Sex and Relationships

Sexual Dysfunction

Answers to questions about sex therapy and sexuality

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7/27/98 Q: Dear Sexdoc,

I am 39 and my wife is 34. We have been married for five years. During the first year of our marriage we had sex on a daily basis. Over the years the frequency and quality of our sexual encounters has diminished to the point that we now only have sex once or twice a month. She has always had problems with lubrication, and so we have used lubricants. I can bring her to orgasm through oral stimulation, but it takes her a long time (30-40 min) and my tongue and mouth gets very tired. She used to stimulate me orally on a regular basis during that first year, but now she seems to regard it as a chore. She has always found the concept of actually taking my semen into her mouth as "Gross". I have suggested that we try new things to put the pizzazz back in our sex life but she finds anything other than strait penal/vaginal sex "disgusting". Since our lovemaking has become so infrequent, I have had problems lasting longer than five or ten minutes of intercourse. I feel she regards sex as a chore now, and I don't know what to do.

I have resorted to masturbation to keep the frustration levels down. She says she has never masturbated because it is "gross".

Before I was married, I had a pretty good sex life. I have had partners who liked sex of all varieties. Anal stimulation, toys sexy clothing, whatever. So I don't think these things are sick or abnormal. My wife on the other hand won't even wear a mini skirt.

What it all boils down to is this, she will allow me to orally stimulate her genitals, and will begrudgingly reciprocate on me. She will have what she calls "normal" sex, but everything else is "disgusting". I really don't know what to do at this point. What can I do to spice up our sexual relationship? What little sex we have is pretty clinical. When she will agree, she will usually just slap some lubricant on my penis and hop on. It makes me feel like I am putting her out, so I can't enjoy it and I know that she is not enjoying it.

A: Uninhibited people increase the frequency and quality of behaviors they are rewarded by. I hypothesize that your wife is either inhibited or unrewarded. They are not entirely independent: if your sexual glass is half empty, it is hard to interpret pleasureable feelings as rewarding.

Some women and some men believe that they have to be sexual before marriage in order for the marriage to occur, and then after marriage prioritize sex lower and lower. "Use it or lose it" is seriously operative, because we know that people who are sexual on a frequent basis (at least twice per week) are aroused more quickly, have more profound experiences of orgasm, and are able to be sexual again more quickly. People describe the downward spiral to me all the time. What I would like to believe is the result of the intervention of sex therapy, however, takes people from circling at the bottom of the curve and sends them spiraling back up again. The process is facilitated by progressively more powerful rewards along the way.

So it sounds like your wife has "Inhibited Sexual Desire" and that a course of sex therapy might help her to get over the inhibitions and to reconnect with the pleasures of sexual feelings.

Please note that the longer this goes on (infrequent sex) the longer it takes to change it in therapy. For both your sakes I hope that you spiral up!

7/27/98 Q: I am a 22 yr old female. My boyfreind and I have been living together for 2 and a half yrs. I have trouble getting excited/horny for sex. Most times when we do have sex, its the same routine and I don't enjoy it. It usually hurts and I never have an orgasm (maybe 5x I have). I have noticed, if I have a few (1-3) drinks, sex is much better. I am into it, not shy, willing to experiment a little and enjoy it. My boyfriend enjoys it more too, but he thinks there is somethimg wrong with the fact that I need to be "drunk" to have a good time in bed. Before him, I can only think of a few times that I had sex sober and they were with new interest guys, so I guess I wanted to impress them and didn't let other things get in the way. Do you have any suggestions on how to increase my sex drive w/o alcohol? Are there vitamins or medications? Please respond soon. Thank you. Shannon

A: Dear Shannon,

I am hesitant to suggest substituting one adulterant for another when the problem sounds psychological. There is a good reason why the expression "Candy is dandy but liquor is quicker" has been around for a long time -- alcohol reduces inhibitions.

You're young and therefore easier to influence in your sexual attitudes than someone older. I suggest that you address this soon so it's easy to take care of. Try acknowledging your tension and dissipating it first. Try the exercises in Lonnie Barbach's book "For Yourself". If those don't work, then try sex therapy.

Please let me know what you think and what happens.


7/27/98 Q: >Help me out of this Mexican standoff. My husband and I have fought about >this issue for years.After knowing each other about a year we got pregnant >and married. Now married 15 years. It seems to have started after the >birth of #1, the weeks of waiting to heal from an episiotimy and his >frustration over lack of sex.Wait, I do remember his anger over yeast >infections, and having to wait for them to clear up for a few days before >having sex. My gyn advised me to stop douching which did cure the yeast >problem.He felt my previous promescuity was the reason I had so many yeast >infections. Anyway, on with the standoff. For quite a while after child >birth probalby six weeks, I was very uninterested, I was nursing, and just >engrossed in being a new kind of person. He was furious by the time a few >weeks had gone by and would leave the house angry heading for the bar and >out drinking. Alone. I was of course offended that he would rather spend >time doing that than staying home with me to adore our new baby. Of course >I felt very lowly because he chose that over me. Perhaps I have never >gotten over it. I was reading somewhere on the net about love debits and >credits. Any way, life continued this way, always the threats to screw >someone else(although I really don't think he has or would yet), and so I >would try to turn it around by giving in to keep him home. I almost feel >like I trained him to threaten me. He would become verbally blasphemous, >so hurtful. Finally about a year ago, after he had been physical several >times, I had an exparte presented to keep him away from me. He cooperated >fully, paid support, and we dated. I never felt like we were getting to >the core of our problems, but bless his heart, he was trying so hard to woo >me and find out what I wanted, I let him move back in and we sort of >recommitted. I knew the standoff would come back. Here it is. His anger >over not enough sex(I call it testosterone backup) has caused him to say >very bad things to me, bad names, make me feel like I have no friends, that >everyone knows I am frigid, and that I fucked too many people before him >to be sexual now. He want's to do it in the anus because no one ever did >that to me before. I am very free about what we do and get very close to >the anal penetration but frankly it hurts and stinks. First things first. >I am so offended by his behavior when I say no that I find it very hard to >have sensual feelings towards him. He is not affectionate any other time, >he is a stressed out angry type guy who thinks women are manipulators and >users. "I got pregnant to force him to marry me" so he says. Funny >though, I'm pretty sure he doesn't mean it. I always find myself forcing >myself to give him a quicky every couple of weeks to try to keep him off my >case but anymore this just makes it worse. He wants to make love. When we >are both into it and I'm hot it's great. It's not the how, but how much >and because he's crabby all the time once every two months is probly all I >can muster. But I don't think I want to split, I want to fix it, but he is >absolute on the fact that it's my fault, and that it's just a controll >thing I do. He has also made comments like you only do it when you want >something. Like I'll start screwing on Thursday to get him to do what I >want Friday. I have grown sick of feeling like I am going to HAVE to do >this to keep my man happy, even if he is crabby and demands it all the >time. He even get's loud about it infront of my teens and it is so >humiliating that I find myself becoming permanently angry with him and >feeling like okay I just will never do it with you again because I'm not >going to be spoken to like that, or put the children on the spot. I have >the right to say no. I feel like it is going to take a whole lot of gentle >persuassion on his part for it to ever happen again. He feels like I >puposely withhold, I feel hurt by his threats and words of degredation. He >tells people we know I won't screw him and they just can't understand why >I'm such a frigid bitch, he's such a great guy. I am not frigid, I can >orgasm in 2 minutes with a vibrator. If I see pornography or videos, I >will slickup and be ready for him. If that is the only way I can get >turned on he eventually gets upset over the fact that I have to have >outside stimulus. See, it's crazy. I also feel humiliated when I do allow >myself to get turned on for the purpose of keeping him from being mad at >me. I don't feel loved. Help. > > >

A: This is NOT a loving, nurturing, caring relationship! He's miserable, you're miserable, the kids are distressed and they are going to start showing it if they aren't already.

This is what justifies the whole mental health care system! You guys need desparately to be in therapy. Obviously what you two have tried hasn't worked!

Run, do not walk, to some therapeutic intervention!

7/27/98 Q:I have been married for three years. When my wife and I started intimate >relations she was shall I say a fountain (always got really wet), however, when >our relationship progressed she became less and less wet. She started >experiencing pain during intercourse and we started using a lubricant >(astroglide). This worked wonders. It was a instant-cure. Now my wife only >gets truely wet when I have performed oral sex or fingered her to orgasm. I >suspect my saliva is partially responsible for the oral sex perceived wetness. >I myself suspect she does not get as aroused as easily as when we were new >lovers. I can accept that however, it bothers my wife. She seems to think >there is something wrong with her. I have continously told her it doesn't >bother me, however I am not the one it bothers. I would like to know if there >is any technique that can encourage more vaginal secretions. I know you're not a >medical doctor and I don't think it is a medical problem. If there isn't any >I will be happy with the lubricant, and continue to support my wife. Doc she >is great!!! I would think myself a callous lover if I didn't at least try to >find a way to make her more wet therefore making her more confident as a >lover, for she is the greatest lover and I am richly blessed. > >

A: Prolonged sexual stimulation is what creates the signal for vaginal lubrication BUT: certain medicines as well as over the counter meds can diminish it. The same stuff you take for colds that makes your nose stop running also reduces saliva and vaginal lube.

I suggest noticing the relationship between length, type, and intensity of stimulation and lubrication, along with reassurance, use of external lube whenever you want, and sexual activity more often than you are now doing it.

It's a rough prescription, but I expect you to do it.

7/27/98 Q: you wrote: >My husband has over 2 dozen porno cassettes, boxes of porno magazines, does >cybersex, and collects porno pictures. I have been inundated with all >this. Then just this past month I learned from 2 different young women >that he has molested them in the past. Could you shed some light on this >for me? Because of the sex charges, I am divorcing him, but would >appreciate some feedback about how all this relates to each other. Thank >you

A: There is no way I can type enough into the e-mail system to address what you describe! I strongly suggest that you see a therapist immediately to deal with the impact on your self-image. A good sex therapist can do that and help with your unraveling your confusion of how he could have done all that he did.

Take care of yourself. The sooner you get into therapy the less time it will take.


7/27/98 Q: Recently my fiancée has felt that her body no longer wants sex. She has been >complaining of tiredness recently and is curious as to whether this is the >cause. She also has PMT but this normally makes her want more instead of >less. > >Any advice would be most welcome, > >G. >

A: with that opening it would be criminal to not refuse comment until she was examined by an MD. "Tiredness" etc., can range from boringly benign to a sign of serious illness.

Thus, my suggestion is to urge her to get checked reasonably soon -- 2-3 weeks?

Then, if you rule out the medical stuff, get back to me.


7/24/98 Q: Dear Sir: > I was severely sexually abused from time of my earliest memories, possibly 3 years old, until 14 or 15 years old by my father. Until I was 10 years old it consisted of oral and vaginal penetration, what would be considered fairly normal sexual activity if I had been an adult. My father sold me to a group of child pornographers for a weekend during my 10th year. Initially I was photographed in sexually explicit poses both alone and with men. This was followed by multiple sessions that included gang rape and sexual torture. I was tied onto a special apparatus so the animal wouldn't kill me with its weight and vaginally raped by a boar. They also had a German Shepherd rape me anally, allowing it to tie and drag me around the room backwards on all fours in front of an audience and on camera. > When my father came to take me home I wasn't able to walk or talk. I was bleeding vaginally and rectally. I was never taken to the doctor for the damage done to by body and I eventually healed. I wasn't able to swallow anything solid without choking for at least a year. > My father continued his abuse about a week after returning home. The only difference is that now he added anal intercourse and occasionally invited male friends for group sex. > Somehow I survived this abuse keeping it a secret all the way into adulthood. Obviously this abuse led to many hangups regarding sexual activity. After leaving home I didn't have sex with anyone until I was 24 years old. It was not enjoyable but felt obligated to participate since it was desired by my then boyfriend. I have never had what I consider a sexually satisfactory relationship. I never married but did want children. I selected someone I considered intellectually superior and who did hold some physical attraction for me. I had 2 children by him and still have occasional contact. My son is in college and my daughter is still in high school. Since childhood I have had endless nightmares about the abuse. > Now that I have given you the background let me state my question. Considering my background I don't understand why I have a fascination with pornography and an obsession with sexual pain. I would like to end this perversion because of how guilty it makes me feel. Can you help me? > >

A:  I am sorry whenever I hear of stories like yours (and I have heard many of them).

Can I help you? The best help I can be is to encourage you to get into therapy to deal with what you experienced, but you should expect that it will probably take several years to work through all of it.

I fear that "simply" answering your question about fascination with pornography and obsession with sexual pain will be but a tiny drop in the bucket of your "cognitive restructuring".

Plus, I can only hypothesize based on other patients. In my experience, some people who undergo abuse and trauma experience a phenomenon called "identification with the aggressor". To illustrate in a different arena, some of the prisoners of war in World War II mimicked their Nazi captors by goose-stepping and straight-armed salutes. It is a sense of trying to magically have some of the power of the captor by behaving like the captor.

Other people, in their burning quest to answer the questions "Why me?" and "Why did this happen?" attempt to "get inside the head" of the abuser by trying to understand why he or she found some things (in your case, pornography and sexual sadism) so rewarding as to engage in them repeatedly.

There is also, often, a component of control by being the instigator -- something like hitting yourself, and saying "You can't hurt me by hitting me -- see, I'm doing it to myself; I am in control of this."

Until you see a therapist about this, I suggest that you put up a sign everywhere you will see it without endangering yourself (on the bathroom mirror, for example, and not on the windshield of your car); the sign needs to read:

It wasn't my fault

I'm not the only one

There is help for this

7/27/98: She e-mails with more details and to say that she checked out the Parents United website, asks that I not post some additional information on this web page, and asks where to get a referral of someone who can deal with such sexually intense material (probably fewer than 2% of therapists have received advanced specialty training to deal with these matters). My suggestions for all to see:

I get people in therapy who tell me on the 5th session that I'm the 7th (or 10th or 19th) therapist they've seen. When I ask why, they say something on the theme of "You didn't look like you were going to throw up or look like you were getting sexually excited when I told you about what happened when I was a child".

The third most frequent comment is that I don't change the subject when sex comes up, like other therapists had.

If there is a University in your town, call the Chairman (or chairperson) of the Department of Psychology and ask for a pin-point referral to a therapist who has a proven track record in dealing with people sexually abused as children.

Or look in the white pages for your county's Psychological Association and ask only the clinician on call (not an answering service) for such a focused referral.

OB-GYNs hear about this -- ask one who he or she refers to.

But for the sake of your quality of life, and indeed, life itself, please get help!

Keep in touch -- can you do this? You checked out Parents United -- there is a life force inside you that wants this dealt with. Keep up the momentum!

I look forward to hearing from you.

Q:  My girlfriend is uninterested in sex 95% of the time. Could her eating habits cause this? She sometimes doesn't eat for 24 hours.

A:  5% of 24 hours is 1.2 hours. I think that a woman who is interested in sex 72 minutes every day is a FIND! A real KEEPER! But, I assume that you mean one day every 20. The question is why she eats infrequently. The greatest probability is that she is somewhat depressed, which could be the "cause" of both "effects": sex and diminished appetite. Consider that.

Q:  I am a 42-year old healthy woman who can achiebe orgasms from clitoral stimulation but not during intercourse. I assume that this is just a "mind" thing. What can I do to teach myself how to have orgasms from penile thrusting?

A:  Only about 40% of women are able to achieve orgasm from penile thrusting alone. It's not a mind thing. Your clitoris neeeds stimulation during intercourse. Either use a position where you or your lover can stimulate it or master the Coital Alignment Technique where either of you is on top, bodies parallel, and the one on top slides his or her body headward and footward so that the pubic bone of one presses against the clitoris of the other.

Q:  Can you have sex and not remember it? I didn't used to enjoy sex but for two months now my fiance tells me that I wake him up in the middle of the night and initiate all kinds of sex, even things I would not do awake. He says I am out of control, have numerous orgasms, and we go for hours. At first I thought he was lying, but now I wake up with his come all over me. I have no recall of this. Three months after we met I got pregnant. I had the baby two months ago. Could this be related?

A:  It is rare that one can "go for hours" on repeated occasions without remembering it. There are things he can do that don't require your participation that can end up with his come all over you. I suggest that you set up a video camera in your bedroom, and ask your fiance to turn it on when you turn on. While guilt from having a child out of wedlock might conceivably account for this, I am inclined to exhaust simpler explanations (possibly wishful thinking or dreaming on your fiance's part?) first.

Q:   When does one lose her virginity. My boyfriend has entered one to one and a half inches on several occasions but there was no bleeding. I believe in being a virgin when I get married. Was that sex? Was that semisex? I'm so confused. I'm so ashamed. Please help.

A:  Because the sexdoc works very hard to reduce stress by helping people achieve their goals, he chooses to be a bit distressed when he reads a question like this. When women were owned by their husbands, and dowrys were based on perceived value of the bride, virginity was a premium -- non-virginity was "damaged goods", a term more often used in cases of rape (unfortunately). I cannot consider ours to be "enlightened" times when we still have people responding to hormones and nerves, and ending up ashamed and confused. One of the most difficult problems in sex therapy is the married couple who were virgins at the altar, who now discover that they are grossly sexually incompatable. What good is being a virgin at marriage if there is a chance that you will be mis-matched sexually. Your options are to suffer in silence, have extra-marital sex, or divorce. The strict prohibition of sex before marriage often is associated with the prohibition on either extra-marital sex and divorce. So: Good news: we were virgins at the wedding. Bad news: we didn't know before we got married what our respective sexual preferences are guaranteed to cause irreconcilable strife. Talk about win the battle and lose the war!

As I have said elsewhere, most cultures accept the tearing of the hymen as the dividing line between virginity and non-virginity. Was what this author did "sex"? I have to say yes -- there was genital-genital contact (a condom doesn't count). I respectfully suggest that the "problem" here is not the loss of virginity. It is the repression that says "shame on you". For what? Experiencing a normal response to internal biochemistry and neurology?

Q: My sister has kidney disease and experiences extreme pain a few days after she has sex, no matter how gentle her husband is. She has given him permission to get sex elsewhere, and he wants it to be me (I'm in my late 20's and very sexually comfortable. I have no problem with anyone's sexuality). But I have a problem with my sister and her husband. She wants me to help. He wants me to be his partner. I just can't see myself doing this. He asked for a kiss, and I obliged because I knew I was not sexually interested in him, and he said it knocked his socks off. He masturbates 6-7 times per day, which I think is excessive. What should I do? What do you suggest?

A:  It sounds like you have concluded what your preferences are. So the problem is what, how to tell your sister and her husband? You have said: "I have a problem with my sister and her husband." And "I just can't see myself doing this". And " I knew I was not sexually interested in him". I suggest that you tell them that the request to be sexual with someone you're not interested in is unreasonable, and the fact that it is your sister's husband makes it too complicated. I suggest that you say that you're flattered, and sympathetic to their problem, but that you can't be part of the solution.

Q:  Does a woman experience pain the first time she has sex? Do all women bleed?

Q: My husband and I are both virgins. We just got married. I am scared that it will hurt. I cannot tolerate any pain at all. Some people have told me it will hurt. Others have said it won't. What's the reality of the situation? I'd be ever so grateful if you could reply and help me out.

A: Make sure you know the anatomy. Pain can come from several sources: the hymen, rapid dilation, and muscle cramping (all in the absence of illness or anatomical abnormalities). The opening to the vagina is called the introitus (short for introitus vaginae). Just inside the vagina is tissue called the hymen. Think of it like a doughnut -- kind of a circular wall with a hole in it. It serves no known biological function and takes on a wide variety of shapes and thicknesses in different women. For some women it is mostly hole and hardly any "wall". For others, the wall is thick and the hole is small (remember, the menstrual fluid has to get out). In very rare cases, it is closed off (all wall, no hole) and must be surgically removed. From the passage of time alone the hymen will often thin and offer no resistance to a penetrating penis. Sometimes women are lulled into a false sense of security because they use tampons. Think diameter. If your husband's erect penis is larger around than a tampon, you need to check to see if your hymen can accommodate that diameter. Wash your hands (or if you have long, sharp fingernails, have your husband wash his -- DO NOT SCRATCH THE INSIDE OF THE VAGINA!!!); get lubed up with lots of K-Y jelly. Insert the little finger (simultaneous clitoral stimulation is a nice thing to accompany this so your body associates penetration with pleasure). If it goes in OK, make it stiff and move it around like you're drawing a circle with the tip of the finger, inside the vagina. Move it in and out, and around and around for 10 seconds, then replace it with the index finger. If that goes OK, use the middle finger. proceed to two fingers. If the finger-owner can feel resistance, gently stretch the tissue. If you have a small opening in your hymen you can stretch it. Do it every 2 or 3 days so it can stretch slowly. Two fingers can go in and out pretty much parallel to each other without increasing in diameter the deeper you push in. By the time you get to three fingers, however, you've got some increased diameter the deeper you push in. Compare the size of your husband's erect penis with the diameter of the three fingers. Big enough? Need four fingers? NOTE THAT THE THREE (OR MORE) FINGERS NEED TO BE INSERTED SLOWLY TO ALLOW THE INTROITUS TO DILATE! If all fails and you can't insert enough, tell your OB-GYN to see if she or he can guide you. If the hole in the hymen is smaller than the erect penis, and if the hymeneal tissue tears during penetration, and if there are enough nerve endings right there, then a virgin (or non-virgin whose subsequent lover had a larger penis that her former lovers) will experience pain and there might be some bleeding. That's the first category of pain.

Rapid Dilation: I have found that analogies are quite helpful in sex therapy. How can a man (or a woman who has never experienced it) comprehend what the pain of premature and rapid intromission (inserting the penis into the vagina) ? Both genders (but especially men) read carefully (and women -- consider explaining this to an inconsiderate lover): It is a universal experience for everyone at some time in their life, to have had either a really large stool (piece of fecal matter that comes out when you have a bowel movement) or a very urgent need to defecate (have a bowel movement) resulting in rapid expulsion of the fecal matter. Think big, fast or slow, or regular size, really fast. Remember the ache in your butt you experienced when that happened? That was caused by dilation of the anal schincters (round muscles -- there's an inner and an outer) too quickly. That is similar to the pain of dilating the introitus too quickly. Although the following might sound sadistic, I will relate what one woman did: during sex play, she tied her lover to the bed spread-eagle (one arm or leg in each corner), lubed up his anus, lubed up a dildo (artificial penis), inserted the tip in his anus to make sure things were "lined up" OK, then, instead of the usual very slow in and out, going deeper each time -- a form of sex play that they had engaged in before and which they both enjoyed, pushed it in quickly (though not deeply). Her lover yelped, and she commented that now he might have a better idea of what it was like when he just plunged into her vaginally. She assured me that he was ever-after more considerate and entered her slowly. So rapid dilation (penetrating too fast) is the second category of possible pain during intercourse (though not just applicable to virgins).

Muscle cramping: If a woman clenches the muscles in the vaginal area so as to prevent penetration, as from anxiety, fear, or disgust (etc.), this can become a conditioned reflex, and subsequently, any physical attempt at penetration, and often merely the thought of it, can cause involuntary clenching of the muscles near the vagina. Any muscle that is contracted for too long exhausts oxygen and builds up lactic acid, and pain is the result. Anyone out there over-exercised a muscle somewhere along the way? Remember the pain? Now think of what that would feel like at the entrance to your vagina (men, focus on the nearest anatomical relative for you -- the anus).

Hello, young lovers, wherever you are ... The moral of the story is that the WORST first sexual intercourse event you can have is in fear (of discovery and/or pregnancy?), with rapid penetration, (and without seeing if you have to stretch your hymen). Conversely, the best is when you're with someone with whom you want to share something very important, you're cool, calm, and relaxed (sexually excited is good), you and your lover know what the inside of the vagina feels like (size-wise at least), you're not afraid of discovery or pregnancy or STDs , and he penetrates you slowly because you are holding his body (one hand on his abdomen and the other on his butt or one on each of his hips) to let him know how slow and how deep to penetrate.

It's been a while since the sexdoc lost his virginity (but boy, oh boy, I can still remember it vividly!) and I would really appreciate feedback from readers about how relevant and true to reality the above is. Your comments will be appreciated. (e-mail

Q:  Is there any safe, reliable way, surgically or non-surgically, to enlarge the penis?

A:  In a word: no. The sexdoc has seen several dozen "before and after" photos of penis enlargement operations, and they are GROSS. The fat tissue implanted looks lumpy and there have been more than a few malpractice suits filed because of the results. Good news: it's bigger. Bad news: it's soooo ugly that no woman wants it in her! (Much less consider a blowjob!) Some primitive tribes hang a weight from the tip of the penis, causing elongation, but I suspect (from pictures) that it's painful and must be done 12-16 hours a day to be effective. Vacuum pumps temporarily enlarge the penis, but after the pump is deflated, so is the penis. And, you can damage penile tissue by over-inflating.

Q:  I am 27, my girlfriend is 24. We have long and satisfying sex events with lots of foreplay, oral sex, etc., during which she has plenty of orgasms. But after I ejaculate, I'm uninterested in sex again for at least a day. Am I normal? Should I have my testosterone checked?

A: There are men who are normal who prefer one orgasm each 6 weeks, and some who have 15 orgasms per day. The same frequency goes for women. The sexdoc finds it curious that we so easily accept individual differences in height, weight, hair color, skin color, and intelligence, but somehow there is this vast cultural myth that someone is not "normal" if they differ from average. A deficiency in testosterone would interfere more. Because you are concerned I suggest that you get it checked when you have your next blood test.

Q:  Will frequent masturbation result in a low sperm count?

A:  For the next day or two, yes. When you want to make babies later in life? No. A Woman has a fixed number of eggs, and they're are all there when she is born. Men manufacture sperm in the testicles from puberty until illness or death compromise them. Sperm are manufactured at greater and lesser rates, but there isn't a warehouse that supplies a whole fresh load immediately after ejaculation.

Reader: Please note: After my initial reply, the author of this question e-mailed back with comments. Because I think his comments and my reactions to them would be intensely meaningful to a number of people, I am sharing them with you. The original reply is in non-bold, flush left. What he is commenting on is highlighted in the text in color. His secondary comments and my reactions are indented.

Q: I am a 37-year old Christian man married for 20 years to a Christian woman. We were both virgins on our wedding night. She has never experienced arousal or desire and occasionally "donates" herself to do her "duty". We have seen dozens of therapists, pastors, doctors, hypnotists, and every sex therapist in our part of the country over the past 14 years and she will do everything they suggest except consent to looking at visual erotic materials or masturbate. What options does a Christian man have who is committed to his wife but whose needs cannot be met (in the marriage) to be with a woman sexually?

A:  FIVE INTO FOUR WON'T GO!  My inference is that here is a woman who gives all outward appearance of cooperating with therapy, but who has her heels dug in and won't budge. The message is "I'll do everything except what is at the heart of the problem."

My speculation is that either this woman has a severe hormone imbalance [he comments: this has been ruled out medically] (unlikely) or she was so beat up emotionally as a kid that she does not DARE to be sexual. Deep down inside what she is saying to herself is that it is better for her to deny desire or arousal (doings of the devil, maybe) than to "cut loose" and enjoy herself sexually.

Unfortunately, some people are unresponsive to the most direct of interventions. So what's a good Christian man to do? What would you do if she had had an accident and suffered nerve damage that prohibited her sexual arousal?

She has literally "cut off" her feelings and refuses to even consider getting in touch with them. One option is to demand that she cooperate with treatment or you will get on with your life. What would you do if she were diagnosed with cancer and refused chemotherapy?

She's been diagnosed with anhedonia, and refuses masturbation. She's effectively killing her sex life and yours with her refusal or inability (so far) to respond to intervention!

Or, you can redefine sexuality as something that excludes penile-vaginal intercourse in a mutually consensual way, and pleasure yourself with or without contact with her body.

Would Jesus want you to live life so frustrated? Coming full circle, it is obvious that you love each other, and obvious that both of you are suffering. Wouldn't it be best for all parties concerned to find someone with whom there was greater compatibility?

You'll have to choose between the tenets of your religion or your reasonably attainable relationship happiness. If she won't cooperate with treatment [she feels she has been much more than cooperative], she's signing the "death warrant" on both your sex lives.

Q: (female author) I have never had an orgasm during (intercourse) -- only during masturbation. I have tried being on top and stimulating my clitoris and I get close but then the feeling goes away. What can I do?

A:  While having an orgasm during penile-vaginal intercourse is desirable, it is attained by only about 40% of women. Before you give up, I suggest that you obtain clitoral stimulation (from either you or your lover) until you are sooooo close to orgasm, then insert the well-lubricated penis, with thrusting. See if you can gradually train your body to stay highly charged with the penis being inserted sooner and sooner. With you on your back with your knees bent, and your lover on his side, 90 degrees from your body (sort of like a "T") you should have continuous access to your clitoris. See if simultaneous penile insertion with clitoral stimulation results in your orgasm. Enjoy experimenting (it's a dirty job but someone has to do it).

Q:  Can you suggest a book on giving blowjobs? I really want to make my husband's head spin, and want to please him in ways he didn't know were possible.

A:  The sexdoc strongly urges lovers to respect the fact that there are very powerful individual differences and that "technique" descriptions should be accepted as "suggestions". Just as women vary dramatically in how they want their nipples or clitoris stimulated -- and indeed varied over time -- men have similar idiosyncrasies. The essence of the blowjob is to provide constant neurological stimulation to the penis, keeping it warm (breathing through your mouth can cause evaporation, thus cooling) and with vigorous contact alternated with less, more teasing, touch. Because of the idiosyncrasies, constant feedback from your partner during "training events" should teach an apt pupil what that man likes. It's less romantic but highly instructional and you need to do it only the first few times.

Next comes both additional erotic stimulation and the element of surprise. While using your mouth (on the tip) and one hand (on the shaft), what is your other hand doing? Coddling the testicles or light fingernail tracings on the scrotum at unexpected intervals electrify many a man, while others will have the top of their head blown off by prostate stimulation from a well-lubricated finger gently but firmly inserted rectally (and rhythmically pressed upward toward the pubic bone), or by the insertion anally of a small well-rounded ice cube. Know that for some men, however, any anal contact is an immediate turn-off. Much of the written literature I have seen on blowjobs is mostly a woman's description of what HER lover likes with an erroneous over-extrapolatiopn to what "all" men like.

Q:  For a year my boyfriend and I had sex with condoms and it was wonderful. Then I got on the (birth control) pill and everything is great until he ejaculates, when I feel an intense burning sensation inside and then around the outside of my vagina. Usually my entire private area is red and swollen afterwards. My doctors says he has no idea of what's going on. We want to get married next year and do not want to spend the rest of our lives using condoms. What is this?

A:  Dear Reader: Please keep in mind that the sexdoc is a psychotherapist, not a medical doctor. However, because the sexdoc specializes in sexuality and relationship matters, he hears about all kinds of unusual things. And this is one of them. The first idea to consider is that the man has a low-grade UTI (urinary tract infection) that is not causing him any discomfort, but is irritating his sex partner. Her doctor says he has no idea of what's going on, but I would first alert the M.D. to this UTI possibility. Another, though outside, possibility is that he is taking too much vitamin C (Ascorbic acid) the excess of which is voided in the urine. If the clear secretion of Cowper's gland (in the vernacular called "pre-cum") does not neutralize it, it could be transported by the semen into the sex partner. I have heard of this circumstance several times before where neither of the two causes above is at fault, , and it has been explained to me as a rare discrepancy between the chemical make up of the ejaculate and the chemical make up of vaginal secretions. There is a slightly caustic aspect to the ejaculate of some men which the vaginal secretions of most women neutralize. But if his irritator is on the "high" end, and her neutralizer is on the "low" end, what has been described to me as a "sort of chemical equivalent of a sunburn" is experienced by the woman on the tissues with which the ejaculate comes in contact. Because what a man eats is known to change the taste and chemical composition of his ejaculate, I respectfully suggest that the challenge for this couple is to experiment with his nutrition. Again, you are reminded that this is a non-medical report of what has been described in several circumstances.

Q:  How can I become orgasmic? I am a 32 year old married woman, had three pregnancies, have stretch marks, my breasts are not firm, I feel very insecure, I love my husband, we have foreplay, do it in different positions, I love knowing that he desires me, and I have never told him that I faked orgasms because I wouldn't want him to think it was his fault. Is there anything I can take over the counter to make me orgasm? Please help!

A:  Dear Readers: This is precisely why Lonnie Barbach wrote "For Yourself". The sub-title is "The Fulfillment of Female Sexuality". Dr. Barbach conducted group therapy sessions for years for women who were NOT YET orgasmic. First, for every woman who is not as orgasmic as she would like to be, I cannot urge you strongly enough to GET THE BOOK. Read it page by page, without skipping ahead. Do each and every exercise no matter how simple or easy or uneventful, or basic, or "too young" for you. Maybe it'll be "ho hum, been there, done that", but I have had a significant number of women say that but have a powerful and meaningful reaction to a simple exercise.

Second: get a powerful vibrator and experiment with it. Hold it on your clitoris until your clit becomes numb so you'll know how long is too long. Get a dildo to see if simultaneous   vaginal and clitoral sensation makes it easier for you to have an orgasm. If you achieve orgasms with the vibrator notice how it feels different whether the dildo is inside you or not.

Those two steps are the self-help phase. If you're still not orgasmic, tell your OB-GYN and ask her or him what they suggest from a medical point of view. Some will run a hormone assay to see if any of your fluid levels is out of whack. A few will be willing to prescribe 2% topical testosterone cream for you to rub directly on your clitoris (but it promotes hirsuitism -- hair on your body).

If that doesn't result in orgasms, see a competent sex therapist. Often, not having orgasms is a combination of lack of information and internalized inhibitory messages. Some of the women who were traumatized as kids about the dangers of pre-marital sex or the shame of pregnancy out of wedlock became so inhibited -- cut off from their sexual feelings -- that they blocked all sensation. Others feel something but are so terrified (unconsciously) of losing sexual control that they get excited but can't get "over the edge". A good sex therapist can help disinhibit -- unblock -- those hidden feelings.


The Sexdoc has had several women in their sixties become orgasmic for the first time in their lives. It's a shame that this woman is 32, but that's 28 years before 60. Today really is the first day of the rest of your life. Please do not suffer in silence if you are non-orgasmic!

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