberal and "just got laid" to get it out of the way.  Because sexuality in humans is totally learned and sexual activity is NOT genetically implanted, as it is with all other living things, you need to expect a "learning curve" regarding sexual behavior.  All virgins are nervous and fumbling the first few times.

My prescription for the fondest memories in retrospect is that you start having sex with someone who is geographically, emotionally, and physically available to you, with whom you can have at least (critical minimum here) ten sexual events.  That way, your intimacy and bonding can progress along with your sexual experience and learning.

Think through the options -- the decision tree.  If things do not go well, you likely will feel literally "fucked" (in the vernacular sense of having been taken advantage of) and probably regret that you didn't "save it" for a lover with whom you have a strong affection.  If they do go well, and you and he are geographically distant, you may well pine for him and have a broken heart or worse, feel abandoned (the unconscious "if he loved me enough ...").

I cannot make this decision for you but I hope this helps you come to a decision.

5 months pregnant and diagnosed HIV positive
1/12/01 Q:  I am a girl aged 24yrs pregnant for 5Months now,but recently i came to
realize that i am HIV+!
I don't know what to do,but my boyfriend was tested and the result
were -ve!Is that means the baby is safe? or what is the risk of the Hiv to
be transimitted to it?

A:  Chance Fisher, M.D. replies:  It is EXTREMELY important that you start a HIV drug therapy program now!!
If you do nothing, the chances of transmitting the virus to your unborn baby
is 0 to 65%.  This percentage is based on your virus load.  The higher the
load, the higher the risk.

You should be started on a combination drug therapy program that includes
Zidovudine(AZT), 3TC and Nelfinavir.

During labor and delivery they will push AZT so that the transmitting
chances are reduced.  After the baby is born they will give AZT to the
newborn orally for about six weeks.

Some doctors also request a C-section to reduce the chance of transmitting
the disease.

You need to get the best medical care possible NOW!!!!

Can't get boyfriend to come doing oral sex
1/12/01 Q: name is S. and i'm 17 years old. My bf is 22. i've performed oral
sex on him 3 times and we've had sex once and neither of these times has
he actually cummed. i dont know what to do. he says that the fact that
he's 22 means that it's going to take longer for him to cum. is this true?
What can i do while giving a blow job to make him cum? Do i just need to
do it longer or what? i dont want to feel like a failure and i've never
had this problem before. Please help me out

A:  Some guys get so used to the vigorousness -- heavy touch -- of their own hand that a mouth is too gentle.  Instead of taking the whole penis in your mouth, use your lips and tongue on the head and put your hand around the shaft and squeeze fairly firmly and move your hand up and down.  Best would be for him to masturbate while you watched, taking mental notes so you could do for him what he finds pleasurable doing to himself.  He could be nervous.

Let me know what happens.


Orgasm problems -- taking numerous prescription drugs
1/12/01  Q:      I am a 50 yr.old woman who has an extremely difficult time not only
getting aroused but also having an orgasm.When I was in my teens to my
thirties I never really had that problem but when I hit my forties,I had a
hysterectomy and a partial ooferectomy.Since then I have had this
problem.I take hormone replacement therapy, receiving both estrogen and
progesterone. I use testosterone creme on my upper legs,supposedly to help
my problem.It hasn't helped.To me,this is a very serious problem,since my
husband is very bothered by this.However, it bothers me even more.
I am depressed about it and don't know what to do.My Ob/Gyn says there's
nothing that can be done about it but I KNOW there must be something out
there that can help. I just need to know where to look.Even when I DO get
aroused, it's almost impossible to have an orgasm,no matter what
we do.I've been doing Koegel exercises,a vibrator and even reading some
really exciting reading material,but to no avail. I NEED HELP!I also take
dexadrine,for ADHD,a small amount of Effexor and Wellbutrin,for depression
and a very small amount of Verapamil, to prevent migrains. However,since I
had this problem before even taking these meds, they probably aren't the
cause but may compound it. Do you have any idea about what might be
causing this disorder, or what can be done about
it(exercises,"toys",sexual activities or medicines) that might possibly
improve both my sexual drive/arousability and my anorgasmia? What do you
suggest I do,now? I refuse to believe that there is nothing that will help
me. I can't imagine life without it. What would you do if I were your

A:  Chance Fisher, M.D. replies:  First, you need a COMPLETE hormone and chemical assay performed by an
Endocrinologist (Reproductive or General).  Not only do you need your
reproductive hormones checked, you also need your Serotonin and Dopamine
levels evaluated.

You are on a lot of different drugs that for the most part, all have the
down fall of sexual dysfunction.  What really caught my attention was the
fact that you have ADHD.  ADHD is known for severe sexual dysfunction in
part by causing imbalances in the brain chemicals Serotonin and Dopamine.
In fact, Dexadrine is known for it's dopamine depleting properties.
Dopamine is responsible for neurotransmitting  messages between nerve cells
in the brain.  If chemical properties in the brain are not perfect, this may
cause a huge sexual problem.

With your drug therapy and your depression and ADHD, you are really putting
your system on a roller coaster ride.  Go to an Endocrinologist, most
appropriate would be a Reproductive Endocrinologist, but a General
Endocrinologist would work.  Take all medications with you, describe your
problems in detail and along with all medical problems.

Also, remember that alcohol will really cause problems with orgasm and
sexual excitement  when coupled with these drugs.

Chronic pelvic pain in a man
1/12/01 Q:    I have been masturbating for 20 years now, usually once or twice a day,
sometimes more.  I have developed a problem that I think is related to this.

I have a pain that starts from my anus and reaches  my testicles.  It burns
and feels hot when I urinate and my urethra and prostate are always
inflammed.  The pain gets severe with activity such as exercise.  I picked
up a 5 lb dumb bell the other day and the pain extended clear into my lower
abs.  It feels like the muscle that I use to squeeze out the last few drops
when I urinate is in the Charlie Horse state at all times.

What is this and will it go away if I quit masturbating?  I have been to a
platoon of urologists with no results.

A:  Chance Fisher, M.D. replies:  Yes, I have seen this before.  It sounds like you have Chronic
Prostatitis-Chronic Pelvic Pain Syndrome (CPPS).  Symptoms are groin pain
that feels like a strain or a pull, especially in the area between the
rectum and scrotum, burning upon urination, and increasing pain with

Prostatitis is the inflammation of the prostate.  It can be caused by
injury, bacteria, a blockage in the urethra or neuromuscular problems in the
muscles of the pelvic area.

CPPS usually involves the Iliopsoas and Pectineus muscles that surround the
prostate.  If these muscles are affected, it will cause a sharp pain from
the rectum clear up into the lower abs.

If you have not been checked or diagnosed with or for prostatitis, do so
right away.  You may need to determine if it is caused by a muscle problem,
urethra blockage or bacterial infection.

If you are not having luck with urologist, you may find that a doctor or
urologist that specializes in sports medicine may be of more help.

You have all the symptoms of CPPS.  This aliment is often overlooked and

The pain will get worse before it gets better!  Hot tubs, deep tissue
massage, and muscle relaxers can help if muscles are indeed involved.
Antibiotics are also usually prescribed.

Vaginal snugness after childbirth or a three-way with a much bigger penis  A MUST READ for everyone considering a three-way!
1/11/01 Q:  I have a question about sex after a woman has given birth. I read on your
site about the incision that is made to a woman's perenium during
labor to allow the child to be removed more easily. Will the woman's vagina
return to its original size and elasticity after full recovery from birth,
how about after several kids? I have just heard that the vagina gets loose
after kids and am wondering if penile-vaginal intercourse will remain as

My next concern is about an experience my partner and I just had. We were
involved in a 3 way. My girl, myself, and another man. I have a slightly
larger than average penis. About 6.5 in X 5.25 in. I watched this much
larger man penetrate my girlfriend. His penis was probably 2 in longer than
mine and nearly twice a thick (nearly as thick as a coke can). He had
considerable trouble inserting his penis into the vagina even after I had
had intercourse to loosen the opening. During intercourse my girlfriend
seemed to have experienced much greater pleasure from his larger member.
Since this experience I have not had intercourse because I am afraid she
won't experience as much pleasure as we did together before this other man.
I am also afraid her vagina will feel more loose.

mr. insecure

A:  Most obstetricians will perform an episiotomy to avoid ripping the introitus during childbirth, and after delivery, the incision is sutured (the last stitch is "for the daddy" because it governs the size, hence "snugness" of the introitus).  Slight scar tissue sometimes also appears, which is less elastic than surrounding tissue.  With successive deliveries, if an episiotomy is performed, and sutured snugly, there is no reason why a woman will get looser because of vaginal delivery.  All women, including those who have never delivered a baby vaginally, experience some loss of tissue tone (that's why there are face lifts!) in various parts of their body and the introitus is no exception.  (see an additional comment in the third paragraph)

Ah, you must not have read what I have said elsewhere about three-ways!  When a woman joins a couple there is comparison of breast and butt size and fat, and when a man joins in it's penis size, staying power, and her experience of pleasure.  In regard to your fear that her vagina will feel more loose, if she has been stretched permanently, there was tissue damage.  The vagina is enormously elastic, and once stretched without tissue damage, returns to its former size and shape.  The closest male homologue would be a bowel movement.  After passing unusually large stool without tearing anal tissue, the anus returns to its original closed position.

In regard to both pleasure and vaginal opening snugness, you are focusing on the genital mechanical aspects of sex.  (It's a guy thing.)  For both men and women the biggest sex organ is between the ears, and for the mature person it is the context of the sex along with the pleasurable neurological sensations that is important.  She could easily have enjoyed the sex with the other guy because of the novelty and the flattery and the excitement of doing something "naughty" -- intercourse with another man while you watched!  Because you say he had trouble penetrating, it might have even been uncomfortable for her (... dirty job but someone has to do it ...).

Yes, up to a point, girth (diameter, circumference) is important because it is directly correlated to friction on the labia which means more pull on the clitoral hood which means more stimulation for the clitoris.  BUT the Sexdoc has had men bawling like a baby in the therapy office because ten women in a row, upon seeing the length and/or girth of their penis, have said "No fucking way you are going to split me open with that thing (or ram my spine)," so up to a point size matters and after that point it is a liability.

Is it possible for a virgin to be artificially inseminated?
1/11/01  Q:  I am 25 years old and a virgin. I have been thinking of having myself artifiacially inseminated for some time now. As a virgin I am not too sure if this is possible and if a doctor will even do this procedure. I'd love your thoughts on this, thank you.

A:  (Chance Fisher, M.D. responds)  Yes, artificial insemination is possible when you are a virgin.  Most of the time excess tissue (hymen) is destroyed when a woman is younger through tampon use or it naturally thins and disappears.  If the tissue is still intact that doctor will just remove it without any pain.  Other than this issue, a virgin still has the exact same hormonal and physical functioning of that of a woman that has engaged in sexual activity.

As for your question of the chances that a doctor will actually do the procedure... It is very unlikely that at your age a doctor will consider going through with the procedure.  It is EXTREMELY costly, time consuming, sometimes painful and emotionally difficult.  You are 25 years old, you still have plenty of time.  Women are having babies clear into their fifties today!

Intercourse didn't "work right" the second time.
1/11/01 Q:  Hi. My name is T. L. and I am 16 years old. About a year ago I fell
in love with the guy I am currently with. Last week we got a little out of
control and had sexual intercourse for the first time. We were both
virgins. I was on my period when it happened and neither of us really
minded since we were both so into it. I don't even know if it was real sex
though. He was on top, my legs were spred and he was in me. We did all of
the "normal" things though I think. I remained on bottem and he did most
of the moving. It hurt a little, but it was my first time so I thought
nothing of it. Yesterday we decided to try it again for the first time
since it happened. It wouldn't work though. We both agreed to give it a
shot, but it just wasn't hapening. I think it was both our faults. His
penis would get erect, but before we would have time to put it in it would
go limp again.  I had trouble getting wet enough to make insertion
possible. Its not that I didn't want to, I just couldn't. Its really
worrying me. The same thing happened again today. I just couldn't get
excited enough and my hole stayed so tight. He tried putting three fingers
in to loosen me up, but nothing helped. I just got really dry. I just
really do not understand. Please help and give any advice you can. I would
really appreciate it.

A:  When you are tense or nervous, unconsciously you will clench your introitus (the opening to your vagina).  If you are afraid of anything -- pregnancy, getting caught, etc. -- that can cause problems.

If he is wearing a condom and if you have privacy, I suggest taking it slower and using external lubricant.  In addition to Astroglide (sold as a sex lubricant) and KY Liquid (also for sex) there is also KY jelly (for inserting nozzles and rectal thermometers).   Make sure you know whether any lubricant is petroleum based, because those eat holes in latex.

But if you take it slow and he performs oral sex on you (with lots of saliva) and he uses his fingers to make sure that your labia are wet with your own lubricant, it "should" be okay.  Think of the psychomotor skill acquisition in sex as learning how to ride a bicycle all over again; getting the moves down "right" takes some time.

Let me know what you try and what happens.


Probably severe guilt manifested as anxiety about HIV
1/10/01 Q:  Dear Dr. Fitz:

Approx. 16 weeks ago I went to a lap dance bar.  In
one occasion, a lap dancer, pressed her sweaty chest
against my face and I licked her chest (between her
breast) for a brief moment.  I immediately tasted the
sweat.  She also rubbed against my body but I don't
worry about that because I always had my clothes on
and she had her bikini or thong on.

I started thinking what if she didn't only have sweat
but she had sperm from a previous lap dance on her
chest or if she had saliva from another guy doing the
same thing?

I tested negative for HIV 4, 12, and 13 weeks after
the incident.  This didn't help because I am still
worried and any small thing that is wrong with me I
associate it with HIV.

I often ask myself "could I be the unluckiest man on
earth that got HIV from this stupid incident"?

I have a wife and family and this is seriously
affecting my relationship since my wife thinks that I
don't love her and that there is somebody else.

Could I ruleout HIV completely or do you think I do
have a risk?


A:  Please take a deep breath and relax!  There is an enzyme in saliva that kills the HI Virus.  Stomach acid destroys HIV immediately.  The virus is so fragile that the current sterilization procedures in medical settings for Hepatitis C is major overkill to HIV.

I respectfully suggest that the overwhelming probability is that you have loaded onto this incident a huge number of sexual guilts, and that this is standing as a symbolic punishment for all the sins (sexual) you have committed.

If this develops into an obsession, I urge you to see a psychologist sooner than later.

RARE penis enlargement from masturbatory activity
1/9/01 Q:  Doc,
 I heard you on the Russ Martin show on Wednesday Jan 3,2000
I went to your site.  Concerning Penis Enlargement, I have had an experience that i would like to ask you about.
I have multiple female partners. Most are Sexually intuitive and exploring as I am.
I am asked to masturbate while they not only observe but assist either orally or in other ways
now I have noticed that since i have begun this My penis has lengthened and become quite thicker.
I consulted my Primary Care Physician and have explained this to him. He has informed me that  it is possible
that my change in sexual activity has triggered something but other than this he has no clue.
It is evident that the lengthening and thickening occured only after the change in sexual activity and took
approximately two and one half years for me to observe this change.  To explain the signifigance let me give you measurements as on of my partners is into measurement(she is truly a math freak-she gets off when i say multiplication tables while she performs oral sex on me). My measurement of length/width(side to side not top to bottom) before was
7 1/4" long / 1 3/4"thick  erect    after this change my measurements increased dramatically i think to  10 3/4 inches long and 2 3/8 " thick  erect  this is a signifigant difference and i was wondering if you had ever heard of this occuring and if you think it is something i should worry about or not? Thanks for any answer you might have

A:  (Chance Fisher M.D. replies)  Hell yes you have a problem!  When all these women find out that you are hauling around a ten inch penis you are going to have more than your fair share of freaky sex calls in the middle of the night.  Known to us youngsters as "Booty Calls."

A growth pattern like this is rare and I have only seen it twice.
Usually what we are dealing with is a growth or enlargement of the Corpora
Cavernosa which is the spongy hollow tissue in the upper two chambers of the
penis where blood engorges to produce an erection.  Repetitive action such
as masturbation may cause a slight damage which in turn causes the tissue to
strengthen and become more profound when there is a regrowth.  This is not
necessarily a "bad" damage or severe, just enough to cause a slight
regrowth.  When the tissue builds up it allows more blood to enter the
penis, increases the blood flow and nerve sensation.

Is gel in semen normal?  AND How to make the first intercourse with a female virgin as pleasurable as possible
1/9/01 Q:  Hello Dr. Fitzgerald,

I heard you on a local Dallas radio station today and had a question or two
for you. I'll get to the serious one first. I check your site and didn't
find anything about it so here is my question:

I am a 25yr old Male. I have been masterbating way before i could exspell
anything from my penis. About 2-3 years ago while washing up from
masterbating i noticed an odd substance in my semen mixture. I dimissed it,
and forgot about it. Later that week i noticed it again. it was about the
size of a peice of rice, but kinda translucent with a dull-dull yellow
tint... kinda like fat from canned meat(like Spam). It had the same
consistancey of geletin. Now that i have noticed that i have looked in my
semen mixture out of couriosity and consern. I have noticed over the
following years that the sizes range from small multi pieces to  1 or 2 rice
sized (and shaped) "gels". I often do "feel" the "gel" when i ejaculate. I
was wondering if this is common or should i speek with a doctor face to
face. I have noticed that when getting aroused my left testicle (left being
on my left side) get a small ache in it. At first i thought it was either a
stragulated testicle to testicular cancer. But doing the exam on myself i
noticed the left one is slightly bigger (just from a feel). If this is a
common or not so common "defect?", should i worry about having offspring? I
have asked guy friends and they have not noticed what i have described to
you. I would like to know what i should do. I do worry about it from time to
time, but i figured it's how mother nature made me.

I ahve another question that is less important but if you can awnser it in
the email i would appreciate it too. I am seeing this young woman who is 24
and still a virgin. She is on the pill and if she decides I am the one to
penetrate her, is the best way to break the hymen with or with a
profolactic? I plan on using one (as i do every time) but I want her
experiance to be as pleasurable as i can make it. I have never been with a
virgin and I will read up more on your virgin section, but i don't think
this question was asked.

Thank you Very Much for you time Dr. Fitzgerald,
I look forward to your replay.


A:  (Dr. Fisher replies)  Gel like strings, globules or beads in semen is actually normal.  The
reproductive tract and urinary tract is lubricated with a gel substance that
aids in the travel and survival of sperm in the male tract clear on through
to the female tract.  Sometimes, the gel will coagulate and form small
clumps while still in the male reproductive tract or will form shortly after
ejaculation.  Plus a lot of by products are released through semen.  Dead
sperm, red and white blood cells and small amounts of infection can also be
found as a normal part of semen.  Most of the time, all of this is normal.

Pain in a testicle upon arousal or ejaculation is also normal.  If it lasts
more than two minutes you need to have it checked out.  So basically, you are

A:  (Dr. Fitzgerald replies)  There is NO reason why a female virgin should bleed when first penetrated!  Several weeks before her planned first intercourse she should insert 2 fingers into her vagina and press down firmly for 2 minutes, then pull up firmly for 2 minutes, then left and then right.  This will gradually stretch the hymen enabling penile penetration.  If she cannot insert 2 fingers because the tissue is too thick, she needs to ask her gynecologist to surgically remove the hymen.  If she doesn't, and it is too thick to be stretched, either penetration will not occur because of pain or the penis will rip the hymen causing bleeding.

Some women simply do not have much hymen tissue and others have stretched it by using tampons.

Who can tell if I am not a virgin?
1/9/01 Q:  Dear Doctor,

Is there any way one can tell if someone is not a virgin?

A:  No.  The presence of a lot of hymeneal tissue means that nothing bigger than the biggest opening has penetrated, but many women either have no hymen or they have stretched it with tampons or fingers or other objects they found pleasurable to insert into the vagina (usually while masturbating).

Another sexual desire discrepancy
1/9/01 Q:  Dear Doctor,

I have seen your web site and I am sending this e-mail to ask for your help.
I am 24 years old, recently married and my husband is 25 years old. He
complains that I am not interested in sex as much as he wants me to be. I
have no kids, I am atractive, I can reach orgasm quite easily but I don't
feel much desire. I just don't know what happens because my husband is very
atractive and this problem is making my marriage worse every day. Shall I
take any medicines, like aphrodsiacs? Can it be something that I learned
from my parents?

Thank you very much for your attention and I look forward to hear from you.

A:  Each person has a particular sexual desire -- a frequency that is comfortable for them.  For some people it is once every 6 weeks; for others three times a day.  It is complicated but primarily affected by hormone levels.

Women are more complex in that their menstrual cycle hormones change things so that they are suppressed part of the month and especially interested around ovulation.  That is biology.

Your husband's desired frequency is no more valid than yours.

Because you do not feel like having intercourse as often as he does, I suggest using alternative techniques, such as a hand job, oral sex, or "letting him" slide his erection between your thighs, catching his semen in a facial tissue.

Please let me know what you think and what happens.


Serious incompatibility.  The challenging question to a psychologist is "Why do people stay in relationships like this for so long?"
1/8/01 Q:  Dear Dr. Fitzgerald,
Have been married 20 years to a low-libido male.  My libido level is
average.  First few years, sex was ok, fairly regular but not great. Now
we have "something close to sex" on a quarterly basis, if we're lucky.
This has proven destructive to my self-esteem in the extreme.

From the beginning of relationship there were implied rules: No
instigation of sex from me; no sexy lingerie worn by me; fellatio ok -
cunnilingus no; only two positions allowed - missionary and from behind
(vaginal - his favorite).  Premature ejaculation always a problem.
Digital stimulation from him for me= no.  Have seen many marriage
counselors, am in therapy for chronic depression myself, he is not.  His
background included alcoholic father/domineering "masculine-type"
mother/extreme distance in parents relationship and severe dysfunction all
around. Divorced when my husband was 10.

He dislikes kissing, when he does kiss me he keeps his eyes open.  He has
no problem with my using a vibrator (THANK GOD!) but after 17 years, it's
not doing much for our marriage and I hate resorting to it.  Have thought
about affairs but never acted on them.

Guess what I'm asking is, based on your years of experience am sure you
have encountered this type of person before.  What are the chances of this
man ever getting "with the program".  Has tried Viagra - still has
premature ejaculation.

Have offered to play sex games, watch videos, meet at hotels, wear
wigs/costumes anything he wants.  Also sex toys - once I even offered to
hire a prostitute for a 3-some (ugh - was I desparate or what?).

We still try to cuddle, but last time after 30 minutes or so and no
erection he just starting laughing and making jokes which just destroyed
Doesn't take me very seriously I guess.  At my wits end about whether I
should invest any more of my time with what appears to be hopeless
situation.  Appreciate your taking the time to consider the above.  With
kindest regards, desperately yours,  B

A:  One of the "nice" things about e-mail is that I can get right to the point.

Because he has rehearsed this for 20 years, it is chiseled in his brain as the "right" way to do things.  You as a couple would be a nightmare for any therapist because the prognosis is so bleak.

If you saw me I would endeavor to help each of you articulate your values and behavioral preferences, then help you change.  If no change was happening (I predict) I would ask each of you to assess your quality of life for the rest of your life and to estimate whether each of you would be more happy with someone with whom you were more compatible.

Neither of you is "good" or "bad" or "better."  You two have remarkably different values.  AND each of you would find much greater happiness and less strife, disappointment, and threats to your self-esteem, with someone who shared your values.

Believe me, there are women who would LOVE to have sex only every quarter, and men who would LOVE to match your sexual frequency.

I hope this helps.

Please let me know your reaction and what happens.

1/9/01 she replies:  Dear Dr. Fitzgerald,

Thank you for your prompt and very direct response.  It's what I needed to
know and coming from you, it means a great deal.

With much appreciation, B

An articulate true description of Sexual Aversion Disorder -- I could not have said it better!
1/8/01 Q:   I need counseling on what to do in my relationship. I love my wife but am
unhappy and don't know how to respond.

Mary and I just celebrated our sixth wedding anniversary. She is 31; I am
36. This is my second marriage, and her first.

I believe I want three things from a marriage relationship (not
necessarily in this order): A best friend, a mother for my children, and a
satisfying sexual partner.

Mary is clearly the best friend I ever had. She's funny, smart, patient,
energetic, and has the best mix of interests (some like mine, some totally
different than mine) to make our friendship work. I couldn't ask for a
better fit, and am thrilled to have her as my best friend.

Mary is also the best candidate for motherhood I could imagine. She is
nurturing, patient, loving, good with kids, and eager to be a mom. She
exceeds my expectations in this regard.

Unfortunately, Mary and I don't seem to be sexually compatible. Because
we are both active in our church, we did not do much more than kiss before
we married, so I didn't have a chance to learn about her other than the
pretty in-depth discussions we had while engaged. Because I had been
married before, I knew what I was looking for, and asked some pretty
specific questions--but because Mary was still a virgin, she was
speculating about her sexual interests.

Mary's older sister is a sexual fanatic--every gift she's ever given us
(from bridal shower to birthdays) has been sex-related. She and her
husband reportedly are always in bed, and love it. Mary's other sister is
equally open about her active sex life. Even Mary's mother gave Mary
positive messages about married sex. During our engagement I know Mary
orgasmed at least twice--"unintentionally" while we were making out--and
that gave me confidence that she was not frigid. I had great hopes for a
busy and fulfilling sex life.

But on our wedding night, despite a premarital exam by her doctor and a
lot of patience and care by me, Mary felt so much pain that we were not
able to actually have sex. We "tried" for three days until finally I think
she just went along with it despite the pain. Since then she's had annual
exams which show no physical barrier, and two years ago one OB/Gyn
prescribed inserts--tubes--Mary could use to stretch herself and mentally
prepare for sex. Mary never actually used the inserts--in my opinion a
sign of the bigger problem.

In the last five years we've had sex on average once per month--sometimes
two times in a week, but very rarely. Mary knows I'm eager for more--it's
been a regular topic of discussion. But that's all we can talk about,
because she won't tell me what feels good, and she certainly won't try to
learn for herself.

Thinking that orgasms would encourage her to want more sex, I bought a
variety of sex toys. She actually likes--and will use--one of them (an
external vibrator), but she'll only use it with me there, and will never
tell me what she likes, where it feels good, etc. It took me months just
to get her to hold the vibrator in her own hands so I could caress her

Thinking that it might be a lack of knowledge about sex--she was sort-of
sheltered as a child--I've bought her a bunch of printed and video sex
manuals--from conservative to religious to hardcore (which she won't read
or watch). Those didn't seem to make a difference, and she'll only read
what I push her to read, and then stop.

On a "special occasion" such as birthday or anniversary, she'll be more
eager to have sex. But in my opinion, sex is a regular part of our
marriage--not a special occasion thing--and it concerns me that she's
associating it with once-in-a-while, not a vital part of our daily

Only two or three times has she ever taken personal intiative to become
more actively involved in sex. For our anniversary last week she purchased
and dressed up in a sexy costume she knew I'd like but was almost offended
when I eagerly approached her and had passionate sex with her. One month
prior she actually had sex with me three nights in a row, but that was in
response to my concern that becoming pregnant would further limit our sex
life, and Mary wanted to overcompensate to assure me that pregancy
wouldn't hurt anything. And at least once in the past five years she has
approached me for sex. In every other case (which hasn't been that often)
I have initiated sex--often requiring significant prodding.

I love this woman. She is gorgeous and sexy. She should be the perfect
sexual partner. Except that we rarely have sex.

Granted, I am probably on the high end of the bell curve in terms of
sexual demand. But I don't think I'm unusual or addicted or anything like

What to do? I can't stand the thought of losing my best friend. But I
can't stand the thought of so little sex. And this is supposed to be the
peak of our sex lives--it's all downhill from here, right?

Please share your advice. Thanks!

A:  Your opening line is prophetic:  I need counseling....

Yes, you do, but in person, on a weekly basis -- couples work doing Sensate Focus with an experienced sex therapist.  She is rehearsing some "negative tapes" about sex and they need airing and dispelling.  Sensate Focus is a couples technique developed by Masters and Johnson in the late 60's and was published in  a book in 1970.  I use it routinely for couples experiencing exactly what you describe.  It is the "fastest road to Rome" and works on two levels -- behaviorally to achieve behavior change and emotionally -- like a big pry bar to flush out the negative messages.

I wager that she is uncomfortable as well, but has not yet been able to come to grips  with whatever it is.  And yes, I concur -- that her not using the dilators prescribed by her doctor for vaginismus -- is a loud and clear message.

See on my web page the link to "How to find a sex therapist" and in the phone call to consider making an appointment, casually ask how recently the therapist used Sensate Focus -- and for what kinds of presenting problems is it useful.  If he or she falters and seems not to know what you are describing, move on.  You want someone who answers "What is your practice orientation -- what school of thought in psychology do you follow?" to say "Cognitive-Behavioral Psychology."

What to do to please an inhibited and sexually ignorant women?
1/8/01 Q:  My girlfriend and I are having problems with our sex life. We have the best
relationship otherwise. We were both virgins before this relationship so
neither of us has any past sex experience. I think this could be part of the
problem.When having sex with a condom, neither of us get any pleasure out of
it. Basically we can't feel much due to the condom. However, when not using
one, we both enjoy it much more but for a short period of time due to the
fear of getting her pregnant. We have thought of ideas such as the pill but
we don't want her parents to know about our sex life. What can we do to spice
up the sex so that we both enjoy it? We have tried different positions and
different condoms but nothing works unless we take the condom off, but that
isn't safe. Also, I have tried to spice things up for her in other
ways(oral,etc). I want to please her very much but I don't exactly know what
she likes and she won't give me much of a chance to find what pleases her. I
know the basic areas of her body but I don't know what she enjoys. She
doesn't really have any background either so when I ask her she what she
likes, she has no idea. She doesn't really even know her own body. She didn't
know where her clitoris was. It is hard to please her when she doesn't even
know what pleases her. I read things that suggested her to touch herself to
find what she likes but she isn't really into it. I have tried everything.
She really gets into when we have sex without a condom but the sex is short
lived because I have to pull out. What can we do to make this work? I told
her I was going to write someone and that I would print her out a copy of the
response and she is willing to try any suggestions. So any help you could
offer would be great. Thanks,

Frustrated Boyfriend

A:  First, the sex unprotected is risky for pregnancy.  See "Coitus interruptus" on my  web page.

Second, your brain is turning off your feelings when you use the condom.  Neurologically it's not that dramatic (with good ultra thin condoms you can hardly feel the difference).

Third, she, at least, does not need a technique.  She needs to feel OK about sex and exploring her body.  Then you'll have all the ideas you can handle.  She needs to bring herself to orgasm then teach you how to do it.  See "Female Orgasm Matters" linked from my home page.


Patience, my boy, patience!
1/8/01 Q:  dear doctor,
    im 18 and have been seeing m girlfriend for 15 months. were young and she
is still a virgin so we have taken everything pretty slow. but i feel ready,
its just that i dont no how to talk to her about it. ive tryed coming on to
her by moving my hand in and rubbing her clitoris. she gets very turned on
but she stops me before to long. am i doing something wrong?  but the biggest
problem is ive been in need for sexual satisfaction. ive been flirting around
with other girls but never do anything. im scared that i wont be able to help
myself and will lose my girlfriend over something stupid.

A:  She is communicating that she is not ready, and I suggest that you get more social and dating experience under your belt before you take it off.


Serious sexual desire discrepancy
1/4/01 Q:  My boyfriend of >5yrs. age 42 really has little sexual libido.  When we do
have sex, it has to be my idea, he has to be lying on his back with his eyes
shut and he never utters a sound except for a few times during his climax
where he moans a couple of times.  He doesn't interact with me during sex
and foreplay involves only my participation.  When speaking with him about
this, he only gets defensive and begins his "cop out" statements like "The
only way you would be happy is if I was all over you all the time" or "You
have a problem.  You want it all the time" or "Why don't you just find
someone else".
Doc, I just want a man that ever now and then sees me in the nude and tells
me how provacative I look to him.  I would like him to playfully tackle me
in the living room and make passionate love to me.  Talk about getting tired
of the same old thing.  It took me 5 years just to get him to insert his
fingers in my vagina and he has only done it once.  Shouldn't a man get
turned on by feeling a woman's body?
I have tried to get him to try Viagra but he refuses.  He is not on any
medication that would interfere and he does not drink at all.  Also, he
doesn't use any illicit drugs.  The almost twisted way that he seems to
pretend that he is asleep when we make love makes me think that he was
sexually abused at some point but of course he denies it and if that is the
case will unfortunately take that secret to the grave.  He actually seems to
have a normal libido at times and engages in looking at porn, all lesbian,
fairly frequently on the internet, and he is well versed on sexual terms and
lingo and the sexual things that men enjoy.
What's your spin on his dysfunction.  Based on the info provided, does he
even have a dysfunction?  Or, is it me like he always says?
Eagerly Awaiting Your Response,

A:    Some people are tall, some short, some like sex once every 6 weeks, and others 2-3 times a day.  Because our current society defines the male role as the sexual initiator, men with a low sex drive contrive a variety of defenses such as projection ("It is not I who has a problem; you have the problem of wanting sex too much") and denial (pretending to be asleep).  While his behavior is consistent with some childhood trauma, whether sexual, emotional, or physical abuse, or neglect, it is also possible that he has a testosterone deficiency, and having a hormone assay would be in order.

The question you must answer is whether you are willing to invest more time with a man with whom you are clearly sexually incompatible, or if you will find a lover who shares your views on sex, lust, and passion.

Sexual Desire Discrepancy
1/3/01 Q:  I have a question. I heard you on the radio today, and have been wanting to ask a professional this question for along time.  I am a very sexual male.  My fiance is not so sexual.  I like to have sex with her alot.  She, on the other hand, does not. She is not very sexual towards me, and never has been.  She says she loves me, and we have been together for 6+ years.  I am clueless.  I don't know what to do.  We rarely have sex.  Maybe once every six weeks or even more.  She seems to enjoy it when we have sex, but I can never seem to get her in the mood.  Any help would be appriecated.

A:  The truth is that each person has a baseline sexual desire level.  For some it is a desire for sexual release (read "orgasm") once every 6 weeks; for others 2-3 times a day.  Your question about increasing her frequency is as meaningful as hers would be if she asked me how to decrease yours.

If she was traumatized in some way at any age or internalized destructive religious, familial or societal messages,  that could easily suppress her sexual desire, but if not, this is probably what she prefers.

You two are seriously sexually incompatible and if you get married I predict fighting and divorce over sex.

Chance of pregnancy from coitus interruptus (pulling out before ejaculation)
1/3/01 Q:  Hi there... I am just a young teenager. My boyfriend and I have been together
for about 4 months now.  The other night... on new years eve.  He got really
crazy.  He wanted to have sex.  We have once before protected with a condom
but thats it.  So this time he just put his penis in and then pulled out
almost right away.  He says he didn't finish inside of me.. but what do you
think is the risk of me getting pregnant?  I have heard sperm die as soon as
they hit the air and he did finish later but not like right there. So well...
I am just relaly worried and have been trying to find help all over. Please
write back if you get a chance.  THank you...

A:   Sperm DO NOT DIE when exposed to air.  And, so-called "pre-cum" -- the clear liquid that comes out when a guy is excited -- contains sperm.

The chance that you are pregnant is slim but for you it will be either zero or 100%

I suggest that you call your County Health Department and/or Planned Parenthood to ask what is legally available to you in your area.

If you are not pregnant, take this as a wake up call and ALWAYS USE PROTECTION!

The scientific name for people who practice Coitus Interruptus is "parents."

Less sensation during penile-vaginal intercourse
1/2/01 Q:  I am a 54 healthy and fit male.  I workout in my basement 3x/wk.  My wife
of 30 years is 52 and more fit than I am.  She looks fantastic and still
turns men's heads.  So...after I'm aroused and ready for intercourse why
can't I sometimes feel anything  within my wife's vagina?  Is it her, or
me, or both of us?  She's really interested in sex and we have a great
time getting ready.  She's still well lubed (naturally) and I'm fairly
hard, but not as firm as I used to be.  Why can't I feel anything during

A:  Does she do Kegel exercises?  See on my home page a link to excerpts from my book and search for Kegels.

Plus, at your ages, your skin is becoming flabby and the opening to her vagina is no exception.

I suggest different positions, different pelvic rotations and/or anal sex.


How to differentially diagnose erection dysfunction ("ED")
1/2/01 Q:  Is it possible for a man to have erectile dysfuntion from simply having 2
or 3 glasses of wine. Or is he blaming something on the alchohol to mask
some other problem like : regular erectile dysfunction or situational
dysfunction perhaps related to performance anxiety.  We are  late 40's,
early 50's and it is early in the sexual involvement of our relationship.
There is definitely mutual strong chemistry that we have both
acknowledged. I am patient and loving and he obviously has intense desire
for me that he expresses in many ways. He says I am one of - if not the
best - sexual partner he has ever had - especially when it comes to my
personal sensuality, seductiveness as well as oral sex. I am agile and
flexible, with a strong pelvic floor that was surgically "tightened" a few
years ago.  I have more than adequate natural lubrication.

  But he seems to have a problem achieving and maintaining erection.

A:  The differential diagnosis requires an assessment of situationality.  Does he ALWAYS have ED with no wine, 1, 2, or 3 glasses; in the morning; evening, when rested, tired, hungry, well-fed, etc.

If there is no time when he can keep the erection this is ED.  If he's OK with no wine, there's a "prescription."

If it IS psychogenic, you would be well advised to see a sex therapist immediately.

I have successfully helped couples in one or two sessions if the problem just started.  If it gets repeated, it gets entrenched and requires many more therapy sessions.

1/3/01 She replies:  Thank you for your reply!!
   Well, After spending two very loving and sexually active days with him ,
I now believe that he always has ED ( we made love  in the afternoon - sans
alcohol -several times).  He is still able to come but seems to be only able
to achieve short term, very temporary erections during oral sex, and so- far
that is the only way that he has been able to come  : but 5 times a in less
than 48 hours let's me know that he does not have a problem with
ejaculation. The good news is that he prides himself on being an attentive-
pleasure giving partner, and his enjoyment of oral and manual sex is
reciprocal. However, to be honest, I am already tired of "blow Jobs" ( and
even though I was with my ex over 25 years, this is the first man I have not
said  "I don't swallow" to - and it has not been an issue for with this man)
But, I really would prefer more vaginal penetration by his penis, as well as
having an orgasm with his penis inside of me instead of a finger or tongue.
( I do not mind orally induced climaxes I would just like it to be more
balanced with coitally induced climaxes.)
   He has told me that he takes anti-depressants:  Celexa and something else
that I can't re-call. Plus antihistamines and decongestants. But it is my
understanding that anti-depressants usually affect orgasm not erection.  I
take 2 anti-depressants plus Buspar and with , a reasonable amount of
foreplay, I do not have any difficulty becoming aroused or reaching climax.
  I can get him reasonably hard with oral foreplay, but he seems to lose the
erection after a short  while. He is not small but he is not particularly
well endowed - and he may have an issue about size - although he has never
indicated this. But I have to say that he has the most wonderfully developed
techniques of oral and manual foreplay that I ( in my relatively limited
experience - as I am not promiscuous) - and these may have been developed as
"coping mechanisms" to please a partner under the circumstances.

  I am starting to suspect that he is "aging" and denial of it - and may
need viagra.

   The relationship shows potential to develop into something long term, but
I need to find a way to resolve this with him.   Any help would be greatly

A:  First, different meds affect different people in different ways.  And some meds inhibit or interfere with erections while others affect ejaculation.  When you write that you can get him hard with oral foreplay but that he loses the erection after a short while I need to ask if his penis is getting continuous stimulation to some degree.  A great unspoken anatomical fact is that for most or all men (I have not done an exhaustive study here), starting somewhere between age 40 and age 65, their penis, which heretofore would stay hard for a long time once standing at attention without continuous stimulation, now needs some constant neurological input or it goes to sleep.  Considering what works for him, just as an experiment, see if you can get him hard and keep him hard for 5 minutes using your oral or manual technique.

There is no such thing as "aging" when it comes to sexual functioning.  Sex is interfered with in bodily functioning when some other system becomes compromised, such as circulatory, respiratory, or hormonal problems.  That having been said, he might have psychogenic ED in which case the self-help is to use Viagra or penile injections of Prostaglandin E1 for the next ten sexual events, then see what happens on the eleventh.  If that doesn't work a sex therapist is called for.

Additional thoughts:  You say that he is not small but is not particularly well endowed.  Great and extremely common misconception.  There is no correlation between the size of a man's penis and ANY other body part -- although height, thumb, foot, nose, and other body parts are pointed to.  And finally, I hear that he is under the care of medical doctors, but he should alert one (if he hasn't already) because ED can be a symptom of other things (hormonal deficiencies, for one).

1/4/01 She replies again:  In my e-mail reply I complimented her on her writing style and indicated that I was going to post this to the web page because I was positive that other women would identify with the dialogue.

 Dr. Fitz;

         Thank you for the compliment. (In my e-mail reply I complimented her on her writing style and indicated that I was going to post this to the web page because I was positive that other women would identify with the dialogue.)  I like to think I do everything with
style - doesn't hurt to shoot for the stars. But this mid -life dating thing
is wearing very thin.
   Anyways back to the subject....

I also asked in e-mail if she requested anonymity because she saw the Q/A on the web page (this web page)  Yes, I did see my Q & A posted with my full name. I was very upset. The site
said that all questions were kept anonymous. I am sure inquiry and your
answers will help others.  I would just prefer to do this incognito. I immediately again proofed this entry and could not find her name anywhere and replied that I most sincerely hoped that she confused her name in the e-mail with the same text without name on the web page.  [1/8/01 see @@@ below]  All readers please note that it is my policy to disguise questions by changing ages, number of children, some first names, etc., and to carefully proof anything to omit someone's name.

I should probably state that this relationship is fairly new, and we have
only been intimate a few times at this point. SO, at this point, I  feel
that I have to be very judicious about what I say and how I say it. My
limited experience has taught me that although a man may be eager to become
sexually intimate, they (men) are much more cautious (almost skittish) about
becoming psychologically and emotionally intimate. He appears to enjoy my
company tremendously, and is very mellow and relaxed when we are together.

Yes, his penis is getting continuous stimulation, once he has achieved
erection, and maintained it for a while (like a minute or two) we endeavor
to  progress towards traditional vaginal intercourse. After about a minute
of continuous thrusting he loses the erection.  There is a rare condition known as "pelvic blood steal" in which a man will lose his erection when he uses muscular effort (such as being up on elbows and knees) and the "test" is to see if he maintains the erection while lying flat on his back letting his lover to all the "work."    He has tried  a very
creative variety of poses, and I am agile, flexible and responsive. I
mentioned in my first correspondence to you that I had my vagina "tightened"
surgically about 4 years ago when I had a complete hysterectomy. So even
though he may not be as well endowed as other partners I have had, I do not
believe he is too small nor that I am too big, or slack. I take estrogen and
have abundant  vaginal lubrication. He seems to have a great deal of ardor -
during our most recent interlude he initiated lovemaking/sex  4 times in 48
hours. But he was  only able to maintain an erection and climax during oral
sex. (yes he can maintain the erection over 5 minutes with oral stimulation) And here is the differential diagnostic tip-off that it is most likely psychological.  It is what we call "situational."  He can maintain an erection for 5 minutes with oral sex but not vaginal.  It could still be pelvic blood steal if none of the "poses" (by which I infer she means "sexual positions" during penile-vaginal intercourse) was flat on his back but the oral sex was performed while he WAS lying very still, using no muscular effort.

Manual stimulation doesn't seem to do much for him. He is articulate about
what feels good and what doesn't.  Although he will blame the wine, or his
decongestants,  I am beginning to think this is psychological or emotional.
But because of the sensitivity of the subject matter - and the fragile male
ego pertaining to this subject matter, I have avoided expressing undue
concern over this.  I have learned that it is common for the American male
to believe they are invincible, and that seeking medical treatment is a sign
of weakness. He has told me that he visits his psychiatrist once a year; and
the allergist about twice a year.  He also had back surgery around L-5 about
13 months ago. (You can see that I am examining all possible sources of the
issue).  But he is due for  an annual check up soon and I , very
off-handedly- , mentioned that he should talk to the doctor about it. He definitely should in case this is a symptom of something worrisome.
Whether he will or not - I cannot predict. I have not felt comfortable
asking if this is a problem he has experienced in the past or if it
relatively recent. But I will probably ask that if the scenario is repeated
again the next time we are intimate. He has told me that the last 7 yrs of
his nine year marriage were devoid of sex and I have shared with him that I
have had a very satisfying sex life during 27 years my 29 years with my
former spouse. He also knows that I have had very positive sexual
relationships with the few men I have dated during the 3 years since my
divorce.  Perhaps he finds this intimidating. He has been single for 20
years and had several long term relationships. But says he has not had many
sexual relationships. (of course, I have no way of knowing what he means by
that -  or if it is the truth)

Obviously if the relationship should endure, I will have to address the
issue with him in a more thorough and direct manner. Hopefully, your replies
will give me some understanding of how to approach this in  a sensitive and
caring manner.

The cornerstone of any discussion of a sensitive topic is to focus on the value of change.  What is his incentive?  Something along the lines of:  "Honey, I have observed that you really get a lot of pleasure out of being pleasured when I take your penis in my mouth, and I am sure that the length of time it lasts is important to you.  While I enjoy a variety of sexual behaviors with you, I would also like our time during penile-vaginal intercourse to last longer, and I think we need to address this.  I know that men are sensitive about acknowledging sexual problems but this is quite common and there are both medical and psychological interventions that can address this.  If you want to please me as much as I want to please you, you'll have to get this diagnosed and cooperate with treatment to take care of this.  If it's psychological, I understand that the most effective and efficient treatment is couples exercises and I want you to know that I will do what I have to to join you in doing that.  By the way, I also understand that couples who enter psychosexual therapy for a sex problem exit the process not just with a "fix" for the presenting problem, but also seriously disinhibited and engaging in a wider variety of sexual behaviors, and usually more often, and with an increased intimacy and bonding.  So maybe this "problem" is a blessing in disguise.

About half of the couples who are ready to wrap up therapy for a sex problem say something like:  "You know, Dr. Fitzgerald, in a funny sort of way I'm glad we had this problem come up.  Sexually and intimately, we are not back to the way we were before we had this problem.  That was pretty much a routine of the same old, same old.  Now, we are sexual more often, we are engaging in a much wider variety of activities, we are communicating what we want without worrying what the other will think, and without the sense of secrecy, worry, guilt, and shame that plagued us about certain things before."  NOTE:  A precious few couples come in for sexual enhancement, without a sexual dysfunction.

I am well aware that the size of the penis is not related to any size of any
other anatomical part. I am also aware, through my very limited personal
experience that size does not affect the potential for sexual satisfaction.

 SO if you have any further insight, please respond.

Thank you so much for being available and so easy to communicate with.

@@@ 1/8/01 she again replies:  I cannot remember, or find where I saw my name - but I checked my e-mails ,
and it was not on there.  It was not on your sight, I think it may have been
on "ask the experts" site.  [NOTE:  She is referring to where Dr. Fitzgerald has been accepted to answer questions in several categories.] BUt it's water under the bridge at this point.

 Thank you for your reply. again.

 We did try intercourse with him prone, and me on top, and he requested a
LOT of rapid repetitive stimulation ( it seemed like this was far beyond
what other men have been with have required - but hey, everyone is
different), and he still lost his erection within about a minute.

 During the oral sex, the positions he was able to climax in were:

Him standing; laying prone,  and laying on his side. We have also tried
intercourse in these same positions , and in each situation, he has been
unable to sustain an erection beyond a minute +/-.

I guess the point of all this is that I would like to see this relationship
go forward.  I understand your verbal approach recommendation, and will
probably utilize it, or a reasonable facsimily at the next appropriate

I guess I should at least find out if he has given it as much thought as I

Lack of sex drive for a month or so even though she loves her boyfriend very much
1/2/01 Q:  Dear Sex Doc,
     Hello and how are you?  Ive written to you many times and have always
found your advice useful.  I'm a 20 year old female and have been in a
monogomous relationship for 2 years, and I am sexually active.  I've always
enjoyed sex. though I have never been able to orgasm from intercourse, I
still get emotional fulfillment out of it, and have found other ways to
orgasm.  Because of the fact that I am at school, I havent had sex with my
boyfriend for about 3 months, and before that it was about 5 or 6 times a
month because of our schedules and I always looked ofrward to it.  But in the
past month or so I have had no sex drive.  My boyfriend wanted to have sex
yesterday and it made me so uncomrfortable and I said no.  He was very upset
by it and thought that I found him unattractive and now he thinks that Idont
love him or that I want to be with somone else.  I explained! ! to him that for
some reason. unknown to me, i'm very uncomfortable having sex with ANYONE
right now and I've always loved it.  But thoughts do not make me
uncomfortable.  I constantley fantasize about him, but when it comes time to
doing it, I just cant get myself to do itMy question is:  is this normal for
me to be going through, and what's causing it?  I love my boyfriend very much
and I am still sexually attracted to him, but I just dont want to have sex
with him even though I think about it alot.  What do i do, its affecting the
relationship very much.  Please help.  Thank you for your time and have a
Happy New Year.

A:  If you don't want to have sex with anyone including yourself it is likely just a hormonal fluctuation.  If it goes on for more than a month, I suggest bringing yourself to orgasm every 3 days for 21 days to see if that kick starts your sex drive.  If after the 21 days you are still unhorny I suggest asking an MD for a hormone assay.

Please let me know what happens!


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