Sex and Relationships

Sexual Dysfunction


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Answers to questions about sex therapy and sexuality

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6/23/98 Q: Hi Doctor, I wrote to you previously about the fact that my husband passing herpes to me had brought an end, pretty much, to our once terrific sex life. We married in 1983, 2nd marriages, (I am 50 he is 46) and had a fantastic time in bed and out. I discovered him in a motel room in 1990 with someone else and found out he had been what I now call a "single married man" since we met. Constant sexual contacts, not love affairs. Then came the herpes. I decided to stay for one year and see what he was willing to do since he begged for a chance to change. He went to a therapist and then we went together. This was intense at first, then monthly from 1990-1995. It was suggested that we read "Don't call it love" and that he seek support in SA. He did but did not find help there (he says) because the group was small and most had a problem with pedophilia....which he does not. So, after a year I decided to stay another year and so it goes.....things had been again between us, different, but good until about two years ago. He says he just lost his libido and sex went down to 2 times a year......even thin no matter what we did or how long, he can not reach orgasm. Sex has stopped altogether now even though affection sure hasn't, we still laugh and enjoy each other as people but not as lovers. This week I found a card in our car with a girl's name and number on the back in his handwriting....I confronted big time and he said he never intended to act on it but since he has been feeling so bad about himself he took it when offered. BIG RED FLAG. I cannot go through the infidelity again even though he swears he only masturbates to movies for release (and still takes 1-2 hours to reach orgasm) and never intends to be with anyone else, I am leary of him and find my rebuilt trust shattered. I know men over 40 sometimes take more time to reach orgasm but isn't this whole pattern somehow connected? I feel pretty bad about myself even though I know it isn't me and he says so too, he admits its him but is at a loss to know why this is happening. I really don't think he ever got much from counseling at all with regard to "why do I do these things?" I don't know if there is any help for him, what do you think? He seems willing to learn and get information and try something new to get back to where we were but is a bit timid about what to do and I think embarrassed too. He says he still feels guilt for giving me herpes and seeing me suffer but would that alone do this? I've had it and been on suppression for 7 years now. I'm at a loss. Thanks a million.

A: Everyone has needs for all kinds of things, and I am struck by the difference between getting other needs met compared with needs related to sexuality. When it comes to sex, it seems to me that more people stick it out longer. Everyone has a threshold, a boundary, beyond which they will not go. If your needs for personal safety and security are violated by physical abuse, you reach a point and then you're "outa' there". Those of you in physically abusive relationships should rent "The Burning Bed" at your local video store -- but please get help and leave before you burn your spouse to death.

If your spouse, and I am emphasizing gender neutral when possible, "becomes" a compulsive gambler, and you lose your car, your residence, etc., what's it going to take? Prostitution or no food for the children before you leave?

What can you put up with? If you (and the kids) don't have a roof over your head, that's pretty serious. If you get beaten up too often, hopefully you won't take that for long. But go without sex with your partner? How long are you willing to do that?

Sometimes sex is just physical, and sometimes sex is symbolic of all kinds of other things. Fun, excitement, being naughty, getting away with something, new, different, an ego stroke, a sign of desirability or attractiveness, etc. And it's OK to have numerous partners, but if you're in a monogamous relationship, it's a breach of contract.

As you describe the situation, it isn't working for you. It sounds like he's doing just fine. My strongest recommendation is for you to assess your role in this, to examine your own self-respect and willingness to put up with third or fourth best (not even "second best"). You deserve better. Examine how you can improve your quality of life. If that includes him, great. But if it doesn't, save yourself from your purgatory!

best wishes

6/23/98 Q: Dear Sex Doc, I was really happy to stumble on your website. I am a 49 yr old male and have been in a totally monogamous relationship with my wife who I love dearly for 27 years. Over that time, in an attempt to be the best lover to her I could be, I have learned to control my orgasms totally at will. (In otherwords I can have sex for protracted periods of time, refrain from ejaculation if I desire and come when I want.) We have a good and pretty experimental sex life. My problem is that this learned ability sometimes makes me feel like I am always in control in the bedroom even when I don't want to be or try not to be. I wonder if there are other men out there like me who have trained themselves to "last long" and found that maybe some of the spontaneity gets lost. I do not have any impotence and I do not believe it is retarded ejaculation since I can "come" in five minutes if I desire, or not at all. Are there ways to "decontrol" this sort of thing? Is it common? I suspect I might not have this ability if I was with a totally different woman. I'd appreciate your opinion.

A: That part of the brain that controls sexual response is the same part that learns how to ride a bicycle or drive a stick shift car. What you are experiencing is a sort of inverse of premature ejaculation ("PE"). I say "sort of" because they're more like opposite ends of the same dimension. The man with PE interprets a modest amount of sexual stimulation as the signal to have an orgasm. Your brain stem interprets prolonged stimulation as a signal to "enjoy but continue". I speculate that when you can "come" in five minutes that you do something a bit different physically -- speed up a bit or not slow down periodically or shift the angle of penetration slightly so the tip of your penis is having some different nerve endings fired.

Yes, there are other men who have mastered this phenomenon, and yes, you are in control because at some point in your sexual history you concluded that being out of control was not OK for you. You can "decontrol" it if you want, but I suspect that you want control on demand and "decontrol" on demand. It doesn't work that way. What you can do is focus on how quickly you have an orgasm once you decide to.

If you were with another woman I bet you'd have less control at first, but that over successive sexual events you'd resort to the way you are now. The short-term effect is NOVELTY, which is VERY STIMULATING! But as you got used to her (the new woman) you'd predict your sensations and her reaction more and more, and you'd be back here.

If you wish to honor your 27-year commitment of monogamy, strive to "give yourself permission" to have an orgasm sooner after you decide to do that, and continue to introduce novelty into your current relationship. There are fun sex toys, and books on fantasy games you can play ...

6/23/98 Q: Dear Dr. Fitz

Hello, I am writing you because for the last 10 months I have been dating a wonderful man who is 30 and I just turned 25 (I didn't know if age makes a difference). Our sex life was great when it was new, but now I am sexually frustrated, because there is no foreplay and he only lasts for about 10 to 15 minutes before he ejaculates. I do not want to hurt his feelings by telling him that I am sexually frustrated! He loves oral sex and so do I, but he never gives me oral sex. When he does give me oral sex I feel awful. I feel awful because I feel like I made him or I think he feels obligated to give me oral sex. When I feel this way I can not enjoy oral sex and will not climax. I have never in my life had an orgasm during intercourse and rarely during oral sex. Do I have climax problem? and should I not blame him for cumming so early and the lack of oral sex. Or, should I expect more from him in bed? I have not been with a lot of men and don't know. I LOVE him and don't want to give up a great guy because I feel sexually frustrated. Please write me back to tell me were to start with my problems. I don't know if I should talk to him, or are there exercises I can do to increase my sexual sensation so I can climax more often and maybe sooner.


Sexually Frustrated

A: Dear Sexually Frustrated:

I'll bet that 11 of every dozen women, on hearing this, would say "Girl, you don't know how good you've got it! I'll trade you my man's sexual problems for yours!" It would be helpful for you to become better acquainted with more aspects of the sexuality of men and women. I KNOW that there are lots of men and women "out there" who are equally uninformed, so I'm going to reply both with a mini-lesson in sex ed, and some suggestions for what you can do.

You need to know: 1) The AVERAGE time between intromission (inserting the penis into the vagina) and ejaculation of semen (the external confirmation of male orgasm) is 90 SECONDS. Many women are delighted when their lover lasts 5 minutes! And: 2) Only about 40% of women have an orgasm from intercourse alone.

That having been said, the bottom line is Communicate and Negotiate. Has he been "rushing to get it in" because he thinks that's the signal you sent to him? Check it out. Tell him "I know that you like to please me sexually, and things have sort of gradually changed since when we first started making love, so I'd appreciate it if we can talk about what each of us likes." Then go into "I need to be 'warmed up' before intercourse -- foreplay like we used to have. I'm delighted that you're eager to be inside me, but my body has to be ready, and lately it hasn't been." That should address the foreplay matter.

Regarding oral sex, be careful to avoid the trap of "tit for tat" -- in this case, "I'll give you oral sex for every time you give me oral sex". What you are striving for is a lover who truly has your pleasure in mind, and vice versa -- you want to please him. So I again entertain the question of whether there is UNcommunication, something not communicated, or MIScommunication, where one or both of you is misinterpreting signals. PLUS: Many men and women are blissfully unaware of the odor and taste of their genitals to their lover's mouth and nose. If he's more willing to go down on you as you walk out of the shower than he is after you get home from the gym, there's a clue.

Plus, now everybody pay close attention: You know how there are some people whose body odor just is out and out repulsive to you? Avoid the temptation to generalize to race or nationality -- just acknowledge that there are times when you're in public on a hot day and you get a whiff of body odor that burns your nose. Are we on the same page? OK, then, a deep, dark secret of sexuality is that while most lovers smell and taste OK, there are some whose odor and flavor is absolute ambrosia -- the nectar of the Gods, the most delicious smell and flavor you've ever experienced. Wow! AND, however, (you knew that the other shoe had to drop, didn't you -- were you way ahead of me on this one?) there are lovers who, no matter what, shower, deodorant, chocolate syrup, honey, etc., it just ain't agonna' cut it. AND there are smells and tastes in between, as in the case of right after the shower. How do you know? ASK.

Orgasm during intercourse is related to the foreplay matter, and is partly independent of it. If you or he gets you so excited before intromission, you might then have an orgasm from the pull of the labia on the clitoral hood. If not, try clitoral stimulation from your or his hand during intercourse to see if you can have an orgasm while he's inside you.

Make sure that you know how to bring yourself to orgasm before you teach him. If he doesn't excite you enough during foreplay, and won't respond to your requests that he do so, touch yourself while he watches (but then expect that he won't last 10-15 minures).

And finally, let him know that you appreciate the fact that he engages in intercourse for 10-15 minutes before having an orgasm, and enjoy it while you got it; the chance of your having another lover who lasts that long are slim.

best wishes


6/23/98 Q: hi :) i asked you a question before and I just wanted to let you know that i bought the book "For Yourself" and I couldnt believe it.... it was like the book was written just for me!

I do have another question though. How exactly do i know if im having an orgasm. I have only had one before and it felt like a wave a heat going up my body until it hit my face... then a sort of explosion where my back arched etc. Well the sensation that i feel now is the same wave of heat going through my body, arching back, and involuntary heavy breathing. as soon as the heat gets to my face, my body relaxes, and my clitoris is very very sensitive and cannot be touched. is it possible that this is indeed my entire orgasm, and i not missing the 'ending climax' like i thought?

A:   The ESSENCE of an orgasm for both men and women -- the defining characteristic, without which there was no orgasm and in the presence of which, REGARDLESS of all else, there was an orgasm is:

Involuntary contractions of pelvic muscles approximately eight tenths of a second apart.

Most men have "one" orgasm -- that is three to 15 of those 8/10 second contractions. In most men, fluid comes out of the tip of their penis 2-6 seconds after the first contraction. A small minority of men can have multiple orgasms.

Women, on the other hand, have different patterns, ranging from the one in men to others like 10 contractions, nothing for 20 seconds, ten more contractions, etc., for several "sets" (reminds me of sets of waves when I was a surfer in La Jolla, actually). Some women, with continuous stimulation of the clitoris and/or the G spot, can remain orgasmic continuously for 30 minutes (and then stop because exhaustion sets in).

Most women experience other things, like a rosy flush on the chest (usually preceding the orgasm), changes in breathing, involuntary muscle clenching, etc. But the critical minimum answer is the 8/10 second contractions. Any Questions?

Thanks for writing back with another question.


6/23/98 Q: Dr. Fitz,

I am 38 years old, my husband 41. We are married 18 years. We enjoyed sex tremendously during the beginning years. It slowed down during the child bearing years and now I seem to not be able to get enough and he never wants to.

How can we better our relationship? He was my first, but now I am curious about others. How can i get what I want from him? I want to have the sex we had at the begining, is this crazy? S.

A: Dear S.

Men sexually peak at around 19 years of age and their desire for sex gradually declines into their 80's. Women jump from low to "medium high" around 17 and gradually their desire for sex increases into their 80's. The genders' desire curves cross in the late 30's to early 40's, before which he wants sex more often, and after which she does. That's biology. And these are AVERAGES -- there are, of course, exceptions.

As a psychological matter, communicate and negotiate. If you can't do it on your own, get help from a sex therapist (this is extremely common). I have had men in their 70's in therapy who wanted and got intercourse 4 times per week. If you wish to retain your commitment of monogamy, back away from the myth that the only real sex is penile-vaginal intercourse, and get all the sex you want -- by yourself when you want sex beyond what your husband is willing to do.

And no, it's not crazy to want the sex you had in the beginning, but it may be, and sounds like it is, incompatible with what your husband wants now.

I hope this helps.

6/18/98 Q: > >My uncle was sexually and physically abusive to me from the age of 5 to 18. >I've gotten therapy for it and thought I was over it. But when my husband and I were married, we had a lot of problems because I would freak out >and think that he was my uncle and start punching at him and pushing him away. >We saw a counselor for this and now I'm actually able to enjoy sex instead of >freezing up and holding my breath. But I still feel bad because I've never >given him oral sex because of what my uncle did to me. How could I get over >this? My husband says it doesn't bother him, but I wonder. I also never ever used to >touch his penis-it was almost like I was afraid to for some reason, but I did >for the first time the other night. Please let me know what I can do to better >for him when we make love. > >Sincerely, > molested

A: Dear Molested, Unfortunately, what you describe is relatively common. By the age of 18 one in four girls, and one in seven boys, will have been sexually contacted inappropriately. You have to be patient with yourself. You can't expect to overcome 13 years of molest in a short time.

Congratulations on the progress you have made. Be gentle with yourself and take baby steps to do more and more. At each new outreach take a deep breath, relax, and get used to all the sensations. Associate your current experiences with being in a loving relationship to replace the older associations of touch=YUCKY. It's kind of like having to unlearn how you ride a bike the "bad" way so you can relearn it the "right" way. Expect, and don't be discouraged by, set-backs. At some point you will outreach too far and experience anxiety -- or repeat something you did before, but this time feel anxious. That's to be expected. Slowly and gradually, get his penis closer and closer to your mouth; by taking baby steps each sexual opportunity, expect that eventually you will be able to pleasure your husband orally.

And if (and probably, when, unfortunately) more new stuff comes up, get back into therapy for awhile.

And please let me know how it goes.


6/17/98 Q: Hello, Dr. Fitz:

I have written to you a few times in the past couple of months. My wife and I have been married for 11 years and we make love four or five times a week. We decided to try a little "light bondage" (just a little spanking and some tying up on the bedposts). We had the best time of our sexual lives (except maybe our honeymoon). It was something we decided to try, and it was very erotic for both of us. We had never tried bondage before, and it was great. This added even more spice to our already active sex life. A couple of questions, Doc: My wife and I can't keep our hands off each other, not even in public, but we do restrict ourselves. Is it strange for a married couple of 11 years to be acting this way? My next question, Dr. Fitz: What book and/or video do you recommend for sexual positions ? We have tried many, but not all of them. I will be looking forward to your reply. Sincerely, JG

A: No, it's not common for an eleven year married couple to not keep their hands off each other, and so long as it is a message of affection between you, it is not offensive or lewd in public, and it isn't a disguised expression of insecurity (This person is MINE -- I get to touch and YOU DON'T!), it's fine.

Congratulations on the light bondage. Remember, readers, ALWAYS HAVE A SAFE WORD -- a word that the one tied up can say that means absolutely and without question, "UNTIE ME IMMEDIATELY".

A Book on positions? Come on, now, JG, you're more creative than that! I know that I am surrounded by sexual ideas all the time, but the few books and videos I have seen on positions I find to be lacking, and look to me like a thinly disguised form of pornography that's trying to give people an excuse to buy it. Give flight to your creative side and figure out all the ways your anatomy can connect with her anatomy, taking into consideration your weight, strength, endurance, and acrobatic ability. Have fun!

6/17/98 Q: i'm a 24 year old woman and i think im missing out on a lot. i lost my virginity at the age of 15 and have had 8 sexual partners since then. i have had only one orgasm in my life, and that occured right after my partner pulled out of me during intercourse (my first time without using a condom) that was 7 years ago and i have never had an orgasm since. ive been with my current partner for 4 years and we have sex about once every 2 months. i dont enjoy sex very much, although foreplay can be somewhat enjoyable. i dont lubricte very much, and i dont even really get "turned on" i rarely masterbate because im never really "in the mood" i know that i must be missing something... im 24 years old, i should be enjoying sex! my boyfriend wants to satisfy me, and tries hard but i just dont think it can be done... a sometimes i get really close to an orgasm.... i feel like it's ALMOST there but then whoosh, it's gone, and my clitoris is very sensitive and painful so i dont like it to be touched again until the next day. i dont remember being really "turned on" by a partner except with oral sex, however simply seeing a short sex scene on tv, or reading a steamy scene in a book turns me on 200% more. do you think there is an answer to my problem?

A: It sounded like you were just "asexual" until you got to the part about being turned on 200% by a book or sex scene. That suggests focusing away from yourself as a means of giving yourself permission to feel sexual. I suggest that you start with "For Yourself", the book by Lonnie Barbach, and get a vibrator and lubricant (if you don't already). If you can't do it on your own -- get in touch with bringing yourself to orgasm -- for your quality of life, please see a sex therapist. When you solve this problem, expect to kick yourself in the butt for not having done it sooner, but you weren't ready then. It sounds like you're ready now.

Q:  The last two times my husband and I had intercourse I experienced a sharp and excruciating pain which lasted for about 90 minutes (both times). After the second event I self-administered a Fleet (tm) enema in case the problem was constipation, with no benefit. I saw my OB-GYN who did a pelvic but no rectal exam and no lab work, and suggested a laparoscopy. Should I seek a second opinion for this dyspareunia?

A:  Not all problems that are experienced during sexual behavior are sexual problems. Whenever I hear of pain or performance problems (as opposed to desire discrepancy or technique), I have to decide whether the problem is psychogenic or if there is a systemic (medical) condition that needs to be seen by a physician. If a man can attain and maintain an erection for ten minutes when he is alone, but not with his lover, there ain't a systemic problem here. It's situational and psychological. If a woman has a new lover who is swarthy, reckless, and dangerous, and physically firm, I wouldn't be at all surprised if she lubricated copiously as the first event of intercourse approached, but clenched up vaginally (vaginismus) at the sight of his huge penis. The thought of being stretched larger than ever before, and/or rammed deeper than ever before, makes for great fantasies (for both men and women), but in reality can simply spell POSSIBLE HARM AND PAIN. In that case, the body's protective mechanisms kick in and she gets a build up of lactic acid in her perivaginal muscles, causing pain and drowning sexual desire.

In the case of this question, when there is no discomfort in event after event of intercourse, then there is a sudden onset inside the body of excruciating pain that lasts for 90 minutes, this is not a sexual problem. This is an internal or OB-GYN problem that was provoked by the penis or something else during intercourse (e.g., muscle spasm). Pain is the body's way of telling us albeit monotonously that something is wrong. I urged this woman to doggedly pursue the medical community either to come up with a definitive differential diagnosis, or to rule out whatever might cause the pain again.

Q: I am almost 18. My girlfriend and I have tried having sex about 3 times, and it hasn't worked 3 times. We are both virgins. My penis gets hard, but not like rock hard like I think it is supposed to be. Do you know anything I can do to help?

And: Q: My boyfriend and I have tried to have sex but the hole is too small. What should we do?

A: Slow down, relax, explore, pleasure yourself in front of your lover so he/she can see exactly what your body likes and how it likes to be touched. Be sure that you're well lubricated; better to be over-slippery the first few times than too dry. Address everything that can make you nervous. Condoms? privacy? fear of being interrupted or discovered? Make sure that you know how things work!

The Single Greatest Cause of Sexual Dysfunction is IGNORANCE

One week just bring each other to orgasm. The next week try just rubbing the erect (and condomed) penis around the outside, using your hand or hers to bring you to orgasm -- then make sure you bring her to orgasm. The next week rub the penis around the outside and insert it in and out 1/2 inch. The next week have the guy on his back and have the woman descend onto his erect penis as deeply as SHE wants -- no unexpected upward thrusting of the penis! Then maybe the next week you can get just hard enough to enter. The penis will take care of its own firmness if you forget about it. It's shy. Think about it and it gets self-conscious and gives up.

Make sure you know all the anatomy! The hole's too small? There are four options: it's the wrong hole, there's a hymen blocking the penis, you haven't patiently and gently allowed the vaginal opening to stretch enough, or you're mismatched in size. (I'm ignoring the possibilities that you are extremely rare or have a medical anomaly.) I have had several patients try to insert a tampon into their urethra (where the pee comes out) and/or direct an impatient penis to the same opening, with disasterous results.

GUYS:  You don't have to be rock hard. Just firm enough so that your penis doesn't double up on itself after the first withdrawal.

And remember, everybody: Pregnancy is caused by the sperm getting into an egg. The egg and sperm don't care how the sperm got transported. Many a woman has become pregnant having a semen-coated finger inserted into her vagina, and there has been a case of a female giving oral sex, the guy ejaculated into her mouth, they french kissed, then he went down on her, and stuck his tongue into her vagina and guess what? They had a baby! Don't just think that "fucking makes you pregnant". Think of the mechanics and the fluids and how to keep a sperm from getting inside the female's vagina!

Dear Reader:  I usually edit the questions down to what I believe is the essence of the question. Sometimes, however, there comes a question that communicates the emotion and anguish so poignantly that it is worth my 40-wpm four finger typing time to share it with you. Thus the following:

Q:  Dear Doctor,

My fiance and I have been together for about three years. When we first met sexuality was a big part of our relationship and was very enjoyable for the both of us. In the last six months or so we have ben lacking in the sexual area. He has difficulty getting an erection and doesn't physically respond to my advances. This has created a vicious circle and has put a bit of a wedge in our otherwise very happy relationship. I feel like he is not physically attracted to me anymore and feel like the sexual part of me has been forced to retract. He says that he thinks about sex with me and wants to be intimate but his penis just doesn't respond. This frustration leads him to feel that it's not worth the effort. We are a young (23) soon to be wed couple and very sad that as our lives as a married couple are just starting our sex life seems to be ending. We would really appreciate your advice.

Thank you.

A:  This question exemplifies why good sex therapists are also good relationship therapists. Sometimes a sexual problem causes relationship problems, and sometimes it's vice-versa. My first reaction is to postpone the marriage until you find out what the problem is. If the marriage is already announced and you can't postpone it without huge consequences, see a therapist as soon as possible to find out the prognosis. What happened six months ago? I'll wager that when they were going to be sexual, he was compromised in some way: sick with a cold, in pain from exercising, some recent medication, maybe a little too much alcohol, not enough sleep, worry about getting caught, maybe irritated with her about something, anxious about the future, confused by a powerful lust reaction to a woman (not his fiance), etc. Then as they were about to have intercourse, his erection got a little softer. He worried, guaranteeing that he lost it. They were both disappointed. Then the next time they were going to be sexual, he remembered what happened, worried that it might happen again, and again was unable to have intercourse. And so the cycle gets established. And then it gets complicated: she thinks that because he has erection problems that he's not attracted to her any more. And I'll wager that he has pleasured himself with a fine erection, to orgasm, and wonders why he can do that but not be in his fiance! Did everybody see the big red sentence four pages (on my browser, anyway) above this? If he knew that:

From time to time EVERY MAN (sooner or later) occasionally loses his erection when approaching vagina penetration. If it hasn't happened to you yet, just wait. Unless you die young, it will. When that happens, RELAX! Do something else knowing that it's no big deal and that next time it will probably be OK.

Now if his problem was transient and perpetuated by ignorance of the above statement, and if there hasn't been too much damage (" ... a bit of a wedge ... " she says), there's no reason to hold up the marriage. But if this is indicative of a deep-seated ambivalence, or of second thoughts about getting married, they could be making a big mistake going ahead with the wedding plans. Getting married is stress enough than to have this stress added to it!

Q:  How will vaginismus impact my ability to be artificially inseminated and to give birth?

A:  Because vaginismus is a spasm of the muscles around the vagina mentally induced by a fear of penetration, the problem will present during insemination, not vaginal delivery. If you have a profound case and cannot tolerate even a tampon, you'll need to try progressive dilation with relaxation to re-program the body's out-of-proportion protective response. If you can tolerate a straw, there's hope that you can progress more. If not, you will have a problem. Because this is a non-recurring intention (just to get pregnant) you might respond to a local anesthetic or to a pudendal block. Check it out in advance of scheduling the insemination procedure.

IN ADDITION -- I strongly encourage you to treat both the symptom through dilation and relaxation AND the cause. The spastic and painful clenching of the perivaginal muscles is the outward manifestation, and it is possible to re-program the body to stop the muscle reaction without adequately dealing with the underlying cause. Please address both and it will synergistically be helpful.

Q:  I am a young female who finds it hard to get aroused when with a partner. What should I do?

A: Read Lonnie Barbach's book FOR YOURSELF, do all the exercises, then, when you know what arouses you, instruct your partner in how your body likes to be touched, stimulated, and pleasured. You can't be aroused if you don't do arousing things.

Q: I love to receive oral sex but ... The complete question and answer can be found on the "oral sex" page.

Q:  Dear Sex Doc: I am a 40 yr. old female and have never had an orgasm with a man, but very mild ones with a vibrator. I believe my very religious background has something to do with this. I am now in my second marriage. Is it possible to fall in love with someone who you are not physically attracted to? Is it possible to have an orgasm with this person? Is it possible that if I could experience orgasms with this person that love could follow? I cannot get myself excited in the least without a vibrator. Would a sex therapist help at all in my situation?

A:  Your religious background probably has a major effect on your sexuality (that's the case with most people). Yes, you can fall in love with someone you're not physically attracted to, yes you could have an orgasm with that person, yes what starts as gratitude for sexual pleasure can evolve into love, and if you were in my office, I'd suggest that you read, and follow each and every exercise in, Lonnie Barbach's book "FOR  YOURSELF" so that we could focus therapy sessions on dis-inhibiting you from experiencing sexual pleasure.

Love is extremely diverse, and some people fall in love with someone they are not physically attracted to, others fall in love with looks alone and may suffer with intellectual or emotional incompatibility. With enough of the right kind of stimulation, you can have an orgasm under the most bizarre circumstances. A major psychological problem for victims of sexual assault -- of any age -- is physical response. If a woman lubricates when stimulated by a rapist, and worse, has an orgasm, she feels like her body "betrayed her". Genitalia are indiscriminate. In the dark the penis doesn't care if the mouth around it belongs to a man or a woman, and the clitoris is blissfully unaware of the gender of the tongue on it (and sometimes even the Genus and Species, as some dog lovers [ -- literally -- ] can attest). If you experienced orgasms, could love follow? Are you talking about your second husband? I would prefer, for your mental state, that you be clear about the nature of the relationship you have with someone with whom you are being sexually intimate. So long as your expectations are congruent with reality, you minimize the chance of being psychologically injured. Consider that if you are in a monogamous marriage, you're hurt if your spouse has sex with someone else. If you're a mistress, you accept the fact that your lover services his wife sexually and you are not entitled to jealousy. If you get a "mercy fuck" (not knowing it was that) and expect more, you're profoundly disappointed. Anyone not know what a "mercy fuck" is?***

*** OK. Someone e-mailed me a few weeks after I answered this question to ask what a "mercy fuck" was, so I have decided to answer it here, adjacent to its reference. A mercy fuck is when you are in a position of hurt, loneliness, confusion, or are otherwise compromised, and someone takes you to bed as a one-time (usually) consolation. Example: Your girlfriend dumps you and a good friend's girlfriend takes you to bed with all kinds of compliments about your lovemaking. Pretty heady stuff, huh? So you're feeling pretty thankful and you'd really like to do it again, but she then tells you that it was a one-time thing. If you expected it to continue, you'd be pretty depressed. Any questions?

I take the stance that everyone is inherently sexual and that socialization INHIBITS them. I have seen it over and over again. Peel away the layers of inhibition and natural, pleasureable sexual response usually follows. Along the way we have to help you think differently about your religious messages, and maybe learn to communicate better with each other, and probably to resolve some scars that we-just-don't-talk-about (the elephant in the living room). So if you do your homework between therapy sessions and let your sex therapist encourage a different way of thinking about things, you've got an excellent chance of finally having an orgasm with a man. But don't throw away the vibrator! You might end up wanting to be sexual more often than he does, and if you are committed to monogamy, your old faithful could come in quite handy.

A controversial P.S.: I'm not critical of religion. Without it, I wouldn't have 80% of my patient case load.

Q:  What would cause the inability to have an orgasm? I am a 46-year old male, married for three years, and have enjoyed an active sex life until two months ago. I have no difficulty attaining or maintaining an erection. It seems that I have lost a lot of the sensitivity I used to have in my penis.

A:  Welcome to "older age". Starting somewhere between 40 and 55, something happens to the penis. It needs neurological stimulation to get erect (gone are the good old days of having a "boner" from fantasy alone). Then, it needs pretty much constant stimulation to stay erect. Ignore it for awhile (it varies from man to man) and it'll deflate and resist efforts to revive it unless you leave it alone for 10-30 minutes (varies ... ). Then, it needs more stimulation to achieve orgasm. I suspect that you're doing the same old things and not getting the same old result. Experiment with substantially more vigorous nerve stimulation (friction on the penis). If THAT doesn't work, see a Urologist who is comfortable with sexual matters. Soon. Don't rehearse the problem or it will be harder to fix.

Q:  What constitutes "premarital sex"?  What is the criterion for losing one's virginity? I don't consider oral sex or intimate touching to be premarital sex but my girlfriend's friends do. As a result, the physical part of our relationship has slowed way down.

A: Oh Boy! Traditionally, the loss of virginity was considered to be when the penis was inside the vagina (no reference to orgasm). To "Pop the cherry" refers to the bleeding caused by the rupture of the hymen. In some cultures, relatives still rush into the nuptial bedroom to spread chicken blood on the sheets to prove that the lady was, indeed, a virgin (and therefore more valuable than "used goods"). A student in a class on Human Sexuality that I taught recently told me that while spending the Summer in Sicily, his cousins gave him the present of a visit to a prostitute. When he attempted to enter her vaginally, she insisted "no, no" and guided his well-lubricated penis into her back door. When he confronted his cousins he was informed that she was a good religious girl who had to be a virgin on her wedding night.

Some men and some women consider "premarital sex" to be anything below the neck. Others consider that anything is fair game so long as the penis doesn't go into any orifice below the waist. There is no hard and fast rule. You'll have to decide between you. BUT:  If I said that you were prohibited from sharing anything with each other about your intellect until your wedding night -- or if I said that you MAY NOT communicate about your emotions until after marriage, what would you say? Religion aside -- I know, that's a big one -- the more you know about your intended spouse before you get married, the better chance you'll have of making an informed decision about your compatibility. I suggest that you also ask your girlfriend what SHE considers premarital sex, not her girlfriends. If she is that easily influenced now, I'd consider that a possible red flag for later.

Q: Where is the "G-Spot"? What is the best position to stimulate it? Are there any pictures or diagrams? I work in a medical clinic and I'm too embarrassed to ask the doctors.

A:  Dear Reader: This question is quite typical of the questions posed to the Sexdoc. Where are we, as a society, failing to make such mundane information readily available? The G-Spot Does Exist but some women's bodies have it become prominent when stimulated and others do not, leading them to conclude either that they aren't doing the right thing or that they don't have one (or that it is a hoax). Please consider individual differences. Some women's breasts are larger than others, some women can have an orgasm from mental concentration alone, others (most) cannot. And some women have a prominent G-spot and others do not. Finding it: You can do it yourself but it's a bit of a contortion. So I'll describe it from your lover's perception. Basics: Just like a penis doesn't get erect without stimulation (mental or physical), and your nipples don't get erect unless you're excited, the Grafenberg spot usually doesn't become identifiable without sexual stimulation. If you are sexually excited, and your lover is stimulating your clitoris or whatever also brings you close to orgasm, then inserts a finger into your vagina as far as possible (comfortably) and, assuming you're lying on your back, strokes the upper wall of your vagina with a "come here" motion, within anywhere from 2 to 45 seconds, your lover should feel a pea-sized raised bump. Constant exactly repeated touch will make the sensation go away (sensory acclimation) so the suggestion is to stroke back to front for maybe 5 seconds (again, respect individual differences), then make circles around it, then maybe left to right to left, etc. Vary the touch! If YOUR Grafenberg spot is responsive, your lover should be able to bring you to the brink of orgasm and keep you there for as long as your stamina holds out (or your masochism is exhausted). Some degree of simultaneous clitoral stimulation will also probably be necessary!

I have a delightful female colleague who was invited to be among a small select few to observe a demonstration of this. They witnessed a woman being stimulated on her clitoris and G-spot for half an hour, undergoing what she described as a state of constant orgasm. Almost delerious, she stopped her lover because she was exhausted.

p.s. Women have told me, and I have read in several places, that one of the "fringe benefits" for some women is that because of the angle of insertion of the penis, anal intercourse provides direct stimulation of the G-spot which does not occur during vaginal intercourse.

Order the Adam & Eve Catalog for a diagram and for a picture of "The G-Spot Vibrator". Please see their web page by linking from my homepage or call 800/765-2326.


Q:  Is there any way to control my emotions so I don't have an orgasm so quickly? It's embarrassing having an orgasm from just passionately kissing my boyfriend. How can I not be excited so soon? T. (Female First Name)

A:  Dear T. : 99.9% of my work is devoted to problems such as erection dysfunction, pain during intercourse, premature ejaculation, vaginismus, sexual desire discrepancy, obsessions regarding what sexual behavior is "normal", desire discrepancy, sexual crimes, lack of sexual desire, and, the grandaddy of them all: GUILT. Consequently, it is refreshing to hear about the other end of the spectrum -- too much of a good thing, as it were.

Dear Reader, please don't snicker or wish you had this kind of problem. It is embarrassing to suddenly have an orgasm in public to find copious vaginal lubricating fluid running down your leg, or to have obvious physiological signs of an orgasm from just the touch of a gynecological exam. One of my first cases was a college woman who claimed that she had a second clitoris -- in the snall of her back. She loved to slow dance but when her partner held her with his hand in that spot and rubbed a bit she would have an orgasm and her knees would buckle. Her solution was to tape a 4 inch square gauze pad over that area when she went to a dance.

Alas, there is not much that can be done short of central nervous system depressants (alcohol and drugs) and some research shows that small amounts of those will briefly enhance sexual response. Laughter, aerobic exercise, and sexual response -- prolonged stimulation and orgasm -- cause the release of endorphins, which are morphine-like chemicals from the pituitary gland. Endorphins are an explanation for the "runner's high" and are known to bolster the immune system. Consequently, T, like the Midas Touch, you have too much of a good thing. Please experiment with seeing if exhausting the system helps. That is, can you pleasure yourself to numerous orgasms first, then see if passionately kissing your boyfriend still results in orgasm? Please experiment and let me/us know; if you follow up I'll post the sequel to the web page also. Any suggestions from readers? Please e-mail them to

Q:  My 20-year old girlfriend and I have been madly in love for a year and a half, and have been sexually active almost that long. Recently she broke up with me saying that she just wasn't attracted to me anymore. I haven't changed -- is her body just bored with mine?

A: Everybody not familiar with the Coolidge Effect needs to know it: Mammals are sexually stimulated by variety! We can only speculate. Maybe she is looking for adventure and more experience with more lovers, maybe she just fell madly in love with someone else, etc. One bit of pro-active advice I can suggest: ASK HER. Maybe not this week, but if you and she had that good of a connection, she might be mature enough to be honest with you. And maybe she's just fickle.

Q: I am a 24-year old married woman and have had vaginismus for five and a half years. I have heard that vaginal delivery birth will cure this problem. Is that true?

A:  Before I can comment precisely enough, I need more information. Vaginismus is a condition in which there is autonomic (involuntary) clenching of the introitus (the opening to the vagina) either when any object (finger, tampon, penis, speculum, etc.) is attempted to be inserted or only when a penis (and maybe a finger) is the contemplated penetrator. Thus: can you insert anything, and is this consistent?

I cannot insert a tampon. I am in therapy and my therapist has me using vaginal dilators (cylinders of graduated size rounded like a nose cone on one end). I can insert #1 and #2 easily but I experience discomfort with #3 and pain with #4. My husband and I would like to have a baby but I don't know if I could tolerate AIH (Artificial Insemmination by Husband's sperm).

There is a rare condition which I believe is yet unnamed that fits what you describe. Rather than situational clenching (OK for tampons, not OK for penis) or universal clenching (anything attempted to be introduced), there is a condition that seems to be like vaginismus but pain occurs at a modest threshhold of dilation. In this condition a woman can receive anything up to a particular diameter without discomfort, and everything after that threshhold diameter is progressively more painful. There are fewer than ten cases reported in the medical literature, and all but one reported that a vaginal delivery eliminated the problem. Just because fewer than ten cases have been written up doesn't mean that there are few in the population at large. PLEASE NOTE that the dilation threshhold here is smaller than the average penis. Categorically, every woman can stretch the introitus to a point of pain, but we're talking about pain at a relatively small diameter in this case.

Please also note that I would EXPECT a woman with this condition to develop secondary vaginismus! The human brain strives to protect its host, and it learns to avoid painful circumstances. If that weren't the case we'd have more burns on our hands. This condition would be consistent with your attempts to overcome vaginismus with the dilators. Best wishes.

Neither my wife nor I have a sexual "dysfunction". Our sex life is just boring. We have exhausted the "pop psych" books to our satisfaction. What can we do now?

You're in luck! The most common solution to sexual dysfunctions is a set of mediated exercises designed to address inhibitions and ignorance. The exercises help participants to get in touch with their most uninhibited sexuality and pleasure, and in so doing, the dysfunction is (usually) corrected. A majority of couples who undergo the treatment remark near the end that they are more sexually flexible after the problem was fixed than before they had a problem. A typical comment is:

One person asked me if non-essential sex therapy for the purpose of enhancement was the psychotherapy equivalent of cosmetic surgery. That caused me to think a bit. If one of the goals of psychotherapy is to help someone achieve the best quality of life possible, and if we perceive sexual behavior and satisfaction as a continuum, then sexual dysfunctions are big signposts that usually motivate people to seek help, and "boring" is down the path but not "bad enough" to signal the need for help. Everyone finds the process of psycho-sexual therapy uncomfortable, but universally, those who complete it are very, very glad that they did.

So to answer the question directly: What can you do now? You can decide if "boring" is what you are willing to accept. If you would like to change it, and you say that you have exhausted bibliotherapy (I love that word!), "sign up" for sex therapy for enhancement!

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