Sex and Relationships

Sexual Dysfunction


Welcome to ASK THE SEX DOC

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

Answers to questions about sex therapy and sexuality

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6/16/98 Q: Dear Sex Doc, I'm an 18 year old female who previously wrote to you regarding me not being able to achieve an orgasm ever. You told me to read a book. Well I no longer think I'm the one with the problem. I think It's HIM. I don't think he is able to maintain an erection long enough to have sex. It takes him frantic masturbation for a good few minutes before his erection is hard enough to insert. Then once it's in, I think it goes limp and that's why I'm not properly stimulated. He lasted particularly long tonight and I think it's because he wasn't feeling much of it. I got up the courage to ask him if he had gone limp and he looked at me with this sad look and told me he had. He jerked off most of the night to get ready and then most of the time it just fell out anyway. He tried to make it seem like I was doing something wrong. A few times ago, he said that he was loosing his erection because my body wasn't yielding to his thrusts. I think this is more the cause of the pain I feel during intercourse. I think he's really frustrated about this and I think it's honestly bothering him. He was quiet the whole rest of the night once I said that to him. Now he claims that I only see him for sex. I don't think he would have said that unless he was feeling ashamed of himself. I need to know how to approach him about this without causing him more stress and how to correct the problem if possible. wanting to help him

A:  Dear Wanting: You need to know how to bring yourself to orgasm. He needs to deal with his erection problem. You both need to embrace the idea that there are lots of ways each of you can pleasure the other to orgasm, and that it's a myth that the only "real" sex is penile-vaginal thrusting leading to simultaneous orgasm. Start over. Get to know each other from scratch. Pleasure each other with lots of feedback to redirect the pleasurer. Bring him to erection and orgasm in a non-demand setting (no expectation of vaginal penetration). When you're able to handle it (little play on words there, I guess), each of you pleasure yourself to orgasm with your partner watching (and taking mental notes of what you like). Maybe then his erections will be OK and you'll have a better idea of what your body responds to when you want to climax.

6/18/98 Q: Dear Doctor: I'm pretty sure this isn't covered in your section on herpes/hiv! I have genital herpes, and my husband does not. He does, however, have oral herpes. I was diagnosed when we were dating, and since then (almost 8 years) he never performed oral sex on me again. Is he right to be worried about getting herpes from me? He thinks there is no possibility that he gave me herpes, he doesn't realize that there is often no difference between genital and oral herpes. He is afraid of getting another kind of herpes, I guess (b/c he has read that there is sometimes viral shedding even without a lesion). Are his fears valid? I'm not sure if my husband gave it to me or not. I had 2 sex partners previous to him, and I contacted both of them when I was diagnosed. They "claimed" that they did not have herpes. Thanks! I love your site.


Dear Kelly,

Dan could have passed his oral herpes virus to you genitally, where it could have mutated (and most likely did).

Yes he has a right to be concerned -- people with herpes are not "safe" to be sexual freely. They can cross-infect over and over again.

Be inventive! Find a way for him to be orally sexual with you without infection. Get over the embarrassment and get a box of "dental dams" from your local medical supply house. Do you know any dental assistants or dental hygienists? Ask for their help.


p.s. Thanks for the compliment. I'm glad you like the site.

6/18/98 Q: Dear Dr. Fitz, I'm a 39 year old male who has been married for 10 years. In that time I have been searching for the cure for premature ejaculation . My wife is very understanding about this problem . We enjoy sex tremendously but premature ejaculation has taken its toll on me. I saw a website on penis hypersensitivity and think possibly this might be the the fault. When we have oral sex and her teeth rub my erection I go through the ceiling with pain. Also when we have intercourse the feeling to ejaculate comes in less than one minute. Is there a chance of this being cured and could my premature ejaculation problem be caused by this sensitive penis problem; or do they both coincide with each other. We have tried the squeeze and one other method also that I can't think of right now and have had no luck. I have used a rubber extension to mask the feeling so my wife can orgasm but I can feel nothing so I'd have no enjoyment there.

I'm almost to the point of giving up and living with this . I almost wish I could obtain a light dosage of Prozac to cure it all and start to enjoy sex together but I don't know how to obtain it.

If you could help me in this matter I would be forever in your debt. I'll thank you in advance for your advice in this matter.


A:  It sounds like they are one and the same problem -- premature ejaculation ("PE") is a combination of neurological stimulation and the interpretation of those nerve impulses by the brain. While most PE is psychogenic, some is due to nerve sensitivity. Nervousness, in your case, fearing that you will ejaculate quickly, works to either prolong ejaculation or cause the loss of the erection. How about bringing her to as many orgasms as she wants prior to penile penetration, then inserting your penis and your having an orgasm as soon as you want? Part of the focus seems to be based on that old myth that the only "real" sex is penile-vaginal intercourse. Not so! I think that there is a chance that if you do more "non-demand" pleasuring (bringing each other to orgasm without the expectation that penile thrusting is going to achieve orgasm for her), you might find that you can last longer inside of her.

6/18/98 Q: hey...i am a 15 male..i want to know what size of a penis i should have

A: What height should you have? What color of hair should you have? You're going to have what you have. Don't worry about it.

OK -- if you want numbers, your UNerect penis can be from zero (flush with your body) to nine inches. Your erect penis "should" be between 3 and 8 inches. Satisfied?

6/18/98 Q: Dear Sex Doc: I have lived with my boyfriend now for 7 years. He is 30 and I am 28. The problem is that we have never had a satisfying sex life. By satisfying I mean that when we try to be intimate it is tense, uncomfortable ( emotionally ) and I feel that we are completely incompatable. We are best friends and enjoy each other very much, but we are not open about our sex life at all. It has gotten to a point to where we have not had sex in 6 months. My questions are; how can we become more sexual with one another. How can we become more confident in our sexual abilities. How can we overcome our inhibitions. I never initiate sex because I am afraid of rejection. He never initiates sex because is often turns out to be an uncomfortable, embarrasing and completely non-satisfying experience that leaves us both feeling ashamed and incompetent. Is there any homework that we could do?? I was thinking that since we have never had a passionate, erotic and satisfying sex life that maybe we could start from ground zero and begin to explore each other as if we were a giddy new couple again. Your help would be greatly appreciated......thanks.....K

A: There are some books on the subject -- I suggest finding the biggest bookstore you can and browsing through the sexuality section. Get one that seems to be appropriate, and yes, start with the basics. Porno flicks are seriously misleading -- don't use them as a benchmark. Be sure to know your own body (each of you) then teach the other what feels good. Make it OK to bring each other to orgasm before you work on penetration. Communication about everything is essential! And be patient.

6/18/98 Q: >I've read several responses to questions on the technical aspects of >virginity. I am 29 years old and recently had my first sexual >intercourse experience with a friend of mine on my birthday. I still >sorta consider myself a virgin because penetration (and there was >penis/vagina penetration) was minimal -- penetration was barely minimal >given his size, and thus there was no hymenal penetration. I didn't >tell my friend I was inexperienced, and couldn't tell if he could tell >or even cared, but I care. In my own mind are associated images and >emotions tied to virginity and sexual maturity. What are the clinical >distinctions as opposed to the social distinction? Could you further >clarify responses you have made in the past. > >

A: Virginity is not a medical label! It is a socio-religious distinction. There are women who will engage often in oral and anal sex but who refuse vaginal penetration because they want to be a virgin until marriage (I don't make this stuff up, folks, I'm just the reporter!). Are they virgins? Hymeneal laceration or rupture is medical, and so is the presence of semen in the vagina, but only a particular pattern of tissue bruising can suggest the introduction of a penis instead of a turkey baster (full of semen, squirted ... well, you get the idea). The most important thing is whether YOU consider yourself to be a virgin -- and you say that you still "sorta" consider yourself one. But why? If you coulda sorta had almost vaginal penetration, which would have occurred if his penis was longer, right?, then I infer you don't have enough of a religious prohibition to stop you. Why not be sexual with some men before you get married so you'll know what is important to you when you want to select a lifelong mate?

6/18/98 Q: I'm 29 (female) and regularly use vibrators for clitoral (maybe once or twice a week), and less occasionally vaginal stimulation. I'm not currently involved in any sort of relationship. I've read repeatedly where you cite that about only 40% of women achieve orgasm from vaginal stimulation, and most from clitoral. I also find that I immediately stop stimulation as I begin feeling the uncontrollable spasms of orgasm come over me. I have 2 questions.... Is there such thing as too much dependence on vibrators for stimulation? Can it become unhealthy? My second question is this, is there anything wrong with me interrupting orgasm? When I usually pull away the vibrator the spasms stop soon thereafter. I worried that I won't be to enjoy long healthy orgasms with partners in the future.

A: Only 40% of women achieve orgasm from penile thrusting because only those 40% get enough clitoral stimulation from that penile thrusting -- clitoral stimulation is mostly what "causes" orgasm in most women. "Too much dependence on vibrators for stimulation" is analogous to "too much dependence on fast food restaurants for eating". No, except that you get spoiled -- in the sense of having consistent, reliable, untiring nerve stimulation that no human, male or female, can duplicate. It's mostly predictable, and when you have a man stimulate you, it's going to be more variable, so you'll need to be patient and highly instructive and encouraging. But unhealthy? No; having orgasms frequently is healthy (strengthens the immune system). Not having orgasms at a critical minimum of 2X/week can cause all kinds of problems. p.s. With a vibrator, you don't have to "put up with" a man before or after the orgasm; with fast food you don't have to cook or do the dishes. A girl can get spoiled that way ....

How do you know you're "interrupting" orgasm? Leave the vibrator on longer one of these times and see if you have more involuntary spasms. If that feels better, do it. The longer you experience orgasm the more endorphins you pump into your blood stream (good, good). Your orgasms will be as long and as healthy as they will be -- you can learn to prolong them if you have a responsive G spot, but few women have one (or have lovers that find them). It WOULD be a problem getting yourself to the point of orgasm and stoppping short of involuntary spasms. In men it's called "blue balls" -- an ache of the pelvis caused by prolonged excitement not culminated by orgasm.

6/18/98 Q: I'm a 29 year old woman who recently had sex for the first time with a friend. He told me that he thought I was sexy, but I doubted him because I am overweight (though not obese). I know that many men will admit to be attracted to beautiful women, but I also know that a lot of men are really turned on by a woman's confidence, as most women are turned on by male confidence. I'm banking on the self-assurance as a sexy and for personal health reasons started working out to improve my body the best I can. On top of that I feel that sexual adventure combined with sexual technique makes for a wonderfully stimulating relationship. However, since I'm so late starting in the game I feel at a loss. I don't want to go out and get involved in numerous sexual encounters to find out what things I like and others like. So my questions are... what's the best way to develop a notion of your own "sexiness" (despite the constant bombarding images of mass advertising), and secondly how can I educate myself on sexual techniques without having to sleep with a lot of folks (I want to be able to bring something sexually to my next relationship). Are there instructional videos on certain techniques? Thanks for not thinking me too crazy or odd!

A: "Sexiness" is in the eyes of the both parties to an encounter. Please learn from experience what you consider to be sexy for you, and be receptive to what your lovers tell you. At the risk of being unpopular, I have not yet found any instructional videos that I consider worth viewing. There are books about sexual technique but I encourage you to find an experienced, gentle, professorial lover who would love to introduce you to the art of lovemaking. Honestly acknowledge your ignorance and naivete and ask him to be gentle with you. The "right" man will love to educate you. You don't need lots of lovers but when you have another, always remember, that each will be somewhat different, as women are different. Respect individual differences. Treat this as a great mysterious journey you are embarking on -- enjoy all your first time experiences! Best wishes (And KEEP ASKING QUESTIONS OF EVERYBODY!)

6/11/98 Q: My friends Ellie and Belkis and I were talking about achieving orgasms. I said (which I now regret) that a man or a woman can sometimes have an orgasm without even touching themselves or being touched. In other words, they can be soooooo excited, that they just happen to have an orgasm without anything ever really "happening". Needless to say, they laughed at me and said I was crazy. I always heard that the brain is the biggest sexual organ there is. Am I right or am I crazy?? Your answer will put to rest a big feud!!

Thanks, Ms. Wondering (Elena)

Dear Elena (Ms. Wondering):

YOU are right (whether you're also crazy or not is another matter). Beverly Whipple, R.N., the author of numerous publications on the "G" spot, conducted an in-hospital study of women who claimed to be able to have orgasms from mental concentration alone. Ten women passed the screening process and interviews, and came into the hospital where they were wired up with all kinds of muscle and nerve sensors to determine whether they were squeezing their thighs together (common way for women to have an orgasm) or otherwise exerting muscle pressure on their labia or clitoris. All of the women used no muscle squeezes. Seven of the women had physiologically unmistakeable orgasms (involuntary pelvic contractions approximately eight tenths of a second apart along with flushing, lubrication, etc.). Three of the women were unable to attain orgasm and all three reported that having sensors all over their body and in their vagina was just too distracting (being under the microscope) -- although all three reported, like the seven others, that they could do this based on thought processes alone.

In over thirty years of tracking sexual behavior I have never heard of a man who had an orgasm from thoughts alone, although men and women report "non-genital" ways of being stimulated to orgasm, from nipple, anal, and earlobe stimulation (common) to sides of the neck and the small of the back (very rare).

(I hope that you, Ellie, and Belkis enjoy having your names circulated around the world! Thanks for providing them!)

Glad to oblige. Sexdoc

6/10/98 Q: I am a 33 year old male, suffering from end stage cystic fibrosis. I am on supplemental oxygen. I have use of all my faculties, although my sex drive is not very strong.

I would like to know what are the best ways to have sex while minimizing my energy output. Are there special things guys in wheelchairs (I am not in a wheelchair) do with their limited mobility that could help me? I have limited exercise abilities and get short of breath very easily.

Thanks for your help


<< Excellent question! I expect to have time to answer it on Wednesday. In the meantime: are you talking about penile-vaginal intercourse? There's a good (although cumbersome to explain in words) position for that. Please reply by noon California time Wednesday if possible. Sexdoc >>

I am referring to penile-vaginal as well as giving oral. I don't expect to encounter any problem receiving oral. Also, I was hoping for something more than just "let her get on top and do all the work". I was looking for something beyond the obvious if such a solution does indeed exist.

How would I get the response to your answer? Is it emailed to me or do I get off (pardon the pun) your web site. If so, can you please provide the addy.

Thanks for taking the time to answer my question Doc.


A: Hey, kids, DO try this at home. It's not just for the trained professionals, and it's FUN! Everyone is stimulated by variety, and variety exists for every limitation except a coma. Lots of people have exertion problems and they search for an alternative to the obvious "Just lie there and have your partner do all the work." One of the most popular positions for a right-handed man is for the woman to lie on her back, drawing her knees up half way (so that her heels are 12-18 inches from her butt and flat on the bed) and with her legs spread apart. The man lies on his left side and positions himself to make a plus ("+") sign with the woman. He scoots his pelvis to a point where his penis can enter her vagina. His left leg is flat on the bed, and his right leg is placed over her left leg resting anywhere between her thigh and her lower abdomen, depending on a comfortable angle of his leg and its weight on her body. Her right leg rests on his body somewhere between his right hip bone and the middle of his flank (half-way between his hip bone and his right arm pit). His left arm can serve as a cushion and/or his left hand can stimulate her right nipple. His right hand can stimulate her clitoris and labia either directly or by directing the tip of his penis to the desired spots. Also, if he needs more direct stimulation than the vagina affords to attain orgasm, he can withdraw the penis partially or completely from the vagina and provide the added stimulation. Her hands, meanwhile, are ad lib to do whatever they want, from touching his face or nipples (if she can reach them), to touching her clitoris and/or the tip of his penis, to clenching the bed sheets in a vice grip when she has an orgasm.

Penile-vaginal stroking is accomplished by the man rocking his pelvis toward and away from the woman while his left hip bone stays firmly planted on the bed. The woman may assist by rotating her pelvis up and down -- that's not as difficult as it might seem because a little rotation goes a long way. Note that the majority of the man's weight is supported by the bed. There is almost no elevation of his limbs requiring muscles, hence, oxygen. Cautionary notes include being hyper-aware of muscle activity during orgasm. A man with strong leg muscles can unconsciously hook his heels and squeeze his legs together, causing serious pain and possibly bruising to the lady's left leg. Also, thrusting is occuring sideways (the top of the man's penis is rubbing against the right side of the vagina and labia) and any curvature of the penis or change in the angle of penetration can touch previously untouched spots.

Dear Reader: Please try this and let me know if it is described adequately. Please suggest any additions or changes based on your experience.

6/10/98 Q: >Dear Dr. Fitz: > >My boyfriend and I have lived together for several years and I need to >know if his sexual behavior is healthy or obsessive/compulsive. He >masturbates several times a day, with a focus on pornography, the >buttocks, the use of a vibrator 'forced' on him orally, and the idea >that he is being a 'bad boy'. I have been open to taking part in his >play, but our sex life is based on his fantasies. He has an aversion to >sexual play, to intimate love making, touching my vaginal area and >exploring alternative love making methods. > I have had a certain degree of fun in playing his games, but as time >goes by and our sex life is purely focused on his fantasies I am >developing a strong aversion to taking part in any sexual activity with >him. >Any help you can give me will be greatly appreciated! L.M.

A:   Dear L.M. The behavior sounds like it is fetishistic -- the "bad boy" and being forced things usually come from being beaten up as a kid around responsibility for and initiating sex. What better way to get sexual pleasure without having to accept responsibility (hence guilt) for sexual pleasure if someone forces you to do it? Part of the problem is that ANY rigid sexual script gets old real fast, whether it's missionary position penile-vaginal intercourse or an exclusive diet of oral sex.

People get "stuck" in their rigidity usually because they experience some amount of anxiety when they deviate from it. Although it may have happened, I am unaware of anyone overcoming this kind of problem without professional intervention. I have never had anyone come in for therapy and report that they used to have this kind of problem but "solved" it on their own.

The best help I can give here is to encourage you to share your concerns with your boyfriend, focus on the idea that there are many other alternative enjoyable ways to be sexually pleasureable with each other, emphasize that you are not condemning his behavior, only that you are dissatisfied with the lack of variety, and that if you engage in other things you can do some of this, too. If he is incapable of adequate long-term change (don't be fooled by a little change for a brief time), and if he won't pursue professional help, then you have to decide if you are sufficiently compatible with him that you are willing to invest more time in this rigidity.

By the way, there are people in very stable relationships of reciprocal fetishes -- B&D and S&M are paired letters for good reasons: a Sadist cannot exist in isolation, and needs to have a Masochist to engage with. FYI, B&D refers to Bondage and Discipline; for some, D&D refers to Domination and Discipline. So if he does not act on your encouragement to get help becoming more flexible, and you two break up, don't be surprised if you see him somewhere in the future wearing a dog collar and accompanied by a woman in black leather....

6/9/98 Q: hello.... hope to hear from you as i am quite concerned about a x actually..... i met her when she was 19...i was 26........i fell madly in love and she says she did as well...... my concern is this....she started her sexual life at age fourteen...she says because she saw her dad unclothed and it started her curiosity.......she has been active every the tune of over 50 lovers.... she is only 20 now and i am concerned that she may have a severe problem. besides the obvious problems of disease. it is my assumption (and only an assumption ) that she has been raped at the young age of 14. i would like to help her before she starts to regret this life style. i fear that she may have deep emotional problems but she says she is merly "playing". i am no longer her partner but i would like to help still as a concerned friend. i know the decesion is hers to get help. but how can i encourage her to do so with out making her lets see....."rebel" ? any information or explination would help me understand. i know you have limited time,so i will greatly appreciate your help. i think you so much. also she has prostituted her self once that i know of. she often speaks of obtaining her "freedome" i know that she was raised in a strict morman home and i know she tends to lie quite a bit. i just know that she is not a bad person ...just a young person and i would like to see her achieve better things and have no regrets. if more information is needed ,or if you would like to contact me : then let me know the next step. i ask you ....please.......if she can be helped show me what to do next.....

i thank you for your time sir

A: Where do we draw the line between being on the "high end" of the sexual partner spectrum and behaving pathologically? Fifty partners in 72 months sounds at least casual, and at most, compulsive. And where does friendship leave off and butting into someone else's business start? Folks, you have to call 'em like you see 'em and be prepared that you can lead the horse to water but you can't make her drink. Those of us in mental health are teased for saying things like "It's not so much what you do, but how you feel about it". This behavior in and of itself is not pathological. It is the mental state behind the actions that makes or breaks the diagnosis. I suggest that whenever you see someone behaving in a way that you think is reckless, self-destructive, or otherwise potentially dangerous to themselves or others, that you step forward and do what you can. In a case like this you can urge her to get an assessment, and then accept that you have dispatched your responsibility whether she acts on your encouragement or not.

Two questions with one answer -- overlapping:

Dear Reader, There are about 30 questions the Sexdoc receives for every one he is able to put up on the web. Many are already answered on the webpage so I kindly ask readers to read that particular section. Many are brief or very highly specific and I just fire off a private answer. And many are like these -- one from a teenage girl, and one from a man, asking about orgasm. I am surprised by the number of such questions. Often when I ask for clarification, I find that something is mis-labelled. So in response to the first question I ask for you to compare the description of an orgasm to what you are experiencing to be certain that that is what you are having. My comments on the second question appear below.

Female Orgasm is characterized by involuntary rythmic contractions of certain pelvic muscles approximately eight tenths of a second apart. The same goes for men. While men are spoiled in their feedback loop by the arrival of semen anywhere from a half second to five seconds later (after the first pelvic contractions), the majority of women do not have such a signpost. One can feel the muscular contractions by having one or two fingers intra-vaginal and feeling the squeezing, or by feeling the anus contract (it all happens at once). Only about 40% of women have orgasms in response to penile thrusting alone, and I am confident that the majority of those women are stimulated to orgasm only because the penis dragging on the labia causes a pulling or tugging on the the clitoral hood that rubs against the clitoris. The vast majority of women who are orgasmic achieve that state from clitoral stimulation.

So to the teenage girl, I ask: "Is it really an orgasm you are experiencing?" And if so, then I suspect that with more experience, the "new toy" will become more familiar, and you will enjoy more foreplay before experiencing orgasm, OR you will become the envy of many of your girlfriends for being so responsive -- many women would love to be multi-orgasmic.

And to the man, I suggest: "Try talking". Ask your partner what feels good; ask her to confirm for you by sound or by hand signal, when she is having an orgasm. Ask if she likes it when you do that and ask if she would like it if you did it more often. COMMUNICATE!

Any Questions?

How do you relax the anus enough to receive an erect penis?

I decided to answer this question on the "Answers to questions about anal sex" page. Please link there for the answer.

Is it strange that my husband and I engage in "fecal sex"?

Dear Reader: If you are distressed by "bathroom things" or are concerned that thinking about the association of having a bowel movement with something sexual will give you nightmares, please read no further. You have been cautioned.

"We have a great relationship -- sexually and emotionally. But: my husband loves to defecate on a pane of glass over my head. I just love the sensation of his feces plopping on top of the glass. It allows me to orgasm immediately. Many would think this sort of activity is disturbed, but we are in a monogamous relationship, and we truly find it pleasureable. So, Doc, what is your take on this?"

Let's go back to basics for a moment and apply some abstract evaluation principles for assessing any behavior.

Is it harmful? Sadomasochistic behavior that draws blood and the ingestion of fecal matter are potentially harmful. Feces can and often do contain bacteria that are non-pathological in the lower gastrointestinal tract but which can cause very serious illness elsewhere. You've heard of having "strep throat'? There are lots of strains of the streptococcus bacterium and one that can be embarrassing is a diagnosis of streptococcus faecalis from a throat culture. Is fecal matter on a pane of glass harmful? I guess only if the fecal matter is disposed of in such a way that it can get into someone's mouth or if the glass breaks. Short of that ...

Is it demeaning? Being made to lick a boot or to drink water out of a toilet bowl or to eat out of a dog dish (all of which is much more common than the average person suspects) are all demeaning, by design. The domination-submission roles that are played are designed to abdicate the submissive of responsibility, among other things. But it is the essence of being demeaned that makes that work. Is what you describe demeaning? If the intent is real or symbolic humiliation, and it is pervasive in other interpersonal behaviors, that could be a problem. If, however, this is an extreme "naughtiness" that you get thrilled about "getting away with", it might not imply deeper "superior-inferior" relationship dynamics.

Is it consensual? Rape, whether by stranger, date, or spouse, is not done with consent. Do you both consent to this and willingly participate? Similarly, if it is compulsive -- "we HAVE to do this in order to be sexual" or if it is exclusive -- "We can't have an orgasm any other way" then there could be a problem. Consent is not always between two people; it can also come from within. So the benchmark is whether this is something you each can choose to engage in with internal consent, and with consent between you both.

Is it mutual? Here is maybe where I start to impose my professional values. I have had couples in which one sexually "serviced" the other exclusively. And even though the "server" insisted that that was what he or she wanted to do, scratch below the surface and you find some complementation or compensation. For example, consider a silent pact that he will ignore her excessive drinking because she never refuses his overture to be sexually satisfied manually, orally, vaginally, or analy. Or she overlooks his adulterous behavior because he is constantly attentive to her sexual needs. Yes, these are complicated examples in which you can make counter-argument for their plausibility. I am suggesting that there are times when these "trades" are dysfunctional while serving to "balance" the system. So in the current question: Sounds mutual to me but you have to decide that for yourselves.

Does it interfere with other responsibilities? I am often asked if a certain behavior is pathological. "My boyfriend and I have intercourse twice per day and yet I still catch him masturbating once or twice a day. Is this normal?" and "How much masturbation is excessive masturbation? Replace "masturbation" (or any sexual activity) with "watching television", "working on the computer", or "playing out in the garage with model trains". If whatever the activity is interferes with other responsibilities such as daily or weekly chores, going to school, interacting with the family, doing what you are supposed to at work, etc., then it needs to be addressed. But if you have a "date" with your SO ("significant other") four times per week to spend an hour being sexual with each other -- which you consider to be reasonable -- and you still hesitate about your safe (non-harmful), respectful (non-demeaning), consensual, mutually enjoyable sexual activity, I encourage you to search for internalized negative messages. "Nice girls don't -- or shouldn't initiate or enjoy sex." "Spanking, men wearing women's undergarments, using a dildo or other sex toys, etc., are kinky." These are internalized messages that inhibit free expression of a person's sexuality.

So what's the problem with: Using a dildo, playing fantasy games (the headmaster and the naughty school girl, the queen and her male harem, etc.) urinating on each other in the shower, light bondage (one gets tied up and the other has to drive the immobile partner crazy with sexual excitement and satisfaction), erotic cross-dressing, shaving pubic hair, dripping chocolate syrup or honey on your body for your lover to lick off, masturbating your partner, or a quick grope in public that no one else sees, or baring your breasts or your penis in an elevator when only you and your lover are in it, etc.?

By these criteria, there is a problem with: "Making" your partner go bra-less if she doesn't want to, "guilting" your lover into vaginal intercourse during your heaviest menstrual flow if he doesn't want to do that, spanking your unwilling partner because you want to prove that you are in control, coercing your partner to do anything he or she doesn't want to do, calling her a slut or a "nymph" if she wants to make love more than you, or calling him "less of a man" if he wants to make love less. Please internalize these principles and apply them to your behavior. What have you been wanting to do (but haven't yet done) that "passes" the above criteria? Please let me know.

SO HERE IS THE ANSWER: Some people are going to insist that what they do is OK, and that what you do is kinky or, your word, "disturbed". Some people will insist for their own reasons that the only permissable sex is penile-vaginal intercourse in the missionary position. And I am amused that I have had numerous couples in therapy who have done ONE of the following things while insisting that ALL THE OTHERS are somehow wrong, disgusting, abnormal, kinky, perverted, or otherwise inappropriate: erotic cross dressing in private, spanking, anal intercourse, using a dildo, vibrator, cock ring, or any other sex toy, having a dog lick one's genital area, wristing, fisting, erotic enemas (no, to some that is not an oxymoron), golden showers (urinating, but not in the mouth, please), homosexuality, bondage of any weight (light or heavy), domination, sadomasochism in any degree, public nudity whether anyone can see you or not, etc., etc., etc.

My boyfriend has no problem getting an erection, but he has never reached orgasm and ejaculated during intercourse. However, he can reach orgasm and ejaculate through oral or manual stimulation. Does this problem require therapy?

I selected this question for the web page for two reasons: First, it's a common circumstance and I know that there are other people out there who would like the answer. Second, however, it is an excellent example of the uncertainty people have about when to consider obtaining sex therapy.

A problem has to "be a problem" before I encourage people to get therapy. For example, if you're trying to get pregnant, the inability to ejaculate during intercourse drastically reduces your chances of conceiving. If this situation has lulled you into the false sense of security that you can't get pregnant because he doesn't ejaculate, that's a potential problem because the clear secretion from a man's penis when he is sexually aroused (from the Cowper's gland) contains lots of sperm, only one of which is needed to penetrate the egg, etc. If you had said "This makes me feel like less of a woman and an incompetent lover", then there's a problem because it is diminishing your self-esteem.

If you are his first, or one of his first few, lovers, this could be only transient performance anxiety which maturation and experience could "cure". The presumption is that once he starts having orgasms intra-vaginally, it will be so rewarding and pleasureable that he will want to repeat the experience. But if you're both in your mid-thirties and he has been sexual with a dozen women, this could be "merely" a symptom of other matters, such as a fear of commitment, or insecurity regarding his ability to be a satisfactory partner to any woman.

If he has never been able to have an orgasm while intra-vaginal, and he would eventually like to sire children, then he would be well advised to seek therapy as soon as he can afford the time and expense because the longer he repeats this non-orgasmic circumstance, the more entrenched -- cast in bronze in his brain -- it becomes, and the longer it will take to correct the chain of mental and physical events.

My boyfriend wants me to participate in a "three way". What are the pros and cons? Is there any literature on this?

How many hours do you have to listen to stories? The fantasy is great, but the reality is very different. If the three-way is with another guy, how do you think your boyfriend will feel if he sees you getting really turned on by this new partner? Will the two men compare penis size? In some cases, including another man is an excuse for the two men to be sexual with each other but "nullified" in the homosexual overtone by the presence of a woman. The actual event is less predictable than people think from the "armchair". If you have simultaneous vaginal and anal intercourse, the sensation of another penis through that rather thin membrane can cause one or both of the penises to become flaccid (lose the erections) from homosexual anxiety alone!


2/10/98: I am adding to this answer based on the following question: Q:  I am a 23 year old woman in a five year relationship with a man I plan to marry. Recently I found myself becoming sexually attracted to my best friend for more than 12 years, who is a heterosexual female. I told my fiance; he suggested I tell her; I was extremely afraid to do so; to my surprise she seemed excited and intrigued about how I felt. This elevated into talks about having a menage a trois with her and my fiance. Is this a good idea? What are the ramifications?

2/10/98 addition: Readers please notice that most questions are brief; I summarize them. This one I cut to the essentials but retained the author's words where I didn't cut. And now to address the author: Dear Curious and Cautious: Please stand back for a moment and consider that we are questioning a course of action to maximize quality of life and relationship and sexual satisfaction. This attraction could be "cold feet" at the prospect of marriage; it could be the emergence of homosexual feelings suppressed until now; it could be fear showing up as the desire to be "mothered" by a familiar friend. What is complicating to the sexdoc, however, is the proposal to neutralize the homosexual aspect by including the fiance. YOU found yourself becoming sexually attracted to her. YOU are curious what it would be like to be sexual with another woman. YOU assert that she is heterosexual but that she seemed excited and intrigued. Why involve your fiance? It may be that both you and your girlfriend are comfortably bisexual and that if you continue with your plans to get married, and if that includes a commitment of monogamy, then you will voluntarily give up being sexual with anyone else regardless of gender, right? Alternatively, if you are homosexual but don't know that yet because you've been marching to the beat of the predominantly heterosexual (and homo-adverse) society, this might provide the opportunity to find out now and avoid heartbreak and divorce 10 years from now. The sexdoc believes that you, your fiance, and your 12-year friend are too close to the forest to see the trees. Your choices are to sally forth risking all that is presented in this section (all the stuff about 3-ways), to suppress your curiosity and wonder ... (and I'll bet that it's not a question of "whether" but of "when"), or to see a sex therapist for values clarification. Only you can weigh off all the factors and decide. And you will have to live with that decision and the subsequent effects. One way or another.


There are similar questions if the third participant is a woman. Mammals are eroticized by novelty. In animal husbandry it's called the Coolidge effect. If she has bigger boobs, a smaller ass, or "better" legs than you, and you see your boyfriend getting really turned on, what feelings will that bring up in you? If he wants to see two women being sexual with each other, you might find that you really like that, and it will have some disruptive impact on your relationships.

Dear Reader, please do not think that the sexdoc is a prude (I can't be in my line of work). My responsibility to you is to encourage you to think through what sounds attractive. Because there are unpredictable consequences, you could end up regretting having done it. But if you're curious, and you are prepared that this might terminate your relationship with this boyfriend, and if you accept the idea that you MIGHT get turned on by sex with a woman, and that you might want to repeat it, go for it.

The patients I have had who have had three-way sex report 100% that they did not anticipate the complications that ensued, and all have said that the cost was not worth the benefit. Besides, acting the fantasy out will spoil its mystique forever.

The main pros are that it is thrilling, exciting, naughty, and somewhat unpredictable (what fun!). The main cons are that the unpredictability complicates matters. At a minimum, the sexdoc can guarantee that you and your boyfriend will have some differences about having done it or doing it again.

Literature? Not that I know of (any reader who knows of any literature please e-mail me

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Is there any self-help for premature ejaculation?

Alas, premature ejaculation ("PE") is the easiest of all sexual dysfunctions to "fix". Please also note that because "premature" is a relative matter, that the following techniques will also teach the body of a "non-PE-er" to maintain his erection longer whether intra-vaginal or not.

STEP 1: Establish your baseline. With privacy, do what you usually do (book, magazine, video, fantasy) when you want to have sex with yourself. Note the time. Time yourself from first penile stimulation to ejaculation.

STEP 2: Make sure that you are acutely and precisely aware of the "moment of inevitability". That's the internal pelvic sensation that from that millisecond on, nothing you can do will stop the orgasm/ejaculation. Not the termination of touch, not someone walking in on you, not even dipping John Henry in a bucket of ice water.

Step 3: As you approach the moment of inevitability, use one of the following three behaviors to reduce the urgency of continuing (no matter how nice it would be to continue right then):

Step 4: One of these techniques works for about 98% of men. Once you have established your baseline, you know when you're close, and you have determined the technique that works for you, practice as often as comfortable with the goal to lengthen the amount of time you can go from initial stimulation to ejaculation. During each practice "event" strive to increase the length of time by 10% to 25% over the time of the prior event. When you've reached your target time, do whatever works for you to reward yourself with an orgasm. If you practice this enough, you can get to the point where you can get an erection, have that erection stimulated (by what you choose), and by varying the degree of stimulation, holding off from ejaculating until you "give yourself permission" to have an orgasm.

4/13/00  I have received a request for clarification:

Dr. Fitz, I read your 4 steps from the internet on how to "fix" pe.I
answered all the questions, it is PE. I am begging you to take a minute and
answer a couple questions I have re: "the steps". Please, my sex live with
my wife is in the toilet and is minutes from being flushed.  I use the pinch
technique, I know my baseline, I don't understand this part: During each
practice "event" strive to increase the length of time by 10% to 25% over
the time of the prior event. The word strive encompasses the entire problem.
If I new how to "strive to increase the time" I wouldn't have a problem. The
other question I have is when you say the prior event do you mean yesterday
or do you mean minutes before when I stopped ejaculation by pinching?
Please, please answer these as I (and my wife) are in desperate need of a
good ...

In minutes instead of percentages:  The following day numbers refer to "days on which you train."  There can be zero to 4 days in-between training days.  So you CAN do this day after day, or skip a few days between training days.   Day 1:  stroke to orgasm.  Let's say it's 1 minute.  That's your baseline (could be 15 seconds).  Day 2:  stroke.  You feel close to the Point of Inevitability (POI) at 45 seconds.  You pause (or pinch or pull) until the urgency subsides(5 to 30 seconds?).   Then you start stroking again.    You stroke gently for another 75 seconds and let the orgasm happen.  45+75/60=2 minutes.  Day 3:  you're getting better at this so you have learned that if you are more gentle, meaning stroking less vigorously, you can get your penis to stay in the envelope -- above going limp and below the POI -- pretty much all the time.  If you get too close to the POI, you stop (pause) or pinch or pull.  But today you just stroke gently sometimes a little faster, sometimes a little slower until you reach 3 minutes.  Then you have an orgasm.  On day 4 you go for 4 minutes.  On day 5, you get cocky (pun intended) and have an orgasm at 3 minutes.  This reminds you that you have got to pay attention to sensing the approach of the POI.  So on day 6 you go for 4 minutes, day 7 for 5 minutes, day 8 for 6 minutes, etc., until days 12, 13, 14, and 15 when you "last" for 10 minutes each time.  Then, when you next have intercourse, you are aware of what the POI approaching feels like and with your lover, you slow down or withdraw and pause, pinch or pull.  She may think or complain that it "interrupts the mood" for her, but you remind her that you are in training.  By re-training your perception of the sensations -- becoming aware of the approach of the POI -- and by your reptilian brain "learning" that when you slow down, etc., that is supposed to cool down the approach of the POI, you now have more influence (not control) over the timing of the orgasm.  If you pace yourself if you wish to make sure that she has an orgasm before you do, then when she starts, you can speed up, providing her with more stimulation and bringing yourself to orgasm also.  Some men call it "giving themselves permission" to come.

I now invite the author of the above e-mail to comment if this explains it better.

Note 1: If you wait too long, you will be unable to achieve an orgasm. Not good. But, you won't know how long is too long for you until you experiment.

Note 2: How "premature" IS  premature? Who is defining this? Focus on compatibility. I have had couples who both loved for copulation to take 2 minutes, and couples who were coupled for over an hour with varying degrees of movement and a variety of intercourse positions. If the definition is "it's premature if he comes before she does" that could be a problem. Only about 40% of women experience orgasm during penile-vaginal intercourse through penile thrusting alone. Many women obtain (from themselves or from their partner) clitoral stimulation during intercourse when they want to have an orgasm soon.

Note 3: Is PE a correct diagnosis? If, with little or no direct penile stimulation, the guy has an orgasm any time less than two minutes after penetration ON A REGULAR BASIS (OK, let's say more than 25% of the time), and if his partner wants penile thrusting for more time, then it's PE and the guy has to choose whether to cooperate with the above therapy assignment (suffer, suffer), or to disappoint his sexual partner. IT'S NOT PE  if the penis gets lots of vigorous stimulation prior to the attempt at vaginal (or other) penetration!

Note 4: Don't procrastinate. Part of the driving force in PE is the added excitement from anxiety. You're already excited -- energized -- and anxiety adds a turbo-charged force on top of that. If you're worried that you will again come too soon, and that worry hasn't diminished the firmness of your erection, you're better assuring that you'll repeat the problem. If you have decided that you have PE, fix it sooner rather than later. Think of how many more good sexual encounters you'll have.

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