Sex and Relationships

Sexual Dysfunction

Answers to questions about sex therapy and sexuality

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7/3/98 Q: At 12:02 PM 7/3/98 EDT, you wrote: >I was wondering if there is anyway other than surgery that i could enlarge my >penis girlfriend says she is satisfied with what i have but she >doesn't reelly seem like she likes the sex in our relationship....I also just >have wanted more length to my 6 and a half inch there any >way....thanks doc....V.

A:  Dear V.: NO, there are no reliable ways -- don't be fooled by vacuum pump ads or other devices.

Make her a deal: You'll be content with the breasts God gave her if she'll be content with the penis God gave you.

If that doesn't work, I suggest that you consider finding a woman who appreciates you for who you are, not for the length of your penis.


7/3/98 Q: Dear Dr. Fitz My problem is that my wife's job has her traveling 3-4 months at a time and I miss having sex very much. I would like to know is there is any prescription medication that acts as a sexual desire represent. This situation is beginning to(after 4 years) put a strain on our marriage. She doesn't miss sex so it shouldn't be a problem for the week or two she spends at home between jobs. Any advice you could give would be greatly appreciated. Thank You

A: Your question reminds me of the myth that: "The Only REAL Sex is penile-vaginal intercourse". The best suggestion I can make is that you NOT attempt to repress your sex drive, but that you experiment with creative ways to be sexual by yourself! Sexual activity releases endorphins, chemicals from the pituitary gland, into your bloodstream, and they not only make you feel good (and put some people into immediate sleep), but they strengthen your immune system! Rejoice in your sexuality, and do it as often as you like (at least twice per week to keeep your plumbing in good working order). Lament that your wife travels so much, but enjoy each other sexually when she's there!


I think I have exhausted the creative masturbation route. I realize you might be hesitant to recommend medication via email, but do you think a local sex therapist could help in that area. I love my wife deeply and will do whatever it takes to save our marriage. I just need a little help through these rough spells. > > thanks again > > >

A: Most sex therapists are psychotherapists, and do not prescribe meds. Only MDs do that, and few of them are trained in psychotherapy, and fewer still in sex therapy.

It sounds like saving your marriage means being asexual at least when your wife is home. Is that true? Please do see a sex therapist -- not for meds but for assistance in sorting out the dynamics of your relationship and your attempt to ignore a major dimension of married life.

The question is not whether you love your wife. The question is how your wife can reconcile her love for you and her preference (?) that you become asexual.


7/2/98 Q: Hello Doctor, I am a 20yr old male in australia. My girlfriend and i have both had blood tests and we are both clear. We have not had sex yet but we have been giving each other oral sex for a short time so far (she does not wish to take it further just yet). She has made me orgasm a few times - and although her methods are sometimes painfull, i do not complain. I have not been able to make her "come" yet, through oral sex, and last night i was told that i was not doing it quite right....i asked if she would mind telling me what she likes but because of her insecurities with her own body she refused, leaving me embarrassed that i had not been doing it right. So I have been feeling very shit to say the least these last 24hrs, and rather insecure with my own "ability", like will i EVER make her come...I cant even call her to arrange to see her again, and i am afraid i might lose her if i dont do it right soon, yes as you can tell this is a very early relationship and so not a secure one just yet. Can you give me some hints on what to do as i think i may be "all thumbs" at the moment... please reply soon and id appreciate this being somewhat anonymous...

Thankyou ahead.. Clueless.

A: Dear "Clueless"

It's not entirely your technique, Part of it is her communication! If you ignored her requests to be more gentle or to spend more time helping her get ready for intercourse, you'd be an insensitive brute. But for you to ask for her guidance in what her unique body responds to, and for her to refuse, leaving you in the dark, is her loss! A "good" lover is not full of techniques to be blindly administered to the masses of lovers. A good lover is sensitive to what his or her partner responds to, and what the partner likes -- and does it.

You're "only" 20. Tell her straight up that you'd be delighted to try to please her sexually but that you can't read her mind. If she can't get over what you describe as her insecurities with her body, wish her well, kiss her off (as well as body parts), and enjoy being with a lover who appreciates your interest in pleasing her!

That addresses your question about being "all thimbs". I said that part of the problem is her communication. Another part of this problem is YOUR communication. If she does something sexual to you, and it hurts, but you don't complain, aren't you role modelling that the recipient should just "suffer in silence"? So if you suffer in silence, why should she open her mouth and reveal her insecurities? You both need to communicate. Give her feedback about the differential way your body responds to stimulation to let her know not only that it's OK to speak up, but it is expected and appreciated!

I can't close my comments on this without capitalizing on the wording: We have not had sex yet but we have been giving each other oral sex for a short time so far (she does not wish to take it further just yet). I know you mean "penile-vaginal intercourse" by "sex" but shucks, folks, if giving each other oral sex isn't "sex", I don't know what is .... (Excluding Presidential definitions, of course).


7/2/98 Q: >I have had problems with retarded ejaculation all my life. I have been >able to identify several factors involved, but haven't been able to solve >the problem. The physical sensation of intercourse at my penis drops to >near zero. In the worst cases, I could as well be thrusting into open air. > Different lubricants may occasionally help, but are not a real solution. >Natural female lubrication is best. One woman leaked small amounts of >urine. Surprisingly enough, that was actually an excellent lubricant. >About half the time I can achieve ejaculation pretty normally (within a few >minutes), but when problems occur, they usually occur in bouts lasting days >or weeks. >1) Masturbation vs intercourse - Frequent masturbation involving >stimulation that is difficult to achieve in intercourse is part of the >problem, but not all. I can withhold masturbation for several days, weeks, >or months (longer times involve repeated attempts at intercourse), which >ususally helps me ejaculate in intercourse. Helps is a key word, this is >only a help. >2) If ejaculation doesn't occur for several days, sometimes it will happen >more easliy, but the sensation is much reduced. >3) If ejaculation doesn't occur for several days, sometimes I can have >intercourse without result, then while urinating I will emit ejaculate at >"low pressure". The same thing can happen as I sit on the toilet, forcing >a bowel movement. >4) Vaginas that are tight or have unusual characteristics adding to >physical sensation level are much better than internally large or loose >ones, with "normal" about in the middle. >5) Excitement on the part of the woman is also helpful both from a physical >stimulation point and mentally, as opposed to an "accomodation", which is >more likely to be unsuccessful. > >I need something that will help me increase physical stimulation, or cause >easier ejaculation by way of muscle movements (mine or hers), drugs >(internal or topical), a lubricant that is very close to natural (I've >tried all that are commercially available, most of them are too effective >as lubricants and don't pass sensation well.), or... > >Can you help in any way? > > >

A: Retarded Ejaculation is one of the most difficult problems to treat because it is caused by so many different and often tangential things. What you describe has what sounds like some systemic (medical, physical) components and some psychological things. It sounds like you need more friction -- urine is an anti-lubricant. Before embracing this as "in your head" with frustration if that approach fails to yield change, I suggest a work-up by a good Urologist first.

And it might just turn out that your unique combination of nerves and sensors require more vigorous stimulation for you to achieve orgasm. Short of seeing a Urologist, does some masturbation before intromission help? If you don't ejaculate within a few minutes, I suspect that the "worry" (of whatever degree) over whether you will drives the possibility deep underground.

This is a complicated picture and needs trying different approaches to see what works. Obviously you've tried some things. A team approach by a Urologist and a sex therapist might be best.

I know you were hoping for a possible solution, but without experimentation, what "works" is going to be elusive.

Please let me know what you do about this.


7/2/98 Q: Hi first of all: its nice to see someone performing a service like this for free!! thank you.

now for my problem: i am 16 and me and my girlfriend had sex for (my)the first time, after having sex for 2 hours she must have had about a million orgasms and I had to stop because I was getting tired, but the thing that was worring me the most was I had not "cum" and I thought maybe you cant always do it so I did not worry.. The second time we had sex (about 6 hours later) I was working on her for 3 hours and we tried different positions and I still failed to "cum", after I could not go on I got her to give me a "blow-job" after a while she got bored with doing it(which i understand), and i lost my erection. and I just started wondering "oh god is there something wrong with me" and serched on the internet


/just call me TURBO

A: Dear Turbo,

How long did it take you to learn to ride a bicycle? I'll bet you wobbled, fell off, jumped off before you learned how to brake smoothly, etc., right? Sex in all other animals is part hard-wired into the brain, and part being a copy cat. Monkeys who do not see grown-ups copulating by a certain age (in their adolescence), are bumbling idiots when trying to reproduce as grown-ups. In humans, however, there is nothing "innate" (in the brain) -- it's all learned. So just keep on experimenting and learning and try really hard to not make the same mistake twice. But you, like me, and like all other humans, will learn from a number of sources and we will all make mistakes. And MAKE SURE that none of your pre-cum or ejaculate gets into her vagina, whether by penis, fingers, or tongue!

7/2/98 Q: What is desenatizing gel used for? > >

A: Desensitizing gel is a topical (goes on skin) anesthetic (makes nerves go to sleep) designed to numb the penis some so a man won't have an orgasm as quickly as usual. The problem is that sometimes some of the gel gets onto the woman's labia, and the two end up feeling like they're without genitals!

I consider it a poor "quick fix" to taking the time to train the penis to be patient. Isn't making your penis numb sort of defeating the purpose?

7/2/98 Q: Dear Doc,

My girlfriend and I are talking about shaving her vaginal area and was wondering if you can recommend what type of shaving cream or other product to use in order to do the shaving and secondly are there products that will stop the itching as the hair grows back, as this is a big concern of my girlfriend and one reason she is reluctant about shaving the vaginal area bald.

Thanks curious

A: In a word (three, actually) Don't Do It. You run the risk of a nick that can hurt and bleed, or use an electric shaver which might be irritating. There is no moisturizing cream that will SUFFICIENTLY reduce the itching. More than one woman has terminated her relationship with the boyfriend who shaved her because of the grow back misery.

There are porno videos of "shaved pussies" but those women get PAID for doing that.

On the plus side, both partners will probably find sex with a shaved pussy extremely erotic. Women have described to me that they were in an almost constant state of arousal for the first few days, feeling the wind and cloth that had previously been held away by pubic hair. Many complained about "leaking" lubrication because of the arousal, creating a wet spot that looked like they had "peed their pants". But almost 100% said that the grow back was NOT WORTH it, and that shaving their genitals every day was one more chore.

You've been informed. It's your (and, hopefully, her) choice. Please let me know what you decided and what happens.

7/2/98 Q: Dr. Fitz, I am 18 and so is my boyfriend. We have been together for 7 months. We have had sex before and have used condoms each time. Recently we have been having problems where we feel like we went too fast and we need to stop all fooling around, sex, etc. but every time we are left alone we end up at least fooling around and we regret it after. Can you give us some suggestions on how to slow down. Is this just hormones or obsession?

A: You're too young for this to be an obsession. Hormones provide the motivation, but I suspect that it is the really, really, good feelings from sex that provides the reward and reinforcement. What you need is an analysis of why you regret "fooling around". Does going "too fast" mean that you feel guilty? We live in a sexually repressed society. You're hungry kids let loose in the candy store with no one to tell you when to stop. You have to learn your own limits. But Please get clearer about what you're doing that warrants "going too fast" and "regretting it".

7/2/98 Q: Dear Doc,

When I was a freshman in college I took a class in human sexuality. One of the curriculum segments focused on masturbation. Several films and videos were shown of people performing masturbation demonstrations. Some performed interviews and answered questions in a clinical atmosphere, others simply performed. Ever since then I have fantasised about being a "demonstrator" if you will, in just such a thing.

Do you think its abnormal to feel this way?

A: It's common for people to fantasize being seen -- it's also a bit narcissistic to think that your genitals are the object of visual adoration (to some degree). But exhibitionism is illegal in every state, so if you want to be a clinical demonstrator, make sure you are protected by someone. Don't do it in public. When (not if) you are caught, you'll have to register as a sex offender, and that will cause some problems in life.

7/2/98 Q: I heard that there is a spot on a woman's foot that, when rubbed correctly, causes an orgasm. Where is this spot, and how exactly is it stimulated? Thanks.

A: Great Street Rumor but I doubt that many women can have an orgasm from foot stimulation alone.

7/2/98 Q: Hello Dr Fitz,

I have been married for a year now and love my wife very much. I also still find her very attractive. A few weeks ago I lost my erection just before I was entering my wife. Since then I have been worried when it comes to the point where I enter her. My legs shake, I feel really, really nervous and lose my erection. Just before we have intercourse I still keep my erection, But the horrible feelings come back just at the entering point. I have never felt like this before and feel very worried. The worst part of all is that I love my wife very much and she thinks I am going off her sexually. Our sex life is very important to us and I don't want to lose her in the long run.

Can you advise me in a way to calm down and relax?

I have tried massage, Just cuddling and starting from scratch with touching etc but the worry just comes back at the crucial point.

I hope you can help, in part at least.

Thankyou in advance.

A: It sounds like a panic attack. The questions are what triggers it and why. I suggest a course of behavior modification monitored by a sex therapist. A word of caution: The longer this goes on (and gets repeated), the more chiseled into your brain it will become and the longer it will take to back you out of the blind alley. I have had cases like this that came in for therapy after the first occurrence, which responded to intervention in only a few therapy sessions. Those that have gone on for years take 6-18 months to "fix".

For your sake, if it doesn't improve, get intervention.

7/1/98 Q: Hi. I am 20 years old and my boyfriend and I have been intimate for almost a year and a half now. Our relationship is great and so is the sex. The only problem is we don't get that many chances or places to do it as often as we'd like. We've done it in many places from the backseat of his car, to my pooldeck. Now we only have sex in a regular bed which is fine with me but sometimes I want more. I don't know if it's a new position I'm looking for or a new place. It also seems like I don't last as long as my boyfriend does. He can go for an hour or longer. Do you have any suggestions on how I can make myself crave the sex longer than I do?

A: The human animal is remarkably stimulated by change and by novelty -- literally, new things. But the price we pay for that is in becoming accustomed to what gets repeated. There is a good reason why there is an expression "same-old-same-old". Virginal experiences become fewer and fewer the older you get, so I encourage you to value innovative elements tremendously. There is no way to re-create the craving you experienced with the sex of your early experiences -- you can have a new experience only once, and thereafter it's not new any more. What you can do is what you refer to: sex in new and different places. And there are lots of sexual positions, and sex toys, and roles you can play with each other, etc. That's the "novelty" within a committed relationship.

One word of caution: Laws regarding exhibitionism (public nudity) are enforced with various vigor in different parts of the country. If you get reported for sex on the pool deck by someone who can see you, you might find both of you, or only your boyfriend, in jail as (a) sex offender(s).

7/1/98 Q: >hey! ummm....i gotta question. I'm a 13 year old female. i wanna have sex with my boyfriend. i dont know why, but i just feel like losing my virginity and getting it over with. a couple of my friends who are my age arent virgins and they say itz nothing....and my boyfriend iznt pressuring me to screw him...i actually asked him if he'd screw me. so, should i screw him or not? > Tart >

A: Dear "Tart":

I strongly urge you to hold off -- at least until I can get more of a repy to you. There are huge consequences if you get pregnant.

While I hear you say that many of your friends are sexually active and they think it's no big deal, I think that women 18-25 years old, who regret having started being sexually active in their early teens, have more of a vote in my book.

NOTE:  The above two paragraphs were sent immediately by return e-mail. The following was composed on 7/1/98.

Part of the challenge of being a sex therapist who has been doing this for over 30 years (which gives you some idea of my age) is getting "on the same page" with a 13-year old virgin who wants to be sexually active.

My first statement is that you hold the power -- to become more sexual or not. Please never forget that. No man, and certainly not your friends, can coerce you to be more sexual (unless it's rape, unfortunately). Please talk to as many women 18-35 years old as you can get your hands on, and ask them about the pros and cons of starting intercourse at your age. Yes, some will say that it was good for them, if they came from homes where there was no emotional support or love, but the majority will say that they regretted it because they were not emotionally prepared for the roller coaster.

The good feelings are the sex itself (it feels damn good!), feeling "mature" (at least doing what "grown-ups do"), feeling valued by your lover, and the thrill of "getting away with it" without anyone knowing.

The down swings of the roller coaster are feeling punched in the gut if you are pregnant, having to decide if you will carry the child to full term or have an abortion, having to decide if you will give the baby up for adoption if you have it, feeling "screwed" if a guy does the 4 "Fs" to you: Find 'em, Feel 'em, Fuck 'em, and Forget 'em. Of less but still important negative emotion, there's the embarrassment of asking your doctor for a prescription for birth control pills, or using condoms, knowing that somewhere between 2 and 10 of every 100 women get pregnant within a year using condoms (they are not 100% effective for either pregnancy or disease prevention), the fear of getting caught, worry if your period is a few days late (and worry can make it late), how to explain the wet spot on your parents silk bed spread, and other matters.

Being sexually active with intercourse is not a right. It is a privilege that comes with responsibilities. You can choose to do it, but you need to be a "well informed consumer" and you need to know what you're buying.

And now for what is probably the least important factor to any 13 year old: It is not known why, but rates of cervical cancer (the cervix is the opening into the uterus) are remarkably higher for women who started sexual intercourse at an early age. I believe that knowing that will not be sufficient to stop a 13 year old, but I hope that you never forget that you were told when you were 13.

And, so I will not be successfully accused of saying what you "can't" or "shouldn't" do without saying what I suggest, I will add that I think that most 19 year old women are emotionally mature enough to begin having sexual intercourse. If you go to college, listen to your girlfriends and observe during your Freshman year, and consider becoming sexually active during your sophomore year. Until then, you and your lover(s) have fingers, lips, tongues, and a mouth to use on each other. And let's be clear: I'm not saying that you "shouldn't" be sexually active with each other -- I'm suggesting that you consider abstaining from intercourse until 19. Any questions?

7/1/98 Q: > I am a 20 year old female virgin. I am currently in a relationship with a 23 >year old male virgin. We both consider ourselves in love with each other and >care about each other. The problem is that whenever we attempt to have sex, >the pain is unbearable. It feels like his penis goes in about 2 inches then >it can't go any further. At that point I begin to feel pain in the vaginal >area, but also in the anus area. We have attempted sex 3 or 4 times and the >same problem keeps arising. I have tried several relaxation techniques but >none of them seem to work. When we attempt intercourse, we practice each time >using great caution and patience - he moves slow and doesn't force anything. >In assessing the situation, you may want to consider that I was repeatedly >sexually abused as a child (between the ages of 7-9). I wasn't abused in the >vaginal area, but rather orally. My main concern is that the amount of pain >seems abnormal because I can't do anything to make it go away. I am also >concerned about the fact that pain travels to the anus area. My boyfriends >penis is quite large in terms of thickness and length - about an inch and a >half wide, and about 7 inches long. What do you suggest? > >

A: Bear with me -- instead of writing a dissertation on all the possible reasons, I'm going to ask you a few questions.

First, however, do not attempt penile penetration again until you and I have come to a way for you to do that that is likely to be pain free.

Starting point: The first thing that comes to mind is that you have a significant amount of hymen. Can you insert a tampon? Can you wash two fingers, make them slippery, and insert them more than 2 inches? If so, does it feel like there is a "doughnut" inside that has a smaller opening than the opening to your vagina?

Have you ever had any problems with having a pap smear or with a doctor using a speculum?

When you respond I can take the next step.

I look forward to hearing from you


p.s. PLEASE don't start off falling into the trap of believing that the only "real" sex is penile-vaginal intercourse. All sorts of other ways to bring each other and yourself to orgasm are great sex!



I have attempted to put a tampon in and have been successful, but a few minutes later, i could feel pain where the tampon was. I don't know if maybe i put it in wrong or not.

My boyfriend says that he could feel the smaller doughnut opening inside. I have a feeling that at that point is when I felt pain and asked him to remove his finger.

I have not yet been to a gynecologists because I am a big baby and too afraid to go. Yes, yes, I realize that should be the first step, but well, you know.

I hope this helps! Thank you for responding so quickly.


ps: yes - we definitely know the possibilities of alternative sexual pleasures! (and practice them much more than actual intercourse!)

I'm pretty sure that what you describe is some amount of tissue called the "hymen". I encourage you to go to a library and look through a text on Human Sexuality or in a book on anatomy (or search the internet?) for a picture of where, and what, the hymen is and looks like. It's not like an ear or a foot, which are pretty much similar looking (except Dr. Spock). The hymen can be just a little ridge all the way around, or it can be like Swiss cheese (sorry about that), covering the entire vaginal opening but with holes that allow menstrual flow to pass. It sounds like it is a thick and somewhat inelastic ridge in you. I suggest that you bite the bullet, see a Gynecologist, and ask him or her what can be done to take care of that problem.

7/1/98 Q: Dear Dr. Fitz My problem is that my wife's job has her traveling 3-4 months at a time and I miss having sex very much. I would like to know is there is any prescription medication that acts as a sexual desire repressant. This situation is beginning to (after 4 years) put a strain on our marriage. She doesn't miss sex so it shouldn't be a problem for the week or two she spends at home between jobs. Any advice you could give would be greatly appreciated. Thank You

Your question reminds me of the myth that: "The Only REAL Sex is penile-vaginal intercourse". The best suggestion I can make is that you NOT attempt to repress your sex drive, but that you experiment with creative ways to be sexual by yourself! Sexual activity releases endorphins, chemicals from the pituitary gland, into your bloodstream, and they not only make you feel good (and put some people into immediate sleep), but they strengthen your immune system! Rejoice in your sexuality, and do it as often as you like (at least twice per week to keeep your plumbing in good working order). Lament that your wife travels so much, but enjoy each other sexually when she's there!

7/1/98 Q: Hello Dr., > >I have two small doubts. > >(1) During oral, partners take the liquid in their mouth. Is it >normal take the liquid (semen/precum or vagina liquid) in through >mounth ? > >(2) For men, Is it problematic to wear little tight underwear ? I >usually wear little tight underwear. But I take-out in night and wear >loose cloth before sleeping. > >Thanks

A: The word "normal" does not apply. There is nothing harmful about taking male or female liquid into the mouth unless the supplier of the liquid has an infection.

Tight underwear on men holds the testicles close to the body and raises the temperature of the testicles, which kills weak sperm and reduces sperm count. If you're trying to get pregnant, wear boxer shorts. Otherwise, tight little underpants are fine!

7/1/98 Q: My boyfriend has no trouble getting erections and ejaculating by hand or mouth; however, when we try to have intercourse he sometimes loses his erection and/or has a hard time ejaculating. Why do you think this occurs? Any suggestions? P.S. He has not had this problem with another woman. Is it me?!

This is a perfect illustration of a psychogenic (mind created) problem. I think he's experiencing some anxiety. More familiarity should solve the problem. Spend more time being sexual together. Have Fun (keep it from being a grim experience.

7/1/98 Q: my wife & I are both in our early thirties. during intercourse my wife usually experiences an orgasm after 2-3 minutes but loses all interest right afterwards -urging me to hurry up and finish.I usually need at least 10 minutes so this leaves me a bit frustrated.........I guess this is the female version of "Premature Ejaculation" how can I slow her down and possibly let her have more than 1 orgasm?

A: Your "speeds" (time from intromission to orgasm) are slow to change, although there are ways to do that. I suggest that your penis be stimulated for 7 minutes before it's put into her vagina. The goal is NOT simultaneous orgasm, but rather, orgasms close enough together that continued stroking is not noxious to either of you. So if you get "three minutes close to orgasm" and then insert, and she takes 2-3 minutes once you're inside, then you should be closer in time.

7/1/98 Q: I'm a 52 yr old woman widowed for 8 yrs. I'm finally getting horny again. Problem--I'm about 50lbs. overweight and don't see a human male partner in my future. What is the best way to masturbate - with my own finger , which just doesn't seem to do the job or with some kind of sex toy? I've checked our some of the sex catologs and am overwhelmed and confused. My husband and I had a very active sex life, lots of licking, sucking and fucking. We tried anal sex but I didn't care for it. Also, how do I get into the right mood when it's just me in the bed? Can you give me some helpful advice before my vagina dries up forever? Thanks , C.

A: Masturbation is highly individualistic. Check out "Sex for One" by Betty Dodson. Different people are eroticized by different things. Many women like trashy romance novels. Check out "Women on Top", a collection of women's fantasies by Nancy Friday. One way or another, gat to two orgasms per week; with less sexual activity you WILL experience diminished vaginal lubrication and thinning of the vaginal tissue. Your local chain drug store sells vibrators -- don't be fooled by those nice pictures of people vibrating their elbow; most are bought for sex play. Plug it in in the store before you buy it. It might be too loud or too gentle for you. Experiment. Have fun.

7/1/98 Q: Hello Doc... I have a question for you regarding a problem I feel I have. Before I make love to my wife I am so excited. I just can not wait to make love. We try several different things during the course of love making. Right after I have an orgasim, I don't want to be touched or anything. It is like all of the excitement is gone. Most of the time she would like to do it again but I just do not have it in me to do it. My question is how can I get the same feeling back for the second time as I had before making love to her....I want this for her not me. Sometimes I make excuses that my penis hurts or that I am tired. She is a very beautiful lady with a huge heart and I would like to make her happy not just once but several times. I hear stories of men going two, three or four times a night. Is this a normal behavior for males or do I have a problem? Please respond back to me.


A: Dear Jim,

Some men are tall, some are short. We have no difficulty accepting individual differences in height, but in areas where we can improve, we strive to do so. Some aspects of sex are relatively easy to enhance, and some are not. While retraining can seriously influence time to ejaculation (the protocol for premature ejaculation), refraction time -- the time after an orgasm before a man is neurologically and physiologically able to again be erect and achieve another orgasm -- is pretty much hard wired.

I suggest that you consider a few things. First, contradict the myth that "the only real sex is penile-vaginal intercourse". You can bring your wife to orgasm with fingers, toes, tongue, lips, your thigh or an elbow, to say nothing of vibrators. Bring her to orgasm several times before you engage in intercourse. If she feels "empty" when she has an orgasm when your penis is not inside her, buy a dildo and stroke her with it as you stimulate her clitoris. Second, check out the books by Brauer and Brauer on ESO: Extended Sexual Orgasm. Third, accept with grace that some men can go 2, 3, or 4 times in a night, but that you are not one of them. No, you don't have a problem.

Q:  What can I do to help my boyfriend from losing his hardness when he goes to put a condom on? This has happened twice. He really got embarrassed and stressed out about it. We usually have foreplay for an hour. I am thinking of switching to the female condom.

A:  FIRST:  Please read what I wrote in the section on HIV & Herpes -- the female condom has a MUCH HIGHER PREGNANCY RATE than male condoms. Second: Pat yourself on the back for writing after it happened only twice. If this repeats too many times it creates "anticipatory anxiety" -- nervousness around thinking that it might happen again (which guarantees that it will happen again!). Third: I know you're relatively young (or at least your boyfriend is) to engage in foreplay for an hour. Experience, maturity, and sexual variety will likely address this problem all by itself.

If these are the first two times you have attempted intercourse, some nervousness is to be expected. If you and he have been sexually active for awhile, this is just a fluke, but something to be addressed NOW so that it doesn't become repeated and "entrenched" (sort of like fixed into his brain). The best way to handle this is to make positioning of the condom part of your foreplay, not the dividing line between "fooling around" and "getting serious". Cold makes a penis wither (in cold water many penises are absolutely miniscule!), so if you're using a lubricated condom, as soon as you remove it from the package evaporation starts, cooling the latex, and surround an erect penis with a cold sheath, and it's no wonder it goes down! If you like lubricated condoms, warm them (be creative as to where you could put it to warm it ...). Many women find the taste of the lubricant nasty, so an alternative is to use an unlubricated condom, and learn to unroll it (onto the erect penis, of course) with your lips and tongue. Go slow so as to do a thorough job. Keep the condom and the penis inside it warm as you proceed. If he loses his erection during this procedure, you've got a different problem! Lubricate the condom and make sure that the lubricant is uniformly spread over the entire length of the shaft and head of the penis by moving your hand, curled around the penis, up and down several times. Teach your boyfriend how to lubricate your labia. Be sure to focus his attention on the upper part where the greatest sensitivity is. If all this proves too much for him (if he now comes too soon), read the section on premature ejaculation. The essence of this "procedure" is to remove the demand on the penis to stay erect. No penis responds to commands (Stay ERECT, Damn It!). Almost all penises repond to attention and stimulation. Any questions?


Q: I have an orgasm only during oral sex, not intercourse. Is there something wrong with me?

Q: I can have an orgasm only when I'm on top. What should I be doing in other positions?

Q:  I have been married for 10 years. I have never been sexual with anyone except my husband. I have never had an orgasm. Five years ago after I delivered our only child I lost all interest in sex. What can I do about it?

A: These questions indicate a lack of familiarity with what "usually" happens as well as expectations of what should be happening. The sexdoc chooses to quote statistics very rarely because so many people want reassurance that they are "normal". But in this case, it seems appropriate: In well-conducted national surveys, the results consistently indicate that only about 40% of women achieve orgasm during penile-vaginal intercourse. I speculate that these women feel good about themselves and their partners (not exhausted or stressed out), that they experienced "enough" foreplay, and that there was the right combination of friction (neither too much nor too little lubrication, whether biological or store bought), pressure, and frequency of stroking that their labia were distended back and forth enough to pull on the clitoral hood, so that the clitoral hood rubbed enough on the clitoris, which, in addition to direct pressure on the clitoris from their lover's body, resulted in orgasm. Penile thrusting is a means to an end, not an end in itself (although I am quick to add that the vast majority of women want some "mass" to constrict against intra-vaginally when they have an orgasm -- but that's different from thrusting.

The clitoris needs stimulation. If you're not getting enough from penile thrusting, TOUCH  yourself on the clitoris or have your partner touch it! Many women think that self-stimulation during intercourse is insulting ("you're not doing a good enough job so I have to play with myself to finish me off") or infantile ("that's what we did as teenagers when we wouldn't go 'all the way'") or categorically different sexual activity ("you only play with yourself when you don't have a man around to take care of your sexual needs"). Well, I've got news for those who think this way: Each person is responsible for his or her sexual response, either by communicating clearly to the partner what your body likes, or by doing it yourself.

If you're having trouble bringing yourself to orgasm, read "For Yourself" by Lonnie Barbach, Ph.D. and follow the directions to the letter! For partner sex I highly recommend the books by Brauer & Brauer (with whom I had the pleasure of working about ten years ago) ESO and The ESO Ecstasy Program. The self and partner activities are worth the effort.

And if you have exhausted all self-help approaches, then SEE A SEX THERAPIST. And please do it sooner than later. I commiserate with patients in their 50's and 60's who lament that they should have sought help decades earlier. Use it or lose it. You can't make up for lost time.

Any Questions?

Q: Is suffocating yourself during masturbation being suicidal? I have heard about this but did not pay much attention to it until I found out that my 25 year-old cousin killed himself doing it a few days ago.

A:  Sexual Hypoxia -- not having enough air to breathe during sexual activity -- is rarely intentional suicidal behavior, but at least several dozen men die from it each year. I say "at least" because many are "simply" classified as suicides. I presume that the coroner might stop there to avoid adding publicity and sensationalism to an unexpected tragedy. Please do not try this! I am purposely withholding a detailed explanation of the technique. If you know anyone who says that they restrict their air intake in any way during sex that could be life threatening, PLEASE do whatever you can to help them get help. What you can do: Just hold your breath as you approach orgasm. BUT:  do not escalate on the idea that if some is good, more (or in this case, less) is better.

Q:  Can you provide some idea of what might be going on? My boyfriend is a 47 year-old electrical engineer who is currently unemployed and having great difficulty finding a job. He is stressed and anxious. He is having problems maintaining his erection and they are better in the AM than in the PM.

A: Henry Kissinger once said that the ultimate aphrodisiac is power. Very often, men who have "out of control" work problems also develop sexual problems. The medical term for erection dysfunction (ED), "impotence" literally means powerless or weak. When men feel less than competent professionally, they sometimes manifest this as an erection problem. I'm not the only sex therapist who had a couple in therapy for ED to have them arrive one week with a big smile to announce that he got a new job and they have been having wild and crazy sex with great erections for hours! Stress, joblessness, and many other factors that affect your self-image can have a powerful effect on your sex life. So what should you do in that circumstance? Don't avoid sex. Avoid performance pressure. The idea that the only "real" sex is penile-vaginal intercourse is debilitating! Plan to be as sexual as possible with the rule that the penis may not enter the vagina! See how many inventive ways you can bring each other to orgasm or just a long time feeling great! Any volunteers?

Q:  Why can't I climax with my partner when my penis gets overstimulated and goes numb?

A:  It's called "sensory acclimation". Your nerve endings "fire" by inverting two chemicals along the nerve pathway. When you fire them repeatedly, they become metaphorically exhausted and cannot fire until they rest. This is a case where "LESS IS MORE". Respect the fact that we all have glorious individual differences, and that the "average" stimulation is too much for 50% of the people, and not enough for the other half! I suggest that you avoid penile stimulation by engaging in other pleasureable activities, and that you leave attention to your penis to when you want an orgasm.

If by " ... can't climax with my partner ..." you mean simultaneously, stop chasing windmills. Simultaneous orgasm is a myth. But, if by the same wording you mean that you can't climax when your partner is stimulating you, you might have a communication problem and need to be very precise about how your body likes to be touched. If your partner is judging you by himself, and his penis likes vigorous stroking, that's HIS penis, not yours!

Actually, I get this question much more frequently from women: Why does my clitoris go numb just when I'm close to climaxing? People who stumilate clitori (just kidding -- it's clitorises) take note: Vary the technique. 10 seconds to and fro on top, 10 seconds with thumb and forefinger on the sides, 10 seconds of a rotary motion.

AT THE RISK of sounding like "Mr. Science", demonstrate sensory acclimation by using three pans or other containers of water large enough to insert a hand without overflowing. Fill one with very warm water, a second with cold water, and a third with lukewarm water. Put one hand in the hot water, the other in the cold water. Wait about a minute. Then put both hands in the lukewarm water. The hand that was in the cold water will sense "warm", and the hand that was in the hot water will sense "cold". One hand's "hot sensors" got exhausted, and the other hand's "cold sensors" got exhausted. Variation: Blindfold someone and use two pans for lukewarm, and ask them to describe what they feel. They will swear that the two pans are different temperatures (then have them switch hands in the lukewarm pans).

Q: SEVERAL QUESTIONS ABOUT ERECTION DYSFUNCTION ("ED"): On Tuesday, 2/10/98 I added comments on treatment of ED. Link there now or look on Answers to Questions #3 when you'd like to see that material.

Q: I get aroused by the thought of my wife with an old boyfriend and her having sex. If she tells me stories about them I get aroused easily. Am I Abnormal should I see a counselor?

A:  It's OK to fantasize about just about anything; it's not OK to act out some fantasies. There are voyeuristic aspects to this fantasy -- doing something naughty -- and there are performance aspects. If the old boyfriend is doing the deed, you don't have to worry about whether you're hard enough or pleasing her enough In addition, there is a lot of curiosity about how you measure up compared to someone else. In the words of one of my patients to her husband who was concerned that he found other women attractive:  "Honey, I don't care where you get your appetite, so long as you eat all your meals at home!" As an occasional excitement in the marital bed, this is fine. If you begin to "need it" during every sexual encounter, that could become a problem.

Q: I am a 23-year old engaged female sexually attracted to my best (female) friend of 12 years. We're thinking of having a menage a trois (3-way) with my fiance. Is this a good idea?

A:  I have added material to the answers to questions like these I already wrote. Please link to Answers #3 now or go there when you wish.

Q:  What is Satyriasis? Does President Clinton suffer from this disorder?

A:  The term "Satyriasis" and the term "Nymphomania" are archaic labels for "excessive sexual desire" in men and women, respectively. They are out of vogue partly because the health care community couldn't agree on what constituted "excessive". The sarcastic definition of a nymphomaniac is "Any woman who wants to make love more often than I do". (Note that this can be stated by either gender.) Functionally, the essence of the disorder is inability to find satisfaction in sexual behavior. That is, engaging in sexual behavior, experiencing orgasm, and immediately feeling compelled to continue to be sexual whether or not the body is responding. It is the insatiable component that makes this malady identifiable. Sigh, if only it were that black and white!

The "shade of grey" rears its ugly head when we attempt to differentiate betwen satyriasis and very high sexual drive. How long is the time period after orgasm and before initiating more sexual activity before we call it one thing versus the other? The Satyr (as the man with the affliction is called) is a sorry person, because no matter how much he is sexual, it is never enough. Pause for a moment to reflect on the last time you were very, very thirsty. You drank water. You were still thirsty. You drank more water. You were still thirsty. Imagine going your entire life being thirsty. Drinking water seems like the best thing to do -- it makes you feel like the inside of your mouth is moist even for a short period of time -- yet within a minute or two after you finish swallowing, you still feel thirsty. So the next time a guy says "Gee, I wish my girlfriend was a nympho", please let him know that you wouldn't wish that on anyone!

Does Clinton suffer from this disorder? I doubt it. I think that he is smitten with power, that he is adolescently competing with Kenndy and other Presidents who had "improper" sex while President, and that he has adopted an adolescent sense of arrogant invincability.

The Sexdoc's take on the Lewinsky-Clinton matter:

The Sexdoc is pleased to have received so many questions regarding his opinion on the Lewinsky-Clinton matter. Herewith, then, my comments.

What is necessary to convict someone in a court of law also works with everyday behavior:  Method, Opportunity, and Motive. She had method -- she knew how to give oral sex. She had the opportunity -- numerous reports say she was admitted to the White House on numerous occasions (like 3 dozen) and at "odd" times -- AFTER she finished her term as an intern. And she had the motive: at least infatuation, at most, adoration, for this man in the most powerful position in the world. Because I find no indication of mental illness in Monica Lewinsky, I assume that she is self-serving and out to maximize the positive and minimize the negative. Therefore, if she had NOT had sexual contact with Clinton, it would be obsessive of her to spend over 20 hours on the phone with Tripp wringing her hands over the deep s--- trouble she was possibly going to be in if she lied during her deposition for the Paula Jones case. She has more "motive" for spending time with Tripp on the phone trying to figure out how to save herself than she has "motive" to lie about having had sex with Clinton. So I surmise that she DID have some sexual contact with Clinton.

Clinton has been quoted in several publications as having told Arkansas State troopers that " ... oral sex is not adultery". For Clinton to now say "I have not had SEXUAL RELATIONS (emphasis the sexdoc's) with Lewinsky"  might be true -- IF by "Sexual Relations" Clinton means exclusively penile-vaginal intercourse.

So I think that Clinton and Lewinsky agreed for Lewinsky to perform oral sex on him on numerous occasions, an act which I infer Lewinsky was honored to do (Geez -- it was the Prez himself! How many [dozen] women can say that?). Feeling affection for the guy and really wanting to avoid embarrassing him (and herself), yet fearing what would happen if she was found in a lie about it, she anguished for hours with Tripp about what to do. So choosing the perceived lesser of two evils, she figured that Clinton wasn't going to blow the whistle on both of them -- he had vastly more to lose than she -- so her safer route was to deny it. CONSIDER FOR A MOMENT what might have happened if she said "Yes, we had sex", and Clinton, under oath or not says "No way, Jose". It's the word of a twenty-something White House intern against that of the President of the United States! At the very least she would have been accused of self-aggrandizement, and maybe even slander!

So here's poor Monica, between the biggest rock and hard place of anyone. She was damned if she said yes and damned if she said no. So now, she said no to protect the Prez, and if Tripp hadn't taped her both on the phone and in person, she'd be in the clear. If she now says she didn't have sex with Clinton, she can't explain what she said to Tripp. And my clinical inference was that she was scared out of her mind about what to do.

If Lewinsky were opportunisitic, she'd choreograph this whole scene much more shrewdly for maximum book rights and movie rights. This is not the sequence of a golddigger! This is a scared young woman.

I predict (as of 4:30 p.m. Pacific time on Tuesday 1/27/98) that Clinton's strategists have advised him to hang his fate on the thinnest thread of the wording "Sexual Relations" -- assuming that only oral sex transpired between him and Lewinsky -- and that that is something that both he and Monica can say in a lie detector and not get caught. So EITHER no one will ask Clinton if he engaged in oral sex with Lewinsky, thus allowing the "white lie" to exonerate both Clinton and Lewinsky (what a graceful, diplomatic out), OR someone will ask about oral sex, and Clinton will either lie or admit it. And if he admits it, I'll bet he'll insist that "Sexual Relations" means (only) intercourse.

Would somebody please ask Clinton if Miss Lewinsky ever performed oral sex on him?

Tuesday, 2/10/98 update: FLASH! Surprise, surprise: Divert attention away from Clinton by accusing the Special Prosecuter's office of leaking ionformation. Who said that the best defense was a good offense?

Q: I am 48 and sexually passionate. I've lived alone for the past 6 years during which I had two significant relationships, both with men who described themselves as "horny". One was 56, the other, 50. Yet I could never get them to have sex with me more than once or twice in any three-day period despite their constant chatter about fucking "young nubile" women. Must I come to terms with the fact that men in their 50's already have a dwindling sex drive or did I just choose men who needed to feel "young" by flirting with women 15 to 20 years their junior? Surely I must be able to find a man close to my age who is capable of responding to an intelligent, passionate, sexual, affectionate woman? Is enjoyment of sex determined by genetics or environment -- or both? Plus, I get turned on just thinking about a man. Do men get turned on by thinking or do they need the visual or tactile to get aroused? Lisa

A:  Dear Lisa -- and remember, folks, there's lots of Lisa's in this world, so this is not indiscreet. The sad truth, and apparently contradictory to Darwin's Theory of Evolution, is that around puberty, women become sexually arousable and steadily increase in their sexual interest well into their 60's (before they level off or get compromised by other system failures). Men, however, peak in their interest in sex around puberty, and it's a downhill slide all the way to their 80's. Somewhere in the late 30's the two genders cross over with an equal sex drive. So on the average, women get hornier, and men become satisfied sooner and are content longer. The AVERAGE man in his 50's does have a dwindling sex drive, hormonally speaking, but because the biggest sexual organ is between the ears (for both men and women), many men in their 50's ignore their hormones and have a lot of sex, and many women believe that a grandmother shouldn't be sexual, and politely decline.

Actions speak louder than words! It may be that it's safe for these men to lust after "nubile young" women, knowing that the chance of bedding one is slim (unless paid for, as you said). One possible inference is that if a man talks alot about fucking young women, maybe this is to compensate for an inferiority complex around sex. See if he puts his mouth to good use elsewhere (on your body). Remember that testosterone stimulates either action or bragging, exaggerating, and boasting.

Turn-ons: Young men can get an erection (sometimes to their intense embarrassment) from thoughts, fantasies, visual stimuli (hence nude centerfolds) and certainly, touch. Over the years, these dimensions are lost, in that order, leaving touch as a necessary component for attaining an erection, for maintaining the erection, and for orgasm. In general, men's brains are more visual, sexually speaking, and women's more "romantic" (hence the huge sales in "Romance Novels").

Because there are immense individual differences among people, screen for a lover who appreciates all of your fine qualities, and with whom you are compatible. But expect that the frequency of sexual contact will probably decline over the months as you become more accustomed to each other. The Coolidge Effect requires that as novelty -- sheer raw "newness" -- decreases, so does sexual interest. So keep it varied and introduce as much "new" as you can (except new people -- see my reference to three-somes elsewhere in Asnswer to Questions). I hope this helps.

Q:  I read in a cheap magazine about a guy giving his girlfriend a wine enema. Is that OK?

A: There are possibly lethal (deadly) consequences. If I asked you whether you thought that putting an NG (naso-gastric) tube through someone's nose, and down into their stomach, then pouring a bottle of wine into their stomach through the tube was romantic or erotic, what would you say? If the lady had had a lot to drink -- maybe to lower her inhibitions so she would agree to something like that -- the additional alcohol could depress her CNS (central nervous system for things like breathing and heartbeat) enough to kill her. Just like alcohol passes easily through the tissue inside your mouth and stomach (upper parts of the GI [gastro-intestinal] tract) to get quickly into your bloodstream, so it passes through the tissue in your rectum and colon. Voluntarily chugging a bottle of wine is insulting to the vintner (unless it's Boone's Farm) and takes you from sober to drunk at 90 miles per hour. Giving someone a wine enema will have the same effect (if the liquid is retained long enough for the alcohol to transport through the tissues) without the social and oral benefits of sipping a drink. And if the wine is not retained long enough, why mix wine with something undrinkable and then just pour it down the drain (the toilet)? This comment would not be complete without the additional WARNING: A wine enema can also irritate the tissue of the rectum and colon with nasty consequences, like several days of diarrhea. So don't try this at home, kids!

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