Overcoming Ejaculation Problems

Are ejaculation problems an issue of mind over matter?
Well, if a man and his partner don't mind how long it takes him to ejaculate, then it really doesn't matter. For example, Ian Kerner, PhD, a sex therapist and author of She Comes First, advises men to bring their partners to the brink of orgasm before having intercourse. Then, if he's prone to premature ejaculation, it doesn't matter since both of them come away satisfied.

Conversely, if a man takes longer than average to ejaculate, but both partners enjoy marathon sex sessions, then delayed ejaculation can be a real plus.
However, some men do mind how long it takes them to ejaculate. They mind a lot -- and so do their partners. But while the mind often plays a big role in creating ejaculation problems, it's also key in overcoming them. Here are some tips on what to do.
Common Ejaculation Problems
When it comes to ejaculation, there are basically three different things that can go wrong.

• Premature ejaculation is by far the biggest complaint that men have about their sexual performance. After studying data gathered by the National Health and Social Life Survey, sociologist Edward Laumann, PhD, estimated that a third of American men complain that they ejaculate too quickly. They want to last longer during intercourse to prolong the pleasure, both for themselves and their partners.
• Delayed ejaculation (or retarded ejaculation) affects a much smaller number of men - as few as 3%, according to some estimates. It's one of the most poorly understood ejaculation problems. Some men cannot reach orgasm at all, at least not with a partner.
• Retrograde ejaculation is the least common of the ejaculation problems. It causes semen to back into the bladder during orgasm instead of exiting by way of the penis. The semen is then later flushed out when you urinate.
  
  Retrograde ejaculation can be caused by diabetes, nerve damage, various medications, and surgery that disturbs the sphincter muscle. It's harmless and won't interfere with the feeling of orgasm. (It can also make for an easy post-sex clean-up.) But since it does affect fertility, some men may need treatment if their partners are trying to get pregnant.

What Causes Delayed Ejaculation?
There are lots of different reasons for delayed ejaculation. Some medicines -- like antidepressants -- are common culprits. For many men, it's age. As we grow older, the nerve endings in the penis become less sensitive, according to Barbara Keesling, PhD, author of All Night Long: How to Make Love to a Man Over 50, and a professor of human sexuality at the California State University, Fullerton.
"When the reflexes slow down, it takes longer," Keesling says. "Another thing that happens with age is that your erection ability goes down too, so it becomes more difficult to ejaculate without a full erection."

You may also have a hand in your delayed ejaculation problem. By adopting a masturbation technique that involves intense pressure, friction and speed, some men train themselves to respond to a level of stimulation no partner could duplicate -- at least not without coaching, which the man usually is reluctant to provide.
Michael A. Perelman, PhD, a sex and marital therapist in New York City says he sometimes tries to get men with delayed orgasm to agree to a masturbation moratorium. This does more than stop the practices that may be contributing to the problem. It also allows a build-up of sexual desire, which provides "a mechanism for reducing the threshold of arousal necessary for orgasm," he says.
But while masturbation can cause delayed ejaculation, it can also aid in the cure. If a guy won't agree to keep his hands off, Perelman will urge him at least to alter his masturbation style -- to switch hands, for example -- in order to break old habits. The problem is that your tried-and-true, quick-and-dirty masturbation style is probably terrible practice for sex with another person.
So instead of just masturbating efficiently to achieve orgasm, Perelman encourages men to fantasize about a sexual experience with their partners while they masturbate. He tells them to try "to approximate, in terms of speed, pressure and technique, the stimulation he likely will experience through manual, oral, or vaginal stimulation with his partner." It might take a little longer, but it makes masturbation more of a "dress rehearsal" for sex. You can also talk to your partner about your fantasy afterwards, Perelman suggests.

Premature Ejaculation Cure: Self-Love

So what about the much more common problem of premature ejaculation? In this case, masturbation can be just the ticket. Having repeated orgasms will bring on delayed ejaculation in almost any guy. Some believe that the best premature ejaculation tip is to double the number of orgasms a man has per week. And if that doesn't work, to double it again.
There's some evidence to support this folk remedy.
"Young men with a short refractory period may often experience a second and more controlled ejaculation during an episode of lovemaking," says Chris G. McMahon, MD, in a 2004 study published in the Journal of Sexual Medicine.
Masturbation may also help men learn to control their level of arousal, which is essential for delaying orgasm.
Other Ways to Treat Premature Ejaculation
One time-honored technique for premature ejaculation is to distract yourself -- to think about something boring or even disgusting to delay your orgasm. While this may work for some, it has the unfortunate side effect of distancing men from their partners and the sexual experience.
There's also an obvious alternative: pull out and stop having sex for a few minutes to postpone orgasm. Sex researchers William Masters and Virginia Johnson elaborated on this when they developed the "squeeze-pause" technique, also known as the "penis grip," to quell the desire to climax. As the name implies, this involves squeezing the head of the penis as orgasm approaches.

Perelman helps men last longer by teaching them a variation of the Masters and Johnson technique. It involves slowing themselves down and altering their movements in a way that maximizes their partner's pleasure. They do this while maintaining their erection but without overexciting themselves.
Antidepressants for Premature Ejaculation?
For men who aren't helped by any of these techniques, there's a pharmaceutical option. Since some antidepressants -- selective serotonin reuptake inhibitors, or SSRIs -- are known to cause delayed ejaculation, researchers tried them as a way to treat premature ejaculation. Your doctor may prescribe an antidepressant for you to take four to six hours before intercourse, men prone to premature ejaculation can last longer.
Not surprisingly, drug companies were quick to take notice. A short-acting SSRI called dapoxetine has already been developed specifically for premature ejaculation. According to a 2006 study published in The Lancet, when taken one to three hours before sex, the drug increased the time from penetration to ejaculation from 1.75 minutes to 2.78 minutes for men treated with 30 milligrams of the drug. Men who got 60 milligrams lasted 3.32 minutes.
"A couple of minutes may not sound like much, but for these guys it was huge," said the lead author of the study, Jon L. Pryor, MD, when the results were published in September 2006. However, dapoxetine has not yet been approved by the FDA and is not available in the United States.
Although they also have not been FDA approved for use to treat premature ejaculation , the antihistamine cyproheptadine and the anti-flu drug amantadine have been used with moderate success to treat delayed ejaculation, McMahon says.
Instead of drugs, some men use a desensitizing cream to delay orgasm. There's an even simpler solution: double up your condoms to reduce your stimulation.
Treating Ejaculation Problems
Whatever your ejaculation problem, there are solutions. The key is to get help. And we don't just mean from a doctor, although that's important -- ejaculation problems can be signs of more serious medical issues, after all.
But you also need to talk openly with your partner -- something that many men are loath to do.
"Almost universally, men [with ejaculation problems] fail to communicate their preferences for stimulation to either their doctor or their partners, because of shame, embarrassment, or ignorance," Perelman tells WebMD.

So don't stay mum and let shame or male pride ruin your sex life (and your partner's). Letting that tension build up will just make things worse. With some openness, some discussion, and maybe a few fun new techniques in the bedroom, you can overcome your ejaculation problem. That means less worry and more sex.

Masturbation: 5 Things You Didn't Know

1. There's no such thing as "abnormal" masturbation.

Men often wonder if there's something abnormal about the way they masturbate. But experts are loath to offer specific definitions of "normal" and "abnormal," pointing out that men show great variations in both frequency and technique. "We humans are too diverse to establish a norm," says Betty Dodson, PhD, a New York City-based sexologist and the author of Sex for One. Every man masturbates in his own way, says Martha Cornog, the author of The Big Book of Masturbation, whether he "uses his hands, rubs against something, uses a sex toy or household object, wears special clothing, fantasizes, looks at a book or magazine, tries different positions, or looks in a mirror."

2. Masturbation is very safe -- but not entirely safe.

Unlike sex with a partner, masturbation can't give you a sexually transmitted disease. Nor will it subject you to the muscle strains, pokes in the eye, and awkward moments that can come with partner sex. But masturbation safety isn't guaranteed. "Masturbation is just about the safest sex there is," says Cornog. "But the laws of physics and biology don't stop operating just because someone is masturbating."
Frequent or overly vigorous masturbation can irritate the skin of the penis, as the average guy knows all too well. Less well known is that habitually masturbating face down -- for example, by thrusting against a sheet, pillow, or even a carpeted floor -- can injure the urethra in such a way that urine exits the penis not in a stream but in a hard-to-control spray. Barbara Bartlik, MD, a psychiatrist and sex therapist in New York City, says she's seen facedown masturbators with urethral trauma so severe that they are no longer able to use a urinal and must urinate while seated.
In certain extremely rare instances, masturbation and partner sex alike can cause penile fracture. This painful condition -- actually a tear in the tunica albuginea, the whitish tissue surrounding the penis's spongy layers -- occurs when an erect penis strikes a hard object or is forced downward. A medical emergency, it often necessitates surgery.

3. Solo sex can supercharge your sex life -- or scuttle it.

For various reasons, solo sex can be a real boon to sex with a partner. It helps teach men about their own sexual response -- what feels good to them and what doesn't -- so they will be better able to explain to their partners just how they like to be touched. It helps men learn to recognize the "moment of inevitability" just before orgasm and helps teach them how to avoid premature ejaculation. Perhaps most significant, it's a great coping mechanism for any man whose partner is temporarily unavailable for sex -- because of absence or illness -- or has a sex drive that doesn't quite match his own (something sex therapists call a disparity in frequency preference).
Of course, some men become so obsessed with solo sex that they begin to lose interest in having sex with their partner. The resulting hurt feelings and alienation a partner feels can make it hard to sustain the relationship. But experts are quick to point out that masturbation is perfectly OK even for men in a committed relationship. "We cannot assume that just because a man masturbates that there is a problem with his primary relationship," says Bartlik.

4. Certain forms of masturbation can lead to sexual dysfunction.

Experts warn that men who frequently stimulate themselves in ways that don't simulate sex with a partner -- for example, stroking very rapidly or with great pressure or friction -- can develop retarded ejaculation. That's a type of sexual dysfunction in which it is difficult or even impossible to climax during partnered sex. "Any man experiencing any sexual dysfunction should ask himself if he's masturbating in ways that produce sensations that differ from those he gets from his partner's hand, mouth, or vagina," says Michael A. Perelman, PhD, clinical associate professor of psychiatry, reproductive medicine, and urology at Weill Cornell Medical College in New York City and the president of the Society for Sex Therapy and Research "Then he should consider what he could say to her to make the stimulation more similar -- and how he could change the way he masturbates to make it feel more similar to what his partner does."

5. Masturbation may affect the risk for prostate cancer.

The relationship between masturbation and prostate cancer is a bit hazy.
A 2003 Australian study published in BJU International linked frequent ejaculation early in life with reduced risk for prostatecancer later on. But in a 2004 study published in The Journal of the American Medical Association, a researcher reported that "ejaculation frequency is not related to increased risk of prostate cancer." In both these studies, ejaculation frequency included sexual intercourse and masturbation.
In a later study published in BJU International, researchers found that frequent masturbation in young men raised the risk for prostate cancer but that frequent masturbation in older men lowered the risk. Sexual intercourse did not affect prostate cancer risk.
The researchers theorize that it may not be the masturbation itself which is increasing risk of prostate cancer in men who masturbate frequently in their 20s and 30s. Men who masturbate more may do so because they have high levels of male sex hormones -- and young men genetically predisposed to have hormone-sensitive prostate cancer will be at higher risk if they have more male hormones. In men over age 50, the researchers theorize, frequent masturbation helps drain the prostate of fluids that may contain cancer-causing substances.

Your Guide to the Sexual Response Cycle

The sexual response cycle refers to the sequence of physical and emotional changes that occur as a person becomes sexually aroused and participates in sexually stimulating activities, including intercourse and masturbation. Knowing how your body responds during each phase of the cycle can enhance your relationship and help you pinpoint the cause of any sexual problems.

What Are the Phases of the Sexual Response Cycle?

The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution. Both men and women experience these phases, although the timing usually is different. For example, it is unlikely that both partners will reach orgasm at the same time. In addition, the intensity of the response and the time spent in each phase varies from person to person. Understanding these differences may help partners better understand one another's bodies and responses, and enhance the sexual experience.

Phase 1: Excitement

General characteristics of the excitement phase, which can last from a few minutes to several hours, include the following:

• Muscle tension increases.
• Heart rate quickens and breathing is accelerated.
• Skin may become flushed (blotches of redness appear on the chest and back).
• Nipples become hardened or erect.
• Blood flow to the genitals increases, resulting in swelling of the woman's clitoris and labia minora (inner lips), and erection of the man's penis.
• Vaginal lubrication begins.
• The woman's breasts become fuller and the vaginal walls begin to swell.
• The man's testicles swell, his scrotum tightens, and he begins secreting a lubricating liquid.

Phase 2: Plateau

General characteristics of the plateau phase, which extends to the brink of orgasm, include the following:

• The changes begun in phase 1 are intensified.
• The vagina continues to swell from increased blood flow, and the vaginal walls turn a dark purple.
• The woman's clitoris becomes highly sensitive (may even be painful to touch) and retracts under the clitoral hood to avoid direct stimulation from the penis.
• The man's testicles are withdrawn up into the scrotum.
• Breathing, heart rate, and blood pressure continue to increase.
• Muscle spasms may begin in the feet, face, and hands.
• Muscle tension increases.

Phase 3: Orgasm

The orgasm is the climax of the sexual response cycle. It is the shortest of the phases and generally lasts only a few seconds. General characteristics of this phase include the following:

• Involuntary muscle contractions begin.
• Blood pressure, heart rate, and breathing are at their highest rates, with a rapid intake of oxygen.
• Muscles in the feet spasm.
• There is a sudden, forceful release of sexual tension.
• In women, the muscles of the vagina contract. The uterus also undergoes rhythmic contractions.
• In men, rhythmic contractions of the muscles at the base of the penis result in the ejaculation of semen.
• A rash, or "sex flush" may appear over the entire body.

Phase 4: Resolution

During resolution, the body slowly returns to its normal level of functioning, and swelled and erect body parts return to their previous size and color. This phase is marked by a general sense of well-being, enhanced intimacy and, often, fatigue. Some women are capable of a rapid return to the orgasm phase with further sexual stimulation and may experience multiple orgasms. Men need recovery time after orgasm, called a refractory period, during which they cannot reach orgasm again. The duration of the refractory period varies among men and usually lengthens with advancing age.

Sexual Orientation

Sexuality is an important part of who we are as humans. Beyond the ability to reproduce, sexuality also defines how we see ourselves and how we physically relate to others. Sexual orientation is a term used to refer to a person's emotional, romantic, and sexual attraction to individuals of a particular gender (male or female).

Sexual orientation generally is divided into three categories:

• Heterosexual: attracted to individuals of the opposite sex
• Bisexual: attracted to members of either sex
• Homosexual: attracted to individuals of one's own sex

Sexual orientation involves a person's feelings and sense of identity; it may or may not be evident in the person's appearance or behavior. People may have attractions to people of the same or opposite sex, but may elect not to act on these feelings. For example, a bisexual may choose to have a monogamous (one partner) relationship with one gender and, therefore, elect not to act on the attraction to the other gender.

Why Are Some People Homosexual or Bisexual?

Most scientists today agree that sexual orientation (including homosexuality and bisexuality) is the result of a combination of environmental, emotional, hormonal, and biological factors. In other words, there are many factors that contribute to a person's sexual orientation, and the factors may be different for different people.

However, homosexuality and bisexuality are not caused by the way a child was reared by his or her parents, or by having a sexual experience with someone of the same sex when the person was young. Also, being homosexual or bisexual does not mean the person is mentally ill or abnormal in some way, although there may be social problems that result from prejudicial attitudes or misinformation.

How Do People Know Their Sexual Orientation?

For many people, their sexual orientation becomes evident to them during adolescence or young adulthood, and in many cases without any sexual experience. For example, homosexuals become aware that their sexual thoughts and activities focus on people of the same sex. It is possible, however, to have fantasies or to be curious about people of the same sex without being homosexual or bisexual, or choosing to act on these impulses/attractions.

Can a Person's Sexual Orientation Be Changed?

Most experts agree that sexual orientation is not a choice and, therefore, cannot be changed. Some people who are homosexual or bisexual may hide their sexual orientation and/or live as heterosexuals to avoid prejudice against people who are homosexual and bisexual. They may live as heterosexuals in order to avoid their own moral dilemmas when their sexual orientation is incompatible with their personal beliefs.

Are There Support Groups for People Struggling With Their Sexuality?

Yes. There are a number of different support groups and systems available to those struggling with sexual orientation. They can help a person develop strategies for dealing with the prejudice associated with homosexuality and the damaging effects of bias and stereotypes.

Your Guide to Masturbation

Masturbation is the self-stimulation of the genitals to achieve sexual arousal and pleasure, usually to the point of orgasm (sexual climax). It is commonly done by touching, stroking, or massaging the penis or clitoris until an orgasm is achieved. Some women also use stimulation of the vagina to masturbate or use "sex toys," such as a vibrator.

Who Masturbates?

Just about everybody. Masturbation is a very common behavior, even among people who have a sex partner. In one national study, 95% of males and 89% of females reported that they have masturbated. Masturbation is the first sexual act experienced by most males and females. In young children, masturbation is a normal part of the growing child's exploration of his or her body. Most people continue to masturbate in adulthood, and many do so throughout their lives.

Why Do People Masturbate?

In addition to feeling good, masturbation is a good way of relieving the sexual tension that can build up over time, especially for people without partners or whose partners are not willing or available for sex. Masturbation also is a safe sexual alternative for people who wish to avoid pregnancy and the dangers of sexually transmitted diseases. It also is necessary when a man must give a semen sample for infertility testing or for sperm donation. When sexual dysfunction is present in an adult, masturbation may be prescribed by a sex therapist to allow a person to experience an orgasm (often in women) or to delay its arrival (often in men).

Is Masturbation Normal?

While it once was regarded as a perversion and a sign of a mental problem, masturbation now is regarded as a normal, healthy sexual activity that is pleasant, fulfilling, acceptable, and safe. It is a good way to experience sexual pleasure and can be done throughout life.

Masturbation is only considered a problem when it inhibits sexual activity with a partner, is done in public, or causes significant distress to the person. It may cause distress if it is done compulsively and/or interferes with daily life and activities.

Is Masturbation Harmful?

In general, the medical community considers masturbation to be a natural and harmless expression of sexuality for both men and women. It does not cause any physical injury or harm to the body, and can be performed in moderation throughout a person's lifetime as a part of normal sexual behavior. Some cultures and religions oppose masturbation or even label it as sinful. This can lead to guilt or shame about the behavior.

Some experts suggest that masturbation can actually improve sexual health and relationships. By exploring your own body through masturbation, you can determine what is erotically pleasing to you and can share this with your partner. Some partners use mutual masturbation to discover techniques for a more satisfying sexual relationship and to add to their mutual intimacy.

Making Lust Last

People sometimes tell me they know a couple married 20 years whose sex life is still as good as it ever was. Here's what I tell them in return: "There are only three possibilities. One: This couple is lying. Two: They are telling the truth, because they didn't have good sex to begin with. Or three: Sex is all they really have together. They never connected emotionally."
I've drawn that conclusion by listening to the many dozens of husbands and wives I've counseled, almost all of whom have admitted that after 10 or 20 years of marriage, passion became elusive.
Sharing lives is different from sharing dinners and long walks and weekends away. When you were dating the man you ultimately married, you were both acting much of the time (consciously or not), putting your best feet forward in order to be attractive to each other.
When you were sick or had a bad headache, you probably pretended it was no big deal. So did he. Now when your stomach is upset, you feel free to tell him you're about to throw up.
When you had an argument with a close friend or your sister, you might have told him, "It really wasn't the best day, but it's getting better now that we're together." He might have smiled, taken your hand, and said, "Tell me what happened. I want to know." Now when he asks how your day was, you might just say, "Fine," and leave it at that. And he might be happy to leave it at that too.
Nobody would write that kind of dialogue into a romantic movie—unless it was a sad or serious one. But that's how married people generally talk because no one can always act adoring or keep up an air of mystery while sharing the same space with his or her spouse, year after year. Here are the truths about sex, as I've learned from years of counseling, for most married couples:

Love is constant; passion needs recharging

No surprise: Everything in the universe eventually demagnetizes when left in proximity to something of the opposite charge. Magnets do, and men and women do too. Some people fall out of lust in seven days, never mind seven years—or 17. Basic animal attraction is a force of nature that seems designed to make us mate—not mate for life. Relaxing in our marriages and freeing ourselves from the pressure of trying to impress our partners has a predictable outcome: Our partners are not impressed. The magnetic spell we once cast on them begins to lift.

Cozy is comfortable, but not sexy

To the extent that men and women become real to each other, they cease to be princes and princesses, gods and goddesses who inspire romantic fantasies or amorous worship. Since couples lucky enough to be emotionally genuine with each other share so many real moments, they need to pay special attention to creating magical ones—because great sex requires magic. I'd never suggest that a couple trade their warm, safe home life for better sex. Why keep your distance just so you can make love with abandon? I believe you can have a close marriage and recapture a good sex life—but only once you admit that reigniting romance takes creativity and a commitment of time and energy.

Intimacy doesn't equal sex

When a man and a woman reveal themselves to each other, it makes each person feel more vulnerable. And, particularly for men, it's hard to have amazing sex while feeling emotionally exposed. Our earliest experiences with being close come from our relationships with parents. And those relationships aren't (in any normal scenario) linked with sexual passion. That's why some husbands and wives are open about what pleases them sexually only when they have affairs. They feel as if they have to be free of "family" to be free with their amorous impulses.

Having kids definitely doesn't lead to better sex

Children in the home define husbands and wives as parents first and foremost, not lovers. That further sets the psychological cement that reminds us we are in a family home, not a love nest. Most couples get caught up in the momentum of deciding who's going to drive which child where, how everyone will end up getting dinner, who's doing laundry because there's no clean underwear for tomorrow, and more. It's hard to switch gears and end up in overdrive in bed.

The love nest you create often feels a lot like the family nest you left

The way we behave in marriage frequently ends up resembling how we acted with our parents and siblings rather than the way we acted on our honeymoon. We wind up expressing jealousies transplanted from sibling rivalries, or we shut down because we feel like we aren't getting the attention we missed as children. And when childhood dramas take over a marriage, the spouses start to drift apart, especially sexually, because powerful, conflicted emotions from the past siphon any pure passion from the present.

What turns him on? You may be the last person in the world he'd tell

With all the talk about the difference between sex and intimacy, the two are powerfully connected. That's why what moves us sexually is usually one of our most closely guarded secrets. It's a window to our soul. In a marriage, opening that window means being seen emotionally naked 24/7. That's why many people don't open it at all. And that's a big loss. In working with couples for more than 15 years, I've rarely met anyone who doesn't welcome hearing a partner's sexual fantasies, once that person summons the courage to reveal them. I've seen lots of people blush, but I've never seen anyone get angry.

5 ways to put the X back in married sex

Luckily, with so much passion locked inside us, there's a lot to unlock. It's just a matter of finding the right key. For most couples, being married makes being passionate together more difficult, not less. Admitting this is happening is the first step toward making it stop. You can change your sex life this week. Pick one item from this five-point plan and try it out. Have your husband pick another for next week. You'll be on your way to married sex that works. Trust me. Not only am I a doctor—I've been married for 12 years.

1. Assume you don't know everything about each other sexually. As I've said, very often a husband and wife can be married for many years without ever telling each other what they find most exciting in bed. This is partly because many people remain painfully embarrassed about their sexual needs. But it's also because too much is at stake—namely, the emotional bond between husbands and wives—to gamble it on fulfilling a need that might be seen as odd, selfish, or simply beyond the comfort level of their partners for life. And after years pass, it often becomes more and more difficult to reveal a "hidden" desire, because it feels like introducing something very foreign into the relationship (or admitting that you've been fibbing about your sexual desires all that time).
   
2. Offer up an emotionally safe way to explore each other's fantasies. The walls separating husbands and wives romantically do not dissolve spontaneously. They have to be dismantled piece by piece. You can start by inviting your husband to slowly reveal aspects of his sexuality. I recommend my patients say something relatively nonthreatening, like, "I had the craziest thought. Why don't you tell me something you think would really surprise me about what you wish we could do in bed? Then I promise to tell you something I think would surprise you." Putting it that way assures the other person that you anticipate being taken aback, and welcome it. And that means your husband doesn't automatically have to edit out the most erotic parts of his fantasy. If saying anything out loud is just too embarrassing for you, try putting a block of Post-its in an envelope for him with a note that says, Leave a fantasy under my pillow, and I'll wake you up in the middle of the night. Or send him a special Valentine's card.
   
3. To make sex less intimidating, turn it into a game. Ask your partner to tell you three of his fantasies, and you get to choose one to act out. Then it's his turn—you tell him three of yours, and he selects one. If he wants to pick two from your list, and you take him up on that offer, he also gets one of the two remaining fantasies on his list. Bargaining builds romantic tension. Being playful will be a welcome reminder of how energized the two of you once were—and could be again. As an alternative, you could simply say, "I know you haven't told me everything you like in bed, even though we've been together for years. So give it up: What have you been dying to do?"
   
4. Provide examples. In order for your spouse to believe that you want to hear his real fantasies, you'll have to prove it by giving a believable example. Otherwise, he'll think you expect him to say something nice about you falling asleep in his arms. Try something like this: "You know, whatever really excites you—being tied up, pretending I'm someone else, you name it."
   
5. Give real-life routine a rest. Monotony (not to be confused with monogamy) is the enemy of passion. In order to see your mate as the prince, and for him to see you as the princess, it helps to set the stage and put on the right costume. Tell him to meet you at a restaurant for a date. Dress to impress each other. Then surprise him with a key to a motel room or a secluded beach cottage—no packing allowed. Even if an overnight isn't possible, you can alter your look to be "new" for your partner. A different style of clothing or different hairstyle or even a tiny tattoo on your ankle might trigger new feelings in him. Being "different" for him in bed doesn't mean he won't love you for everything you've always been outside the bedroom. But part of him (you know which part) wants to believe he just met you. And there's nothing wrong with your wanting to meet him for the first time too. Feel free to suggest that a beard or more closely cropped hair might look cool on him for a while.

Ironically, the kind of fantasies we try to keep so private are the kind of scenes that actually do appear in movies. That suggests that all of us have some potential to write true romance into our lives. We just have to decide it's time to start. My guess is you won't get too far down that road before you notice the passion wasn't really gone from your relationship. It was just hibernating.

A Change-Your-Life Valentine

Not every card needs to be a syrupy expression of undying love. Make this year's an expression of your commitment to charging up your sex life. Create your own card, conveying one of these messages:
"This week, let's forget we're married and pretend we're still dating. Where should I meet you to fool around?" (Leave a blank space for his answer.)
"Valentine, I have a secret I've never told you about what turns me on." (Enclose a blindfold, a battery, or a receipt from a bikini wax.)
"Tell me one thing we haven't done in bed that you want to do, and I'll be your Valentine." (Leave a blank space for his answer.)
If this still seems too risky, create a time limit: "What we do tonight is just for tonight. We can decide never to do it again. So why not experiment?"

365 Nights of Sex: Can It Strengthen a Marriage?

Two long-married couples decided to find out. When lovemaking fell off their respective "to-do" lists, they ditched the sweats, bought sex toys and books, stepped up exercise, lit candles, and took trips. Then they chronicled their "sexperiment" in two recently released books, Just Do It: How One Couple Turned Off the TV and Turned On Their Sex Lives for 101 Days (No Excuses!) by Doug Brown and 365 Nights: A Memoir of Intimacy by Charla Muller with Betsy Thorpe.


But will daily sex really help a relationship that's hit a rough patch? Some experts say yes; others aren't so sure. As for the two couples who tried it, the Browns and the Mullers, both say the experiment strengthened their marriages in -- and out -- of the bedroom.
Charla Muller had been married for eight years to her husband, Brad, when she embarked on what she calls "the year of the gift" as a way to celebrate her husband's 40th birthday Rather than fixing anything wrong in her marriage, she writes that frequent sex made her happier, less angry, and less stressed.
Doug Brown's wife, Annie Brown, initiated the offer of daily sex after hearing about sexless marriages on Oprah. He had a similar revelation after they started having daily sex. A feature writer for The Denver Post, Brown writes of releasing "an avalanche of flesh pleasures upon our relationship."
"There's a special sense of being desired that only comes from sex," he tells WebMD. "You can be good at your job or at sports, but the daily confirmation you get through sex is a super feeling."
(Is this something you’d ever try? Why or why not? Talk with others on WebMD's Sexuality: Friends Talking message board.)

Reversing the Downward Sex Spiral

According to the National Opinion Research Center, the average American couple reports having sex 66 times a year. Newsweek has noted that 15% to 20% of couples have sex less than 10 times a year, which is defined as a "sexless" marriage.
Familiarity, advancing age, work pressures, the challenges of raising a family, and household responsibilities all conspire against regular sex among many otherwise loving couples who feel too harried to get physical.
When Doug Brown and his wife began their experiment in 2006, they were juggling two kids and two jobs. Married for 14 years, they averaged sex three times a month. And he admits he had performance anxiety.
"I felt I had to be a porn star or an Olympic gold medalist. That melted away with [daily] sex. We learned so much about each other. Sex became much more playful and that translated into a more playful union. We regained an electricity that wasn't always there before."

 

They also lost their inhibitions and embarrassment about the subject and gained confidence. "Now we can talk about anything."
The Mullers had a similar experience.
"I didn't realize how much not being [regularly] intimate stressed our relationship," Charla Muller tells WebMD. "I was a bit of a dodger, because I felt pressure to make it fabulous, because who knows when it will come around again? Now I'm not willing to give it up again."
She says an unexpected benefit of daily sex was the kindness it required of the couple.
"I wasn't expecting that. I thought we would only have to be really nice after hours. But we both had to bring our best game to the marriage every day. That was an important part of what went on behind closed doors."

The Science of Frequent Sex

Helen Fisher, PhD, a research professor and member of the Center for Human Evolutionary Studies in the department of anthropology at Rutgers University, says couples trigger sex drive, romance, and attachment -- along with their attendant hormones, testosterone, dopamine, and oxytocin -- with regular sexual activity.
Fisher is an advocate of frequent sex.
She says that in some hunting and gathering societies, such as the Kung bushmen in the southern Kalahari, couples often make love every day for relaxation. Unlike our time-pressed culture, there is more leisure time.
"Sex is designed to make you feel good for a reason," says Fisher. "With someone you love, I recommend it for many reasons: It's good for your health and good for your relationship. It's good for respiration, muscles, and bladder control. It's a fine antidepressant, and it can renew your energy."
Andrea M. Macari, PhD, a clinical psychologist who specializes in sex therapy in Great Neck, N.Y., says the theories presented in the two books reflect sex therapy literature.
"Regular sex actually increases sexual desire in the couple," she tells WebMD. "In other words, the more you 'do it,' the more the individuals will seek it. You develop a desire that wasn't normally there. The act itself is reinforcing."
But she points out that sex doesn't have to be "mind-blowing."
"I encourage couples to have 'good enough' sex. This sets realistic expectations and often lowers anxiety. Sex is like pizza: even when it's bad, it's usually still pretty good. On a scale from one to 10, good-enough sex is between 5 and 7."
Doug Brown admits that he and his wife were tired on many nights. But, he says, "Once we started, we got in the mood. We were never sorry we did it."

Scheduled Sex: Good for Your Relationship?

"The two married couples who document having sex on a daily basis are great role models for other couples who want to take their relationship to a higher level of intimacy," says Ava Cadell, PhD, founder and president of Loveology University and a certified sex counselor.


Cadell's six-week course called "Passion Power" includes a commitment form, a questionnaire, and daily sensual exercises to help couples deepen their bond. "When a couple makes a commitment to explore and expand their sexuality together, they become 100% fluent in the art of love, intimacy, and sexuality. They can stay in lust forever."
But some experts think scheduled sex can backfire.
Pepper Schwartz, PhD, a professor of sociology at the University of Washington in Seattle, says, "Whether or not it works, most couples can't do it. Those who do maintain that kind of schedule have either a sexual appetite of Olympian proportions or have at least one partner who finds that as their most important way of staying connected and the other partner has tremendous grace and goodwill. There are no couples I have ever met that are in that good a mood, or have that kind of energy every day. So this is a model that will appeal to few and be practiced by even fewer."
But, she concedes, staying sexually and emotionally connected on a frequent basis has merit.
"Sexual attraction and sexual arousal bring to bear two very important hormones, dopamine and oxytocin, both of which create bliss and bonding. Even if the lovemaking session started out with only a modest amount of interest, once arousal starts, these hormones create attachment, pleasure, and intimacy. So while everyday sex isn't necessary, frequent sex is a great bonus and even an essential part of most couple's commitment and happiness with one another."
Stress management expert Debbie Mandel, MA, thinks such sex might be a bit "gimmicky" and could lead to dissatisfaction.
"In many cases, abstinence makes the heart grow fonder. You don't have to abstain for a long period of time -- a few days off creates anticipation and eagerness. You might love steak, but having it every night diminishes the gustatory pleasure. Habituate yourself to regular sex, but don't ever let love become a routine, a robotic obligatory habit."
Doug Brown disagrees. He says setting up a period of time -- be it a long weekend, a week, or a month -- is a way to jump-start a sagging sexual relationship. "It should be possible for any couple to do it for a week and for it not to be a chore. It's free and it's fun. Why not plan it and take advantage of it? Anticipation is a big part of sex."
Having sex every day may be unrealistic for most couples, but if you and your partner want to ramp up your sex life, experts offer the following tips for success:
Increase in increments. Muller recommends couples start by doubling their frequency. Then doubling it again in six months.
Re-examine your sex life -- often. Though they now average sex three times a week, Doug Brown says his wife recently told him they need a "tune-up," or a mini-marathon of sex.

Act on your desires. "Whenever you have the urge, says Macari, head straight for the bedroom. The more time [that elapses] between having the idea and following up and you'll lose motivation."
Fake it till you make it. Several experts agree: Even if you aren't in the mood, once you begin, you'll enjoy sex.


 

Reducing the Embarrassment of Incontinence

Stress incontinence has an annoying way of showing up at the most inopportune times.
You're jogging along, feeling great -- and then you realize your running shorts are damp with urine. Later that night, during a romantic rendezvous with your partner, a trickle of urine appears again, definitely spoiling the moment.
Lest you think stress urinary incontinence is a problem only of middle-aged or elderly women, think again. Surprisingly, young women actually have more stress incontinence during sex than older women, according to Amy Rosenman, MD, a gynecologist at Santa Monica -- UCLA Medical Center, Santa Monica, Calif., and co-author of The Incontinence Solution.
When incontinence occurs during intimate moments, women feel anxious, Rosenman says, even if they are in stable marriages. This could even lead to sexual dysfunction.
The same anxiety can occur during a workout, where you may end up with an embarrassing wet spot on your pants for the world to see.

Stress Incontinence Due to Weak Pelvic Floor Muscles

The problem, whether the stress incontinence occurs during exercise or sex, has a common denominator, says Beverly Whipple, PhD, RN, professor emerita at Rutgers, The State University of New Jersey, and a sexuality researcher.
"Stress incontinence is related to the strength of the pelvic floor muscles," Whipple says. The weaker those muscles are, the more likely you are to have symptoms of stress incontinence -- leaking urine during physical activity, such as exercise, sex, sneezing, laughing or jumping--in the absence of bladder contraction.
While many women experience minor leakage from time to time, at any age, if it becomes more frequent or interferes with your normal routine, you should tell your doctor. There is an array of very effective treatments for stress incontinence. Stress urinary incontinence is the most common cause of urinary incontinence in younger women and the second most common cause in older women.
If you have had several pregnancies and childbirths, your pelvic muscles and tissues may have gotten stretched and damaged. With age, the muscles can weaken, too, although stress incontinence is not an inevitable part of aging. Excess weight can also weaken pelvic floor muscles and cause stress incontinence.

Kegels Can Help Stress Incontinence

Strengthening the muscles of the pelvic floor is crucial, experts agree.
One recommended way to do that is through Kegel exercises, according to the American Academy of Family Physicians (AAFP).
First, some anatomy: at the bottom of the pelvis, many muscle layers stretch between your legs, attaching to the pelvic bones at the front, back and sides. If you think of the muscles you would use to stop the flow of urine, those are the ones you will be targeting when doing your Kegels.
The how-to's: Pull in or squeeze the muscles, pretending you are trying to stop urine flow. You should hold that squeeze for about 10 seconds. Follow that by a 10-second rest. How many? Try three to four sets of 10 squeezes a day, recommends the AAFP.

Kegels Can Help Stress Incontinence continued...

The beauty of Kegels, most experts find, is that they can be done anytime and just about anywhere -- sitting in your car or at your desk or watching television or while talking on the phone. No one will know what you are doing unless you tell them. But to ensure proper form, ask your doctor or nurse to describe to you exactly how to do them correctly.
If you do Kegels correctly and often, you can expect to leak less, Rosenman says.
Typically, bladder control improves after 6 to 12 weeks of daily Kegels, according to the AAFP. But you may notice improvement in stress incontinence after just a few weeks.

Kegels and Vaginal Weights for Stress Incontinence

Another way to prevent stress incontinence is to use vaginal weights. Vaginal weights can help you to isolate the pelvic floor muscles while doing your Kegel exercises. They come in various sizes and are inserted into the vagina using a cone. As you progress, you insert heavier weights.
Vaginal weight kits are sold online and over the counter.

Biofeedback for Stress Incontinence

Biofeedback, as the name implies, uses monitors and "feeds back" information to patients about body processes, including control of the pelvic floor muscles.
In one study of 14 women with stress incontinence, a 12-week program of pelvic floor training with biofeedback gave favorable results, according to a report published in the International Brazilian Journal of Urology. The number of leakage episodes decreased from about eight a day to 2.5 among study participants, the researchers report.

Self-Help Products for Stress Incontinence

If your stress incontinence is not severe, you may get by with urinary incontinence products such as pads and panty liners. You might want to consider rubberized bed sheets.
Another stress incontinence treatment option is a device called a pessary, which is inserted into the vagina to help elevate the bladder neck and keep urine from leaking.

Medications, Surgery for Stress Incontinence

If your stress incontinence becomes more severe or if it interferes with your lifestyle and kegel exercises and other self-help measures fail, your doctor may suggest medications or surgery.
Medications can help tighten muscles at the bladder neck and urethra, preventing urine from leaking and relieving stress incontinence.
In one operation for stress incontinence, surgical threads are used to help support the bladder neck. In another procedure, called a "sling" operation, the surgeon uses strips of material, either natural or synthetic tissue, to support the bladder neck. Bulking material such as collagen is sometimes used around the bladder opening for women with stress incontinence

Talking to Your Doctor About Stress Incontinence

Your doctor should routinely ask you about your bladder function to determine if you are having stress incontinence or urge incontinence (also called overactive bladder), Rosenman says.
 

 

Talking to Your Doctor About Stress Incontinence continued...

If your doctor does not ask, Rosenman advocates the straightforward approach. Try something like: "I'm having some problems with my bladder." At that point, if your doctor does not pepper you with questions about how often you experience symptoms, and how long it has been going on, Rosenman suggests asking for a referral to another doctor or to a specialist, such as a urogynecologist. A urogynecologist is a gynecologist who has extra training in urology.
Talking to your partner about stress incontinence is not simple, either, Rosenman acknowledges. But she tells women it may be the most important thing they can do to help their relationship. Communicating well about the problem, she writes in her book, will lead to greater affection and trust. And getting the problem out in the open is often a relief, she says.
In addition to good communication and effective treatments, Rosenman says some simple measures can help women with stress incontinence enjoy a better sex life. Among other tips, she tells them to always empty the bladder before intercourse and to cut back a bit on fluids before intercourse. Don't dehydrate yourself, but don't overdo the fluids, she says. And she encourages experimentation to find positions that are more comfortable, reducing overall anxiety.
In getting more comfortable with talking about stress incontinence, you might also take a cue from two famous Olympic athletes from the U.S. -- speed skater Bonnie Blair and gymnast Mary Lou Retton. In recent years, both have spoken publicly about their experiences with incontinence, raising awareness that the problem exists and, more importantly, that treatments can improve or eliminate the problem.

 

What is sex therapy, and what happens in a sex therapy session?

Sex therapy is a form of relationship counseling that focuses specifically on intimacy and sexual problems. A sex therapist can be a psychiatrist, psychologist, a family or marriage counselor, or sometimes even a clergyman, as long as they are specifically trained in this area.

The role of a sex therapist is not to change someone’s sex drive or orientation, but to help them maximize their potential for satisfaction and happiness. Generally, sex therapy is talk therapy. However, in a very small number of cases, surrogacy may be involved. But note, this is not common and should never be forced upon a patient, who should also not be encouraged to believe that surrogacy is their only treatment option.

Understanding Male Sexual Problems -- the Basics

What Are Male Sexual Problems?

Problems with sexual functioning are common, affecting more than half of all couples at some time. Although sexual dysfunction rarely threatens physical health, it can take a heavy psychological toll, bringing on depression, anxiety, and debilitating feelings of inadequacy. Many sexual problems are actually symptoms of other more serious heath disorders.
Determining which factors are affecting your ability to enjoy your sexuality -- whether psychological or physical -- can be very difficult and will require great patience from you, your partner, and your health care provider. Problems may be difficult to resolve without expert help, especially because misinformation and embarrassment are leading causes of sexual dysfunction.
If your sexual problem only occurs under a particular set of circumstances, or only with certain sexual partners, then your condition is considered to be "situational" rather than "generalized" (occurring regardless of the circumstances or partner).
The major categories of sexual dysfunction in men include:

• Erectile dysfunction (sometimes called impotence): the inability to have or maintain an erection sufficient for sexual functioning.
• Premature ejaculation : an inability to delay orgasm and ejaculation, such that it occurs very early in the course of sexual contact, leaving the other partner dissatisfied.
• Male orgasmic disorder: an inability to reach orgasm (climax) with a partner; or the inability to achieve orgasm without lengthy sexual contact; or the inability to have an orgasm during intercourse. In some cases, orgasm can be achieved only through masturbation or oral sex.
• Inhibited or hypoactive sexual desire: a disinterest in sexual contact or complete lack of sexual desire.
• Retrograde ejaculation: the semen,rather than emerging from the end of the penis, moves backward into the bladder during orgasm.
• Priapism: a prolonged erection unaccompanied by sexual desire; this rare condition is potentially dangerous and requires immediate medical attention.

Many of these sexual conditions will occur at some point during the course of a man's life. In fact, some researchers only consider a diagnosis of sexual dysfunction if the problem occurs in 25% of all attempted sexual encounters.

What Causes Male Sexual Problems?

Because the sexual response is so complex, involving multiple factors, there are many causes of sexual dysfunction. Sometimes simple lack of information is to blame. Emotional issues may be a barrier to a healthy sex life. An erection involves the nervous and vascular systems (the network of arteries and veins) and appropriate levels of hormones, so problems with any of these systems can interfere with sexual functioning. Common problems include the following:

• Hypogonadism, in which the testicles do not produce enough testosterone
• Thyroid disorders (both hyperthyroidism and hypothyroidism)
• Adrenal lesions (Cushing's syndrome)
• Noncancerous pituitary growths that increase levels of a hormone called prolactin
• Diseases that affect the nervous system, including strokes, spinal cord injuries, multiple sclerosis, long-standing diabetes, and Parkinson's disease
• Damage following pelvic surgery (such as prostate, colon, or bladder surgery)
• Conditions that affect the penis directly, such as Peyronie's disease (penile curvature) or injury to the penis itself or to the arteries, veins, or nerves that supply the penis
• Any serious and debilitating diseases that result in intense fatigue, including emphysema, chronic bronchitis, heart disease, cirrhosis, cancer, and kidney failure

Premature ejaculation (PE) is usually not due to physical causes, although the problem is sometimes linked to a neurological disorder, prostate infections, or urethritis. Possible psychological causes include:

• Anxiety
• Guilt feelings about sex
• Ambivalence toward women
• Learned behavior pattern of rapid ejaculation seen with frequent masturbation or infrequent sexual activity

Erection problems can be caused by:

• Blockages in the blood flow to the penis
• Atherosclerosis, or hardening of the arteries leading to the penis
• Damage to arteries or nerves after radiation treatment
• Leaky veins
• Low levels of the male hormone testosterone or other hormonal disturbances
• Conditions or behaviors that increase the risk of vascular disease, such as smoking, high blood pressure, diabetes, and high cholesterol or the medications to treat these and other disorders

Painful intercourse usually has physical causes such as these:

• An infection of the prostate, urethra, or testes, which can be initiated by sexually transmitted diseases, such as chlamydia and genital herpes
• An allergic reaction to spermicide or condoms
• Peyronie's disease, fibrous plaques on the upper side of the penis that often produce a painful bend during erection
• Arthritis of the lower back

Lack of sexual desire may be due to any of these factors:

• Physical illness
• Hormonal abnormality (usually low testosterone levels)
• Medications that affect libido
• Psychological causes, including depression or interpersonal problems, which a therapist may help identify

Retrograde ejaculation may occur in men from these causes:

• Prostate or urethral surgery
• Medication that keeps the bladder neck open
• Diabetes (which can injure the nerves that normally close the bladder during ejaculation)

Can Medication Cause Sexual Problems?
Many medications have been implicated in sexual dysfunction, causing inhibited sexual desire and/or erectile dysfunction, such as:

• Drugs to treat high blood pressure
• Diuretics (including thiazides and spironolactone)
• Histamine blockers
• Antidepressant medications
• Common over-the-counter preparations (particularly antihistamines and decongestants)
• Anti-psychotic medications
• Sedatives
• Medications used to treat anxiety
• Use of drugs, including alcohol, methadone and heroin, anabolic steroids, and tobacco

Psychological Factors in Sexual Problems
Psychological factors play an important role. You may find it difficult to enjoy a sexual relationship if:

• You are under a lot of stress
• Your relationship is troubled
• You have a history of traumatic sexual encounters (rape or incest)
• You were raised in a family with strict sexual taboos
• You're afraid of getting your partner pregnant or of contracting a sexually-transmitted disease
• You have negative feelings (including guilt, anger, fear, low self-esteem, and anxiety)
• You are depressed
• You are severely fatigued

Environmental Factors in Sexual Problems
You may find it difficult to enjoy sex if there is no safe, private place to relax and allow yourself to become sexual, or if fatigue due to an overly busy work and personal life robs you of the energy to participate sexually. Parents may find it difficult to find the time to be sexually intimate, given the demands/presence of their children. Fear of contracting HIV (human immunodeficiency virus, which can lead to AIDS), the difficulties of striving for "safer sex," and the psychological effects of discrimination, are just a few of the factors that can cause anxieties in gay men.

Basic Causes of Male Infertility

If a couple tries to conceive but can’t seem to do it, one of the first things that doctors look for is a problem with the man’s sperm. Sperm compose about 5 to 10 percent of semen, and are the only part of the semen that can cause pregnancy. If a man is infertile, there is a problem with his sperm — often a low sperm count or low motility. Sometimes, male infertility can be treated.

Just because your testicles look normal doesn’t mean that they are fully functioning. The most common problems of male infertility are

• Low sperm count, which means that the man isn’t producing enough sperm
• Low motility, where the sperm he is producing lack sufficient ability to swim to the egg

The basis for the problems may be abnormal sperm production, which can be difficult to treat, or that the testicles are too warm. Heat is known to decrease sperm count, so the solution could be as simple as changing the style of underwear from tighty whities (briefs) to boxers. Another cause can be a blockage somewhere along the line, which may be corrected through surgery.

Interestingly enough, most semen analysis is done by gynecologists, specialists in the female reproductive system. A gynecologist is usually the first person a woman consults when she has problems getting pregnant. Commonly, the gynecologist asks that the man’s sperm be analyzed. If the tests reveal a problem with the sperm, the man is sent to a urologist for further evaluation.

How to Deal with Low Libido in Men

Lack of sexual desire, or low libido, can affect men and women. Low libido isn't just a “slump,” but a continued lack of desire to have sex for a period of time. What causes low male libido ranges from emotional distress to physical problems. The best way to treat the lack of sexual desire is to see a doctor. A medical doctor can rule out physical factors whereas a sex therapist or marriage counselor can treat psychological factors.


One of the most common causes of low male libido these days is stress. You come home late every night from work, or you’ve lost your job, or whatever, and sex is the last thing on your mind. If your partner is amorous and then starts to complain about being rejected, you become even tenser and want to have sex even less. A vicious cycle builds up, and your sex life can deteriorate down to nothing.

Can you fix a problem such as this by yourself? Maybe, but it’s not easy. One of the components of this problem is usually a lack of communication. And breaking down the barriers that have been set up can be very hard to do. A good recommendation is to visit a sex therapist or marriage counselor.

Some of the causes of loss of sexual desire aren’t emotional but physical. For example, testicular and prostate cancers can both affect the libido. A good sex therapist always asks that the man see a medical doctor first to rule out any medical problems.

How to Deal with a Bent Penis

A bent penis is an erect penis that curves to one side or the other — and in most cases, it is absolutely normal. A curved penis simply can be a result of individual anatomy. If, however, your penis has a pronounced curve or bends sharply to the left or right — especially if penetration is impossible or if an erection is painful — you should see a urologist. You may suffer from Peyronie’s disease — where scar tissue develops in the penis.
The direction that an erect penis takes depends on the proportion of crus (penis under the skin) to exposed penis. Men with a shorter crus, and thus a longer penis, are more likely to have an erection that points downward, while an erect penis that has a longer crus will probably point outward, or even straight up. Sometimes the penis also bends to the left or to the right. In the vast majority of cases, the curve falls well within the norms of most men and should not be a deterrent for a relationship.

If you feel that your penis has an abnormal shape is to go to a urologist to make certain that this curvature doesn’t indicate some problem.

Once in a while, a man does have a more pronounced curve than most. Even the majority of these men don’t have a problem in bed, although a few may have to adjust the positions they use. In some cases, however, a man may have Peyronie’s disease, a condition that can make sex impossible.

Peyronie's disease results in a curved penis.

 

Peyronie’s disease inflicts some men with a penis that bends so severely when it becomes erect that intercourse becomes impossible. The cause of Peyronie’s disease is unknown; in many instances, it arises as a result of an injury. In early stages of the disease, men usually experience pain associated with having an erection. Sometimes that pain begins before the actual curvature starts and serves as an early indicator of the problem.


How bad can Peyronie’s disease get? Bad enough for doctors to describe severe cases in which the erect penis looks like a corkscrew. On the other end of the spectrum, the bend may be very slight, not affect the man’s ability to have intercourse, and not cause any concern. In mild cases of the disease, if the man has any pain, it usually goes away on its own; all the doctor has to do is reassure the man that in two to three months all will be well.


Sometimes the curve disappears on its own. Because the disease is basically a scarring process, some men have reported positive results from taking vitamin E, although no scientific proof exists that this technique works. Surgery can sometimes remove the scarred tissue, but surgery can also result in a loss of the man’s ability to have an erection, so he would then need to have a prosthetic device implanted.
The best advice for a man who has Peyronie’s disease is to visit a urologist who can help you. Some men are so embarrassed by their condition that they refuse to get help, but urologists have helped many men with this problem, so you have no reason to be shy.

If the first urologist you consult can’t help you, look for another one. Doing so is worth the effort.

Understanding Male Circumcision and Sex

Circumcision is the surgical removal of the foreskin from the penis, and it's done mostly for cultural or religious reasons. Baby boys are always circumcised in Jewish and Muslim cultures, and many Western societies also perform circumcisions.
Part of the impetus for circumcision’s popularity in many Western societies is that the penis is easier to keep clean without the foreskin. Small glands underneath the foreskin secrete an oily, lubricating substance. If these secretions accumulate and mix with dead skin cells, a cottage cheese–like substance called smegma forms. In an uncircumcised man, smegma can build up and lead to infections and, sometimes, even more serious diseases.

Some parents and physicians no longer believe circumcision is necessary. Because of today’s better hygiene, circumcision isn't always considered necessary, although the debate isn’t entirely over.

An uncircumcised man should always take special precautions when bathing to pull back the foreskin and clean carefully around the glans.

A circumcised penis (l.) with the foreskin removed; an uncircumcised penis (r.) with the foreskin intact.

Circumcision and sexual performance

It's common to question the affects of circumcision on sexual performance and other aspects of a man’s life. The penis of a man who hasn’t been circumcised is often more sensitive than that of a circumcised man. The reason for this is that the glans, or head, of a circumcised penis gets toughened by coming into contact with the man’s underwear all day without the protection of the foreskin. As such, people may wonder whether circumcision affects sexual performance.

Also, some men who aren’t circumcised erroneously believe that, because their skin is more sensitive, they are more likely to have premature ejaculation. Adult men may ask if they should be circumcised to cure them of this problem. There is no scientific study suggesting that circumcision makes a significant difference. Most certainly a man who isn’t circumcised can learn how to prolong his climax just as effectively as a man who is.
Some men have also asked if a way exists to replace their foreskin. These men feel that, because the skin of the glans has been toughened, they are missing out on certain pleasures. In truth, as long as they are having orgasms, this isn’t something that they should worry about.

Circumcision and sexually transmitted diseases

Many studies have been done to see whether a man’s penis being circumcised affects his risk of getting HIV, but no connection was found. Then in 2006, a study in Brazil showed a clear correlation. The theory is that the virus grows in the warm, moist environment under the foreskin of an uncircumcised penis. Although this one test isn’t enough to prove that circumcising at-risk men, particularly in Africa, would reduce the rate of transmission, perhaps further study will do just that.

How to Deal with a Permanent Erection

What's commonly called a permanent erection is an erection that won’t go away within four hours; the medical term for this condition is priapism. In priapism, blood becomes trapped in the penis and cannot flow out.
A permanent erection isn't a sign of masculinity, but of a true medical problem.

Anyone who has an erection that won’t go away even after orgasm/ejaculation should seek medical treatment or head to the emergency right away. Let go of the embarrassment, because if left untreated, priapism can lead to permanent damage.

A persistent, long-lasting erection can result from the man taking or injecting himself with medication because he suffers from impotency, or from some disease that thickens the blood, making it impossible for blood to leave the penis after it has entered. Sickle cell anemia is one such disease. Other medications can also cause priapism — for example: antidepressants, anticoagulants, and antipsychotics.

Priapism is not only painful, it is potentially harmful and the man usually ends up in the emergency room. Doctors can now treat priapism without surgery, but the condition still requires medical care.

Retarded Ejaculation: When a Man Can't Ejaculate

Believe it or not, there is such a thing as lasting too long during sex. Retarded ejaculation (or male orgasmic disorder) is a condition in which a man can’t make himself ejaculate. Whether in a man or woman, the inability to orgasm can make sexual intercourse frustrating or even undesirable. Finding the cause is the key to learning how to fix retarded ejaculation.


While rare, retarded ejaculation is a real problem. Sometimes a medical problem causes retarded ejaculation, in which case only a urologist can help. Sometimes the cause is psychological, and a sex therapist can treat the problem. A relationship problem can be one of the psychological causes, which may lead to a man unconsciously holding back his ejaculation. In that case, fixing the relationship is key to curing the problem.

Although being able to last a long time is something our society puts great value on, retarded ejaculation is a problem. Don’t cover it up by bragging about your power to “last all night long.”

The Connection between Men's Health and Erections

Impotence and erectile dysfunction (ED) may seem like health tragedies to the men who suffer from them. In fact, the ability to have an erection may be more centrally connected to good health than you realize.
Studies have proven that long before troublesome symptoms of heart disease or obesity present themselves, a man is likely to notice differences in his ability to have an erection. This trouble can be caused either by being out of shape or from smoking.


The connection between men's health and erection leads to a few conclusions:

• If a man notices any changes to his erections, he should immediately consult with his physician to be checked for any signs of heart or circulatory disease.
  
  
• If a man would like to keep erectile dysfunction (ED) at bay and he smokes, he should stop.
  
  
• A man who strengthens his heart through cardio workouts also maintains his ability to have erections. A recent study showed that men who expended energy equivalent to running 1.5 hours a week reduced the chances of encountering problems with ED by 30 percent as compared to men who didn’t exercise.
  
  
• That same study found that men who didn’t exercise and were also overweight were 2-1/2 times likelier to develop ED than men who led active lifestyles and were of normal weight.

How to Deal with Short-Term Impotence

Impotence — meaning, the inability to have an erection when desired — frightens men, even though many have suffered from impotence at some point. Men may confuse short-term impotence with erectile dysfunction. The good news is that a couple of failures to have an erection doesn't mean there's something wrong with your penis. In fact, it's almost always psychological in nature. That means most men can learn how to “solve” short-term impotence.

Anticipatory anxiety has caused many men to experience impotence. Anticipatory anxiety means the fear or expectation of a possible failure causes an actual failure. If a man starts worrying about his erection, usually doing so is enough to prevent him from having one. And the more he worries, the more likely that he will fail the next time he tries. Many men, because of one failed erection, have suffered through years of misery.
Treating short-term impotence involves several steps:

• The first step is to visit a urologist. Even though younger men usually suffer impotence as a result of psychological factors, a urological exam rules out any physical factors. Also, a clean bill of health may reassure a man about his well-being — enough to clear the problem up completely.
• The second step is building confidence. This can be done via masturbation or confidence-building exercises with a partner. Sex therapists usually recommend against intercourse during this time because it removes the pressure of requiring an erection for penetration. After the man regains confidence in his ability to have erections, it is usually easy to transfer that confidence to intercourse.
• The third step, if the man is physically sound but doesn’t respond to treatment, is to find out whether he has erections while he’s asleep. Because a man usually doesn’t have performance anxiety while he’s asleep, a man who suffers from impotence while he’s awake but doesn’t have a physical problem usually has erections while he sleeps.
  During the course of the night, a healthy man gets several erections during REM or “dream” sleep. He’s not necessarily having an erotic dream or any dream at all, but having erections is definitely part of the male sleep pattern. This phenomenon even has its own name, nocturnal penile tumescence.
  The simple, at-home test to find out whether you’re having erections during your sleep is to wrap a coil of stamps around the base of your flaccid penis. (A few turns around the penis should be enough to keep it in place.) If you find the circle of stamps broken when you wake up, you probably had an erection.
  If the coil of stamps doesn’t work, book an appointment at a sleep lab. At a sleep lab, physicians substitute the stamps with plastic strips and Velcro connectors, which are more reliable indicators than postage stamps. And doctors have even more precise devices, if needed.

If all this testing doesn’t turn up any sign of erections, then return to your doctor. But for many men, these tests do uncover some erectile functioning, which probably indicates that the problem is psychological in nature. This is not true 100 percent of the time, but it certainly deserves following up. The basic aim is to build back the man’s confidence to the point where he can have erections while he is awake — and even with a woman around.

Erectile Dysfunction: The Causes and Treatments

Erectile dysfunction (ED), also called impotence, is the term used when a man is unable to have an erection. Erectile dysfunction is the second most common male sexual problem. Although ED can strike at any age, it becomes much more common as men grow older. Among men in their late 70s and beyond, some symptoms of ED are almost universal. ED doesn’t necessarily mean the end of a man’s sex life. Depending on the cause of the problem, several possible solutions are usually available, so take heart.

Causes of erectile dysfunction

The causes of ED can be either psychological or physical, while the degree of ED can vary from a simple loss of rigidity to a total inability to have an erection.

Fewer psychogenic erections does not mean you are impotent. Some men worry this means they are impotent and begin to avoid sex. This can cause a rift in a longtime relationship. Instead, adding foreplay can solve this problem.

As a man gets older, his erections begin to get weaker and weaker, and he may need more and more stimulation to get an erection. Some older men can get an erection but can’t keep it long enough to have intercourse. Sometimes they can get an erection, but the erection isn’t stiff enough to allow for penetration.
Eighty percent of ED problems occur as a result of serious medical conditions including diabetes, hypertension, or prostate cancer surgery. These conditions are much more common in older men, though they can happen in men of any age. These are all real, physical problems, but they don’t necessarily spell the end of a man’s sex life. If men are willing to take appropriate action, many men can continue to have sexual relations through their 90s.

Treatments for ED

The morning cure: Have sex in the morning instead of at night. Because you’re probably retired and have no children at home, you have no reason to always try to have sex at night, except the force of habit. However, blood flow and testosterone, both key to erections, tend to be at higher levels in the morning.

The older you are, the longer it takes you to get your body warmed up for activity. Because you probably don’t have to be on a rigid schedule, try waking up, having a light breakfast, getting your blood flowing, and then taking your partner back to bed for a sexual interlude.

• The stuff technique: Have sex without first having an erection. After stuffing a nonerect penis into the vagina, a man begins to thrust. Sometimes, the blood then flows into his penis and causes an erection.

This technique doesn’t always work — or may never work for some men. Try it for a few minutes, and if it doesn’t seem like an erection will occur, then drop it.

• Oral medications: Viagra, developed by Pfizer, is the most commonly known prescription drug for treating ED. Other companies have similar drugs. These drugs may have side effects and should only be taken after prescribed by a doctor.

Men with heart conditions who take nitrates such as nitroglycerin should never take Viagra because the combination of the two drugs can be deadly.

• Penile implants: Non-hydraulic prostheses (semi-rigid rods that surgically implant within the erectile chambers) are reliable but leave the penis always in a rigid state. Hydraulic prostheses are now becoming more reliable and allow a man to create an erection only when desired using a mechanic pump into a fluid reservoir (also surgically implanted).
• Injection therapy: A man injects his penis with a medication that relaxes the muscles, thus allowing blood to flow into the penis and cause an erection. The penis is relatively insensitive to pain, so you can barely feel the injections. Most men who use this system have reported good results although side effects are possible. This method may be appropriate for men who can’t take a pill.
• Vacuum constriction: Vacuum-constriction devices, placed over the penis, allow blood to flow into the penis as air is pumped out, creating an erection. A ring at the base of his penis holds the blood in place. This does not require surgery (like prostheses) but may not provide as rigid an erection and may result in bruising.

A couple should decide together which method will work best for them and when to use one of these ED therapies, instead of the man making the decision on his own.