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Sex Health Blog

With Technology, Sex Has Come a Long Way

Jan 30, 2018

With Technology, Sex Has Come a Long WayConsider how different dating, relationships, and sex have become with the influence of technology.

Back in the late 1970s, Rupert Holmes sang from the point of view of a man who was bored with his relationship. Looking through the personals section of his local newspaper, he spotted an intriguing ad from a woman who was seeking a more exciting partner to “escape” with.

And thus “Escape (The Piña Colada Song)” continued: Holmes’s character “wrote to the paper” and arranged to meet his new partner at a bar. (Spoiler alert: His correspondent was actually his current partner, and the experience allowed them to learn more about each other and their relationship.)

The situation seems quaint now – after all, few people are writing letters to newspapers to find love or a hookup. Nowadays, Holmes’s character would likely pick up his smartphone, browse a dating site, and perhaps meet his new romantic interest the same night. They would already have information about each other – whether they were looking for a long-term relationship, for example, or a one-night stand. And they might have used apps to sext one another, track their sex lives, or learn more about sexual positions.

Last year, a survey by the Kinsey Institute at Indiana University and women’s health app Clue revealed some of the many ways that people around the world use technology to find partners, get sexual health information, and track their sex lives. You might be surprised by some of the results. Let’s take a look.


Over 140,000 people from 198 countries participated in the survey, which was translated into 15 languages. All respondents were required to be age 18 or older.

The vast majority of the respondents were women, with only 2,500 men and 2,100 genderqueer/nonbinary people participating. Still, the study authors called this distribution of participants “statistically legitimate.”


About 30% of the respondents used dating apps to find partners, but “friends with benefits” (sex without commitment) was the least desired relationship sought. Ten percent used apps to find partners for one-night stands.

People in Sweden were the most likely to find partners through technology, with 46% saying they’d used a dating app. Just over a third of Americans had used apps in this way.

Sex Education

How we learn about sex has changed, too. Apps, websites, and even video channels are used for sex education, from the basics to the finer points of solo and partnered sexual technique.

The survey found that 18% of the participants used apps to learn about sex, and that those with sexual experience were about as likely to do so as those who had no experience.

Nineteen percent of Americans had used apps for sex education. Almost a third of Chinese respondents had, and people form Singapore were the least likely (11%).

Men were more likely than women to seek information this way (27% and 18% respectively).


Sexting – using a device (such as a smartphone) to send a partner sexually explicit photos or messages – was common for the respondents. About two thirds of all respondents had sexted, with 40% saying they’d done so using SMS text messaging. In the United States, 65% sexted by SMS, and 38% said they used Snapchat. Overall, Snapchat seemed to be the preferred venue for younger people.

The practice was most common in South Africa and the U.S. and less common in Japan and South Korea.

Sexting is becoming more frequent, too. Kinsey Institute researcher Amanda Gesselman pointed out that in a 2012 survey, only 21% of the respondents had ever sexted. “This increase, and this large of a proportion of respondents, suggests that incorporating tech into our private lives is becoming normal—sexting may be becoming a new, but typical, step in a sexual or romantic relationship,” she commented.

Improving Relationships

Can tech be used to improve a sexual relationship? About 12% of respondents thought so, and they used apps accordingly. Men were more likely to do this. They were also more likely to use apps to learn about safe sex and their partner’s bodies than women were.

Less than 1% of the respondents felt that using an app to improve a relationship was “detrimental or useless.”

Tracking Sexual Activity

One in four respondents said they used an app to track their sexual activity. Over half of Filipinos did so, followed by 45% of Americans and 23% of those from the United Arab Emirates. Using apps to track sexual satisfaction and sexually-transmitted diseases was much less common (3% and 1% of respondents, respectively).


Apps were more frequently used by respondents who identified as a sexual or gender minority. Overall, 28% of heterosexual people used dating apps. But 44% of bi/pansexual, 49% of homosexual, and 55% of queer respondents did.

“This signals tech as a potentially more comfortable environment or a safer space than in-person or face-to-face encounters for those on the LGBTQ spectrum who are seeking romantic and sexual partners,” noted Amanda Gesselman.

What’s Next?

With technology constantly evolving and improving, it’s hard to know where we’ll be in another 40 years. Will we still use terms like swipe left and swipe right as a comment on attractiveness? Will we still be meeting people IRL (in real life), as the characters in the Piña Colada song did? Only time will tell.


Clue and the Kinsey Institute via

“Technology & Modern Sexuality: Results from Clue and Kinsey’s International Sex Survey”

(August 9, 2017)

Crist, Ry

“Sex and technology make a hot pair, Kinsey study suggests”

(August 11, 2017)

La, Lynn

“How does real sex look? These sites show the awkward truth”

(November 7, 2017)


Roman, Laura, Ashley Brown, and Alyssa Edes

“From 'Bae' To 'Submarining,' The Lingo Of Online Dating”

(January 7, 2018)

Sex Health Blog

How Do Women Feel About Orgasms?

Dec 26, 2017

How Do Women Feel About Orgasms? One word that’s often used to describe women’s orgasms is “elusive.” Sometimes, they’re easy to achieve, sometimes not. They can be fueled by both physical stimulation and emotional bonding. They might not happen all the time. They might not happen at all. Or, they might happen multiple times in one encounter.

Indeed, women’s orgasms can be mystifying. But that doesn’t stop researchers from learning more about them, even to the point of asking volunteers to pleasure themselves in an MRI machine for scientific study.

Last year, a team of researchers from Finland analyzed the results of five sex surveys conducted between 1971 and 2015. Focusing on orgasms, the team looked at women’s history with orgasm and what mattered most to them and their partners. Overall, the project involved over 10,000 men and women. The results were published in the journal Socioaffective Neuroscience and Psychology.

In this post, we’ll take a closer look at what the researchers discovered, with more to follow in a later blog post. (Note: Not all of the surveys asked the same questions. In some cases, results pertain to just one survey.)

First Orgasms

Most women had their first orgasms through masturbation; for some, it occurred before age 13. However, first orgasms during intercourse tended to happen at a later age. The women’s average age of first intercourse was 17. Only a quarter had their first intercourse orgasm in their first year of partnered sexual activity. (In contrast, three-quarters of the men did experience orgasm during that first year.)

Importance of Orgasms

About 60% of the women said that having an orgasm was “rather important” while less than 20% felt orgasms were “very important.” About 10% didn’t think orgasms were important at all.

Among women who rated orgasms as very important, about 30% had multiple orgasms the last time they had sex.

For women who didn’t consider orgasms to be important, only 13% climaxed during their last intercourse. One study noted that women in this category may place less value on orgasms as a “sensible coping strategy.” In other words, if women don’t value orgasms, they won’t be disappointed about not having them.

Almost all the women thought that helping their partner reach orgasm was important.

Pathways to Orgasm

Forty-eight percent of women said they climaxed more easily while masturbating compared to intercourse. For 14%, the reverse was true, and for 17%, both methods were equally effective.

Was stimulation of the vagina or clitoris more effective? Over half the women said they usually reached orgasm through stimulation of both areas. Thirty-four percent preferred the clitoris, and 6% climaxed mainly through vaginal stimulation.

For many women, a longer duration of intercourse made them more likely to reach orgasm. For example, those who had intercourse for fifteen minutes were more likely to climax than those who had sex for a shorter time period. However, more time was not always better. Intercourse lasting 20 minutes was not more likely to bring about climax.

Sexual positions could also contribute to orgasm. Some women attained orgasm more easily if they were in an active role, such as with the woman-on-top position. In this way, they had better control over the encounter. Women who took on more passive roles, such as with the man-on-top position, were less likely to climax.

What’s Next?

Throughout this research, there is one common thread: orgasms can be as individual as women themselves. And what works for one woman doesn’t necessarily work for another.

In part 2 of our blog discussion of women’s orgasms, we’ll continue exploring the Finnish study, focusing on other ways partners are involved, the importance of communication between partners, factors that reduce frequency of orgasm, and the ability to achieve multiple orgasms.

In the meantime, please see these links to learn more:

Orgasm Problems: What Can Women Do?

Benevolent Sexism and Female Orgasm

What Happens During Orgasm?

Anatomy Could be a Key to Orgasm

Female Ejaculation

After Orgasm: A Range of Reactions


Socioaffective Neuroscience and Psychology

Kontula, Osmo PhD and Anneli Miettinen MSSc

“Determinants of female sexual orgasms”

(Full-text. Published: October 25, 2016)

Sex Health Blog

The Effects of Cancer on Women’s Sexuality

Nov 28, 2017

The Effects of Cancer on Women’s SexualityIn August 2017, the European Journal of Cancer Care published a comprehensive review by Canadian researchers that involved over 100 medical studies concerning women, cancer, and sexual health. The authors delved into the physical and psychological aspects of cancer that can affect sexuality. They also discussed some of the ways patients and their healthcare team might approach sexual problems during and after cancer treatment.

Their review included studies on a variety of different cancers, including gynecological cancers (such as ovarian or cervical cancer), breast cancer, and cancers affecting the gastrointestinal organs, blood, head, and neck. Patients who participated in the studies came from around the world.

Today, we’d like to share some of the findings from their review.

Physical Aspects

Some women start having cancer-related sexual problems even before their diagnosis. For example, women with gynecological cancers might have abdominal pain, heavy periods, or bleeding after sex.

For others, sexual issues are a result of treatments. Here are some examples:


  • Sometimes, genital nerves or blood vessels are damaged during surgery, which might reduce sensation or make it difficult for blood to travel to the area when a woman is aroused.
  • If a woman has her ovaries removed (oophorectomy), her body produces less estrogen, an essential hormone for vaginal health. This can leave the vagina brittle and dry.
  • Women who undergo mastectomy may feel self-conscious about the loss of one or both breasts and surgical scars.

Hormone Therapy

  • Medications that interfere with estrogen production can cause vaginal changes, leading to dryness and loss of elasticity.
  • Hormonal therapy might also lessen sexual desire.


  • Chemotherapy often triggers early menopause, and estrogen levels decline.
  • Fatigue and gastrointestinal problems from chemotherapy may leave women too tired or ill for sex.
  • Hair loss and weight gain associated with chemotherapy can affect a woman’s body image.

Hematopoietic Stem Cell Transplantation (HSCT)

  • Women who undergo this treatment might develop graft-versus-host disease (GVHD). In the genitals, GVHD may lead to vaginal dryness, narrowing, scarring, and pain.

Radiation Therapy

  • Radiation has been linked to fatigue, vaginal shortening, incontinence, loss of sensation in the genitals, and scarring.

Emotional Aspects

The physical side effects of cancer and treatment are intertwined with emotional ones, which can be just as distressing.

  • Poor body image. As mentioned above, hair loss, weight gain, scarring, and other bodily changes make many women feel less feminine or less attractive to a partner.
  • Shame and embarrassment. Women may not want a partner to see their changed bodies. Episodes of incontinence can bring about anxiety.
  • Guilt. Some women worry that they cannot please their partner sexually.
  • Grief. It is not uncommon for women to grieve the loss of the sexual relationship they once had with their partner.
  • Anxiety. Women may be concerned that their partner will end their relationship or go elsewhere for sexual satisfaction.
  • Avoidance. Some women avoid sexual relationships altogether, particularly single women who fear rejection from partners after disclosing their cancer diagnosis.


All of these effects may sound overwhelming. The good news is that there is hope. The study authors listed a number of therapies that can help with the sexual repercussions of cancer and treatment:

  • Counseling. Therapists can help women cope with the anxiety and depression often associated with a cancer diagnosis. They can help couples strengthen their relationship through better communication. And sex therapists can offer guidance on adjustments to make in the bedroom that can improve intimacy for both partners.
  • Yoga and mindfulness. Practicing yoga and mindfulness activities may lower stress, encourage relaxation, and induce a feeling of centeredness.
  • Vaginal moisturizers and lubricants. These over-the-counter products can relieve vaginal discomfort and dryness, making intercourse more comfortable.
  • Vaginal estrogen-based treatments. As noted above, estrogen is essential for vaginal health. Estrogen therapy is not appropriate for all women with cancer, but for some, it can minimize the vaginal effects of medical menopause if applied locally.
  • Vaginal dilators. In cases where the vagina shortens or narrows, dilators can help preserve the vagina’s original shape.
  • Pelvic floor physical therapy. The pelvic floor muscles act as a “hammock” that keep the pelvic organs stable. Strengthening these muscles through physical therapy can reduce the likelihood of incontinence.

Keep in mind that women experience sexuality in different ways. The degree to which cancer and its treatment affects a woman’s sex life depends on the woman herself, her outlook, her relationships, her support network, and her oncology team. But overall, there is hope. Women with cancer should know that they can still enjoy intimacy.


European Journal of Cancer Care

Sears, Carly S., et al.

“A comprehensive review of sexual health concerns after cancer treatment and the biopsychosocial treatment options available to female patients”

(Full-text. Published online: August 10, 2017)

Sex Health Blog

Enjoying Intimacy Despite Sexual Pain and Discomfort

Oct 31, 2017

For most people, enjoyable sex is sex without pain. But even small discomforts can make sex less pleasurable. While sexual pain can have many causes, the clue to resolving it can start with our mindset.

What causes sexual pain?

Sometimes, sexual pain is situational. You might have a new partner and need time to adjust to each other’s bodies. Or you might be trying a new sexual position or having sex in a place you’re not used to. Any of these scenarios are possible, and they’re usually easy to fix.

However, sexual pain can be caused by medical conditions, too. It might be temporary, but it could be chronic. And it might be difficult to solve at first.

Here are some common and not-so-common causes:

For men:

  • Phimosis (occurs when the foreskin of the penis cannot be pulled back)
  • Peyronie’s disease (formation of plaques that cause the penis to bend)
  • Chronic prostatitis/chronic pelvic pain syndrome (inflammation that affects the prostate gland)

For women:

  • Endometriosis (growth of endometrial tissue outside the uterus)
  • Ovarian cysts
  • Pelvic inflammatory disease (an infection often caused by untreated STDs)
  • Recent childbirth
  • Vestibulodynia (pain at the entrance of the vagina)
  • Vulvodynia (chronic pain in the vulva – the clitoris, labia, and opening of the urethra)
  • Vaginismus (involuntary contraction of vaginal muscles)
  • Gynecologic cancer
  • Menopause
  • Vulvar and vaginal atrophy

For both men and women:

  • Arthritis
  • Allergies (e.g., to personal care products, latex condoms, or sperm)
  • Psoriasis
  • Genital or pelvic injury
  • Surgery
  • Sexually-transmitted infections
  • Lichen sclerosis (a genital skin condition)

For more details on these causes, please see the helpful list of resources at the end of this article.

Keeping sex pleasurable

So, what can couples do to stay intimate without pain? Here are some ideas:

  • Rethink your definition of sex. Many couples believe that sex equals penetration and that other activities don’t “count.” Focus instead on what counts for you and your partner. Is it pleasure? Excitement? Connection and bonding? Think of ways you can achieve these goals without pain. It might mean trying new sexual positions, engaging in oral sex, or doing mutual masturbation. It could be kissing, fondling, or massage. Whatever it is, you and your partner can decide what will make an intimate experience satisfying.
  • Talk to your partner. Lots of couples are anxious about discussing sex together. But it’s important to do so, especially if one of you is feeling pain. Be direct about telling your partner about what is painful and what it enjoyable. Be open about the ways that your sexual challenges are affecting your relationship. If you have trouble with these discussions, seeing a counselor or sex therapist can help.
  • See your doctor. Many sources of sexual pain can be treated with medication, lubricants, physical therapy, counseling, sex therapy, or surgery. Talk to your gynecologist, urologist, or primary care physician about what’s happening.It may take some time to pinpoint the cause, but it’s a path worth exploring.
  • Be willing to make adjustments and compromises. As noted above, some couples need to try new things in the bedroom. Take your time discovering what these things are. For example, a woman who finds vaginal intercourse painful might try a warm bath or a romantic slow dance with her partner, if those activities will help her relax. She and her partner could also decide to take intercourse out of their sexual routine while she seeks treatment.

If you are having sexual pain, you don’t have to grin and bear it. Chances are, your partner will want to do what it takes to make the experience satisfying for both of you. Work together to reach your sexual goals.


Centers for Disease Control and Prevention

“Pelvic Inflammatory Disease (PID) - CDC Fact Sheet”

(Page last updated: July 10, 2017)

“9 Problems That Can Make Sex Painful for Men”

(February 29, 2016),,20190111,00.html

International Society for Sexual Medicine

“Antidepressants and Vulvodynia”

“What is a sperm allergy?”

“What is chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)?”

“What is clitorodynia (clitoral pain)?”


“What is dyspareunia?”

“What is lichen sclerosus and whom does it affect?”

“What is phimosis?”

“What is provoked vestibulodynia (PVD)?”


Kerr, Breena

“How to Rethink Intimacy When 'Regular' Sex Hurts”

(September 8, 2017)


“Conditions – Peyronie’s Disease”

“Dealing with Arthritis”

(August 25, 2011)

“Endometriosis and Sex”

(July 26, 2016)

“Pain During Sex – Vaginismus”

“Psoriasis and Sexuality”

(May 31, 2016)

“Sex For Women After 50”

(October 29, 2014)

“Vulvar and Vaginal Atrophy”

(June 26, 2013)

Women’s Sexual Health After Childbirth”

Sex Health Blog

How Does Cancer Affect Men’s Sexual Health?

Oct 02, 2017

How Does Cancer Affect Men’s Sexual Health? Earlier this year, the American Cancer Society estimated that about 15 million Americans were living with cancer in 2016.

On top of that, more than 161,000 men are expected to be diagnosed with prostate cancer in 2017, representing 19% of new cases. Lung and bronchus (air passages of the lungs) cancer comes in next, with almost 117,000 new cases expected (14% of new cancer diagnoses). Colon and rectal cancer ranks third, with over 71,000 cases (9% of new diagnoses).

Fortunately, survival rates have increased over the years. In 1975, only 68% of men with prostate cancer survived for five years. In 2012, the rate increased to 99%. Five-year survival rates for colon cancer rose from 50% to 66% during that same time period.

Higher survival rates are good news. But with that good news comes adjustments. For sexual relationships, there can be challenges. In fact, of those 15 million people mentioned above, about 46% have sexual problems due either to cancer or the treatment of cancer.

Male cancer patients and survivors often face sexual dysfunction, sometimes in the short term, and sometimes for years.

In today’s post, we’ll go over some of those challenges, why they occur, and what men can do.

What might happen in the short term?

Some of the sexual issues men may develop immediately after treatment include:

  • Reduced sexual interest
  • Fatigue and trouble moving
  • Pain
  • An inability to resume sexual activity
  • Depression and anxiety
  • Difficulties working and earning a living
  • Relationship problems
  • Changes in family roles

You’ll notice that not all of these issues are directly sexual, but they still apply. A man who is chronically tired or in pain may not have the energy for sex. If he can no longer work, he may feel anxious about providing for his family. If his partner or children have had to care for him, he may feel like a burden to those he loves and become depressed. All of these issues can affect his sex life, and it’s not uncommon for them to overlap.

What about the long term?

Over months or years, the following issues may develop:

  • Erectile dysfunction
  • Ejaculatory disorders
  • ncontinence
  • Low desire
  • Depression
  • Infertility
  • Poor body image
  • Sexual pain
  • Fatigue
  • Relationship issues

What causes these sexual problems to occur?

They may result from the cancer itself or the treatment. Here are some considerations:

  • Location and extent. If a man’s cancer affects his genitals, or if it has spread to other parts of the body, he may be more likely to develop sexual dysfunction. Example: A man who has had both testes removed due to testicular cancer will not be able to produce the hormone testosterone, which is important for desire and erections.
  • Types of therapy. Surgery, radiation, hormone therapy, and chemotherapy can affect a man’s body in different ways. Examples: Surgery can affect ejaculation and urinary function. Hormone therapy could dampen libido. Chemotherapy may leave a man exhausted.
  • A healthcare provider’s expertise. Men with cancer usually have several providers working for him as a team. Some may be more experienced than others. Example: A man with prostate cancer might have his prostate gland surgically removed. But nerves needed for erections lie very close to the prostate. Surgeons can do their best not to disturb these nerves, but it’s a painstaking process.
  • Age. Some sexual problems are more prominent as men get older, especially if they have other health conditions that contribute. Examples: A man’s risk for erectile dysfunction increases as he gets older, regardless of whether he has had cancer. Diabetes and heart disease, which can also impair erectile function, are common in older men.
  • Sexual function before cancer treatment. Good sexual function before treatment is more likely to be preserved after treatment. Example: If a man could get and maintain firm erections before he had cancer, he has a better chance of recovering erectile function after treatment. 

What can men do?

Sexual challenges related to cancer may seem overwhelming. But men should know that they are not alone. Here are some suggestions for coping:

  • Talk to your cancer team. Keep your healthcare providers updated. Your team can offer solutions that are tailored to you. That might mean medication for erectile dysfunction or counseling for anxiety.
  • Talk to your partner. You don’t need to keep your feelings bottled up inside. If you miss the intimacy you once shared, say so. If you need something specific from him or her, don’t hesitate to speak up.
  • Ask for help. If you’re feeling fatigued, ask a family member or friend to help out with household chores, shopping, or childcare. Many people want to help, but they aren’t sure how. This is an opportunity to let them know.
  • Consider a support group. Talking – either in person or online - to other men who have “been there” is a valuable way to share information, get tips, and feel some camaraderie.
  • Try to maintain a healthy lifestyle. You may not feel up to exercising, but ask your doctor about ways to stay active. Following a healthy diet is important, too. Involve your partner or friends so that fitness or meals are more fun.
  • Get together with friends. Your social network will be a tremendous source of support. It can take your mind off things, too. If you feel up to it, have some buddies over to watch a big game or go out to a funny movie – whatever you enjoy.
  • Consider a sexual therapist. A sexual therapist specializes in enhancing communication with your partner and setting realistic goals for sex. Even without having undergone cancer treatment, there are tremendous societal pressures and unrealistic expectations surrounding sex.

There is more ground to cover on cancer and sex, but we hope this has been a helpful introduction for men. In the coming months, we plan to discuss more topics, so be sure to watch this space.


American Cancer Society

“Sex and the Man With Cancer”


Stein, Kevin, PhD, et al.

“Physical and psychological long-term and late effects of cancer”

(Full-text. First published: April 1, 2008)

Livestrong Quarterly

Broderick, Gregory, MD with Brian Alexander

“Private Parts, Private Reactions” (Summer 2011)

No link available.

Sexual Medicine Society of North America

Broderick, Gregory, MD

“Sexual Function in Male Cancer Survivors”

(Presentation slides. May 12, 2017 in Boston)

No link available.

Sex Health Blog

Young Men and Erectile Dysfunction

Sep 06, 2017

Young Men and Erectile Dysfunction

If you pay attention to the media, you might think that erectile dysfunction (ED) happens only to older men. The ads for ED medications tend to show men with salt and pepper hair discussing how their improved erections helps them feel young again. Comedians may joke about an elderly man’s sex life – or lack of it.

It’s true that the chances of developing ED increase with age. Many medical conditions associated with ED, such as diabetes and heart disease, start occurring as men get older.

But did you know that ED affects a considerable number of younger men as well?

In 2017, Sexual Medicine Reviews published a study that focused on ED younger men. The authors estimated that just over half of men between 40 and 70 have erection problems to some extent. But younger men are still affected.

How many? Here are some research results the scientists shared:

  • In a multinational study of almost 28,000 men, 11% of men in their 30s and 8% of men in their 20s had ED.
  • A Swiss study of over 2,500 men between the ages of 18 and 25 found that around 30% of men had some degree of ED.
  • An Italian study revealed an increase in ED in men under 40, with rates rising from 5% to 2010 to over 15% in 2015.

It’s important to understand that the severity of ED can vary. Some men with ED can’t get erections at all. Others have trouble occasionally. And others feel that their erections aren’t as firm as they’d like.

ED rates could be higher than reported, too. A lot of men aren’t comfortable discussing their erections with a doctor, so they suffer in silence. Some doctors might not realize that ED affects younger men and may not ask about sexual health.

Why Might Younger Men Get ED?

Age is a major risk factor for ED. So why might younger men get it?

The answer is complicated. ED can be caused by both physical and psychological issues, and sometimes there are a combination of factors involved.

The study authors discussed several possibilities:

  • Vascular problems. A rigid erection depends on good blood flow to the penis. If anything obstructs that flow, such as plaque buildup in blood vessels, an erection might be difficult to achieve.
  • Hormonal disorders. Conditions like diabetes, over- or under-active thyroid, Klinefelter syndrome, and others can interfere with erectile function.
  • Nervous system disorders. Men with multiple sclerosis, epilepsy, spinal cord injury, or other nervous system disorders may have trouble with erections because important messages from the brain can’t “connect” with the genitals.
  • Medication side effects. Many medications, such as antidepressants, non-steroidal anti-inflammatories (NSAIDs), and antipsychotics have sexual side effects, including erectile dysfunction.
  • Psychological and emotional concerns. Erectile dysfunction can also occur in men with depression and anxiety. Relationship issues can play a role as well.
  • Smoking and illicit drug use. In another study, published in 2013 in the Journal of Sexual Medicine, younger men with ED were more likely to smoke or use recreational drugs compared to their older counterparts. Marijuana in particular has been linked to erectile problems. The drug’s active ingredient, tetrahydrocannabinol (THC), interacts with proteins called cannabinoid receptors. This interaction can impair normal functioning in the brain. Research has shown that it may affect the penis as well.

Sometimes, these causes work together. For example, a man with diabetes may have occasional ED, but become so anxious about his ability to perform and please his partner, the ED becomes more frequent. Or, a man may be taking medication that causes mild ED, but the stress of a life event (such as losing a job) could make the ED worse.

Hints of Future Medical Problems for Younger Men with ED?

Younger men should know that ED is often a symptom of other medical conditions, like diabetes and heart disease.

As we mentioned above, a man needs good blood flow to his penis to have an erection. Blood is what gives an erection its rigidity.

But diabetes or heart disease can cause atherosclerosis – hardening of the arteries. When a man has atherosclerosis, cholesterol and other materials build up in his arteries, making it more difficult for blood to pass through. Atherosclerosis can happen anywhere, but because the penile arteries are so small, they’re often among the first to become blocked. As a result, less blood flows to the penis and erection problems occur.

ED is sometimes called a “sentinel marker” – a warning sign of other diseases that need to be addressed.

What Can Younger Men Do About ED?

If you’re having problems with erections, take it seriously. Talk to your doctor. If your ED is a symptom of another medical condition, start treatment. You might need to make some lifestyle changes or go on medication, but taking care of the situation now can help you enjoy more sex in the future.

Learn more about erectile dysfunction, its causes, and its treatment here.


Sexual Medicine Reviews

Nguyen, Hoang Minh Tue, BA, et al.

“Erectile Dysfunction in Young Men—A Review of the Prevalence and Risk Factors”

(Full-text article in press. Published online: June 19, 2017)

Counsel & Heal

Hsu, Christine

“1 in 4 Young Men Suffer Erectile Dysfunction, Study”

(June 6, 2013)

Huffington Post

“Erectile Dysfunction May Affect 1 In 4 Men Under 40 Seeking Treatment, Study Suggests”

(June 11, 2013)

The Journal of Sexual Medicine

Capogrosso, Paolo, MD, et al.

“One Patient Out of Four with Newly Diagnosed Erectile Dysfunction Is a Young Man—Worrisome Picture from the Everyday Clinical Practice”

(Full-text. First published online: May 7, 2013)

Medical News Today

“Erectile Dysfunction Much More Common Among Young Men Than Previously Thought”

(June 9, 2013)

Sexual Medicine Reviews

Jackson, Graham, FRCP, FESC, FACC

“Prediction of Coronary Artery Disease by Erectile Function Status: Evidence-Based Data”

(Full-text. First published online: June 11, 2013)

Sexual Medicine Society of North America

“Marijuana and Erectile Dysfunction”

(May 31, 2011)


“Study Finds One in Four Patients with Newly-Diagnosed Erectile Dysfunction is a Young Man”

(Press release. June 6, 2013)

Sex Health Blog

Need to Tone Your Pelvic Floor? Try Kegels!

Aug 09, 2017

Need to Tone Your Pelvic Floor? Try Kegels!

Squats, crunches, curls. If you’re a fitness buff, these exercises are probably part of your regular workouts. But there’s another exercise you might not have added. It can improve both your urinary and sexual function, and it’s called the Kegel.

Developed in the 1940s by an American gynecologist named Arnold Kegel, the exercises were first intended to help women with incontinence. They target the pelvic floor muscles, which support the bladder. Over time, scientists learned that Kegel exercises have sexual benefits as well, for both men and women.

We’ll discuss the benefits in a moment, but first, let’s learn more about the pelvic floor muscles and how to do Kegel exercises.

The Pelvic Floor

The pelvic floor is sometimes compared to a hammock that keeps pelvic organs (like the bladder) in place. But like any muscle group, it can weaken. Childbirth, surgery, weight gain and aging are some of the risk factors, as are medical conditions like diabetes, overactive bladder, and inflammatory bowel disease.

A person with a weak pelvic floor might leak urine or feces or experience sexual problems like erectile dysfunction.

How to Do Kegel Exercises

Before you start doing Kegels, make sure you’re exercising the right muscle group. You can do this the next time you’re in the bathroom. Just stop the flow of urine for a moment. Women should feel a tightening in the vagina and rectum. Men will feel it in the anus and notice movement in the penis. The muscles that you feel tightening are your pelvic floor.

If you are unsure if you have the right muscle group, try these tips from the Urology Care Foundation:

Women: Lie down and place a finger inside your vagina. Next, squeeze your vaginal muscles so that you feel pressure in your vagina and around your finger. If you do, you’ve found your pelvic floor muscles. (Some women may need to insert two fingers.)

Men: While standing before a mirror, make your penis move up and down while keeping the rest of your body still. This action should contract your pelvic floor muscles.

Your doctor can also help you pinpoint your pelvic floor.

It’s important that none of your other muscles tighten while you’re doing Kegel exercises. Make sure the muscles in your stomach, chest, buttocks, and thighs stay relaxed. Also, take care not to hold your breath during Kegels.

Once you’re ready, Kegel exercises are easy:

  • Squeeze your pelvic floor muscles for about five seconds.
  • Relax the muscles for five seconds.
  • Repeat the process 10 times (or however many times are comfortable for you).

How many rounds of Kegels should you do? There’s no single answer, but three sets of ten each day is a good goal. You may need some time to get there, but with practice and dedication, you can. Keep in mind that it may take a few weeks to see results.

Sexual Benefits

We know that Kegel exercises can help with urinary symptoms. But how about sexual problems? Here are some of the ways:

  • Women. Many women find that Kegels keep their vagina relaxed and better lubricated, which makes intercourse more comfortable and pleasurable. (Better lubrication is due to better blood flow to the genitals, another benefit of Kegels.) Women may also become more sexually aroused and reach orgasm more easily. Some say Kegels increase orgasm intensity as well. Kegel exercises can also help women with vaginismus, a condition in which vaginal muscles involuntarily contract at the start of penetration. Vaginismus can lead to painful intercourse, and some women are unable to have intercourse at all. Through Kegels, women can learn to relax these muscles, making penetration easier.
  • Men. Kegel exercises may help men get better erections and have more intense orgasms. Men with premature ejaculation (PE) may develop better control after doing Kegels for a while. In addition, research suggests that men who do Kegel exercises may be able to shorten their refractory period - the resting time between orgasm and another erection. The stream of semen at ejaculation may become stronger as well.

Stick to a Schedule

For best results, try to do your Kegel exercises regularly. Since no one can see you doing them, it’s easy to add them to your day. You might do them while you’re watching TV, working at your desk, or riding the bus to the office. It may take some time to see some changes, but stick with it and you’ll see why it’s worth adding Kegels to your exercise routine.


International Society for Sexual Medicine

“What are Kegel exercises and what sexual health benefits might they have?”

Journal of Sexual Medicine

Sharif, Hisham, et al.

“Importance of Kegel Exercises for Male and Female Sexuality and Prevention of Vaginismus”

(Abstract. May 2017)

Panza, Sancho M.

“Kegel Exercises for Vaginismus”

(Last updated: October 7, 2015)

Urology Care Foundation

“What are Pelvic Floor Muscle (Kegel) Exercises?”


“Kegel Exercises - Topic Overview”

(Reviewed: November 20, 2015)

“Kegel Exercises: Treating Male Urinary Incontinence”

(Reviewed: July 31, 2016)

Sex Health Blog

After Orgasm: A Range of Reactions

Jul 04, 2017

After Orgasm: A Range of Reactions

Orgasm is sometimes described as an out-of-the-body experience. We’d add that it’s a full-body experience, too. Think about the body parts involved: Your eyes see your partner’s smile; your skin receives touch. Your brain sends signals through your nervous system, telling your genitals to start getting ready for the main event. Your blood pumps harder. Your breathing quickens. And then, if things go as planned, you and your partner climax – sometimes together, but more often separately.

Given what happens to your body during orgasm, it’s probably not surprising that body it can respond in a variety of ways afterward. Such responses can be pleasant, like intimate pillow talk with your partner. Or they can be painful, like getting a sex headache.

Sometimes, people report unusual events during or after orgasm, like hallucinations or temporary hearing loss. There is even a story of orgasms starting in a woman’s left foot!

Below are some of the things that can happen to you after an orgasm. Keep in mind that all orgasms can be different. And no two people experience orgasm quite the same way.

  • Bonding with your partner.  At orgasm, the body releases a hormone called oxytocin, which is sometimes called the “love hormone.” When this happens, partners tend to feel especially close. (Touch can trigger the release of oxytocin, too.)
  • Better sleep. Another hormone the body releases during orgasm is prolactin, which can make you drowsy. Women might get a double benefit here – estrogen released during orgasm can be good for sleep, too.
  • Post-sex blues.Have you ever felt inexplicably sad or irritated after sex, even if it was a pleasant encounter? You might be experiencing postcoital dysphoria (PCD) – the “post-sex blues.” This condition affects women who may feel more emotionally sensitive after bonding with their partner during intercourse. However, doctors aren’t sure of the exact cause.
  • Sex Headaches.Some people develop severe headaches during sexual activity, especially after orgasm. Generally, sex headaches are not serious, but if you get them, talk to your doctor. They can be managed with medication.
  • Postorgasmic illness syndrome (POIS). Men with POIS experience flu-like symptoms, like fatigue, fever, and nasal congestion, for a few days after they ejaculate. POIS is rare. Scientists aren’t exactly sure what causes it, although some believe it’s an allergic reaction to semen.
  • Sneezing. For some, just thinking about sex triggers a fit of sneezing. For others, it occurs after orgasm. Either way, scientists don’t know why it happens. One possible explanation is a disconnect in the autonomic nervous system, which controls functions we don’t necessarily think about, like breathing and digestion, as well as sneezing and sexual response.
  • Seizures. Also known as orgasmolepsy, seizures following orgasm are rare, but do happen.

If you are concerned about of these post-orgasm feelings or events, don’t hesitate to discuss them with your doctor.

To learn more about orgasms, check out these links:

What Happens During Orgasm?

Orgasm Problems: What Can Women Do?

Vaginal Orgasm

Should Men Worry About Dry Orgasms?

Anatomy Could Be a Key to Orgasm

Benevolent Sexism and Female Orgasm

Size and Location of Clitoris May Affect Orgasm

Female Ejaculation


Tanner, Claudia and Alexandra Thompson

“Eight weird things that can happen after you climax - including an orgasm in your FOOT, hallucinations and sneezing!”

(May 30, 2017)


Hillin, Taryn

“Why do some people sneeze when sexually aroused?”

(January 4, 2016)

The Guardian

Randerson, James

“Sneezing uncontrollably after sex may be more common than realized”

(December 19, 2008)

Braca, Nina

“7 Weird Things That Can Happen After You Orgasm”

(June 19, 2017)

Journal of the Royal Society of Medicine

Bhutta, Mahmood F. and Harold Maxwell

“Sneezing induced by sexual ideation or orgasm: an under-reported phenomenon”

(Full-text. December 1, 2008)


Rettner, Rachael

“Woman's 'Foot Orgasm' Is First Known Case”

(June 28, 2013)

National Center for Advancing Translational Sciences

“Postorgasmic illness syndrome”

(Last updated: June 19, 2017)

Sexual Medicine Society of North America

“Feeling Depressed after Sex”

“Health Benefits of Sex”

(April 4, 2017)

“Sex and Intimacy”

“Sex Headaches”

Sex Health Blog

What’s Causing Your Low Sex Drive?

Jun 06, 2017

What’s Causing Your Low Sex Drive?

Low sex drive can be puzzling. Sex is supposed be pleasurable, so why would anyone lose interest?

The answer might be simple, like a medication you’re taking. But it might also be complex, like stress in your relationship. Here are some of the more common libido-busters faced by men and women, along with links to help you learn more.

Low Testosterone

While it’s often associated more with men, testosterone is an important hormone for both men and women. Low sex drive is a common symptom of low testosterone.

Men can get a primer on low testosterone with the link below. You’ll find out about its symptoms, diagnosis, and treatment.

Low testosterone

Here are some more helpful links:

What Causes Low Testosterone?

How Can Low Testosterone Be Treated or Replenished? (video)

Low Testosterone and Low Sexual Desire (video)

Some women benefit from testosterone therapy, too, although the hormone has not been FDA-approved for this use. Also, it is not safe for all women, such as those with uterine or breast cancer, heart or liver disease, or high cholesterol.

Women and Testosterone


When estrogen levels decline at menopause, many women find themselves less interested in sex.

Sex for Women After 50

Pregnancy, Childbirth, and Parenthood

Hormonal changes during and after pregnancy can affect a woman’s libido. And adjusting to life with a baby can make couples less interested in sex as well, especially when new parents are stressed and fatigued.

Sexual Function of Pregnant Women

Women’s Sexual Health After Childbirth

Parenthood and Sex

Hypoactive Sexual Desire Disorder (HSDD)

Sometimes, women lose interest in sex for a reason that can’t be explained. When this situation causes distress, doctors diagnose it as hypoactive sexual desire disorder or HSDD. Click on the link below for an overview of the causes, diagnosis, and treatment.


These links may also help:

Talking About HSDD

Looking At HSDD

HSDD Infographic


Common medications - like antidepressants, birth control pills, and blood pressure drugs - can have sexual side effects, including diminished libido, as the blog posts below explain. If you’ve noticed a change in sex drive after starting a new medication, see your doctor. But don’t stop taking a certain drug without checking with your doctor first.

Drugs and Low Libido (Part 1)

Drugs and Low Libido (Part 2)

Birth Control Pills Can Have Sexual Side Effects

Stress, Anxiety, Depression, and Relationship Issues

When we’re stressed, anxious, or depressed about something – such as work difficulties, parenting responsibilities, or taking care of an elderly relative – we might put so much focus on what’s happening that we lose interest in sex. The same can happen when life gets busy and we’re fatigued. Sometimes, we’re too tired to even think about it.

In addition, trouble in your relationship – such as infidelity or another breach of trust, anger, resentment, or even boredom – can make you feel less inclined to be intimate with that person. If you and your partner find yourselves in this situation, communication is key. Find a quiet time to discuss what’s happening and what you might do to resolve it. It can be worthwhile to see a counselor who specializes in couples counseling.

If you think the issue might be specific to your sexual relationship, you might give sex therapy a try.

Sex and Anxiety

What is Sex Therapy Like?

Sensate Focus

It’s important to know that low sex drive may have a combination of causes. For example, diabetes can lead to issues with libido, but the associated stress and anxiety of managing diabetes may also play a role. Men with diabetes often have trouble with erections, which can lead to anxiety about performance.

Similarly, cancer and its treatment can affect sexual function. Hormonal ups and downs, body image concerns, side effects of chemotherapy drugs, stress, anxiety, and depression can all interfere with a person’s libido.

Seeing your doctor is often the first step toward getting your sex drive back. Many people feel embarrassed to discuss sexual issues with a healthcare provider, but doing so can go a long way to improve your sexual health, your overall health, and your relationship with your partner.

Sex Health Blog

Fertility Options for Men with Cancer

May 02, 2017

Fertility Options for Men with Cancer

Kyle’s diagnosis of testicular cancer came as a shock to his family. He had always been a healthy guy with a bright future. He and his wife Emilia hoped to start a family within the next few years

So when Kyle felt an unusual lump during his last testicular self-exam, he knew he should go to the doctor. But he never expected to have cancer.

There are lots of men like Kyle. Sometimes, cancer strikes when men are thinking about fatherhood. It can also happen when men aren’t ready for children quite yet, or when they aren’t sure.

Cancer and its treatment can have a big impact on a man’s fertility. Men should know that, in some cases, fathering children biologically will be a challenge. However, there are also options available that provide hope.

How Does Cancer Affect Men’s Fertility?

For men, infertility usually stems from two situations: Either the body cannot produce enough healthy sperm to fertilize an egg cell, or that sperm cannot reach the egg cell. For example, some cancers, like Hodgkin’s disease and testicular cancer, affect sperm quality.

However, it’s often the treatment for cancer that is the main culprit. Here are some of the ways it can affect fertility.

Radiation. Some cancers are treated with energy rays that attack cancer cells. If radiation is pointed directly at the testes (the glands that produce sperm and testosterone), it can damage the stem cells needed for sperm production. Similarly, if the pituitary gland in the brain receives radiation, it may no longer be able to “tell” the testes to make sperm. This can occur even if steps are taken to shield these areas or if radiation is targeted to a nearby organ.

Chemotherapy. Chemotherapy drugs kill cancer cells, but they can also kill the stem cells involved with sperm production, leaving a man infertile. In some cases, sperm production may recover in time, but that can take several years. Some drugs are less toxic to sperm stem cells than others, and patients can ask their doctors about which drugs are most appropriate.

Surgery. Surgery’s effects on fertility can vary. For example, if a man with testicular cancer needs to have both testicles removed, he will no longer be able to produce sperm. But if only one testicle is affected, the remaining testicle might make enough.

Men who have their bladder removed often have trouble with fertility because the vas deferens, (a tube that creates the path for sperm to travel), is cut. While the testicles can still create sperm, that sperm does not leave the body with ejaculation. (Learn more about “dry” orgasms.)

What Are Men’s Options?

Men with cancer should not give up hope of starting a family. There are several options available, including the following:

Sperm banking. Frozen properly, sperm can be frozen for many years, even decades. Some men decide to bank their sperm before they start cancer treatment, even if they are unsure about fatherhood in their future. The process is fairly simple. Generally, the man masturbates in a private room at the sperm bank or clinic, either alone or with his partner. The sperm is collected and frozen until needed. At that time, it can either be placed into a woman’s uterus (intrauterine insemination) or injected into an egg cell in a lab (in vitro fertilization). If that latter method is chosen, the resulting embryos can be inserted into the uterus.

Men with fast-growing cancers, like acute leukemia, may not be able to bank their sperm if treatment begins immediately. Also, some sperm banks will not store the sperm of men who have HIV or hepatitis B.

Electroejaculation. This method is helpful for men who are unable to ejaculate or feel too anxious to do so in a clinic. The procedure involves using a light electrical current to stimulate ejaculation. This current is delivered through a special rectal probe. Once sperm is collected, it is frozen and stored at a sperm bank.

Adoption. If a man is unable to father a child biologically, adoption is another path for creating a family.

Learning More

If you are a man facing cancer treatment, it’s important for you to understand all your options. Your oncology team can put you in touch with fertility and family planning specialists who can advise you on your personal situation. If your doctor doesn’t discuss fertility with you, but sure to bring it up yourself. And know that you are not alone. Your team will be with you every step of the way. It can also help to talk to your partner, trusted family members and friends, or support groups to help you decide what is best for you.

For more information on fertility and cancer, we suggest these resources:

Alliance for Fertility Preservation / Fertility Scout


Alliance for Fertility Preservation


“Sperm Banking”

American Cancer Society

“Fertility and Men With Cancer”

(Page last revised: November 6, 2013)


“Male Fertility Preservation”

OncoLink (Penn Medicine)

Vachani, Carolyn, RN, MSN, AOCN

“Male Fertility and Cancer Treatment”

(Last modified: July 25, 2016)

Sex Health Blog

Health Benefits of Sex

Apr 04, 2017

Health Benefits of Sex

Good sexual health is part of good overall health. That’s a fact we consider often here at But have you ever wondered just how having sex is good for your health?

Here are just some of the benefits:

Sex can be a great stress reliever.  Human and animal studies have shown that having more sex can reduce blood pressure, improve stress responses, and reduce anxiety.

Sex can burn calories.Have you ever thought of sex as exercise? Depending on how intense you are, you could burn between 85 and 250 calories during a half hour of sex. Certain activities tend to burn more calories than others, such as dancing with your partner or trying more strenuous positions.

Sex might keep the common cold away.In a study of 112 college students, researchers from Wilkes College in Pennsylvania found that those who had “frequent” sex (once or twice a week) had higher levels of immunoglobulin A (IgA) in their saliva. IgA is a type of antibody that helps boost your immune system. (Interestingly, the students who had sex more than once or twice a week did not see the same results.)

Sex can help you bond emotionally with your partner.When you have an orgasm, your brain produces more oxytocin, “the love hormone.” For many people (but not all), oxytocin promotes a feeling of bonding, closeness, and intimacy. Oxytocin also relieves stress for some people. And you don’t necessarily have to have an orgasm to reap the benefit. A simple touch or hug can spur oxytocin production. Oxytocin has also been associated with pain relief and better sleep.

Sex can be good for your heart. In January 2010, a study in the American Journal of Cardiology reported on the relationship between sex and heart disease. They found that men who had sex once a month or less ran a higher risk of heart disease when compared to those who had sex two or three times a week. Since sex is like exercise, your heart rate increases and your blood flows faster.

Keep in mind that while sex is considered safe for most heart patients, you should see your doctor if you have any concerns about sex and your heart.

Sex might boost your self-esteem.Researchers from the University of Texas at Austin asked 450 people to give the reasons they (or people they knew) had sex. Then, the scientists asked 1,500 undergraduate students how those reasons applied to their lives. Some of them reported that sex made them feel better about themselves because their partner desired them or made them feel sexy.

For men, regular sex might lower prostate cancer risk. According to research presented at the annual meeting of the American Urological Association in 2015, frequent ejaculation could lower a man’s risk for prostate cancer. In a study of almost 32,000 men, prostate cancer risk dropped by about 20% for men who ejaculated at least 21 times each month compared to men who ejaculated 4 to 7 times each month.

Sex might relieve headaches. If you can’t imagine having sex during a headache, you may want to think again. A 2013 study in Cephalalgia found that for some people who suffer from migraines or cluster headaches, sex relieved headache pain. (Note that some headache patients reported that sex worsened their pain, so you may need to experiment.)

Sex might help you sleep better. Many people find that sex is good for insomnia. When you have an orgasm, your body releases prolactin, a hormone that can make you feel drowsy. For women, orgasm increases estrogen production, which promotes deeper sleep. And proper rest can make sex even better for both women and men.

These are all great reasons to have sex. But did you know that the reverse is also true? Taking good care of your health can lead to better sex.

For example, keeping diabetes under control can help men have better erections.  It can also help women with vaginal lubrication and libido.  

Exercising regularly can also improve your sex life.  Exercise keeps our body strong and flexible, giving us more energy for sexual activity. It can help relieve anxiety and depression, two conditions that can interfere with sexual desire. Exercise may also make us more confident by boosting our body image. And the endorphins released during exercise might make us aroused more quickly and enjoy sex more.

As we said above, good sexual health is part of good overall health. And good overall health can improve our sexual health. The two go hand in hand.

Can you think of other ways that sex improves your health? Feel free to share your thoughts in the comments.


Sexual Medicine Society of North America

“Diabetes and Women’s Sexual Health”

“Diabetes – Erectile Dysfunction”

“Sex and Burning Calories”

“Sex and Cardiovascular Health”

“Sex and Intimacy”

“Sex and Self-Esteem”

“Sex and Stress”

“Sex Boosts Immunity”

“Sexual Activity Safe for Majority of Heart Patients”


Doheny, Kathleen

“10 Surprising Health Benefits of Sex”

(Reviewed: November 26, 2012)

Sex Health Blog

Smartphone Apps with a Sex Health Focus

Mar 01, 2017

Smartphone Apps with a Sex Health Focus

If you use a smartphone or tablet, you probably use apps every day. These handy tools can help us learn more about current events, track how many steps we take each day, find reviews of the nearest Thai restaurant, and even provide specialized music to help our pets sleep at night.

So it’s not surprising that there should be sexual health apps, too. With just a few taps on a touchscreen, you can access sexual health information, track menstrual periods and sexual activity, or find out where condoms are sold near your location.

Why would people want to use a sex health app? Convenience is one reason. Having the information you need easily and immediately accessible can be a relief when you’re in the moment with your partner or visiting your doctor.

Privacy is another reason, although one that must be considered carefully. Many people use passwords on their smartphones to keep their data to themselves. This allows users of sex health apps to keep their information private. That said, the privacy policies of apps can vary and it’s important to vet any app or network you use to see how your information is protected.

Below, we list some popular sex health apps. Please keep in mind that this list is intended to give you an idea of the types of apps available and is not endorsement by SexHealthMatters or the Sexual Medicine Society of North America.

Tracking Sexual Activity

Apple users can use the Health app on their device to keep track of reproductive health data. For example, you can enter the dates and times of your sexual encounters and record whether they were protected or unprotected. (Entering partners’ names is not an option.) This information can be helpful if you are diagnosed with a sexually-transmitted infection (STI) and need to determine just when you might have become infected.

Women can also track their menstrual periods, ovulation, and spotting history. These features can be useful for couples who use the rhythm method for birth control or those who would like to conceive. Spotting can also be a symptom of a gynecological issue, so tracking that history is important, too.

Sex Education

What happens when one body part touches another body part or an object? Sex Positive, an app created by the University of Oregon Health Center, can tell you. Using a spinning wheel, you can make a variety of matches that come into contact during sexual activity, such as finger-vagina or mouth-penis. The app explains that match’s risk for STIs, provides safe sex information (such as tips for using a dental dam), and offers tips for talking to your partner about sex.

While Sex Positive is targeted to college-age people, older adults can find it useful as well, especially if their sex education has been limited.

Exploring Positions

Looking to try something new in the bedroom, but short on ideas? Sex Positions 3D offers guidance on 55 sex positions from 7 different categories. Each position includes a 3-D graphic along with instructions. You and your partner can view them together or separately, save the ones that look interesting, and rate the ones you’ve tried. You can also request a random position for something really new.

LGBT Focus

Moovz is a social networking app for the lesbian, gay, bisexual, and transgender community. Users can connect on a local and global level to make friends, chat, and share ideas and information.

Gender Variant and Queer Community

Launched in July 2016, GENDR offers camaraderie and information for gender variant and queer individuals. Members can create their own profiles, communicate with other members, find out about live events, and discuss a wide range of topics, including gender and sexual identity, health, equality, transitioning, travel, and authentic living.

Talk to Your Doctor, Too

Note that sexual health apps are not a substitute for a qualified doctor’s care. Only a professional can answer questions tailored to your personal situation. And while sometimes it can feel awkward to bring up issues surrounding sexuality, we encourage you to do so. Remember, sexual health is an important part of your overall health, and your doctor is a professional who is there to help you.

Your doctor might also be able to recommend some apps – be sure to ask!



Weiss, Suzannah

“4 Sexual Health Apps You Should Know About, Because Everyone Deserves To Be Having Amazing Sex”

(June 9, 2015)

Bridges, Alisha

“The Best Phone Apps You Need for Better Sexual Health”

(Updated: March 9, 2016)

Huffington Post

Nichols, James Michael

“Introducing The World’s First App For The Gender-Variant And Queer Community”

(Updated: July 13, 2016)


Alptraum, Lux

“Apple's Health App Now Tracks Sexual Activity, and That's a Big Opportunity”
(October 23, 2016)

University of Oregon

“SexPositive: A shame-free sex education smartphone app from the University of Oregon Health Center”

(Last updated: July 1, 2015)

Sex Health Blog

Sex and Inflammatory Bowel Disease

Jan 31, 2017

Sex and Inflammatory Bowel Disease

Rita was happy about this weekend away with her husband, Stan. It was the first time they could really relax together, now that she had recovered from her surgery. After a long road with inflammatory bowel disease (IBD) – ulcerative colitis, in her case – she was feeling energetic and optimistic again.

Stan had found a quaint bed and breakfast by the ocean and they were enjoying drinks on the deck. But they had some quiet time too. And during those moments, Rita felt nervous about the evening.

She and Stan hadn’t been intimate since her surgery. Now that she was better, her doctor said it was fine to start having sex again. She and Stan were both eager. But with her colon and rectum removed, she was extremely self-conscious about her colostomy bag. Stan had seen it in the hospital, but how would he feel about it now? Would he still think she was attractive? Would he be disgusted if it leaked? Would it come off? Would it make noise?

She had voiced these concerns to Stan, who said none of that mattered to him and that they could take their time. Rita wasn’t sure if he was just saying that, though.

Many people with inflammatory bowel disease share Rita’s concerns. IBD can affect sex and relationships, both physically and emotionally. However, with some adjustments, patients and partners can still enjoy satisfying sex.

What is IBD?

IBD is a chronic condition marked by inflammation of the digestive tract, which includes the large and small intestines and the rectum. People with IBD often have diarrhea, pain, cramping, and bloody stools. Fatigue is another common symptom.

Generally, IBD falls into two categories: ulcerative colitis and Crohn’s disease. Experts aren’t sure what causes these illnesses, and some people have more severe cases than others. Sometimes, IBD can be managed with lifestyle changes and medications. But sometimes, parts of the digestive tract need to be removed. Some patients need to wear a collection pouch (a colostomy bag) after surgery because they can no longer move their bowels as they used to.

How does IBD affect sexuality?

IBD can present some physical and emotional challenges to sex.

Pain and cramping might make some positions uncomfortable. Some women experience vaginal and rectal pain, especially if abdominal organs have shifted during surgery. Nerves may also be damaged during surgery, which can reduce sensation in the clitoris. Men with IBD may develop erectile dysfunction or trouble with ejaculation.

Fatigue can also make sex problematic. Many people with IBD find that they are just too tired for intimacy.

Not surprisingly, chronic pain from IBD can leave patients depressed and anxious, and anticipating pain during sex can make it difficult to relax and enjoy the experience. Some couples start to avoid sex and their relationships suffer.

Patients may also be concerned about their partner’s reaction if an accident occurs during sex, such stool passing or a leaky collection pouch. Many feel unattractive with a colostomy bag. Single people may not want to pursue new relationships because they feel embarrassed or don’t know how to bring up the subject with a prospective partner.

Tips for Coping

IBD might make sex challenging, but issues can be resolved with communication and planning.

·         Talk to your partner. We say this a lot here at SexHealthMatters, but communication is key. If you have IBD, be open with your partner about how you’re feeling. If you don’t feel up to having sex, it’s okay to say so. If a certain activity hurts, speak up and suggest other options. If you worry about accidents or appearance, mention that too. Your partner should understand and will most likely want to reassure you.

·         Make yourself comfortable – physically and emotionally. Work with your partner to determine which sexual activities are most comfortable and pleasurable. If you wear a colostomy bag, change it before sex and be sure the new bag is secure. If you feel self-conscious about visual changes to your body, try wearing a long T-shirt or specialty underwear. You might also consider soft lighting, romantic music, or anything else that helps you relax.

·         Ask your doctor about treatment for sexual problems. For example, men who develop erectile dysfunction have a number of treatment options.

·         Find support. It can be helpful to talk to other people with IBD who can share their experiences, answer questions, and make recommendations. Your doctor can probably suggest a support group near you. You might also find listings online or consider starting one of your own.

·         If you’re single, don’t let IBD stop you from dating. Remember that your next partner will like you for who you are. When you feel ready for intimacy, be honest about your concerns.

·         Consider therapy. If you’re feeling depressed or anxious about your IBD, a mental health professional can help you work through these feelings. Sex therapy is another option if you and your partner are having difficulty discussing the sexual changes in your relationship.


Colostomy Association

“Living with a Colostomy – Relationships”

Crohn’s and Colitis Foundation of America

“The Intimate Relationship of Sex and IBD”

(May 1, 2012)

International Society for Sexual Medicine

“Can inflammatory bowel disease (IBD) affect a person’s sex life?”

Mayo Clinic

“Inflammatory bowel disease – definition”

(February 18, 2015)

“Inflammatory bowel disease – treatments and drugs”

(February 18, 2015)


“Inflammatory Bowel Disease and Sex”

Sex Health Blog

Treating Peyronie’s Disease Without Surgery

Jan 02, 2017

Treating Peyronie’s Disease Without Surgery

Kevin was nervous about his upcoming appointment with his urologist. He had been having painful erections for a while now, and he didn’t like to admit there could be a problem with his private parts. But he knew he had to do something. Now, in addition to pain, he was having trouble with sex. His penis curved about 30 degrees when erect and vaginal sex with his girlfriend Lily was getting difficult. Sometimes it even hurt for her.

Lily was understanding and had been encouraging him to see a doctor. They had been reading up on Peyronie’s disease, a condition that causes plaques to form just under the skin of the penis. The plaques made the penis less flexible, and that’s why the curve was happening. They also read that Peyronie’s disease could be a wound healing disorder. Kevin had no idea how he might have injured his penis, but Lily pointed out that they liked vigorous sex. Maybe they’d been a little too vigorous.

Kevin didn’t want to admit it to Lily, but he was worried about needing surgery. He would do it if it meant he could get his sex life back, but he was hoping there would be another option.

Fortunately, there are other avenues. For some men, Peyronie’s disease can be treated nonsurgically. Recently, the American Urological Association issued new clinical guidelines on these approaches. With these guidelines in mind, a team of experts reviewed medical studies on the topic. Let’s take a closer look.

Oral Therapies

Oral therapies – pills that can be taken by mouth – include vitamin E, Tamoxifen,

potassium para-aminobenzoate, and phosphodiesterase type 5 inhibitors. (The latter are the same medications used to treat erectile dysfunction, such as Viagra, Cialis, and Levitra.) The experts noted that oral drugs are not used often to treat Peyronie’s disease, as their effectiveness is limited. Also, some patients experience side effects, like stomach upset, that may make them stop treatment altogether.

Intralesional Therapies

Intralesional treatments are injected directly into the plaques in the penis. While the idea of injections might make men squeamish, they can be quite effective. Currently, the U.S. Food and Drug Administration has approved only one drug for the treatment of Peyronie’s disease – Xiaflex - which is administered this way. Other intralesional therapies are being investigated, however.

Traction Therapy

Men who undergo traction therapy wear a special device that gently pulls the penis in the opposite direction of the curve. Usually, the device is worn for several hours each day. The authors wrote that this therapy has an “overall minimal impact” on its own, but it could work well in conjunction with other treatments (such as intralesional therapies), especially if men are worried about shortening of the penis.

Topical Therapies

A topical medication is one that can be applied directly to the skin. Different topical treatments for Peyronie’s disease have been studied, but the authors concluded that “no topical therapy currently appears to be effective for [Peyronie’s disease].” One topical combination they reviewed did have good results, but the study was designed to assess safety, not effectiveness. More research is needed.

Extracorporeal Shock Wave Treatment

With this approach, shock waves are administered to the penis using a special device outside the body. The authors explained that this therapy could help men with pain, but not with curvature. They added that pain from Peyronie’s disease often gets better on its own, in time.

Which Treatment Should a Man Choose?

The answer to this question depends on his situation. A urologist will assess the stage of Peyronie’s disease, the type and degree of curvature, and experiences with pain and/or erectile dysfunction. After a thorough exam, a man and his doctor can discuss the treatment options best suited for him.


“Peyronie’s Treatments – Traction Therapy and VEDs”

(July 10, 2014)

The World Journal of Men’s Health

Joice, Gregory A. and Arthur L. Burnett

“Nonsurgical Interventions for Peyronie's Disease: Update as of 2016”

(Full-text. Published online: August 23, 2016)

Sex Health Blog

Manage Diabetes for Better Sexual Health

Dec 06, 2016

Manage Diabetes for Better Sexual Health

Do you or your partner have diabetes? If you do, you’re in good company. The American Diabetes Association estimates that 29.1 million people in the United States had diabetes in 2012 – about 9.3% of the population. In Canada, diabetes affected 3.4 million people in 2015 – also 9.3% of the population.

Many people don’t realize that diabetes can have a serious effect on sexual health. How serious? Here’s an example. Research suggests that men with diabetes are four times more likely to develop erectile dysfunction (ED) than non-diabetic men. ED also tends to occur ten to fifteen years earlier in diabetic men, and cases may be more severe.

There’s a lot to learn about diabetes and sexual health and we’re here to help. Below, you’ll find a list of SexHealthMatters articles that can answer many of your questions.

What is Diabetes?

First, let’s get an overview of diabetes.

Generally speaking, diabetes affects the body’s use of insulin, a hormone secreted by the pancreas. Insulin helps the body process glucose (a type of sugar) from the foods we eat so that the body can use it for energy. Glucose may also be converted to fat.

Diabetes is classified in two ways:

·         Type 1. People who have type 1 diabetes (previously known as juvenile diabetes) are unable to produce insulin on their own. According to the American Diabetes Association, about 5% of people with diabetes have this kind. It is often diagnosed during childhood.

·         Type 2. Type 2 diabetes is the most common form. With type 2, the body can produce insulin, but it doesn’t use it as well as it should. To compensate, the pancreas makes more insulin, but eventually the demand exceeds the supply. When that happens, the pancreas can’t produce enough insulin to keep blood glucose levels in a healthy range.

Now, let’s look at some ways diabetes affects sexual health.

Sexual Issues for Diabetic Men - General

Diabetes and Erectile Dysfunction This blog post discusses two ways diabetes leads to ED – neuropathy and atherosclerosis (hardening of the arteries).

Diabetes – Erectile Dysfunction Common questions about diabetes and ED are answered here.

Diabetes Screening Important for Men with ED Experts suggest that men – especially middle-aged men - be screened for diabetes if they have ED.

Sexual Issues for Men with Type 1 Diabetes

Premature Ejaculation and Type 1 Diabetes Research suggests that type 1 diabetes is not a risk factor for premature ejaculation.

Erectile Dysfunction (ED) and CVD in Joslin Medalists with Type 1 Diabetes In this study, scientists found that ED could be a sign of heart disease in men with type 1 diabetes.

Sexual Issues for Diabetic Women

Diabetes and Female Sexual Satisfaction This blog post provides details on how diabetes affects women’s sexual health.

Female Sexual Dysfunction and Diabetes Sexual issues are more common in diabetic women than non-diabetic women, this study reports.

Sexual Issues Related to Gestational Diabetes

Sexual Function in Pregnant Women with Gestational Diabetes This type of diabetes, found in pregnant women who have not had diabetes before, can also present sexual challenges.

Other Information

Neuropathy and Diabetes One of the ways diabetes causes sexual problems is through neuropathy – nerve damage. When this happens, the genitals don’t “get the message” that they should start getting ready for sex, leading to ED in men and poor vaginal lubrication in women.

Mediterranean Diet Might Improve Sexual Function in Men and Women with Type 2 Diabetes Researchers discovered that a Mediterranean diet, which includes plant-based foods, fish, and olive oil, could have sexual health benefits for people with type 2 diabetes.

Moving Forward

If you or your partner are diabetic, what steps can you take to improve your sexual health? Here are some important points to keep in mind:

·         Talk to your doctor. Be sure to see your doctor regularly and ask questions. If you’re having sexual issues, don’t hesitate to speak up.

·         Stick to your treatment plan. Check your blood sugar regularly and take all of your medications and insulin exactly as prescribed.

·         Follow a healthy diet. Make sure your diet includes fruits, vegetables, and whole grains. Your doctor can give you more specifics about which foods are best for you. Keep an eye on portion size and be sure to eat at regular times. Diabetic cookbooks are full of appealing recipes. Sit down with your family and decide which ones to try.

·         Exercise. Come up with a fitness plan that you’ll enjoy, whether it’s running in the park, swimming at the community pool, or joining a spin class at the gym. You might consider asking your partner, family, or friends to join you.

These suggestions, such as healthy eating and exercising, benefit all of us, not just people with diabetes. And while managing diabetes can relieve some physical sexual problems like ED, it can also make you feel stronger, more energetic, and more confident, which also helps in the bedroom.


American Diabetes Association

“Facts About Type 2”

“Statistics About Diabetes”

“Type 1 Diabetes”

Canadian Diabetes Association

“Diabetes Statistics in Canada”

Hormone Health Network

“What Does Insulin Do?”

Medline Plus


(Page last updated: November 30, 2016)

Sex Health Blog

New FDA Testosterone Labeling Rules: What Should Men Know?

Nov 08, 2016

Have you heard the latest on testosterone?

On October 25, 2016, the U.S. Food and Drug Administration (FDA) announced new rules regarding the labeling of testosterone products. Manufacturers must now warn consumers about the risk of abuse. (See the SexHealthMatters summary here.)

Testosterone has a number of medical benefits, which we’ll discuss more below. However, some men take more than they need. Or they take it with androgenic anabolic steroids - drugs based on testosterone or a synthetic version of it. For example, some athletes and bodybuilders take these drugs to build up their muscles and give them more strength.

The FDA has concerns about the effects of testosterone abuse, which can include heart, brain, and liver damage. Abuse can also lead to problems with a man’s endocrine (hormonal) system and mental health.

In a statement, the FDA explained that men who abuse testosterone are at risk for “heart attack, heart failure, stroke, depression, hostility, aggression, liver toxicity, and male infertility.” Testosterone withdrawal can have side effects also, such as fatigue, insomnia, appetite loss, and decreased sex drive.

What does all this mean? Is it still safe to take testosterone? Today, we’ll go over some of the basics and put the new FDA warnings into perspective.

What is testosterone?

Testosterone is a male sex hormone, one that is inextricably linked to masculine characteristics. Think about the changes a boy undergoes during puberty. His penis grows larger. His voice deepens. He becomes more muscular. He develops facial hair and pubic hair. Testosterone is responsible for all these changes. It maintains those characteristics in adulthood, too.

Testosterone is also important for sexual function. It drives a man’s libido and plays a role in his erections.

Why might men need to take testosterone?

Sometimes, men’s bodies do not produce enough testosterone on their own. Certain congenital conditions (present at birth) can affect testosterone production. So can cancer treatments like chemotherapy or radiation, along with genital injuries. The FDA has approved the use of testosterone for situations like these.

Men’s testosterone levels decline as they get older, too. This is called adult-onset hypogonadism and it’s a natural part of aging. Men may start to feel weak, fatigued, and less interested in sex when this happens. Sometimes, men can boost their testosterone by making healthy lifestyle choices, like losing weight or keeping their blood sugar under control if they have diabetes. Doctors may also prescribe testosterone therapy, although this use has not been approved by the FDA.

Should men worry about the new FDA rules?

Remember, the new FDA warnings concern testosterone abuse. If you feel that you are abusing testosterone or anabolic steroids, absolutely see your doctor. Otherwise, you can probably continue taking testosterone, as long as you do so responsibly and sensibly, under a doctor’s care.

Here are some other things to keep in mind:

·         Take testosterone as directed. If your doctor has prescribed testosterone for you, take it exactly as directed. If you feel your testosterone therapy isn’t working as you’d hoped, talk to your doctor. You may need to make some adjustments, but this should only be done with a doctor’s advice. Do not raise or lower your dose on your own.

·         Do not buy testosterone online or over the counter. Testosterone should be obtained only by prescription. Supplements may contain ingredients you’re not aware of and these could have dangerous side effects. (Clickhere to learn more about the dangers of non-prescription testosterone and similar products.)

·         Don’t hesitate to ask questions. If you have questions about testosterone and whether it’s right for you, see your healthcare provider. Your doctor can measure your testosterone levels to see where you stand. He or she can also give you a full medical checkup to determine whether other medical conditions are contributing to low testosterone symptoms. Overall, it’s best to get the whole picture.


Hormone Health Network

“What Does Testosterone Do?”

(January 2014)

Rettner, Rachel

“Prescription Testosterone Gets New Warning”

(October 25, 2016)

MD Magazine

Black, Ryan

“FDA Announces Stern New Warning Labels for Testosterone Treatments”

(October 25, 2016)


Brooks, Megan

“FDA Adds New Warnings to All Testosterone Product Labels”

(October 25, 2016)


Clarke, Toni

“U.S. FDA adds abuse warning to prescription testosterone”

(October 25, 2016)

Sexual Medicine Society of North America

“New Research on Adult-Onset Hypogonadism Provides ‘Conceptual Framework’”

(June 21, 2016)

“Performance-Enhancing Drugs and Sexual Health”

“Risks and Realities of OTC Testosterone Supplements”

(April 9, 2013)

U.S. Food and Drug Administration

“FDA approves new changes to testosterone labeling regarding the risks associated with abuse and dependence of testosterone and other anabolic androgenic steroids (AAS)”

(Press statement. October 25, 2016)

Sex Health Blog

Sex and Anxiety

Sep 27, 2016

Sex and Anxiety

Here on SexHealthMatters we often talk about the role of the brain during sexual activity. While the genitals may seem more involved with the “action,” the brain is a great coordinator. It takes in sexual stimuli (like a provocative smile or a touch), processes them, and sends messages to the genitals to start getting ready, either through erection or vaginal lubrication.

But there’s more to the brain and sex than these physiological processes. The brain also filters our emotional and psychological responses to sex. It analyzes questions like:

·         Do I trust my partner?

·         Will my partner or I become pregnant?

·         Does my partner have a sexually-transmitted infection?

·         Is this a safe place to have sex?

·         If I can’t perform sexually, what will my partner think?

·         Will sex hurt?

·         Will my spouse find out I’m having an affair?

·         Do I really want to have sex with this person right now?

The list could go on. Such anxieties – and more formally diagnosed anxiety disorders - can have an impact on our sexual function. That’s what we’ll be talking about today.

What is anxiety?

We’ve all felt anxious at times. Life events like starting a new job, getting married, or having a baby can all be anxiety-inducing. But so can smaller-scale events like asking for a raise at work or handling a dispute with your neighbor.

Sometimes, these feelings of apprehension occur in situations that wouldn’t make the average person anxious. The feelings can start to interfere with daily life.

In that case, a person might be diagnosed with an anxiety disorder, such as generalized anxiety disorder (excessive anxiety), panic disorder (episodes of great fear), social anxiety (fear of social situations and judgement by others), or posttraumatic stress disorder (PTSD – anxiety triggered by a traumatic event).

The relationship between anxiety and sex, however, can be circular.

Feeling anxious can impair your sexual function. For example, if you’re concerned about your partner’s fidelity, you might find yourself focused on that during sex, making it more difficult to relax and stay in the moment.

Conversely, if you have a medical condition that can make sex uncomfortable, such as endometriosis, the anticipation of pain can dampen your sexual desire or lead you to avoid sex altogether.

How can anxiety impact sex?

The brain works in many mysterious ways and anxiety’s effects on sexual function can take many forms. Here are some of the more common ones:

·         Low desire. Anxiety can make us less interested in sex. For example, if a woman suspects that her partner is unfaithful, she may feel inadequate, angry, and less inclined to have sex.

·         Performance. Sometimes people are so worried about pleasing their partner that their performance suffers. Men might have trouble getting an erection or might ejaculate before they want to. Women might have trouble relaxing enough to allow penetration.

·         Pain. Pain is a common sexual problem, especially for women. Unfortunately, the expectation of pain can become so intense that it blocks out any pleasure.

·         Trouble with orgasm. The effects of anxiety can have a cumulative effect, making it more difficult to reach orgasm.

·         Avoidance. People may be so anxious about sex that they shy away from dating, relationships, and sex.

What can people do?

If you think anxiety is interfering with your sex life, there are several steps you can take:

·         See your doctor. Sometimes, people feel awkward about seeing a professional for anxiety and try to manage it on their own. But there’s nothing wrong with asking for help. Your doctor can refer you to a mental health specialist who will come up with a treatment plan tailored just for you.

·         Consider couples counseling. If you feel anxious about some aspect of your relationship, you might see a specialist who focuses on couples therapy. You and your partner can learn to work through your issues constructively and come up with strategies to improve life at home. You can also learn better communication skills.

·         Try sex therapy.Sex therapy is another type of counseling, but it focuses more on sex itself. It can be a helpful option for people with performance anxiety or sexual fears.

·         Be up front with your partner. Lots of couples have trouble discussing sex. Sometimes, we just need to take a deep breath and start the conversation. Be honest about how you’re feeling. Your partner might be thinking about the same issues and feel relieved that you brought them up. Also, be open with your partner about what feels good to you and ask for what you want sexually.

·         Focus on the intimacy. Your fears and anxieties can take a lot of your mental energy and keep you from just enjoying sex for what it is – a connection between two people at one moment in time. Try to focus on what’s happening. Use your senses – what sorts of touch, sounds, and smells are you experiencing? Are they pleasant? Put your attention there.

·         Say “no” if you want to. If you don’t want to have sex with a certain person or at a certain time, you do not have to. You have every right to say “no.” This is also true if you and your partner disagree on sexual practices, like condom use. (Click here to learn more about sexual consent.)


Florio, Gina M.

“7 Ways Sex Is Different When You Have Anxiety”

(July 29, 2016)


National Institute of Mental Health

“Anxiety Disorders”

(Last revised: March 2016)


Psychiatric Times

Corretti, Giorgio, MD and Irene Baldi, MD

“The Relationship Between Anxiety Disorders and Sexual Dysfunction”

(August 1, 2007)

Sex Health Blog

Orgasm Problems: What Can Women Do?

Aug 30, 2016

Orgasm Problems: What Can Women Do?

Would it surprise you to learn that an estimated 10% to 40% of women have trouble reaching orgasm? And that some women have never had an orgasm at all?

The clinical term is anorgasmia and it troubles many women. It can distress partners, too, who may think their bedroom skills are not up to par.

We often think of orgasm as the goal of the sexual journey. A lot of what we see in popular culture – TV, movies, magazines – can sure make us think that’s so. Often, people feel that if there is no earth-shattering climax, then something’s wrong.

But this is real life and the female orgasm is complicated. A woman needs her brain and her body to work together to achieve orgasm. Fortunately, there are steps women can take start having orgasms or to make their orgasms even more satisfying.

Today, let’s look at some of the causes of anorgasmia in women and ways to work with them.


Stress has many facets, both small and large. Will you finish that work project in time? Should you be concerned about that clunking noise in the car? Will the kids walk in and catch you and your partner in the act? Any of these questions can distract you from enjoying intimacy.

Try this: Do something, alone or with your partner, to wind down and keep the worries at bay. You might take a walk, take a bath, or do some yoga. During sex, focus on the here and now. Concentrate on the sensations – the touch, the breaths, the sounds – and stay in the present.


As mentioned above, a woman’s brain and body need to work together for an orgasm to occur. Anxiety can work against the process and sometimes, seeing a mental health professional is the best path.

A woman may feel anxious about the sexual encounter itself. She may worry about pleasing a new partner. If she has experienced sexual pain before, she may tense up at the thought of penetration. Or, she may feel expected to do something she’s not ready for. A sex therapist can suggest relaxation and communication strategies.

Relationship issues are another common source of anxiety. Infidelity, other breaches of trust, fighting, or boredom can all get in the way of relaxation and orgasm. A therapist can teach couples ways to communicate about their needs and negotiate important aspects of their relationship.

Anxiety can go deeper, too. Women who have been sexually molested or assaulted may fear sex or not trust any partner in a sexual situation. A psychologist can help women cope with past abuse.

Try this: Talk to your doctor about a referral to a mental health professional. Don’t hesitate to ask for help if you need it.

Beliefs about Sex

Sex is a complicated, personal topic. Some women grow up in environments where it is accepted and discussed openly. Others are raised to believe that sex is dirty, sinful, or something to be tolerated, not enjoyed.

Try this: If you feel that your beliefs about sex are holding you back, take some time to reassess your views. It might be helpful to talk to your partner, a trusted friend or relative, a counselor, or a member of the clergy to help you work through your hesitations.


Unfortunately, we aren’t born knowing how our bodies work, especially when it comes to sex. If you haven’t had much sexual experience – or much sex education – you might not know what feels good to you.

Try this: Get to know your anatomy. Ask your doctor questions, read a good sex health book, or try watching an educational video about women’s health. Hold a mirror to your genitals to see how your particular body is designed.

You can also try masturbating. Solo sex is one of the easiest ways to find out what brings you pleasure. Find a private place where you can relax and feel safe. Give yourself enough time to explore your own body. If something feels good, see where it leads you. Don’t hesitate to let your mind wander, too. You might also consider trying sex toys, such as vibrators, during this private time.

Health Conditions

You might have trouble reaching orgasm if you have a health condition like diabetes or if you’ve had gynecologic surgery. Anorgasmia can also be a side effect of antidepressants and other medications.

Try this: Talk to your doctor. Yes, it can be awkward discussing sex, especially orgasms, with a medical professional. But doing so can help get your sex life back on track. Just take a deep breath and speak up. Or, if you’re especially nervous, try practicing the conversation beforehand.

Your Body

For many women, the clitoris is the command center for orgasm. It contains over 7,000 nerve endings that, when stimulated, bring most women great pleasure. However, research has found that the size and location of a woman’s clitoris can influence orgasm. If the clitoris is too small, there might not be enough surface area to stimulate. If it’s too far away from the vagina, it might not be stimulated enough during intercourse.

Try this: You and your partner might need to try different positions or activities to help you reach orgasm. Most women don’t climax during intercourse. But they do when their partner rubs their clitoris or stimulates it orally.

It’s also important to be patient. For some women, it just takes longer to reach orgasm and that’s okay. If your partner climaxes before you and you want to continue sex, say so. And remember, most partners do not reach orgasm at the same time.


As we’ve seen, women’s orgasms are influenced by a variety of factors, which may overlap. Communication – with a partner, friend, doctor, or other professional, is a key to keeping the body and brain working together toward sexual satisfaction.


The Journal of Sexual Medicine

Rowland, David L., PhD and Tiffany N. Kolba, PhD

“Understanding Orgasmic Difficulty in Women”

(Full-text. Published online: June 23, 2016)

Mayo Clinic

“Anorgasmia in women”

(February 14, 2015)

“Are you having trouble reaching orgasm? A guide for women”

(November 29, 2013)

NHS Choices

“What can cause orgasm problems in women?”

(Page last reviewed: December 17, 2014)

Psychology Today

“Help! I Can't Have An Orgasm”

(November 19, 2011)

“Size and Location of Clitoris May Affect Orgasm”

(November 12, 2014)

The Society of Obstetricians and Gynaecologists of Canada

“Female Orgasms: Myths and Facts”

Sex Health Blog

Endometriosis and Sex

Jul 26, 2016

Endometriosis and Sex

Did you know that an estimated 170 million women worldwide have endometriosis? Characterized by chronic pain, this condition can make sexual activity difficult for many couples. Fortunately, there are ways to cope, and we’ll talk about them today.

What is endometriosis?

This gynecological condition involves the endometrium – the lining of the uterus. During a woman’s menstrual cycle, the endometrium prepares itself for a possible pregnancy. If no pregnancy occurs, the endometrium is shed and leaves the body with menstrual blood.

Sometimes, endometrial tissue grows outside of the uterus. Areas of this tissue, called implants, can form on the ovaries, fallopian tubes, bladder, rectum, and the lining of the abdominal cavity, among other areas. This is endometriosis.

Women with endometriosis may feel significant pain, especially during certain times of their menstrual cycles. They may also have pain during sex, while urinating, or while moving their bowels. Some women experience bleeding and spotting between periods. They might also have diarrhea, constipation, and or nausea.

Infertility is also a common problem for women with endometriosis.

Unfortunately, there is no cure. Depending on its location and severity, women might be treated with pain relievers, hormonal therapies (such as birth control pills), or surgery.

How does endometriosis affect a woman’s sex life?

Intercourse can be painful for women with endometriosis. This pain can fluctuate between mild or severe and may worsen at some points of the menstrual cycle. It might occur during all intercourse attempts or just during deep penetration. Much depends on the location of the affected areas. Some women continue to feel pain for several days after sex.

Not surprisingly, the pain of endometriosis makes many women anxious about having sex. The anticipation of pain can make it hard to relax. Some women start to avoid sex altogether, leaving their partner wondering what is wrong. Couples may start to distance themselves from each other and feel isolated and depressed. A woman might feel like a failure for not being able to please her partner. And her partner may worry that she no longer feels attraction.

What can women with endometriosis do to have sex comfortably?

If you have endometriosis, these tips could help:

·         Talk to your partner. Good communication is essential for couples dealing with endometriosis. Your partner may not understand how painful the experience is for you. If, during the middle of sexual activity, something hurts, by all means speak up. Suggest other intimate activities that are comfortable for you. Good communication is important outside the bedroom, too. Many couples have difficulty talking about sex, but being open about endometriosis can help you both work out ways to cope with it. You might consider seeing a sex therapist or couples counselor if you need more help.

·         Plan. You might find that you have more pain at certain points in your menstrual cycle because of hormonal fluctuations. If this is the case, try to plan sex for times when you have less pain. This strategy might not sound romantic, but you can make it so. If you know the pain tends to subside at a certain time of the month, try scheduling a date night or a quick getaway with your partner then.

·         Try to relax. We know this is easier said than done, especially if you’re anticipating pain. But keep in mind that tension in the body can make sex more difficult and add to any pain. When you’re in bed with your partner, focus on what feels good, like the intimacy you share, the kissing and caressing, or the excitement of your connection. Also, try to keep your general stress levels down and find ways to decompress. Don’t hesitate to ask for help from family and friends if you find your responsibilities too overwhelming.

·         Experiment. Some women with endometriosis experience more pain in certain positions, such as man-on-top. The depth of penetration, thrusting of a penis, or weight of your partner’s body can aggravate endometrial tissues. Instead, try other positions that give you more control, like side-by-side or “doggy style.” Remember, too, that while intercourse is often the main event, it doesn’t have to be. There are plenty of other ways to have sex and share intimacy. Oral sex, kissing, hugging, touching, are all ways to connect. You and your partner might enjoy this type of exploration, too.

Coping with endometriosis can take time and patience. But with some flexibility and creativity, you and your partner can still enjoy sex together.


American College of Obstetricians and Gynecologists


(October 2012)

“Interview With a Woman Who Had Endometriosis: Heather Roppolo-Guidone”

(Updated: March 29, 2012)

Davis, Julie

“Why Sex Hurts With Endometriosis”

(Last updated: May 21, 2010)

International Society for Sexual Medicine

“Endometriosis and Sexual Function”

“What can women with endometriosis do to improve their sexual relationships?”

“What kinds of sexual problems are caused by endometriosis?”


(Last updated: December 5, 2014)

Sex Health Blog

Sex After Heart Attack – Is it Safe?

Jul 04, 2016

Sex After Heart Attack – Is it Safe?

Lenny had to admit – his heart attack was definitely a wake-up call. He knew he hadn’t been taking good care of himself. And after talking to his doctor, he was committed to making changes. Eating right and following his doctor’s exercise plan were his first priorities.

He was still anxious though. The thought of having another heart attack frightened him. And he wondered what activities could trigger another one. He was in regular contact with his doctor, but one question nagged at him that he was a little embarrassed to ask: What about sex?

His girlfriend Charlene wondered about that, too. She was gentle with him now; they were both afraid that anything too vigorous would send him back to the emergency room. But it wasn’t the same. Before his heart attack, their sexual relationship was intense. Any night with Charlene definitely got his heart rate up – in a good way. Now, they were both scared to go back to the way things used to be.

The good news for Lenny – and for most heart patients – is that sex after a heart attack is usually safe. However, there are still reasons to be concerned, and that’s what we’ll talk about today. Let’s look at some common questions.

How strenuous is sex?

Experts believe that having sex is about as strenuous as taking a brisk walk or climbing two flights of stairs.

After a heart attack, how soon can I have sex again?

Your cardiologist will give you the best answer to this question and you should always ask before resuming sexual activity. The doctor will likely run tests to see how well your heart responds to certain tasks, like climbing stairs, walking at a certain rate, or riding a stationary bike.

Some patients can go back to sex a week afterward. Other doctors recommend that patients wait four to six weeks.

Can sex trigger a heart attack?

It’s unlikely that sex will trigger a heart attack. In 2015, the Journal of the American College of Cardiology published a study that examined this question. In a group of 536 people who had had a heart attack, less than 1% had had sex an hour beforehand. Almost 80% of the patients had not had sex for a full day before their heart attack.

However, research has shown that sex could be more likely to trigger a heart attack in certain scenarios. Sex with an extramarital partner is one example. The stress associated with infidelity could be a concern.

When should I avoid sex?

If you have chest pains, shortness of breath, lightheadedness, an arrhythmia (irregular heartbeat), uncontrolled high blood pressure, or advanced heart failure, you should ask your doctor if sex is safe for you.

If you have chest pains during sex, stop the sexual activity immediately. Talk to your doctor before having sex again.

If my doctor advises me to restrict sexual activity for a while, what can my partner and I do?

It can be frustrating to hold back on sex because of a heart attack. But that doesn’t mean you and your partner can’t be intimate. You can still kiss, hug, and touch each other. Try giving each other a sensual massage or take a relaxing bath together.

Your doctor might suggest that you have sex less often or tone down the intensity. Try not to be disappointed. Take your time and enjoy being with your partner. Consider this time an opportunity to try new things – maybe new positions or oral sex.

Do I really have to ask my doctor?

Yes. Again, your doctor is the best person to advise you on sex after a heart attack. For many people, talking about sex, especially with a healthcare professional, seems intimidating and awkward. But don’t let that stop you. If your doctor sets limits, it’s important to know exactly what they are. And if you can have sex without restrictions, you might feel less anxious, making sex more enjoyable for both you and your partner.


American Heart Association

“Sex and Heart Disease”

(Updated: September 16, 2015)

Brown, Jennifer, PhD

“Sex After Heart Attack or Stroke: When's the Right Time?”

(July 29, 2013)

International Society for Sexual Medicine

“Is it safe for heart patients to have sex?”


Rettner, Rachael

“Sex After a Heart Attack? Here's How and When”

(July 29, 2013)

NHS Choices

“When can I have sex again after a heart attack?”

(Page last reviewed: June 30, 2015)

Sex Health Blog

Psoriasis and Sexuality

May 31, 2016

Psoriasis and SexualityBrenda was excited about her new relationship with Jake, the guy from her wine tasting class. He was attractive, funny, intelligent, and adventurous. Their dates had included binge watching Star Wars movies and hiking in the state park nearby. She felt they were getting closer with every meeting, and while that pleased her, it also filled her with dread.

She wasn’t sure how to tell Jake about her psoriasis. She’d been grateful for the cooler weather, since she could hide her red, scaly skin under long sleeves. While her psoriasis wasn’t severe all the time, and she took her medicine just as the doctor ordered, she still felt self-conscious. She wondered if Jake would be turned off when he saw her elbows.

Even worse, psoriasis sometimes flared up in her genital area and on her upper thighs. The area got itchy and red and sometimes she felt pain.

Brenda liked Jake and had to admit she thought about sleeping with him. A lot. She was getting vibes from him that he was interested in a sexual relationship, too. But she couldn’t imagine being naked in front of him. And she was afraid he’d think she had a sexually-transmitted infection. Her doctor had assured her that psoriasis wasn’t contagious, but would Jake believe her?

Brenda’s concerns are common. Psoriasis can affect a person’s sex life. There’s good news, however. With treatment, open communication, and some adjustments, people with psoriasis can enjoy satisfying sex lives.


Psoriasis can affect a person’s sex life, but people with psoriasis can enjoy satisfying sex. (Click to tweet)


What is psoriasis?

Psoriasis is a skin disease caused by problems with the immune system.

Normally, skin cells develop inside the skin’s surface and gradually make their way to the top. This process is called cell turnover and it usually takes a month. But for people with psoriasis, cells from the immune system go into overdrive and accelerate the pace of cell turnover. As a result, skin cells turn over in a few days and accumulate on the surface, leaving thick, red, scaly patches. The areas are often itchy and painful.

Psoriasis can be treated with ointments, creams, oral medications, or injections. Some patients also benefit from light therapy. While these approaches can help keep the condition under control, times of stress and illness can lead to flare-ups.

It’s important to know that psoriasis cannot spread to another person, sexually or otherwise. It is not contagious.

How does psoriasis affect someone sexually?

Psoriasis can have both physical and psychological effects.

As was the case with Brenda, psoriasis can occur on the genitals and surrounding areas – the vagina, vulva (the “lips” surrounding the vagina), pubic area, and near the anus. During a flare-up, women may feel pain and experience bleeding during sex.

For men, psoriasis can develop on the penis, scrotum, as well as in the anal and pubic areas and upper thighs. Studies have shown that erectile dysfunction (ED) is common in men with psoriasis, too. Often, men with psoriasis have other health problems that are linked to ED, like diabetes, heart disease, high blood pressure, depression, and anxiety.

Indeed, the emotional and psychological aspects of psoriasis can be a problem for both men and women. Because psoriasis affects appearance, people may feel unattractive and embarrassed. They may worry that potential romantic partners may not want to be with them. Their self-esteem may suffer and they may shy away from starting new relationships.

What can people with psoriasis do?

Luckily, treating psoriasis can alleviate some of the sexual problems. If you have psoriasis, be sure to see your dermatologist regularly and take your medicine as directed.

Here are some other steps you can take:

·         Communicate with your partner. It may feel awkward to discuss psoriasis, especially with a new partner. But being open about it can take pressure off of both of you. Help your partner understand what psoriasis is and how it’s treated. Reassure him or her that it is not contagious. Be willing to answer any questions. And be honest about your feelings. If you are anxious about your partner’s reaction, say so. But remember, your partner is interested in you – the whole you. You are so much more than psoriasis, and your partner knows that.

·         Make some adjustments. If you’re having a flare-up, especially on the genitals, you might need to put off sex until the symptoms settle down. Or, you might need to experiment with other ways of being intimate. Try to relax and tell your partner what feels good and what is uncomfortable. Some men with psoriasis on their penis find that using lubricant under a condom helps relieve irritation. Having sex in a darkened room can help the partner with psoriasis feel less self-conscious, too. Your doctor can tell you more about managing genital psoriasis.

·         Consider counseling. While your dermatologist can treat the physical aspects of psoriasis, a therapist or support group can help you with the emotional side. When you have psoriasis, it’s common to feel depressed and anxious about relationships. With a therapist, you can work to build up your self-esteem and confidence and learn ways to discuss psoriasis with a partner. In a support group, you can ask questions and seek advice from others who have “been there.”

Overall, don’t let psoriasis stop you from pursuing a happy sex life. If you feel that you need help, be sure to talk to your doctor.


International Society for Sexual Medicine

“How does psoriasis affect sexuality?”

“Is there a link between psoriasis and male sexual dysfunction?”

“Psoriasis and Sexual Dysfunction”

“What happens when psoriasis occurs on the genitals?”

National Institute of Arthritis and Musculoskeletal and Skin Diseases

“What is Psoriasis?”

(November 2014)


Rapaport, Lisa

“Men with psoriasis may be more prone to erectile dysfunction”

(March 24, 2016)

Sex Health Blog

Thyroid Disorders and Men’s Sexual Health

Apr 12, 2016

Thyroid Disorders and Men’s Sexual Health Here on Sex Health Matters, we often discuss medical conditions that interfere with a man’s sexual health, such as heart disease, diabetes, and obesity. But did you know that thyroid disorders can also be involved?

Today, let’s talk about the thyroid gland, its role in the body, and how certain disorders have been linked to sexual problems for men.


Certain thyroid disorders have been linked to sexual problems for men. Learn more... (Click to tweet)


What is the thyroid gland?

Your thyroid is a small, butterfly-shaped gland at the front of your neck. It’s about 2 inches long and weighs about an ounce. But despite its small size, it is a major player in your overall health.

The thyroid gland produces hormones that control your metabolism – how fast or slow organs in your body work. These hormones influence your breathing, your heartbeat, your brain, and your nervous system. They also help regulate your body temperature, weight, and cholesterol levels.


Hyperthyroidism and hypothyroidism

When your thyroid makes too much hormone, a condition called hyperthyroidism or overactive thyroid, your body will work faster than it should. As a result, you may feel your heartbeat race, feel nervous or jumpy, and have problems sleeping. You might also feel warm, lose weight, and have diarrhea.

In contrast, hypothyroidism or underactive thyroid occurs when your thyroid doesn’t make enough hormones. In this case, your body works more slowly. Symptoms of hypothyroidism include feeling cold, tired, achy, and constipated. You might gain weight and have dry skin.

Fortunately, both hyperthyroidism and hypothyroidism can be treated by bringing thyroid hormone levels to a normal range.

For people with hyperthyroidism, this might mean medication or surgery. Another option is radioiodine therapy, which involves taking radioactive iodine pills. This substance eventually destroys the thyroid gland. In turn, patients do develop hypothyroidism, but some doctors feel that an underactive thyroid is easier to treat than on overactive one.

Patients with hypothyroidism must take a medication called synthetic thyroxine, which is a substitute for the thyroid hormone. Typically, medicine must be taken for the rest of a patient’s life, but it is very effective for treating an underactive thyroid.


What does the thyroid have to do with sexual problems?

Thyroid disorders, particularly hyperthyroidism and hypothyroidism, have been associated with erectile dysfunction (ED) – the inability to get and keep an erection firm enough for sex – as well as other sexual problems like low libido, premature ejaculation, and delayed ejaculation. However, experts aren’t completely sure why the conditions are related.

Research published in the Journal of Clinical Endocrinology & Metabolism in 2008 found that in 71 men with thyroid problems, 79% had some degree of ED. Erection problems were more common in men with hypothyroidism than hyperthyroidism. Men saw their erections improve with treatment for their thyroid disorder.

In 2005, the same journal published a study that looked at ED as well as other sexual dysfunctions in 48 men. Thirty-four men had hyperthyroidism and the remaining 14 had hypothyroidism. The men’s sexual function was assessed while they were experiencing thyroid symptoms and again 8 to 16 weeks after their thyroid hormone levels were restored to a normal range.

At the start of the study, the researchers found that about 64% of the men with hypothyroidism had low sexual desire, ED, or delayed ejaculation. Around 7% had premature ejaculation.

Among men who had hyperthyroidism, half had premature ejaculation, 18% had low libido, 15% had ED, and 3% had delayed ejaculation.

Men’s symptoms generally improved with thyroid treatment, however. For example, premature ejaculation prevalence dropped from 50% to 15% in the hyperthyroid men.


What should men do?

If you are having problems with erections, talk to your healthcare provider. ED can be a sign of other medical conditions, like heart disease and diabetes, so it’s important to have a thorough checkup.

If a thyroid problem is suspected, your doctor will likely conduct a test for thyroid stimulating hormone (TSH). This hormone is produced by the pituitary gland and it regulates how much thyroid hormone the thyroid gland should produce. Your doctor will probably do some bloodwork to test for thyroid hormones, too. You might have a thyroid imaging scan as well.

Usually, treatment for thyroid disorders resolves any related sexual problems, although this might take a few months for some men. If the problems persist, don’t hesitate to see your doctor again.

Print this article or view it as a PDF file here: Thyroid Disorders and Men’s Sexual Health


“Men: Is Your Thyroid Causing Sexual Problems?”

(Updated: February 23, 2016)


Hormone Health Network

“What Does the Thyroid Gland Do?”

(November 2012)


International Society for Sexual Medicine

“Can thyroid problems contribute to erectile dysfunction (ED)?”


Journal of Clinical Endocrinology and Metabolism

Carani, Cesare, et al.

“Multicenter Study on the Prevalence of Sexual Symptoms in Male Hypo- and Hyperthyroid Patients”

(Full-text. 2005)

Krassas, Gerasimos E., et al.

“Erectile Dysfunction in Patients with Hyper- and Hypothyroidism: How Common and Should We Treat?”

(Full-text. Accepted: February 5, 2008)


National Institute of Diabetes and Digestive and Kidney Diseases


(August 2012)


(March 2013)

Sex Health Blog

Should Men Worry About Dry Orgasms?

Mar 15, 2016

Should Men Worry About Dry Orgasms?A dry orgasm?

For men, it sounds like a contradiction, doesn’t it? Men ejaculate semen at orgasm. Doesn’t that make orgasms, by definition, wet?

The answer is: Not all the time. Some men reach orgasm – and feel great pleasure from it – but do not ejaculate any semen at all. Or, they might ejaculate a very small amount. This is what we mean by “dry orgasm.”


Some men reach orgasm – and feel great pleasure from it – but do not ejaculate any semen at all. (Click to tweet)


While they might seem a bit unusual, dry orgasms are usually nothing to worry about. They can be a challenge for couples who would like to conceive, but they generally not a health risk.


What causes dry orgasms?

Men may have dry orgasms for a variety of reasons.

Younger men with short refractory periods might have them occasionally. The refractory period is a period of time after orgasm during which a man’s body recovers and doesn’t respond to sexual stimulation. These intervals often don’t last long in younger men. In fact, it can be just minutes before a man is “ready to go” again. And he might climax several times during one sexual encounter.

Eventually, however, the well runs dry. A man has a limited amount of semen to ejaculate and if he keeps going, that supply will be depleted. It’s not a cause for worry, though. In a day or two, the man’s body will produce semen to replace what has been ejaculated and he’ll be back to a full supply.

Certain medical conditions can lead to dry orgasms, too, especially in older men. Men who have had surgery for prostate cancer or an enlarged prostate (benign prostatic hyperplasia) often experience dry orgasm. So do men who have had their bladder removed.

Other possible causes include medications (such as those for high blood pressure or an enlarged prostate), radiation therapy, nerve damage, low testosterone, and spinal cord injury.

In some cases, men develop retrograde ejaculation. When this happens, semen isn’t expelled from the tip of the penis. Instead, it goes backward into the bladder. It is not harmful, however. The semen exits the body when the man urinates.


How do dry orgasms affect fertility?

Men who regularly have dry orgasms have difficulty getting their partner pregnant through intercourse. But it still might be possible for them to father children. For example, men who have retrograde ejaculation may have sperm cells removed from their urine. Those cells can be used to fertilize egg cells. Eventually, an embryo can be transferred to a woman’s uterus.

Do men with dry orgasms still need to practice safe sex?

Men who have dry orgasms should still use condoms if they want to reduce the risk of unplanned pregnancy or sexually-transmitted infections. Some men do ejaculate small amounts of semen, so safe sex is still important.

What can men do about dry orgasms?

If dry orgasms are a problem for you, be sure to see your doctor. If a medication is the cause, changing medications might be the solution. (Note: One should never adjust medication without the advice of a doctor.) If you and your partner wish to conceive a child, your doctor can refer you to a fertility specialist.

Print this article or view it as a PDF file here: Should Men Worry About Dry Orgasms?


Healthdirect Australia

“Dry orgasm”

(Last reviewed: July 2015)

International Society for Sexual Medicine

“What causes retrograde ejaculation?”

Mayo Clinic

“Dry orgasm”

(January 22, 2015)


Delvin, David, MD

“Dry orgasms”

(June 27, 2013)

Sex Health Blog

Are Men Satisfied with Penile Implants?

Feb 15, 2016

Are Men Satisfied with Penile Implants? Bill took a deep breath, looked at his wife Judy, and finally told his urologist, “Okay. I’ll get the implant.”

It wasn’t something he necessarily wanted to do. But he had been dealing with erectile dysfunction (ED) for a few years now and no other treatments seemed to be working out. Because he took heart medication, he couldn’t take the pills he saw advertised on TV. And the vacuum device, which was far from romantic, didn’t seem right for him either.

He didn’t like the word “prosthesis” when it referred to his manhood. It made him think of artificial limbs. But he knew that an implant was just that – a device designed to give him an erection when he wanted.

He and Judy were in their fifties - still young - and still had a long sex life in front of them. He wanted to be more spontaneous with their lovemaking. He wanted to feel confident, like he did early in their marriage. And he wanted to keep Judy satisfied. She was patient, but he knew he was disappointing her every time.

Bill had heard that penile implants had a high satisfaction rate. He’d also heard that sex would probably still feel the same as it did before he had ED. But he was nervous. He knew that after getting the implant, there was no turning back. So he wanted to make sure he was doing the right thing.


Many men getting implants share Bill’s concerns. Penile implantation is a big decision. Today, we’ll talk about men’s experiences with implants and some things to keep in mind if you’re considering one.

What kind of implant?

Bill’s urologist recommended a 3-piece inflatable implant, which is currently the most common type. These implants have three components:

·         Cylinders that are surgically implanted into the shaft of the penis. These cylinders replace the corpora cavernosa – the spongy tissue that typically fills with blood and gives an erection its firmness.

·         A reservoir filled with saline fluid. This fluid fills the cylinders on demand, similar to the way blood once filled the corpora cavernosa.

·         A pump placed in the scrotum. When a man wants an erection, he can activate the pump by squeezing it, sending the saline fluid into the cylinders. Similarly, when he no longer desires an erection, he can deactivate the pump, returning the saline fluid to the reservoir until next time.

Another type of implant, but less commonly used, involves malleable rods placed in the shaft. The man can move his penis to an erect position as he chooses.


Why do men like their implants?

In December 2015, The Journal of Sexual Medicine published a study on men’s satisfaction and dissatisfaction with penile implants. The researchers interviewed 47 men with an average age of 61 years and asked them to share their thoughts.

Overall, 79% of the men were “fairly” or “very” satisfied. The main reasons they gave were:

·         Improved sexual performance. Men could get erections, penetrate their partners, and feel sexually satisfied.

·         Improved self-esteem, confidence, and male identity. “It was a giant step I took in my life, and I'm glad I took it,” one man said.

·         Improved relationships. One participant remarked, “My general relationship with my wife is much better now.” Others said they were happy that they could please their partners.

·         Improved urination. Some men said their urinary function was better with the implant.


Why are men dissatisfied?

While the majority of men were satisfied, there were some who were not. Here are some of their reasons:

·         Unmet expectations. Some men found that the implant did not “feel” the way they thought it would.

·         Shortening of the penis. In some cases, the penis was shorter than it was before. Two men were not able to have intercourse. [Note: A small 2014 study of penile shortening showed that 70% of men experience some degree of shortening after penile implantation, usually in the range of 0.5 centimeters to 1.5 centimeters. However, over half the men in the study didn’t notice.]

·         Feeling “artificial.” One man said, “It is always artificial. It takes time to inflate, it always disturbs.”

·         Malfunction. After a while, some men with inflatable implants had trouble activating their devices. It is possible for pumps to malfunction, although this is rare. A urologist should give instructions on how to keep the device in good working order.


Should you get an implant?

That’s a question only you, your partner, and your doctor can answer. As the study suggests, the majority of men are satisfied with their choice. But men should be prepared – and have realistic expectations – before surgery. If you have any questions or concerns, be sure to let your urologist know.

Print this article or view it as a PDF file here: Are Men Satisfied with Penile Implants?


American Urological Association

Kohler, Tobias, et al.

“Penile Implants – Why are Men Dissatisfied?”

(Abstract PD40-10, presented May 18, 2015 at the annual meeting of the American Urological Association, New Orleans, LA, USA)

The Journal of Sexual Medicine

Carvalheira, Ana, PhD, et al.

“Why Are Men Satisfied or Dissatisfied with Penile Implants? A Mixed Method Study on Satisfaction with Penile Prosthesis Implantation”

(Full-text. December 2015)

“Penile Implants – Erectile Dysfunction”

“Will a penile implant change the way my partner feels during sex?”

Urology Times

Morey, Allen F., MD

“IPP satisfaction: What you can anticipate”

(January 1, 2016)

Kuznar, Wayne

“Survey reveals why patients discontinue IPP use”

(January 1, 2016)

Sex Health Blog

How Do Certain Diseases Lead to Erectile Dysfunction?

Jan 12, 2016

How Do Certain Diseases Lead to Erectile Dysfunction?Here at SexHealthMatters, we talk a lot about erectile dysfunction (ED) and its link to certain medical conditions, like heart disease and diabetes. Often, ED is one of the first symptoms of something more serious, so we encourage men to have a thorough checkup with their doctor when they start having problems with erections.

Why do certain diseases lead to ED? Last month, the Basic Science Committee of the Sexual Medicine Society of North America (SMSNA - the scientific organization behind SexHealthMatters) published a white paper on this subject in The Journal of Sexual Medicine.


Why do certain diseases lead to ED? Learn more... (Click to tweet)


The authors analyzed a number of studies to help us better understand the “mechanistic link” between cardiovascular/metabolic diseases and ED. In other words, they aimed to explain what’s happening in the body and why that process can lead to ED.

Today, we’ll take a closer look. But before we start, let’s break down some scientific medical concepts:


·         Cardiovascular diseases. The word “cardiovascular” refers to the heart and blood vessels, so cardiovascular diseases affect these areas. Many are caused by atherosclerosis – hardening of the arteries – which happens when plaque accumulates on the walls of the arteries. This can impair, and sometime block, blood flow. Some examples of cardiovascular diseases are heart failure, heart attack, heart valve problems, stroke, and arrhythmia (abnormal heart rhythm). Cardiovascular disease is sometimes called heart disease.

·         Metabolic diseases affect your metabolism – your body’s ability to convert the food you eat into energy. Diabetes is one example. In fact, diabetes is a major player in the development of ED. Diabetic men usually start having erection problems years before men without diabetes. Risk factors for both cardiovascular and metabolic diseases include high blood pressure, obesity, smoking, high cholesterol, and aging.

·         Erections. To understand how medical conditions can lead to ED, it helps to have the basics on how an erection occurs. When a man is sexually stimulated, his brain sends messages through the nervous system to his penis. This triggers an erection. These messages tell arteries to expand so that the penis can fill with blood. Smooth muscle tissue relaxes and helps the process along. When the penis is rigid, veins constrict to keep the blood inside until the man ejaculates. Once this happens, veins open up again and the blood flows back into the body. As you might imagine, good blood flow is critical for a good erection. But so is the neurological network that sends messages back and forth between the penis and brain.


Now, just how do these diseases interfere with erections? Here’s what the SMSNA scientists reported:

·         Endothelial dysfunction. The endothelium is tissue that lines your blood vessels. Endothelial dysfunction is often considered a precursor to atherosclerosis and can interfere with blood flow to the penis.

·         Smooth muscle tissue. ED’s link to problems with smooth muscle tissue have not been studied as widely as endothelial dysfunction. However, the authors noted that problems with the production of nitric oxide (an important compound for erections) can make it more difficult for smooth muscle tissue to relax. In turn, this can impair penile blood flow.

·         Autonomic neuropathy. “Neuropathy” means nerve damage. Cardiovascular and metabolic diseases can damage the autonomic nervous system, which controls bodily processes that you don’t necessarily think about. For example, you don’t “tell” your digestive system to process food or your heart to keep beating. Erections work the same way. However, illnesses can interfere with the autonomic messages that travel between the brain and penis. When this happens, the brain can’t properly “tell” the penis to get ready for sex, so the erection process may be incomplete. Or, it might not happen at all.

·         Hormones. Testosterone is an important hormone for men’s overall health, particularly sexual function. Sometimes cardiovascular and metabolic diseases can impair the release of testosterone or the way it works in the body, resulting in ED.

·         Metabolism. Cardiovascular and metabolic diseases can disrupt a man’s metabolism, making it more difficult for him to get erections. You might have heard the term “metabolic syndrome.” This is actually an umbrella term for a number of conditions, including high blood sugar, high blood pressure, obesity, low HDL (“good”) cholesterol, and high levels of triglycerides. These factors can disrupt blood flow to the penis.


What does all this mean for men?

If you are having trouble getting erections, seeing a doctor is the first step. As we mentioned earlier, ED is often the first sign of an underlying medical condition and it’s best to have everything checked out. If there is something more serious going on, your doctor can start treating you right away.

Sometimes, that treatment resolves the other ED. In other cases, you might need more help. There are many ways to treat ED.  Chances are good that you and your doctor will find the right therapy for you.

If you’re in a relationship, include your partner in the conversation, too. ED can be frustrating, embarrassing, and stressful. Make sure your partner is part of your team.

Finally, even if you’re not having erection troubles right now, keep cardiovascular and metabolic health in mind. Try to lower your risk for these illnesses by following healthy habits: eating right, exercising, and quitting smoking are great ways to start. Your doctor can help you develop the right program for you, so don’t hesitate to ask.  

Print this article or view it as a PDF file here: How Do Certain Diseases Lead to Erectile Dysfunction?


American Heart Association

“What is Cardiovascular Disease?”

(Last reviewed: December 18, 2014)


The Journal of Sexual Medicine

Musicki, Biljana, PhD, et al.

“Basic Science Evidence for the Link Between Erectile Dysfunction and Cardiometabolic Dysfunction”

(Full-text. First published online: December 8, 2015)



“Metabolic Disorders”

(Last reviewed: September 12, 2014)


Sexual Medicine Society of North America

“Diabetes – Erectile Dysfunction”


“How is Diabetes Affecting Your Sexual Health?”

(March 12, 2013)


“Metabolic Syndrome More than Doubles ED Risk”

(June 4, 2015)


“Nitric Oxide Microspheres”

(November 13, 2013)

Sex Health Blog

Understanding Sexual Consent

Dec 15, 2015

Understanding Sexual ConsentNot long ago, a clever video called “Tea and Consent” was making the rounds on social media. Produced by the Thames Valley Police in England, it offers ways to tell whether a partner is giving consent for sex. However, it compares sex to a cup of tea.

The video has a humorous edge. (“Unconscious people don’t want tea,” the narrator explains. “Trust me on this.”) But it quickly makes its point and gives people of all ages some language to discuss consent, which is an important concept to understand.

The Thames Valley Police defines consent this way:

“Sexual consent is where a person has the ability and freedom to agree to sexual activity.”

It sounds straightforward enough, but there are still times when sexual consent is not asked for, not given, or misunderstood.


“Sexual consent is where a person has the ability and freedom to agree to sexual activity.” (Click to tweet)


Let’s look at consent in more detail. To illustrate each point, we’ll meet Jerry and Lisa, both in their late twenties. Their relationship is just starting to get serious.


The Basics of Consent

When partners give sexual consent, each of them willingly agrees to the terms of that sexual encounter. Each partner must also be able to give consent. In other words, the person should not be incapacitated in any way. Disability, intoxication, or the influence of drugs are all examples of incapacitation.

It’s important to know that having sex without consent is rape or sexual assault. Also, consent cannot be legally given by underage partners, even if they are willing to have sex. Sex with an underage partner is statutory rape.

The age of consent varies from area to area. To learn more, contact authorities in your locality.

The best way to get consent is to ask. That is the only way you can be absolutely clear that consent is granted. For example, if you are kissing your partner and would like to go further, ask how he or she feels about the next steps.


Jerry and Lisa are kissing passionately on the couch. Lisa would like to move the encounter to the bedroom.

Lisa: You know, I’ve been thinking about how I’d like to have sex with you. Would you like to do that and spend the night?

Jerry: Yes, I’d like that very much.

Consent must be confirmed for each sexual encounter. Don’t assume you’re granted consent because of past sexual experiences together. Even married people should get consent.


When Jerry visited Lisa at her home last weekend, they had sex several times. Now he is visiting again, but Lisa isn’t so sure about the relationship. Perhaps they’re moving too fast.

Jerry: So, shall we head to the bedroom?

Lisa: No. I’m not comfortable with that right now. Perhaps we should talk a bit.

Jerry: Okay. I understand.


Consent must be given for each type of sexual activity. If one partner has agreed to vaginal sex, oral or anal sex cannot be taken for granted.


Jerry and Lisa are in bed together. Lisa suggests anal sex.

Jerry: You know, the idea of anal sex is really a turn off for me. I’m sorry.

Lisa: No problem. I’m glad you told me how you feel.

Consent can be withdrawn at any time. When a couple starts sexual activity, they do not necessarily need to finish. If a person has second thoughts, he or she can say no and the activity should stop immediately. It may be frustrating for the partner, but the decision needs to be honored.


Lisa discovered that Jerry has been with other women while he’s been seeing her. She wonders whether he has been having safe sex. Even so, she starts having a sexual encounter with him. Then:

Lisa: We have to stop. I just can’t do this. I’m sorry. I just don’t know who you’ve been with.

Jerry: What? Are you kidding? We’re almost there.

Lisa: I know. But this just isn’t right.

Jerry: Okay. Let’s talk about it.


A person who is incapacitated cannot give consent. For example, a person who is drunk is not in any position to give consent, even if he or she appears to want sex.


Lisa is at a bar at her friend’s bachelorette party. Most of the women have been drinking heavily. (They hired a limo to take them home.) Lisa has been flirting with Zack. Jerry is the last person on her mind. She smiles provocatively and asks if Zack wants to take her home. He does want to. But he stops himself. Lisa is not capable of giving consent at this time.

As much as he wants to have sex with her, Zack declines and orders her some coffee. He asks one of Lisa’s friends how they are getting home. The woman explains that the limo will be picking them up shortly and reassures him that Lisa will be safe.

Safety, respect, and trust

Do these examples seem far-fetched to you? They might. But we hope they illustrate what consent is about: safety, respect, and trust. And when partners feel safe, respect each other, and foster trust, intimacy is often more pleasurable for both of them.

Print this article or view it as a PDF file here: Understanding Sexual Consent


Palo Alto Medical Foundation

“Consent & Consensual Sex”


Thames Valley Police

“Crime prevention – What is sexual consent?”


“Tea and Consent”


University of Michigan

“What is Consent?”


Sex Health Blog

Erection Concerns After Prostate Biopsy

Nov 11, 2015

Erection Concerns After Prostate BiopsyWhen his doctor mentioned the prostate biopsy, Stan’s heart sank. What did this mean? Did he have cancer? And if so, how would his life change?

Quietly, he listened his doctor explain. Stan had high levels of prostate-specific antigen (PSA) and the doctor had found an unusual lump on his prostate during his digital rectal examination. These two factors made a biopsy necessary. Stan might have cancer and catching it early was important.


Some men do develop ED for a time after a prostate biopsy. But not all do. Learn more here... (Click to tweet)


The biopsy could be done at the office and would probably take about fifteen minutes. A needle would be used to remove about ten tissue samples from his prostate. Then, an expert would analyze the tissues in a lab, looking for cancer cells. Having the biopsy didn’t mean he had cancer. It just meant they needed to take a closer look.

Stan’s expression was stoic, but inside, his body was in turmoil. He was anxious about his prognosis, of course. Also, the idea of having a needle in his private parts made him nervous. He knew the biopsy was necessary. He knew it could save his life. But he had other questions, too.

For example, what would happen to his erections? Would the biopsy procedure affect his sex life?

Lots of men share Stan’s concerns. The anxiety of a biopsy is enough to cope with, but wondering about your erections afterward is also difficult.

Some men do develop erectile dysfunction (ED) for a time after a prostate biopsy. But not all do. Let’s look at this topic more closely.


What happens during a prostate biopsy?

As Stan’s doctor explained, a biopsy involves removing tissue with a special needle. To do a thorough analysis, the doctor removes several samples from different areas of the prostate. Then, a specialist examines the samples under a microscope to check for cancer.

Typically, a prostate biopsy is done in one of three ways:

·         Through the rectum. With a transrectal biopsy, the needle travels through the rectum (the last part of the large intestine, which ends in the anus). This is the most common approach.

·         Through the urethra. With the help of a tiny camera, the doctor removes tissue through the tube the carries semen and urine out of the body.

·         Through the perineum. Doctors who use the transperineal method make a small cut in the perineum (the area between the scrotum and anus). The needle is passed through the cut to collect tissue.


Will I have problems with erections afterward?

You might. The prostate is surrounded by sensitive nerves important for erections. These nerves are hard to miss when placing the needle.

Sometimes, it depends on the type of biopsy you have. A 2015 study in BJU International found that men who have a transrectal biopsy can have trouble with erections up 12 weeks after the procedure, especially if they are over age 60.

Another 2015 study, published in the International Journal of Impotence Research, reported that men had a 5% increased risk for ED after a transperineal biopsy, but that the ED usually got better within three to six months.

Often, psychological issues contribute to ED as well. It’s possible that anxiety over the biopsy or depression after a cancer diagnosis, can lead to erectile difficulties.

If you have concerns about your erectile function after a prostate biopsy, be sure to mention them to your doctor. He or she can go over the types of procedures that are best for your situation and discuss the odds of ED afterward. Your doctor can also talk with you about treatments for ED, such as medications and vacuum devices. You may also be referred to a counselor who can help you (and your partner) cope with anxieties associated with ED or a pending cancer diagnosis.

We have lots of information on prostate cancer here on SexHealthMatters. Just click this link to read more. You’ll also find comprehensive information on ED and its treatment here.

Print this article or view it as a PDF file here: Erection Concerns After Prostate Biopsy


American Cancer Society

“How is prostate cancer diagnosed?”

(Last revised: March 12, 2015)

International Journal of Impotence Research

Pepe, P. and M. Pennisi

“Erectile dysfunction in 1050 men following extended (18 cores) vs saturation (28 cores) vs saturation plus MRI-targeted prostate biopsy (32 cores)”

(Full-text. August 20, 2015)

BJU International

Murray, Katie S., et al.

“A prospective study of erectile function after transrectal ultrasonography-guided prostate biopsy”

(Abstract. March 23, 2015);jsessionid=9A2ECAB5E2109C9FBFD5D45760D7FE93.f03t03

Johns Hopkins Medicine

“Prostate Biopsy”,p07710/

Mayo Clinic

“Types of prostate biopsy procedures”

(April 26, 2013)

Medscape Medical News

Mulcahy, Nick

“ED Induced by Prostate Biopsy Likely 'Underestimated'”

(October 1, 2015)

Sex Health Blog

What Causes Low Testosterone?

Nov 02, 2015

You probably know the important role testosterone plays in a man’s life. It’s the stuff that makes a man a man, from facial hair and a deeper voice to sex drive, erections, and sperm production. When a man has low testosterone, his libido can plummet, along with other aspects of his sexual function.

So you might wonder what causes low testosterone. And is there anything you can do to maintain your testosterone levels, even as you age?

Let’s define what we mean by low testosterone. Testosterone is measured with a simple blood test. Most healthy adult men have testosterone levels between 270 and 1,070 nanograms per deciliter (ng/dL). 300 ng/dL is usually the threshold for a low testosterone diagnosis.

But keep in mind that a man’s testosterone levels fluctuate during the day. Levels are usually highest around 8 a.m. and lowest around 9 p.m. Most doctors conduct testosterone tests early in the morning so they can get a consistent reading over time.

Another thing to think about is the way testosterone is produced. Most of it is made in the testes, but before that even happens, signals from the pituitary gland and the hypothalamus (a part of the brain) need to trigger that production. The pituitary gland and hypothalamus are just as important as the testes.

Now, let’s look at some of the reasons behind low testosterone.


Aging. For most men, testosterone levels start decreasing around age 40 and continue to decrease about 1% each year. So by age 70, your levels can decline by about 30%. The good news is that even with the drop, three-quarters of older men still have testosterone levels in the normal range.

Obesity. Some of a man’s testosterone is naturally converted to estrogen, a hormone usually associated with women. But men need estrogen, too, especially to maintain healthy bone density. The problem with obesity is that the conversion from testosterone to estrogen mainly happens in fat cells. The more fat cells you have, the more testosterone is being converted to estrogen, leading to lower testosterone levels.

Injury to the testicles or scrotum. Injured testes are sometimes unable to produce the amount of testosterone a man needs. Interestingly, amounts can remain stable if only one testicle is injured. The healthy one can still produce enough testosterone on its own.

Chemotherapy and radiation therapy. These therapies can damage cells in the testes that make testosterone. Sometimes, levels return to normal if the cells recover, but sometimes the damage is permanent.

Medications. Opiates, taken for pain, and certain hormones can cause problems with testosterone production.

Performance enhancing drugs (anabolic steroids). Bodybuilders and athletes sometimes take anabolic steroids to make them stronger or faster. But performance enhancing drugs can make testicles shrink and impair testosterone production. They are also illegal, when used in this way.

Inflammation. Certain conditions and diseases, such as sarcoidosis, histiocytosis, tuberculosis, and HIV/AIDS can affect the pituitary gland and/or the hypothalamus because of inflammation.

Infection. Mumps, meningitis, and syphilis are known to lower testosterone levels.

Head trauma and tumors. These conditions can also affect the pituitary gland and hypothalamus.

Too much iron in the blood (hemochromatosis). This can cause damage to your testes and your pituitary gland.


Is there anything I can do to keep my testosterone levels from decreasing?

Maybe. Keeping yourself fit and healthy – important for so many reasons – is also important for your testosterone. Protect your testicles when you play sports. Make sure you get enough exercise, including resistance exercises and strength training. Eat a healthy diet full of fruits and vegetables and high-fiber foods. Watch your fat intake. Practice safe sex and don’t abuse drugs and alcohol.

Taking these steps can help prevent some of the causes of low testosterone, such as obesity, cancer, and HIV/AIDS. Plus, you’ll improve your overall health and your sex life. It’s a win-win situation.

If I have low testosterone, should I have hormone replacement therapy (HRT)?

Talk to your doctor. There are pros and cons to hormone replacement therapy. Researchers are still unsure how much HRT helps a man’s sexual function overall and there are other factors that can affect your sex life as much as testosterone.

Sex Health Blog

Sex and Low Back Pain

Oct 14, 2015

Sex and Low Back PainLow back pain can interfere with many of our day-to-day activities, like climbing stairs, sitting at a desk, mowing the lawn, or vacuuming the living room.

We can add sex to that list as well.

Think about it. While intercourse does not have to involve strenuous acrobatics, the back can still get quite a workout. Movement during sex, such as thrusting or supporting the weight of the partner on top can all make low back pain flare up.


34% to 84% of men have sex less often due to low back pain. Changing sexual positions may help. (Click to tweet)


Sometimes, the pain is so severe that couples avoid having sex altogether. Indeed, an estimated 34% to 84% of men have sex less often because of low back pain. Women are affected, too. When this continues, couples can become distant and depressed. Relationships may suffer.

Changing sexual positions may be the key to relief. Last year, researchers from the University of Waterloo in Canada published a pair of studies that investigated the best sex positions for people with low back pain. Let’s take a closer look.


The Study

For this research, the scientists recruited ten heterosexual couples who agreed have sex in the lab. Each partner wore electrodes that allowed the scientists to analyze spine movement during intercourse. The same technology is used by filmmakers and video game producers for animation.

Each couple tested five different sexual positions: spooning (in which the man and woman face the same way, like nested spoons), two versions of the missionary position (“man-on-top”), and two versions of the rear-entry quadruped position (“doggy-style’).

Note: The study included heterosexual couples, but the findings can apply to same-sex couples as well.

Types of Low Back Pain Make a Difference

The scientists found that the type of low back pain can affect comfort during intercourse.

Two distinctions are made. People who are flexion-motion intolerant have pain when they touch their toes or sit for a long time. In contrast, people who are extension-motion intolerant feel pain when arching their back or lying on their stomach. Often, what is comfortable for a flexion-motion intolerant person is painful for an extension-motion tolerant person and vice versa.


Flexion-motion Intolerance

Doggy-style was deemed best for flexion-motion intolerant men, according to the study.

For women in this category, spooning worked well. Doggy-style was also helpful for women, as long as they used their hands – not their elbows – to support their upper body.

Extension-motion Intolerance

Extension-motion intolerant people should avoid arching their backs during sex, the researchers explained. Men in this group may find doggy style or missionary positions more comfortable. If the missionary position is used, the researchers recommended using the elbows to support the upper body instead of the hands.

The missionary position was considered best for extension-motion intolerant women.

Moving with the Hips and Knees

The researchers also noted that moving with the hips and knees instead of the spine could limit pain. For example, it might be more comfortable for a man to thrust using his hips instead of his spine. For women using the missionary position, flexing at the hips and knees could be less painful. Placing a pillow or a rolled up towel under the back can help, too.


Couples Need to Experiment

It’s important to remember that while changing positions can help make sex more comfortable, there is no one-size-fits-all solution. Couples need to experiment and determine what works best for them. Open, honest communication between partners is essential. If something hurts, tell your partner. Stop the activity if you need to. Try something else when you feel ready.

If you and your partner feel nervous talking about sex (as many couples do), don’t hesitate to see a sex therapist. A counselor can help you learn to express what you need. Your doctor can refer you to a qualified sex therapist in your area.

Other Tips

In addition to changing positions, there are other things you can try to reduce back pain during sex, such as taking a pain reliever or a hot shower beforehand. You can also try icing your back afterward.

Don’t Give Up

Having low back pain doesn’t mean the end of your sex life. Many medical conditions require us to make adjustments in the bedroom. And sometimes, a simple change can make a world of difference – for ourselves and our partners!

Print this article or view it as a PDF file here: Sex and Low Back Pain


European Spine Journal

Sidorkewicz, Natalie, MSc and Stuart M. McGill, PhD

“Documenting female spine motion during coitus with a commentary on the implications for the low back pain patient”

(Abstract. First published online: October 24, 2014)

Medscape Orthopedics

Laidman, Jenni

“Is There Sex After Low Back Pain?”

(August 26, 2015)


Sidorkewicz, Natalie, MSc and Stuart M. McGill, PhD

“Male Spine Motion During Coitus: Implications for the Low Back Pain Patient”

(Full-text. Published online: September 11, 2014)

University of Waterloo

“New findings will improve the sex lives of women with back problems”

(News release. October 24, 2014)

University of Waterloo Magazine

Bezruki, Christine

“Less Pain, More Pleasure”

(Fall 2014)

The Washington Post

Phillip, Abby

“Bad back? These are the best sex positions to ease the pain.”

(September 10, 2014)


Kam, Katherine

“Don’t Let Low Back Pain Ruin Sex”

(Last reviewed: June 1, 2011)

Sex Health Blog

Quitting Smoking May Improve Erections

Sep 22, 2015

Quitting Smoking May Improve Erections“Mind if I smoke?”

It’s not a question you hear much nowadays. Still, almost 18% of adults in the United States smoke cigarettes, according to the Centers for Disease Control and Prevention (CDC). And more men smoke than women.

Most people are aware that smoking is bad for their health. Smoking is linked to cancer, heart disease, respiratory disease, and a host of other illnesses.

What men might not know, however, is that smoking can also lead to erectile dysfunction (ED).  Studies have shown that men who smoke are more likely to develop ED. And the more a man smokes – both quantity and duration of time - the worse his ED tends to be.


Quitting smoking may improve erections, research suggests. (Click to tweet)


The good news is that quitting smoking can help restore erections. Let’s look at this relationship more closely.


How does smoking cause ED?

First, let’s go over the physiology of erections.

When a man is sexually stimulated, his brain sends signals to the penis to trigger an erection. Smooth muscle tissue relaxes and arteries widen, allowing the penis to fill with blood. When enough blood flows in, veins constrict to keep it there until the man ejaculates (or the stimulation stops). Then the veins open and blood flows back into the body.

As you can see, blood flow is critical for a good erection. Blood is what gives the penis the firmness needed for sex. When blood flow is compromised, so is the erection.

Smoking tobacco releases chemicals that interfere with this process. This can happen in a few ways.

·         Hardening of the arteries (atherosclerosis). Chemicals can damage the lining of blood vessels, making it difficult for blood to flow into the penis.

·         Damage to smooth muscle tissue. When this tissue can’t relax properly, blood flow becomes impaired.

·         Decreased nitic oxide. Smoking interferes with the body’s production of nitric oxide, a compound needed for erections.

Other health conditions, like diabetes and heart disease can contribute to ED, too. If you’re having erection problems, it’s important to have a full checkup with your doctor. But quitting smoking definitely can’t hurt.


Tips for Quitting

Ready to quit? Here are some tips to consider:

·         Talk to your doctor.  He or she can give you personalized advice and refer you to a smoking cessation program in your area. Your doctor can also monitor other medical conditions that might be contributing to your erection problems and guide you toward making healthy lifestyle choices, like exercising and eating well.

·         Manage stress. For many people, stress and anxiety are smoking triggers. It may be easier said than done, but try your best to manage stress. If you need help, don’t hesitate to ask for it. For example, if you need a hand caring for children, see if a friend can babysit once in a while. If work is overwhelming, talk to your boss about possible changes. There are times when we need a healthcare professional to help us through stressful times. That’s okay, too. Your doctor can put you in touch with a therapist or counselor.

·         Get support. Tell your friends and relatives about your goal. They can cheer on your progress and encourage you when you’ve hit a rough spot. You might also consider a formal support group of people who are facing the same challenges you are.

·         Set mini-goals. Break your goal down into reasonable mini-goals. Instead of saying, “I’ll go 24 hours without a cigarette,” try going an hour, then two, then three.

·         Celebrate your successes. If you’ve met one of your mini-goals, pat yourself on the back! Quitting smoking is difficult, so reward yourself by going out with friends, catching a movie, or any other activity you enjoy.

·         Be Kind to Yourself.  If you don’t meet a mini-goal, don’t beat yourself up.  Give yourself credit for trying and resolve to tackle it again tomorrow.

·         Try technology. There are a number of free and low-cost smartphone apps for Apple and Android devices designed to help users quit smoking. Some will keep track of how many cigarettes you haven’t smoked and how much money you’ve saved. Some offer tips and words of encouragement, too.


Quitting smoking should make you feel better overall. You’ll feel good about yourself knowing that you’ve taken an important step toward better health – and possibly better sex!

Print this article or view it as a PDF file here: Quitting Smoking May Improve Erections


Centers for Disease Control and Prevention

“Current Cigarette Smoking Among Adults in the United States”

(Page last updated: August 25, 2015)

European Urology Focus

Verze, Paolo, et al.

“The Link Between Cigarette Smoking and Erectile Dysfunction: A Systematic Review”

(Full-text. August 15, 2015)


Woolston, Chris

“Smoking and Impotence”

(Last updated: March 11, 2015)


Roth, Erica and Rena Goldman

“The Best Quit Smoking iPhone and Android Apps of the Year”

(August 4, 2015)

Sexual Medicine Society of North America

“Smoking and Erectile Dysfunction - Surgeon General’s Report”

(February 5, 2014)

“Have You Built a Quit Plan?”

Sex Health Blog

What Should I Know About Addyi?

Aug 26, 2015

What Should I Know About Addyi?There’s been a lot of talk about Addyi – on TV, on the internet, maybe even among your friends. Approved by the FDA on August 18th, it’s the first drug designed to treat acquired, generalized hypoactive sexual desire disorder (HSDD). In general terms, HSDD refers to low sexual desire in women, but there’s a little more to it than that.

According to Sprout Pharmaceuticals, the maker of Addyi, the drug should be available by October 17th. Between now and then, it’s important to understand just what Addyi is, whom it is intended for, and what patients might expect.

In today’s post, we answer some common questions about Addyi. Keep in mind that only your doctor can best advise on whether Addyi is right for you or your partner.


What should you know about Addyi? Find out here... (Click to tweet)


What is HSDD?

It’s normal for women to experience fluctuations in sexual desire. Life gets busy and stressful, relationships can get rocky, and hormonal changes during pregnancy and menopause can all interfere with our interest in sex. So can certain medications, like antidepressants.

What makes HSDD different is that it can’t be explained by life circumstances, medications, or another health situation. It also causes women distress or disrupts their personal relationships. Distress is important in an HSDD diagnosis. If a woman lacks sexual interest but isn’t bothered by it, she doesn’t have HSDD.


What is Addyi and how does it work?

Addyi’s technical name is flibanserin. It’s a non-hormonal drug that acts on neurotransmitters in a woman’s brain. Two of these neurotransmitters – dopamine and norepinephrine – are involved with sexual excitement. Addyi raises levels of these chemicals. Another neurotransmitter, serotonin, is associated with sexual inhibition. Addyi lowers serotonin levels. By balancing out these chemicals, Addyi may help restore a woman’s sexual interest.

Addyi is taken once a day at bedtime. It is not meant to enhance sexual performance. In other words, it won’t make sex feel more exciting. But it might help a woman feel more excited about having sex.

Who can take Addyi?

While all women can experience low sexual desire, not all women can take Addyi.

The FDA has approved Addyi for specifically for women who meet the following conditions:

·         Are pre-menopausal. Your doctor can help you determine your menopause status. Typically, a woman is considered to be finished with menopause if she hasn’t had a menstrual period in twelve months.

·         Have acquired HSDD. This means that the woman has had a healthy sex drive in the past. She hasn’t had HSDD for her entire life.

·         Have generalized HSDD. When HSDD is generalized, it occurs in all sexual situations with all partners. Sometimes, women lose interest in sex because it’s routine. New activities or new partners can rekindle their libido. But this doesn’t happen with generalized HSDD.


Who cannot take Addyi?

Addyi is not recommended for:

·         Women who have finished menopause.

·         Men

·         Women who have poor liver function

·         Women who take a class of drug called CYP3A4 inhibitors (If you don’t know, ask your doctor.)

·         Women who regularly drink alcohol. Addyi and alcohol do NOT mix.

What are the side effects of Addyi?

Women who take Addyi may feel dizzy or sleepy. Nausea, fatigue, insomnia, and dry mouth are other reported side effects.

Is Addyi safe?

Extensive studies have found that Addyi is safe for women as described above. However, there are still safety risks.

Syncope (fainting, loss of consciousness) and hypotension (extremely low blood pressure) have been reported among women who take Addyi, especially if they drink alcohol, have liver problems, or take CYP3A4 inhibitors.

As part of the approval process, Sprout Pharmaceuticals is required by the FDA to conduct further studies on the interaction of Addyi with alcohol.

Also, doctors and pharmacies are required to undergo a training and certification process before they are allowed to prescribe or dispense Addyi.


Is Addyi effective?

There have been some concerns about how well Addyi works. And it might not work for all women.

However, clinical trial results are encouraging. According to the International Society for Sexual Medicine (ISSM), in studies of over 11,000 women, 53% of participants felt improvements in sexual desire. The number of satisfying sexual events doubled and sexual distress was reduced by one-third.

Is Addyi right for me?

That’s something only you and your doctor can answer.

If you feel that your sexual interest has declined, make an appointment for a full checkup. Your doctor can assess the medications you take, your hormone levels, your relationship, and the day-to-day stresses in your life. He or she might also use a tool called the Decreased Sexual Desire Screener to evaluate your symptoms.

If you and your doctor decide to that Addyi is appropriate, you can discuss next steps. Keep in mind that your doctor might not be certified to prescribe Addyi and that it may not be covered by your insurance.

If you do take Addyi, do NOT drink alcohol. Be sure to notify your doctor or other healthcare professional if you have any concerning side effects. It’s also critical that your other doctors – present and future – know that you are taking Addyi to avoid drug interactions.

Print this article or view it as a PDF file here: What Should I Know About Addyi?


International Society for Sexual Medicine

“Flibanserin approved as the 1st pharmacologic treatment option for women suffering from HSDD”

(August 18, 2015)

“What is flibanserin and how does it work?”

“Definition of syncope”

(Last editorial review: August 28, 2013)


Stein, Rob

“FDA Approves First Drug To Boost Women's Sexual Desire”

(August 18, 2015)

Sprout Pharmaceuticals

“Sprout Pharmaceuticals Receives FDA Approval of ADDYI™ (Flibanserin 100 MG)”

(Press release. August 18, 2015)

U.S. Food and Drug Administration

“FDA approves first treatment for sexual desire disorder”

(News release. August 18, 2015)

Sex Health Blog

ISSM Issues Testosterone Deficiency Guidelines

Aug 11, 2015

ISSM Issues Testosterone Deficiency Guidelines Low testosterone has been a hot topic in the media lately. Advertisements ask men if they might have “low T.” Older men wonder whether testosterone replacement therapy might re-ignite their virility and sex life. And medical studies investigate possible safety risks of therapy, especially in light of cardiovascular health and prostate cancer.

In this whirlwind of information, it can be difficult for both patients and professionals to understand exactly what testosterone deficiency (TD) is, how it’s diagnosed and treated, and how it’s best managed over time.


ISSM issues testosterone deficiency guidelines. (Click to tweet)


Last month, the International Society for Sexual Medicine (ISSM) issued a “Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men.” This document explains TD based on the latest research and offers diagnosis and treatment guidelines for healthcare providers, especially those who don’t specialize in sexual medicine.

Today, we’ll answer some questions about the Process of Care, its beginnings, and its impact.


What is the ISSM and why did it issue a Process of Care?

Formed in 1978, the International Society for Sexual Medicine is a professional organization dedicated to sexual health research and education. It comprises six regional societies from around the world, including the Sexual Medicine Society of North America, the organization that produces Currently, the ISSM has about 2,200 members from 89 nations.

The ISSM noted that while formal guidelines on testosterone deficiency were available, they were somewhat dated and meant for specialists. The Process of Care addresses current concerns and is geared toward family physicians and other providers who do not specialize in sexual medicine, urology, or endocrinology.

How was the Process of Care developed?

After an extensive literature review, a panel of experts met for three days last year to discuss TD – its definition, causes, symptoms, diagnosis, treatment, and management. The group also discussed how TD affects certain populations and the current controversies surrounding testosterone replacement therapy.

For the next six months, panel members continued the conversation electronically and submitted reports on their areas of expertise. Together, the committee wrote and revised the Process of Care document.


What information does the Process of Care include?

Reading the Process of Care, professionals will learn about:

·         The definition and classification of TD

·         The physiology of testosterone

·         Causes of TD

·         Subtypes of TD

·         Diagnosis of TD, including physical examinations and lab testing

·         Assessment of TD, including questionnaires

·         Treatment - pharmacological and non-pharmacological, as well as treatment without testosterone

·         Monitoring treatment

·         Controversies (prostate cancer, cardiovascular risk)

·         Testosterone replacement therapy (TRT) in special populations (men with prostate cancer, an enlarged prostate, cardiovascular disease, obesity, metabolic syndrome, osteoporosis, or depression. Men with fertility concerns are also discussed.)

·         Cost-benefit of TRT

·         General or specialist management

What happens next?

It’s important for professionals to have updated guidelines. The Process of Care authors recommend that the document be re-evaluated and updated in four years.


How can I read the Process of Care?

Currently, the Process of Care is available as an accepted article through the Journal of Sexual Medicine website. Please click here for more details.

Print this article or view it as a PDF file here: ISSM Issues Testosterone Deficiency Guidelines


International Society for Sexual Medicine

“ISSM’s Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men”

(Press release. July 6, 2015)

Journal of Sexual Medicine

Dean. John D., FRCGP FECSM, et al.

“The International Society for Sexual Medicine's Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men”

(Full-text. Accepted for publication.)

Sex Health Blog

Neuropathy a Common Cause of ED

Jul 29, 2015

Neuropathy a Common Cause of Erectile DysfunctionAn erection is a complex process. It may not seem that complicated – a man can be sexually turned on by his partner’s smile, an erotic fantasy, or a beautiful person who passes him on the street. An erection might even seem automatic.

But inside his brain and body, connections must be in tip-top shape for an erection to occur. The sexual stimulus – that smile or a sexy voice – gets processed by his brain, which sends signals to his genitals to trigger an erection. Smooth muscle tissue needs to relax, arteries need to widen, blood needs to flow into the penis, and veins need to constrict to keep the blood in place until he ejaculates or the stimulation stops.


Neuropathy is a common cause of erectile dysfunction. More here.... (Click to tweet)


Today, we’re going to focus on the signaling that takes place in the central nervous system – the network that connects the brain and the genitals. For some men, nerve damage interferes with the pathway, making it more difficult – or impossible – for sexual signals to get through. A man may experience something that makes him excited, but the erection just doesn’t happen.


What is neuropathy?

The medical term for this nerve damage is neuropathy. The type of neuropathy associated with erectile dysfunction (ED) is called peripheral neuropathy. This term is used because the nerve damage affects other parts of the body, like the hands, feet, and penis.

This type of neuropathy is also classified as autonomic. It affects processes that happen without our thinking much about them, like breathing, digestion, and erections.

What causes neuropathy?

Neuropathy that leads to ED can have a number of causes. Here are some examples:

·         Injury to the genitals

·         Endocrine disorders, especially diabetes

·         Blood vessel diseases

·         Cancer and cancer treatments, particularly chemotherapy

·         Infections

·         Excessive alcohol consumption


Diabetic neuropathy

The National Institute of Neurological Disorders and Stroke estimates that 60% to 70% of people with diabetes have some degree of neuropathy. And diabetes is an important risk factor for ED. Diabetic men are almost four times more likely to develop ED than non-diabetic men. And they tend to develop ED ten to fifteen years earlier, too.

High blood sugar can disrupt the signals between the brain and genitals. It can also damage blood vessels, reducing blood flow to the penis. (To learn more about diabetes and erectile dysfunction, click here.)

Treating neuropathy

Sometimes, nerves can heal when the cause of the damage is addressed. For example, drinking less alcohol or treating an infection may be enough for the nerves to repair themselves.

Diabetic men are encouraged to keep their blood sugar under control. Managing diabetes may involve medication, special diets, and exercise programs. Your doctor can tell you more about the best approaches for you. And be sure to check your blood sugar levels regularly.


Reducing the risk

As with many health issues, maintaining healthy habits plays a key role in preventing neuropathy. If you drink too much, try to cut down (and don’t hesitate to ask for professional help if you need it). If you smoke, ask your doctor about a smoking cessation program. If you have diabetes, follow your doctor’s instructions to the letter. Make healthy food choices and keep to a healthy weight. Try joining a gym or getting together with friends to exercise.

The benefits of good habits are enormous. You’ll maintain your health, reduce the risk of neuropathy, and might enhance your sex life, too!

Print this article or view it as a PDF file here: Neuropathy a Common Cause of ED


Medscape Medical News

Newman, Laura

“Neuropathy an Underappreciated Cause of Erectile Dysfunction”

(November 16, 2011)

National Institute of Neurological Disorders and Stroke

“Peripheral Neuropathy Fact Sheet”

(December 2014)

Sexual Medicine Society of North America

“Understanding Diabetic Neuropathy and Erectile Dysfunction”

Sex Health Blog

Sleep and Women’s Sexual Health

Jul 14, 2015

A good night's sleep can boost a woman's libido the next day.We hear it all the time – get more sleep!

It’s sometimes easier said than done, of course. We lead busy lives, work and play hard, and take care of children and elderly parents. Sometimes, we stay up late binge-watching our favorite TV shows or chatting on social media.

But rest is important. During sleep, our body makes important repairs and helps us readjust for the next day. When we’re sleep deprived, we just can’t function at optimal levels.


A good night's sleep can boost a woman's libido the next day. More here.... (Click to tweet)


Sleep is important for sexual health, too. Last winter, we talked about sleep’s effects on men. Quality sleep helps their testosterone production, improves their sexual judgment, and reduces the risk of obstructive sleep apnea, which can interfere with erections.

Sleep is just as critical for women. Let’s take a look at what some recent research in The Journal of Sexual Medicine found.


The study

American researchers worked with 171 college-aged women, asking them to submit daily reports on sleep and sex for two weeks. First thing in the morning, the women revealed how long it took them to fall asleep, their sleep duration, and how well they slept the night before. The average amount of nightly sleep among the women was about 7 hours and 22 minutes.

They also answered questions about their sexual activity during the previous 24 hours. Did they have vaginal, oral, or anal sex with a partner? Did they masturbate? How much desire for sex did they feel? How aroused did they become?


Sleep is good for sex

The researchers made some interesting discoveries.

·         The longer women slept, the more sexual desire they felt the next day.

·         For women with regular partners, sleeping longer increased the likelihood of having sex the next day. Just one extra hour of sleep increased their chances by 14%.

·         Women who generally slept longer tended to feel more aroused during sex. (Arousal refers to the physical changes that happen when a woman is sexually stimulated, such as increased blood flow to the genitals and vaginal lubrication.)

·         However, women were less aroused the following day if they slept longer for just one night.

It’s unclear why the women responded the way they did. The scientists thought it might have something to do with hormones and more research is warranted.


Sleep tips

Even if we don’t know the reason why, the potential for better sex can still be an incentive for improving our sleep habits. How can we do this? Here are some tips for good sleep hygiene.

·         Keep a sleep routine. Go to bed and get up at the same time every day, even on the weekends. In that way, your body will “know” when it’s time to sleep.

·         Have a relaxing bedtime ritual. Take a bath, read a good book, listen to some relaxing music. Signal to your body that it’s time to rest.

·         Use your bed for sleep only – unless you’re having sex, of course!

·         Unplug. Electronic devices like TVs, tablets, and smartphones emit blue light, which can make us feel more awake and make it more difficult to fall asleep.

·         Ask for help. If you’re feeling overwhelmed with tasks, have a friend or family member help share the load. If you’re worried about a troublesome issue, talk to someone you trust.

·         See your doctor. Sometimes, a medical condition like obstructive sleep apnea may be interfering with our ability to get enough rest. You might need to spend a night or two at a sleep clinic to pinpoint the cause. Sleep disorders can be treated; your doctor can guide you on your situation.

Print this article or view it as a PDF file here: Sleep and Women’s Sexual Health


Centers for Disease Control and Prevention

“Sleep Hygiene Tips”

(Last reviewed: May 3, 2012)

The Journal of Sexual Medicine

Kalmbach, David A., PhD, et al.

“The Impact of Sleep on Female Sexual Response and Behavior: A Pilot Study”

(Full-text. First published online: March 16, 2015)

Sexual Medicine Society of North America

“Quality of Sleep Can Have Major Impact on Men’s Sexual Health”

(December 4, 2014)

“Women’s Desire, Arousal Improved by Sleep”

(April 21, 2015)

Sex Health Blog

What Happens During Orgasm?

Jun 30, 2015

Orgasm is a complex, mysterious process. But that hasn’t stopped scientists from trying to learn as much as they can. In fact, some volunteers have brought themselves to orgasm inside an MRI machine in the name of science.


Orgasm is a complex, mysterious process. But scientists are trying to learn as much as they can. (Click to tweet)


Here’s some of what experts have learned:


·         The brain plays a huge role in orgasm. We might think orgasm is localized to the genitals, but it really affects our entire body, starting with the brain. Orgasm triggers activity in brain areas involved with touch, memory, emotions, and judgment. And the process is similar for both men and women, even if their anatomies are different. Brains are such a powerful force in orgasm that some women are able to achieve it simply by thinking, with no bodily stimulation at all. Unfortunately, this does not appear to be true for men.

·         The brain and genitals communicate through a system of nerves. Such nerves connect the penis, prostate, clitoris, vagina, uterus, and cervix with the brain. This is why, for women, a clitoral orgasm may feel different from a vaginal one.

·         The brain releases chemicals that increase pleasure. For example, the neurotransmitter norepinephrine helps blood flow to the genitals during sex, which makes the stimulation feel even better. And during orgasm, the brain releases a hormone called oxytocin, which brings about feelings of intimacy and trust.

·         Women’s orgasms usually last longer. On average, a woman’s orgasm lasts 20 seconds. For men, it’s about 10 seconds.


What can you do if you have trouble with orgasm?

Unfortunately, these moments don’t happen to everyone. Many people have trouble reaching orgasm. For some, it’s a lifelong situation. For others, it happens with certain partners or in certain situations. No matter when it occurs, it can be frustrating. What can you do?

·         See your doctor. Some people feel embarrassed discussing their sexual health with a healthcare provider. But sex is important for your overall well-being. There could be something physical interfering with your ability to reach orgasm, such as diabetes, multiple sclerosis, or high blood pressure. It’s also possible that certain prescription medications, or recreational use or drugs or alcohol, may be the culprit.

·         Be honest with yourself. Think about the reasons why you might be having trouble reaching orgasm. Consider your upbringing, your feelings about sex, and your overall health. Is there anything in your background that could be inhibiting you? Do you feel that sex is “bad” or “dirty”? Do you feel guilty for wanting sex? Do you fear giving up control? Is there a trust issue with your partner that keeps you from letting go?

·         Be open with your partner. If you’re not reaching orgasm, your partner has probably noticed, even if you “fake it” well. He or she may feel inadequate. Chances are, your partner genuinely wants to make sex better for you. It could just be a matter of telling your partner what you like or don’t like. You might need more time, more stimulation, a gentler touch, or more variety in your sexual repertoire.

·         See a sex therapist.  You may choose to do this alone or with your partner. The idea of describing your sex life to a professional may seem daunting. But sex therapists are trained to put you at ease and help draw out what’s troubling you. With a therapist, you might be able to work through issues that occurred long ago, like sexual abuse during childhood. Or, you might focus on resolving problems in your relationship.

·         Try masturbating. Sometimes, people don’t reach orgasm because they just don’t know how. If you can, try to find some private time alone when you can relax and explore what excites you sexually. Go somewhere comfortable and let your mind wander into your deepest fantasy. Don’t worry about whether your thoughts are practical. Just run with them. Let your hands follow suit and try pleasuring yourself in different ways to see what you like. You might consider using a sex toy as well.


Try to relax

As mentioned earlier, many couples see orgasm as the main goal of a sexual encounter. It doesn’t have to be. You can still enjoy intimacy with your partner even if orgasm doesn’t happen. Try to put your focus on that closeness.


Elite Daily

Haltiwanger, John

“Having An Orgasm Has More To Do With Your Brain Than Your Body”

(April 9, 2015)

Berman, Laura, PhD

“Anatomy of a Climax”

(Last updated: October 31, 2014)

International Society for Sexual Medicine

“How is anorgasmia treated?”

“What causes anorgasmia in men?”

“What is anorgasmia?”

Medical Daily

Borreli, Lizette

“Brain On Sex: How The Brain Functions During An Orgasm”

(April 2, 2014)

Psychology Today

Firestone, Robert W., PhD

“7 Factors Affecting Orgasm in Women”

(April 28, 2014)

Sexual Medicine Society of North America

“Sex and Intimacy”

“Why Does Sex Feel So Good?”

Stromberg, Joseph

“This is what your brain looks like during an orgasm”

(April 1, 2015)

Sex Health Blog

Alcohol and Women’s Sexuality

Jun 16, 2015

Alcohol and Women’s SexualityBack in January, we talked a bit about how alcohol affects us sexually. It lowers our inhibitions, makes us feel a little more comfortable with a partner and free to experiment, for better or for worse. We’ve also discussed what alcohol can do to a man’s sex life. Poor erections and delayed ejaculation are just two problems that can happen.


Overall, having sex after drinking may be a disappointing experience. (Click to tweet)


Today, we’re going to focus on women. How does alcohol affect women sexually? Let’s start with some of the physical aspects.


Physical changes

Some say that the brain is a woman’s most important sexual organ. When a woman is sexually aroused, neurotransmitters in the brain send messages to other parts of the body to get her ready for intercourse. For example, her vagina will start to lubricate so that penetration is more comfortable.

But too much alcohol can interrupt this process. A woman may feel plenty of sexual desire while drinking, but when the act itself begins, she might not be lubricated enough for it to be pleasurable. Penetration may feel tight and painful. Dehydration from alcohol can also lead to vaginal dryness.

In addition, she may not reach orgasm. Or if she does, it might not be as intense as it is when she hasn’t been drinking.

Overall, having sex after drinking may be a disappointing experience. The effects of alcohol on women’s sexuality aren’t just physical, however. Let’s look at some other factors women (and men) should consider.


Risky behaviors

Alcohol impairs our judgment. People become more attractive and situations are often less intimidating after we’ve had a few beers. We can’t make good decisions if we’ve been drinking excessively, and that can lead to the following risky situations:

·         Unprotected sex. Under the influence of alcohol, people are less likely to use condoms, increasing the risk of unwanted pregnancy and the transmission of sexually-transmitted infections (STIs) like HIV, herpes, chlamydia, and human papillomavirus (HPV).

·         Casual sex. People may have sex with people they don’t know well, with complete strangers, or with multiple partners. This often occurs without any discussion of the person’s sexual history, STI status, or safe sexual practices.

·         Date rape, sexual assault, and other violence. Women (and men) can find themselves in dangerous situations if they’ve had too much to drink. They may be too trusting of another partner, follow that person to an unfamiliar location, and be unable to leave when the encounter turns violent.


Plan ahead

Drinking alcohol doesn’t affect all women the same way. But most women have an idea of how much alcohol they can handle before they start feeling out of control.

Keep that in mind when you’re at a party or out with your friends.

If you’re planning to have sex, remember that alcohol might make it less enjoyable. And even if you’re not planning a rendezvous, keep your wits about you. Don’t let yourself become susceptible to pregnancy, an STD, or worse.

To learn more about how alcohol affects us sexually, check out the following links:

Alcohol and Unsafe Sex

Excessive Alcohol Consumption Could Affect Sperm Count and Quality

Alcohol and Sex

Alcohol and Male Sexual Function

Survey on Women’s Condom Use After Substance Use

Print this article or view it as a PDF file here: Alcohol and Women’s Sexuality


Elite Daily

Engle, Gigi

“Whiskey Vag: Science Says Drinking Is The Reason You’re Not Getting Wet”

(May 15, 2015)

Hormones and Behavior

George, William H., et al.

“Women’s Sexual Arousal: Effects of High Alcohol Dosages and Self-Control Instructions”

(May 2011)

Sexual Medicine Society of North America

“Alcohol and Sex”

(January 27, 2015)

University of Illinois at Urbana-Champaign McKinley Health Center

“What You Should Know About Sex & Alcohol”


Sex Health Blog

Erections after Prostate Cancer Surgery

Jun 04, 2015

Erections after Prostate Cancer Surgery When Karl received his prostate cancer diagnosis, he naturally had lots of questions. Was the cancer only in his prostate gland or had it spread? What kind of treatment would he need? Surgery? Radiation? Chemotherapy? A combination of the three? How would he feel during and after treatment?

He felt a little awkward about another question: How would treatment affect his sex life?


ED is common after prostatectomy. May take two years for full function to return, if it does. (Click to tweet)


He knew that his focus should be on his health, survival, and family. But he and his wife had had a fulfilling, active sexual relationship spanning four decades. He didn’t want to give that up.

Karl’s oncologist recommended a prostatectomy – complete removal of the prostate. Nowadays, this surgery is often done laparoscopically, through small incisions. In many cases, the procedure is performed by a surgeon-controlled robot.

Karl’s doctor was honest with him. He might have problems with erections after surgery.

Indeed, erectile dysfunction (ED) is common after prostatectomy. It may take two years for full function to return, if it does. Research presented at the European Association of Urology Congress last March suggested that men’s erections are seldom as good after surgery as they were before surgery.

The situation isn’t as bleak as it sounds, though. Let’s talk a bit about why men develop ED after surgery, what might be done, and how to cope.


Why does prostatectomy affect a man’s erections?

The prostate is a small, walnut-sized gland located beneath the bladder. Its main job is to produce seminal fluid – the liquid that mixes with sperm when a man ejaculates.

Surrounding the prostate is a network of nerves that need to be in good working order for erections to occur. When a surgeon removes the prostate, he or she tries to preserve as many of these nerves as possible. (This is called nerve-sparing.)

But sometimes, nerve-sparing just isn’t possible. The nerves can be difficult to see. And size and location of the tumor might make it difficult to remove without damaging the nerves.

Whether the surgeon uses a nerve-sparing approach or not, most men have some degree of erectile dysfunction (ED) after surgery. It takes time for the area to heal.


Penile Rehabilitation

After surgery, Karl started a penile rehabilitation program (PRP). His doctor said it was similar to physical therapy. Karl thought the name sounded funny, as though he and his private parts would be going to the gym.

The goal of a PRP is to keep the penis healthy and strong by inducing erections. This may be achieved with medications, including pills like Viagra, Cialis, or Levitra. Other methods are penile self-injections, suppositories, and vacuum erection devices.

PRPs can be successful, but much depends on the patient and his cancer treatment. For example, if he had trouble with erections before surgery, he may still have trouble after rehabilitation. Any nerve damage during surgery will affect the results. Other forms of treatment, like radiation and hormonal therapy, can also play a role.

A man’s overall health status is important, too. If he is older or overweight, smokes, or has a medical condition that increases his risk for ED (like diabetes), he might have a poorer outcome.

Men must be committed to the program as well. Penile rehabilitation takes patience. It could take several years before erections come back. In the meantime, men need to continue with their exercises and follow their doctor’s instructions.

There were times when Karl felt like giving up. But his wife, and the memories of what they had shared, kept him going until they were enjoying intercourse again.


What can men do?

The uncertainty and anxiety associated with cancer is a lot to handle. Here are some things to keep in mind, as far as your sex life goes:

·         Having your prostate gland removed doesn’t have to mean the end of your sex life. But you and your partner may need to make some adjustments, at least for a while. Be prepared.

·         Remember that there is more to intimacy than a good erection. You and your partner can enjoy kissing, cuddling, touching, and oral sex. You might try having sex in a different location or experiment with some sex toys. Be creative and playful.

·         Talk to your partner about your feelings. Some men feel they are “less of a man” if they can’t have firm erections easily. Most likely, your partner will assure you that you are every bit as masculine as you were before surgery.

·         It’s normal to feel depressed when you’re coping with cancer. Try to get out with friends and continue with activities you enjoy, to the extent that you can. If you start to feel like it’s all too much, reach out to a trusted friend or family member. Talking to a counselor can help. Your doctor can suggest one.

·         You and your partner might consider seeing a therapist who specializes in sex after cancer treatment. The therapist may suggest new techniques to try in the bedroom and help you and your partner better communicate your feelings and needs.


Overall, remember that you’re not alone. Your oncology team and support network are there for you. Don’t be afraid to ask for help. Sexuality is a fundamental part of who we are and, just like any other aspect of our health, it deserves attention. While your sex life might not be the same as it was before surgery, you might find that it is still just as satisfying afterwards.

Print this article or view it as a PDF file here: Erections after Prostate Cancer Surgery


American Cancer Society

“Sexuality for the Man with Cancer”

(Last review: August 19, 2013)

Harvard Health Publications

“Penile rehabilitation after prostate cancer surgery”,N0111b

International Society for Sexual Medicine

“How successful are penile rehabilitation programs (PRPs)?”

“What does a penile rehabilitation program (PRP) involve?”

“What is a penile rehabilitation program (PRP)?”

Prostate Cancer Foundation

“About the Prostate”


“#EAU15 - Study shows regaining normal sexual functioning is ‘rare’ after prostate operations”

(March 21, 2015)

Sex Health Blog

For Parents: When Your Child is Intersex

May 19, 2015

For Parents: When Your Child is IntersexWhen Carol and Adam had their baby, they were overjoyed. But when friends asked them if they’d had a boy or a girl, they didn’t know quite how to answer.

Their baby, whom they named Cameron, was genetically a boy. He had an X chromosome and a Y chromosome. (Girls have two X chromosomes.)

But he had incomplete androgen sensitivity syndrome, which meant the cells in his body didn’t respond properly to testosterone and other male sex hormones. So in many ways, he looked more like a girl.


For parents: when your child is intersex. Here's some support. (Click to tweet)


Cameron was an intersex child. The word “intersex” refers to disorders of sex development (DSDs) – when a fetus develops differently from a typical male or female. It’s actually an umbrella term for many different conditions, such as:


·         Vaginal agenesis.A girl is born with either a partially-developed vagina or no vagina at all. Some girls with this condition are also born without a uterus.

·         Penile agenesis. A boy is born without a penis.

·         Congenital adrenal hyperplasia (CAH). Malfunction of the adrenal glands lead to an overproduction of male sex hormones. CAH may not be detected at first in male babies, but female infants may have male genitalia or ambiguous genitalia (both male and female).

·         Klinefelter syndrome. Boys are born with an extra female chromosome (X) and do not fully develop masculine characteristics.

·         Swyer syndrome. Genetically male babies have female genitalia and female reproductive organs. Their gonads (testes or ovaries) are not fully developed.

·         True gonadal intersex. Babies are born with both ovarian and testicular tissue. They might have one ovary and one testis. Or, they may have one gonad that is a combination.

Some intersex conditions are noticeable at birth, but others don’t become apparent until the child reaches puberty or adolescence. Vaginal agenesis, for example, might not be diagnosed until a girl’s teenage years. Often, it is detected when a girl does not menstruate.


What causes intersex conditions?

Intersex conditions start when a baby is still in the womb. As we’ve seen above, they can be genetic, linked to problems with chromosomes. They can also be hormonal. Either the body produces too much or too little of a particular sex hormone or it doesn’t respond to the hormones correctly.

Can surgery help?

Some parents wonder if immediate surgery to make an intersex child “look normal” is the best route. But many experts tell parents to wait.

Genital assignment surgery can be difficult – and sometimes impossible – to reverse. And there have been cases in which a child has genital surgery but grows up to feel more attuned to the opposite gender.

The Intersex Society of North America (ISNA) recommends taking all diagnostic information into account and assigning a gender to the child based on what parents and clinicians think the child will feel as he or she gets older, without surgery. The ISNA stresses that such an assignment is “preliminary.”

The ISNA explains it this way: “Note that gender assignment does not involve surgery; it involves assigning a label as boy or girl to a child. (Genital ‘normalizing’ surgery does not create or cement a gender identity; it just takes tissue away that the patient may want later.)”


What can parents and family members do?

·         Seek support. Support – from a medical team and from others who have been through the experience – are important for families and for intersex children themselves. Your pediatrician can refer you to appropriate groups in your area. Families may feel more comfortable sharing ideas and discussing pitfalls outside of a doctor’s office. Children can also learn from each other and talk about school, gym classes, or scouting trips.

·         Be honest with your child. It’s natural for children to be curious about their genitals and wonder why theirs doesn’t match those of their parents. Explaining the situation with age-appropriate language, with love, reassurance and support, can help them understand. Therapists can help parents find this language.

·         Be honest with others. Some parents feel embarrassed or ashamed for having an intersex child. They may avoid having a babysitter or feel anxious about gossip in the community. Being honest can help educate your neighbors and friends about intersex conditions and may help them develop more sensitivity, if they are unkind. And often, communities embrace the children and their differences with no problems at all.

·         Let the child decide, if possible. Many experts believe that children, once they are mature enough, should play an active role in their gender assignment. They often know best whether they feel like a girl or a boy.

To learn more about intersex conditions, please see the following links:

Disorders of Sex Development

Disorders of Sex Development for Boys

Vaginal Agenesis

Print this article or view it as a PDF file here: For Parents: When Your Child is Intersex


American Psychological Association

“Answers to Your Questions About Individuals With Intersex Conditions”


The Atlantic

Greenfield, Charlotte

“Should We 'Fix' Intersex Children?”

(July 8, 2014)

Associated Press via Daily News

“Surgery to choose gender no longer only option for intersex children”

(April 17, 2015)

International Society for Sexual Medicine

“What are disorders of sexual development (DSDs)?

Intersex Society of North America

“How can you assign a gender (boy or girl) without surgery?”

“What does ISNA recommend for children with intersex?”

“What is intersex?”



(Updated: August 22, 2013)

Properzio, Linda

“What to Do if You Have an Intersex Child”


Sex Health Blog

Discussing Erectile Dysfunction with Your Doctor

May 06, 2015

Discussing Erectile Dysfunction with Your DoctorGordon hadn’t been able to get a good erection in six months and was feeling edgy. He had hoped the situation was temporary. He was 56 and knew that men could develop erection troubles as they got older. But were the changes always this dramatic? Was this the new normal? Would he ever get a firm erection again?

The problem was taking its toll on his girlfriend Kathy, too. She said it was okay and that she understood, but he knew better. They had been together for five years and had always had an active sex life. He knew what she liked in bed and hated to disappoint her. She questioned whether he was still attracted to her and asked if he was seeing someone else. But that wasn’t the case. Far from it.

It was Kathy who suggested he see a doctor. Now he was in the waiting room, wondering what he was going to say. Admitting that he couldn’t perform made him feel like less of a man. He was nervous to find out the cause. And he had no idea what treatment would be like.


Discussing ED with your doctor might not be easy, but it's important. This can make it easier. (Click to tweet)


There are lots of men like Gordon. And it’s okay to feel anxious about discussing erectile dysfunction (ED) with a doctor. But it’s important to do so. Today, we’ll explain why you should and offer some tips for the conversation.


Why should men talk to their doctor about ED?

There are several good reasons:

·         ED can be a sign of a larger medical issue. ED is common in men with heart disease and diabetes. It can also happen to men with high blood pressure or kidney disease. Often, it’s the first sign that something else is wrong. The good news is that treating these conditions can usually alleviate the ED. Plus, taking care of yourself now can improve your overall health for years to come.

·         ED can affect a man’s mental health. As we saw with Gordon, ED can damage a man’s self-esteem. For many men, part of their identity is connected with their ability to perform sexually. Being unable to do so can lead to a lack of confidence and anxiety in new sexual situations. Depression – and sadness over the loss of intimacy – are common, too.

·         ED can be treated. Most men with ED have lots of options. Medications like Viagra, Levitra, and Cialis have been popular for many years now. But not all men can take this class of drugs, particularly men who take nitrates for heart conditions. If you can’t take pills for ED (or if they don’t work for you), there are other treatments to consider. Some men try self-injections, suppositories, and vacuum devices. More serious cases might be treated with surgery or penile implants. Sex therapy may also be helpful.

Keep in mind that medications for ED are available only by prescription and are not appropriate for every man. You should always be checked out by a doctor before starting them. It may be tempting to order them online and avoid seeing the doctor, but this is a dangerous practice.

It’s possible that you won’t need formal treatment at all. Sometimes, ED can be managed through lifestyle changes. For example, if your ED is caused by diabetes, changing your diet to keep your blood sugar under control may do the trick. Some men’s erections improve when they get more exercise.


Talking to the Doctor

Once you’ve decided to see your doctor about ED, how do you start the conversation? Here are some steps to consider.

·         Think over your questions beforehand. It may help to write them down and take them with you, so you don’t forget anything. Partners may think of questions that haven’t occurred to you. This list of questions (PDF) can get you started. Remember that no question is foolish. If it matters to you, be sure to ask.

·         Try not to feel anxious. While you may feel awkward, remember that ED is common and chances are, your doctor has treated it before. If not, he or she can refer you to a specialist. You might say, “You know, I feel a little embarrassed about this, but lately I’ve been having trouble with erections.” Most likely, your doctor will try to put you at ease and ask questions to guide the discussion.

·         Consider bringing your partner. If you are in a relationship, you might bring your partner to the appointment with you. He or she can be a second set of ears if there is a lot of information to process. And since ED affects partners, too, he or she can provide some perspective.

·         Follow up. Don’t hesitate to call the doctor if you have questions or concerns later on.

When you leave the appointment, pat yourself on the back. You’ve taken a huge step forward for your overall health, for your sex life, and for your relationship.

Print this article or view it as a PDF file here: Discussing Erectile Dysfunction with Your Doctor


Men’s Journal

Kubota, Taylor

“Everything You Need to Know about Erectile Dysfunction Drugs”

Sexual Medicine Society of North America

“Causes of ED/Talking with a Healthcare Provider”

(March 27, 2013)

“Questions to Ask Your Healthcare Provider About Erectile Dysfunction (ED)”


“Discussing Erectile Dysfunction With Your Doctor”

(Reviewed: October 4, 2014)

Sex Health Blog

Exercise for Better Erections

Apr 21, 2015

Exercise for Better ErectionsWe hear it all the time – it’s important to exercise. A sedentary lifestyle isn’t healthy. We need to keep moving. But after a long day, it can be difficult to get off the couch.

What if we told you exercise could improve your erections?


Want better erections? Exercise! Details here... (Click to tweet)


It’s true. In the past, we’ve discussed why exercise is good for men’s sexual health in general.  How does it help erections in particular?


Good blood flow is important.

Exercise keeps your blood moving freely and that’s very important for a man’s erections. When he’s turned on sexually, smooth muscle tissue in his penis relaxes, allowing more blood to flow in. Veins constrict so that the blood stays put, giving him the firmness he needs for sex. Once he ejaculates, the blood is released.

Men with erectile dysfunction (ED) often have trouble with blood flow because of damage to the endothelium or smooth muscle tissue, which support the blood vessels. When this happens, it becomes more difficult for blood to flow into the penis properly. The result is a weak erection or no erection at all.

What causes damage to the endothelium? High blood pressure, smoking, and high levels of cholesterol, triglycerides, and blood sugar are all factors.

Once the damage is done, it leaves blood vessels more susceptible to atherosclerosis (hardening of the arteries). Plaques that build up along artery walls can block the blood flowing into the penis.

Exercise can help maintain endothelial health. It may also help prevent – or control – other medical conditions associated with ED, such as obesity, heart disease, and diabetes.

In addition, it can help men with some of the psychological aspects of ED. For example, exercise may alleviate depression and anxiety and make a man feel more sure of himself. He may lose weight, improving his body image. With a more positive outlook, he may feel more confident about his sexual performance.


Recent research

A recent study published in the American Journal of Cardiology provides a good example of just how much exercise can help men with ED. A team of Brazilian researchers worked with 86 men who had had recent heart attacks. Eighty-four percent of them reported having ED before their hospitalization.

Forty-one of the men were assigned to a special home-based outdoor walking program. The rest received their usual care, but did not participate in the walking protocol.

After 30 days, the men took a 6-minute walk test and completed a survey about their sexual function, which was compared to results from the beginning of the study. The men who did not walk had a 9% increase in ED. But the men who walked regularly saw a 71% decrease in ED.

So just a simple walking program may do the trick.


What kind of exercise is best?

The answer is up to you. We suggest that you see your doctor before starting any exercise program. He or she can best guide you on your specific health situation.

Any type of exercise can have benefits, though. If you choose something you enjoy, you’ll be more likely to stick with it. Here are some ideas to get your blood pumping:

·         You might start at local gym to see what it has to offer. A personal trainer can help develop a regimen tailored for you. You can also try a variety of activities and see which ones you like best.

  • Want to hang out with the guys more often? Why not start a community basketball team?
  • Get to know your co-workers by joining the company softball team.
  • Swim some laps at the community pool after work.
  • Explore the countryside by hiking, cycling, running, or jogging. You might also try rowing on a local lake or river.

Including your partner in your exercise routine can be a great idea, too. Getting fit together can have health benefits for both of you. And who knows what might happen next? That moonlight walk holding hands by the beach or the dance lessons that involve lots of touch may lead to great sex when you get home!

Print this article or view it as a PDF file here: Exercise for Better Erections


The American Journal of Cardiology

Begot, Isis, MsC, et al.

“A Home-Based Walking Program Improves Erectile Dysfunction in Men With an Acute Myocardial Infarction”

(Abstract. Published online: December 11, 2014)

American Stroke Association

“Atherosclerosis and Stroke”

(Last update: April 2014)

Vann, Madeline, MPH

“Exercise and Erectile Dysfunction”

(Last updated: May 10, 2011)

HealthDay via Renal and Urology News

“Walking Improves Erectile Function After Myocardial Infarction”

(March 5, 2015)

International Society for Sexual Medicine

“Can exercise help with erectile dysfunction (ED)?”

The Journal of Sexual Medicine

Simon, Ross M., MD, et al.

“The Association of Exercise with Both Erectile and Sexual Function in Black and White Men”

(Full-text. First published online: March 20, 2015)

Sexual Medicine Society of North America

“Exercise and Men’s Sexual Health”

(August 20, 2014)

Weill Cornell Medical College - Department of Urology

“How Erections Work”

Sex Health Blog

A Man’s Penis Changes with Age

Apr 08, 2015

A Man’s Penis Changes with AgeAs we get older, it’s inevitable that our bodies change. Our hair might turn gray, our skin may become wrinkled, and we might put on a little weight. These are changes we can usually expect.

Some men might be surprised to learn that their penis and testicles change with age, too. Why does this happen? And should men be concerned? We’ll look at these questions today.


Men might be surprised to learn that their penis and testicles change with age. (Click to tweet)


Testosterone Levels Gradually Fall

Testosterone is an important hormone for men’s health, as it gives them their masculine traits and contributes to sex drive.

As men get older, their testosterone levels naturally decline. Some experts call this process “andropause” or “male menopause” to compare it to female menopause, when estrogen levels drop. However, it is not the same. Once men are in their 40s, their testosterone levels decrease about 1% each year. For women, the hormonal drop is much more dramatic.

Still, it helps to understand this decline in testosterone and the role it plays in the aging man.


Changes in Penis Appearance

Men might notice that their penis starts to look different:

  • It might change color. Good blood flow to the penis is important for genital health. But with age, atherosclerosis – hardening of the arteries – becomes more common. When this happens, the blood supply decreases and the tip of the penis becomes lighter in color.
  • It might look smaller. Some older men worry that their penis is shrinking, but this can be an optical illusion. If a man has gained abdominal weight, the extra fat can hide part of the shaft, making the penis look shorter than it actually is.
  • It might actually become smaller. Sometimes, the penis does actually shorten, due to reduced blood flow and testosterone levels. A buildup of scar tissue can also contribute to the problem. This “shrinkage” could be as much as an inch over time. Keep in mind that the change is gradual and that for many partners, penis size is not important.
  • It might start to curve. Peyronie’s disease, a condition marked by a distinct bend in the penis, becomes more likely with age. In some cases, the curve becomes so great that intercourse is impossible. Men in this situation should see their urologist for treatment.
  • Testicles may become smaller. Over time, the size of a man’s testicles may decrease by as much as a third.
  • Pubic hair may diminish. As testosterone levels decrease, so might the amount of a man’s pubic hair.

Functional Changes in the Penis

Aging can affect the way a man’s penis performs, too:

  • Men may need more time. With their testosterone levels falling, older men often need more stimulation to become sexually aroused, get an erection, and reach orgasm. They may also need more time before they can have sex again. It can be frustrating, but it’s normal. Keep in mind that female partners may need more time, too.
  • Erectile dysfunction (ED) may develop. ED – being unable to get or keep an erection firm enough for sex – is quite common in aging men, especially if they have developed atherosclerosis in penile blood vessels. Fortunately, there are a variety of treatments for ED, including pills and vacuum devices. If you are having trouble with erections, be sure to see your doctor. ED can be a sign of other medical conditions, like heart disease or diabetes, so it’s important to have it checked out.
  • Urinary problems may occur. Older men are likely to have an enlarged prostate, also called benign prostatic hyperplasia (BPH). When this occurs, the prostate gland grows inward. The urethra – the tube that carries semen and urine out of the body – runs right through this gland. When prostate tissue enlarges, it can squeeze the urethra, making it more difficult for men to urinate. Men with urinary problems are encouraged to see their doctors as well.

What Can Men Do?

While none of us can turn back the clock, there are a number of ways men can keep the penis healthy as they get older.

  • See a doctor when you have concerns. It might be awkward to discuss your private parts and even more awkward to acknowledge that you’re having a problem. But talking to your doctor is the first step toward better penis health, better sexual health, and better overall health.
  • Develop healthy habits. Ask your doctor about dietary changes and fitness plans that are right for you. You might consider having fruit for dessert instead of cake, going to the gym, or taking a walk around the block after dinner. Maintaining a healthy lifestyle can reduce your risk of heart disease and diabetes, which can contribute to erection problems. And losing some weight might bring back some of that penis length you “lost.”
  • Communicate with your partner. If you’re worried about changes in your penis, be open with your partner. Most likely, he or she will be glad you brought it up, supportive in your search for answers, and understanding if your performance isn’t what it used to be. Your partner may also have ideas for adjustments the two of you can make in the bedroom.

By accepting the course of aging and maintaining healthy habits, you and your partner can still enjoy an active sex life for many more years.

Print this article or view it as a PDF file here: A Man’s Penis Changes with Age


Levine, Beth

“6 Penis Problems That Happen With Age”

Sexual Medicine Society of North America

“Andropause, or ‘low testosterone’”

“Sex for Women After 50”

(October 29, 2014)


Freeman, David

“Life Cycle of a Penis”

(Reviewed: December 5, 2011)

Sex Health Blog

First Visit With the Gynecologist

Mar 25, 2015

First Visit With the GynecologistVisiting the gynecologist may be routine for many women, but if you’ve never been before – or if you haven’t been in a long time – it’s normal to feel anxious. Today we’ll talk a bit about why it’s important to go, what to expect during the visit, and what you can do to make the appointment easier.

Why should women see the gynecologist?

Gynecologists specialize in women’s health. So there are many reasons to see one:

  • Overall checkup. Perhaps you have an annual physical. Or you might see the dentist once or twice a year. While going to the gynecologist isn’t quite the same thing, it’s still good to make sure your female organs are healthy.
  • Cancer screening. Most of the time, a pelvic exam involves a Pap test. Doctors do this to check for any unusual cells on the cervix (the organ between the uterus and the vagina) that could turn into cancer later. But they also look for other types of cancer, such as vaginal cancer.
  • STI screening. If you’re sexually active and have been having pain or a vaginal discharge, your gynecologist can test you for sexually-transmitted infections (STIs). Some STIs don’t have symptoms, so it’s especially important to be tested if you’re having sex.
  • Breast exam.  Most gynecologists also conduct a breast exam to check for any abnormalities. They can also teach you how to do a breast exam at home.
  • Help with other issues. Gynecologists can help with other situations, like painful periods, missed periods, or birth control. Some gynecologists also work with their patients on eating disorders or gender identity issues.
  • Learn about your body. Even if you’re not sexually active and not having any problems, it’s still helpful to see your gynecologist. You can learn about your own anatomy and how the different parts of your reproductive system work together. Your doctor might let you hold a mirror to learn more about your individual anatomy.

What happens during the pelvic exam?

Often, the pelvic exam brings women the most anxiety. But knowing what to expect can ease your nerves a bit.

When you enter the exam room, you’ll be asked to remove all of your clothing and put on a gown. (Don’t worry – you can do this in private!) You’ll also be given a sheet to put over your legs on the exam table.

Once you’re ready, the doctor will ask you to lie down on the table with your legs opened wide and your feet placed in stirrups. Your genitals will be at the end of the table and the doctor will sit in a chair just below you.

First, the doctor will do a visual inspection of your external genital area, including the labia, vaginal opening, clitoris, and rectum.

Next, there is a speculum exam. A speculum is an instrument inserted into the vagina that helps the doctor see your vagina and cervix. It is usually made of metal or plastic. It has two blades that open, spreading the walls of the vagina a bit so that the doctor can get a better view. Speculums come in many different sizes. If it’s your first visit, your doctor will probably use a small one. He or she may also put some lubricant on the speculum so that it slides into your vagina more comfortably.

During the speculum exam, there will likely be a Pap test. The doctor uses a special brush to take a sample of cells from your cervix. This sample will be sent to a lab to make sure there are no problems.

Finally, there is the bimanual exam. The doctor will insert one or two gloved fingers into your vagina and gently press your abdomen. Doing this helps him or her check your ovaries, fallopian tubes, and uterus.

If it’s your first visit and you’re not sexually active, your gynecologist might not do a pelvic exam right away. He or she might talk to you about it and help you get ready for one at a later date.


How can women make the most of their visit?

Most women don’t relish the idea of seeing the gynecologist. Keeping these tips in mind can help make the experience go more smoothly.

  • Try to relax. For many of us, this is easier said than done when you are on the table with your feet in stirrups. Having your legs spread out seems unnatural for many of us, especially if we’re brought up to believe that good girls always keep their legs together. But relaxing is key to a comfortable exam. If your body is too tense, it will be difficult for your doctor to insert a speculum or finger and it might be painful for you. Try taking some deep breaths beforehand. Let the doctor know if you need a minute to calm down. Try to think of something pleasant. Some gynecologists have serene photos on their ceilings to distract women during the exam. Others start conversations about the latest movies or your summer vacation plans.
  • Be honest. Some women worry that if they tell the truth about their behavior, their doctor will disapprove. Your gynecologist shouldn’t judge you. So if you’ve been having unprotected sex with your boyfriend, don’t be afraid to say so. If you’ve had many partners, it’s okay to mention that, too. In fact, this information can help your gynecologist give you the best treatment and guidance possible.
  • Don’t hesitate to ask questions. Think of your gynecologic visit as an opportunity. Was there a question you always had in health class but were too embarrassed to ask? This is a perfect time to do so. Don’t worry if your question sounds silly or weird. If it’s important to you, it’s important to your doctor.
  • Build a rapport with your doctor. Most gynecologists are trained to put their patients at ease, especially if they haven’t had a pelvic exam before. They understand if you’re nervous. But if you don’t feel comfortable with your doctor, you don’t have to continue seeing him or her. Rapport with your physician is essential. Without it, you won’t be able to relax for your exam or ask the questions you need answered.

Now that you have the basics, you’re ready for your visit! It’s an important next step to maintain good health – and good sexual health – for years to come.

Print this article or view it as a PDF file here: First Visit With the Gynecologist


American College of Obstetricians and Gynecologists

“Your First Gynecologic Visit”

(May 2011)

Center for Young Women’s Health

“Your First Pelvic Exam”

(Updated: August 22, 2013)


“5 Tips to Improve Your Visit to the OB-GYN”

(July 9, 2009)

Sex Health Blog

What is Sex Therapy Like?

Mar 12, 2015

What is Sex Therapy Like?Have you ever thought about seeing a sex therapist for help with a sexual problem?

If the question makes you feel uncomfortable, you’re not alone. The idea of discussing the intricacies of one’s sex life with a stranger can be awkward, especially if you find sex difficult to talk about. And sex therapy can have an air of mystery around it. What, exactly, goes on during the sessions?

Simply put, sex therapy is a form of psychotherapy designed to address sexual problems for individuals and for couples. It is talk therapy only – no sexual situations occur during sessions.  

Therapists can help clients:

  • learn more about their sexuality, including the anatomical aspects of sex
  • build communication skills so they can talk to partners about sex
  • develop strategies and techniques to improve a couple’s sexual relationship
  • work through sexual orientation or gender identity questions
  • cope with past sexual abuse or trauma
  • learn to manage unwanted sexual behaviors or compulsions


Ever thought about seeing a sex therapist for help with a sexual problem? (Click to tweet)


Sometimes, psychological factors contribute to sexual problems. For example, anxiety can play a role in premature ejaculation or vaginismus. Therapists can help with that as well.

Can sex therapy help you? Today, we’ll answer some common questions that can guide your decision.


What are the first steps?

Before you start looking for a therapist, see your doctor. This could be your regular doctor, a urologist, or a gynecologist.

Sometimes, sexual problems have physical causes. For example, erectile dysfunction (ED) – the inability to get an erection firm enough for sex – may be a symptom of an underlying medical condition like diabetes or heart disease. Painful sex for women could be related to endometriosis or hormonal changes during menopause. Low sexual desire in both men and women can be linked to stress, fatigue, or medications like antidepressants.

Who are sex therapists?

Sex therapists may be psychologists, physicians, social workers, or other clinical professionals. Usually they have graduate degrees and special training in sexual issues and counseling.

How do I find a sex therapist?

Most likely, your doctor can refer you to a sex therapist who specializes in the type of problem you’re having. If not, try looking for one through a professional association, such as the American Association of Sexuality Educators, Counselors and Therapists (AASECT).

Your therapist should have appropriate training, credentials, and licensing. Don’t hesitate to ask the therapist about his or her background before you start therapy. If for any reason you feel uncomfortable with your therapist, or if you feel the therapist-client relationship is not a good fit, it’s fine to look for another one. For sex therapy to be effective, it’s important to have a good rapport.


What is a sex therapy session like?

Sessions usually take place at the therapist’s office. Some therapists work in medical centers, but many have private practices. Many design their consultation spaces like living rooms in an effort to make the atmosphere relaxing and welcoming.

Sex therapists understand that you might be nervous. They are trained to put you at ease and guide you through the conversation. They will probably ask you about your physical health, relationship with your partner, your upbringing and sexual education, and your attitudes about sex.

Once they understand the problem, they might assign “homework.” This could be reading or watching videos to learn more about the body and sexual technique. It might also include exercises to try with your partner, if you have one. Sensate focus – a process that moves from non-sexual to sexual touching – is one type of exercise, designed to foster trust and intimacy between partners.

Remember that sex therapy sessions are talk therapy only. They do not include any physical contact or sexual relations at the session, with partners or with the therapist.

Should my partner go with me?

If you and your partner are having sexual issues, it’s helpful if you attend sessions together. Often, couples need help in communicating with one another. They may not know how to talk about their sexual needs. Or, there might be deeper problems in the relationship that are affecting what happens in the bedroom.

If your partner won’t go with you, sex therapy can still be beneficial for you alone. Your therapist can help you work out strategies for approaching your partner about your situation.


What if I don’t have a partner?

Even if you don’t have a partner, sex therapy can still help. Some patients avoid new relationships because of sexual problems, even when they would like to be in a couple. Working with a therapist can help solve the issue and build self-confidence.

Making the call

It’s tough to admit you have a sexual problem. Making that first appointment may be the most difficult step. But it’s worth trying, not only for your sexual health, but for your relationship and overall well-being.

Print this article or view it as a PDF file here: What is Sex Therapy Like?


Mayo Clinic

“Sex therapy”

(February 14, 2013)

Bellows, Amy, PhD

“An Overview of Sex Therapy”

Psychology Today

Watson, Laurie J, LMFT, LPC

“Should We See a Sex Therapist?”

(November 4, 2012)

Sex Health Blog

Why Does Sex Feel So Good?

Feb 27, 2015

Why Does Sex Feel So Good?There are both physical and emotional reasons why sex provides such intense pleasure.

The Physical

First, let’s consider the physical aspects of sexual pleasure. The human body is designed to enjoy sex. Some experts believe the reason is evolutionary – in order to keep the species going, people should enjoy the process of procreating. But this isn’t the only reason people have sex.


Why does sex feel so good? (Click to tweet)



The Physical (continued)

Our bodies come with a number of erogenous zones – those areas that make us sexually excited when they’re touched by the “right” person (one we want to be sexual with). Male and female genitals are probably the most obvious erogenous zones. But there are others: some people are turned by a foot massage or when their partner nibbles their ears. It can take some time to learn where you and your partner like to be touched, although that can be part of the fun.

Our brains also help us enjoy sex. They process sexual stimuli, such as a touch, an arousing image, or a seductive whisper. And they trigger the release of chemicals that make us feel excited. For example, the neurotransmitter serotonin helps us feel happy when we’re sexually aroused. Another neurotransmitter, norepinephrine, helps blood flow to the genitals, making stimulation even more enjoyable.


The Emotional

The emotional side of sex is complicated.

In the right circumstances, couples enjoy sex because of the intimacy it provides – the bonding and sharing that helps keep their relationship strong. The hormone oxytocin, released during orgasm, fosters a sense of closeness and trust.

But not all sexual relationships are emotional, romantic ones. Some couples have sex for fun, for the release it provides, and to reduce stress and tension. And they still enjoy it.

It’s not unusual for people to enjoy sex when they’re not in a loving, caring relationship. But many would argue that the sexual experience is better when they are.


When Sex Doesn’t Feel Good

On TV and in movies, it may look like sex always feels fantastic. But there are many times it doesn’t.

For example, a woman may not feel pleasure if her partner pressures her to have sex when she doesn’t want to. People who do not feel ready for sex may feel too anxious and tense to enjoy it. (Click here to learn more about sexual readiness. Keep in mind that if you’re not ready, that’s perfectly okay.)

Also, good sex comes with experience. It may take some time before it feels good. If it’s not all fireworks at the beginning, don’t worry. Take it slow. And make sure that sex is something you and your partner truly want.

Print this article or view it as a PDF file here: Why Does Sex Feel So Good?


Go Ask Alice (Columbia Health)

“Why does sex feel good?”

(September 12, 2014)


Vernacchio, Al

“What Teens Really Want to Know About Sex”

(September 26, 2014)

Psychology Today

Shpancer, Noam, PhD

“Why Do We Have Sex?”

(April 16, 2012)

Sex Health Blog

Painful Intercourse for Women (Dyspareunia)

Feb 11, 2015

Painful Intercourse for Women (Dyspareunia)Sex is supposed to be enjoyable, not painful. But many women have pain during intercourse. The medical term is “dyspareunia.” The American Congress of Obstetricians and Gynecologists estimates that 3 in 4 women experience it at some point.

The pain might occur at the start of penetration. Or, it could happen with deep penetration and thrusting. It can start suddenly or be a lifelong situation. It may be a dull ache or a sharp pain. Some women feel pain in their vulvar region – the area surrounding the vagina. Others have pain in the vagina itself or in the pelvis or lower back.

There are many reasons, both physical and psychological, that a woman might feel pain during intercourse. Today, we’ll discuss some of them and offer some strategies for coping.


Physical Factors

Here are some of the more common physical factors that can cause sexual pain in women:

·         Hormonal changes. When women go through menopause, their estrogen levels drop significantly. This can lead to vulvar and vaginal atrophy. The vagina becomes less moist and flexible. Estrogen is also important for vaginal lubrication. If the vagina isn’t lubricated enough, the friction from penetration can be uncomfortable. Hormonal changes don’t just occur during menopause, though. Breastfeeding women have lower levels of estrogen, too, and can experience vaginal dryness because of it.

·         Recent childbirth. The vagina needs time to heal after childbirth. If a woman’s vagina was cut to ease delivery, she may still be sore for a while. Many obstetricians recommend waiting six weeks before having vaginal sex again.

·         Medications. Some drugs can interfere with arousal and lubrication. Examples include antidepressants, blood pressure drugs, and birth control pills.

·         Inflammation and infections. Certain infections, like urinary tract infections, yeast infections, and vaginitis make sex painful. Skin conditions like eczema and dermatitis can as well. Skin can also become irritated by douches, perfumed soaps, and other personal products.

·         Gynecological conditions. There are many conditions that can cause sexual pain:

o   Vulvodyniapain in the vulva.

o   Endometriosis – growth of endometrial tissue outside of the uterus, commonly on the ovaries or fallopian tubes. (The endometrium is the lining of the uterus.)

o   Pelvic inflammatory disease a bacterial infection that moves from the vagina to the uterus, fallopian tubes, or ovaries.

o   Tilted uterusa uterus that tips backward toward the spine and rectum instead of forward.

o   Ovarian cystsfluid-filled sacs that form on the ovaries.

o   Uterine fibroids tumors that form inside or outside the uterus or within the uterine wall

·         Vaginismus. Women with vaginismus experience involuntary spasms of vaginal muscles at the start of penetration. They can’t control these spasms. Sometimes, the vagina almost closes, making penetration next to impossible.

·         Birth control devices. If a diaphragm or cervical cap doesn’t fit correctly, that might cause pain.

·         Other medical conditions and treatment. Some women with arthritis, thyroid conditions, and diabetes have pain during sex. Cancer and its treatment, including pelvic surgery, can cause problems, too.

·         Female genital cutting. In some cultures, particularly in parts of Africa and the Middle East, girls’ genitals are cut or removed. Vaginas may be stitched so that they are almost closed. These practices can lead to sexual pain as well as serious infections and hemorrhaging.


Emotional and Psychological Factors

For women, sex and emotions are closely bound. If something is troubling you, it could be affecting your ability to relax. If you can’t relax, your pelvic floor muscles can become tense and it’s more difficult to become aroused. Both of these issues contribute to sexual pain.

Some emotional and psychological factors include:

·         Depression. Feeling sad and fatigued can dampen your sex drive and interfere with your sexual response cycle.

·         Anxiety. You may feel anxiety in general or anxiety about sex in particular. Some women believe that they are not supposed to enjoy sex and feel shame if they do. If you don’t have much sexual experience, you may become anxious about expected pain or worry about your partner’s pleasure.

·         Stress. It’s hard to relax with your partner if you’re worried about a to-do list that’s too long or you’re having a rough time at work. You might also be exhausted from childcare or helping elderly parents.

·         Body image. Some women are concerned that their naked body will turn off their partner. This is common in women who have had surgery.

·         Problems in your relationship. If you’re upset with your partner, you might not feel much desire for sex and become less aroused.

·         Past sexual abuse. Your body may “remember” the pain of this abuse and anticipate it, even if you are in a stable, loving relationship now.


What Should You Do?

First, see your gynecologist. If a serious condition is causing the pain, such as endometriosis, pelvic inflammatory disease, or ovarian cysts, it’s important to treat that. Women with vaginismus may benefit from physical therapy and sex therapy. A doctor can also help you decide if you need to change a medication because of sexual side effects.

If you’re past menopause and your estrogen levels have declined, your doctor might recommend a lubricant or hormone therapy to help with poor vaginal lubrication. A drug calledospemifene (Osphena) may also help.

If the problem stems from psychological or emotional troubles, your doctor might refer you to a counselor or sex therapist. You may consider asking your partner to go with you, but it’s okay to go alone.

A sex therapist can help you and your partner better understand and communicate each other’s feelings and needs. If you have a history of sexual abuse or feelings that make you uncomfortable with sex, a counselor can help you work through those issues, too.

Be sure to talk to your partner as well. He or she might not realize that you have pain during sex. You might try different positions to see if you can find one more comfortable for you. Or, you could try having more foreplay to make you fully aroused. Keep in mind that sexual activities that don’t cause pain, such as oral sex and mutual masturbation, can be just as pleasurable for both of you.

Some women feel uncomfortable about discussing sex with a doctor or a partner. They might feel that women aren’t supposed care so much about sex. It can be a difficult subject to bring up. But it’s worth it. Your doctor will understand your concerns. He or she has probably treated many women just like you. And your partner will likely be glad you spoke up.

Print this article or view it as a PDF file here: Painful Intercourse for Women (Dyspareunia)


American Congress of Obstetricians and Gynecologists

“When Sex is Painful”

(May 2011)

Mayo Clinic

“Painful Intercourse (dyspareunia)

(January 24, 2015)

Sexual Medicine Society of North America

“Painful Intercourse for Women”

Sex Health Blog

Alcohol and Sex

Jan 27, 2015

Alcohol and SexJustin was the new guy at the office and he was looking forward to the company’s annual summer party, always held at the boss’s ritzy estate by the ocean. These parties were legendary, he’d been told. People from all over the region came to play volleyball on the beach, have bonfires after the sun went down. And it wasn’t uncommon for couples to wander off, claiming that what happens at the party stays at the party.


Too much alcohol and sex can be a risky combination. More at... (click to tweet)


He had to admit that he wasn’t always comfortable with parties. Sometimes, he had to have a few drinks before he felt at ease meeting new people. He always behaved himself, but he usually needed something to take the edge off.

The night of the party was no different. In fact, Justin helped himself to more beers than he usually would while Courtney from Marketing downed cocktails and flirted with him all night. What did she mean when she said they should go explore the caves on the beach?

The situation may sound cliché, but Justin and Courtney are not much different from couples who “hook up” when they’ve had too much alcohol. Today, we’ll look at some of the ways drinking alcohol can affect someone sexually.


Physical Issues

Alcohol is a depressant and can cause havoc with your central nervous system. It can also dehydrate you and interfere with blood flow to the genitals.

For men, problems with blood flow can eventually lead to erectile dysfunction – being unable to keep or maintain an erection firm enough for sex. It can happen in one encounter or eventually become a long-term problem.

Alcohol can also make it more difficult for men to ejaculate, even if they’re fully aroused.

In the long term, men who use alcohol excessively could also have trouble conceiving. Research suggests that drinking five units a week could lower a man’s sperm count and affect the quality of that sperm.

For women, dehydration can cause vaginal dryness. Sex can be uncomfortable or even painful for women when they are not sufficiently lubricated. Women may also have problems reaching orgasm if they’ve had too much to drink.


Risky Behavior

In a recent poll, we asked SexHealthMatters readers if alcohol use had ever led them to have unsafe sex. Just over 88% of the respondents said yes, they had had unsafe sex under the influence of alcohol.

It probably comes as no surprise that too much alcohol impairs our judgment. We may chuckle about the phrase “beer goggles” – when someone finds a partner more attractive than he or she would in normal circumstances – but lapses in behavioral judgment can have significant health implications.

In 2012, a Canadian study found that a person’s willingness to have unsafe sex increased with the amount of alcohol he or she consumed. And in 2013, American scientists reported that the more drinks a woman has before sex, the less likely she is to use a condom with that partner.

Unsafe sex can have a number of complications. Unplanned pregnancy can occur with partners who are ill-prepared to bring a child into the world. Sexually-transmitted infections (STIs) like chlamydia, gonorrhea, and genital herpes are common. Certain types of another STI, human papillomavirus (HPV) can cause cervical, anal, and penile cancers, along with some head and neck cancers and genital warts. And HIV is the STI that causes AIDS.

Impaired judgment from too much alcohol can have an emotional impact, too. Friends may have sex when they didn’t mean to take their relationship to that level. Partners may make promises they won’t remember in the morning – and don’t intend to keep. Committed partners may be unfaithful or say things they don’t mean. Strangers may feel guilt or shame after an encounter. They may also feel frightened, especially if a pregnancy or STI develops.


Social and Legal Issues

In Justin and Courtney’s case, pairing off could lead to a number of troubles at work. There might be some awkwardness in the break room. But there could also be some volatility, especially if their encounter ended with an STI or a pregnancy. The situation could impair their work performance as individuals and affect their ability to work together as a team. Their supervisors and colleagues would likely notice that something wasn’t right. If a romance blossomed, their company might have policies against employees dating.

Alcohol may also fuel sexual harassment and violence. Staying sober can help one recognize an unsafe situation and improve the chances of leaving it or calling for help.

This isn’t to say that you shouldn’t have a few drinks if your body can handle it. And for some, having a little alcohol can make one feel less inhibited and more relaxed, which can help in sexual situations.

But keep in mind that too much alcohol and sex can be a risky combination. Having a clear mind and honest discussion about protection and expectations before going to bed can make the experience more enjoyable for both partners.

If you feel you’re having trouble with alcohol, be sure to see your doctor and get treatment.

Print this article or view it as a PDF file here: Alcohol and Sex



Brown University Health Promotion

“Alcohol and Sex”,_tobacco,_&_other_drugs/alcohol/alcohol_&_sex.php

Iliades, Chris, MD

“Why Boozing Can Be Bad for Your Sex Life”

(January 4, 2012)

Huffington Post

Zebroff, Petra, PhD

“What Alcohol Really Does to Your Sex Life”

(January 7, 2013)

Sexual Medicine Society of North America

“Alcohol and Male Sexual Function”

“Alcohol and Unsafe Sex”

“Excessive Alcohol Consumption Could Affect Sperm Count and Quality”

“Has alcohol use ever led you to have unsafe sex?”

“Survey on Women’s Condom Use After Substance Use”

Sex Health Blog

Am I Ready For Sex?

Jan 12, 2015

Am I Ready For Sex?How do you know if you’re ready to have sex?

Sex seems glamorous, especially the way it’s shown in the media, where people hop into bed with each other with no talk of consequences. Things go perfectly and they wake up snuggling the next morning, all warm and happy.

But that’s not reality. Sometimes sex is awkward and doesn’t go quite as planned. And partners need to have some pretty thoughtful discussions beforehand.

In this post, we’re going to try to answer the “am I ready?” question with a series of other questions – for both you and your partner. Discussing these issues is a great way to get started.


Why do you want to have sex?

That question sounds easy, doesn’t it? Doesn’t everyone want to have sex? Isn’t everyone having sex already?

You might think so, especially if you watch a lot of movies and TV. You also might overhear conversations. It seems like everyone is doing it except you.

That’s not true though. Sometimes people embellish or lie about their sexual experiences.

Think about why you want to have sex. Is it because you love your partner and want to take those feelings to a physical level? Do you want to have the emotional closeness with that person that sex can bring? Sex can be wonderful when both partners feel this way.

Or do you feel pressured to do it – either by your peers or your partner? Is your partner saying things like “if you loved me, you would”? Is sex something you feel you need to get over with? Do you feel like having sex will bring you closer to adulthood?

If this is the case, think twice about having sex.


Lots of people wait. Some don’t want to worry about pregnancy or sexually-transmitted diseases (STDs). Others feel that sex right now goes against their religious or cultural beliefs.

And some just don’t feel ready. If you feel you should wait until you’re more comfortable with the responsibilities of having sex or in a more committed relationship, that’s perfectly fine. Congratulate yourself on having the maturity to know what is right for you.

Do you know how sex “works”?

Sex can be mysterious, especially in an anatomical sense. Before you have sex, it helps to understand your own body – and that of your partner.

It’s easy to assume that your partner “knows it all” and will know exactly what to do. But your partner might be just as inexperienced as you are.

You might decide to take it slow and learn more about each other’s bodies. Or you might decide to wait until you’re clearer about what you’re doing.


Can You Talk to Your Partner?

Sex can be tough to talk about. Almost everyone has trouble opening up about it at times. But before you have sex, you and your partner need to have a heart-to-heart talk. And you both need to be honest. Here are some questions to get you started:

Reasons and Feelings

  • Is sex something we want to do? Or do we feel pressured to do it?
  • What is our relationship like now? What kind of future might we have?
  • Do we love each other?
  • Do we trust and respect each other?
  • Are there any aspects of sex that make us nervous or frighten us?
  • How do we feel about seeing each other naked or touching each other in an intimate way?
  • Can we handle the emotional aspects of sex?


  • What method of birth control will we use?
  • How we will get this birth control?
  • Do we know how to use it properly?
  • If a partner has had sex before, what is his/her STD status?
  • How will we lower the risk of STDs?
  • What will we do if one of us wants to stop having sex, even if we’re in the middle of it?
  • Where will we have sex?


  • What will we do if there’s a pregnancy?
  • Are we mature enough to make decisions about keeping a baby, giving it up for adoption, or terminating a pregnancy?
  • How would we manage to care for a baby? Can we afford it?
  • Are we willing to change our future plans dramatically if there is a pregnancy?
  • What if one of us gets an STD? What will we do about treatment?

The relationship

  • Will we have sex only with each other?
  • What if one partner “cheats”?
  • What happens if we break up?
  • If we break up, will we be able to handle the emotional aspects?



Can you talk to a trusted and experienced confidant?

All these questions can make your head spin. Sometimes, it helps to talk to a trusted person who knows you well. It may also help to talk with a professional, such as a mental health counselor, a member of the clergy, or your healthcare provider.

Are you ready for sex?

Here we are, back to the main question. Are you ready to start having sex?

The answer is up to you.

Print this article or view it as a PDF file here: Am I Ready For Sex?


Planned Parenthood

“Am I Ready?”

Sutter Health/Palo Alto Medical Foundation

“Am I Ready?”

(Last reviewed: October 2013)

Sex Health Blog

Genital Cosmetic Surgery for Women

Dec 31, 2014

Genital Cosmetic Surgery for WomenCosmetic surgery is common these days, with people sporting “new” noses, fuller lips, and reshaped ears. Procedures like breast augmentation, face lifts, and tummy tucks are widely-advertised. It seems like any body part can be surgically altered.

So why not the female genitals?

Some women are dissatisfied with the appearance of their genitals or the size of their vagina. Others feel that sex would be more satisfying if their genitals were shaped differently. Genital cosmetic surgery aims to address some of these issues. But is cosmetic surgery on this very private area safe and effective? Are there alternatives?


Is genital cosmetic surgery for women safe and effective? Click here to tweet.


In this post, we’ll discuss the more popular procedures, the potential risks, and the reasons why women consider this route.


What types of genital cosmetic surgery procedures are available?

Women may have surgery on external and/or internal genitals. Here are some examples:

·         Vaginoplasty. Sometimes called “vaginal rejuvenation,” this procedure involves removing tissue from the vaginal lining to make it tighter. Women may choose this surgery if they feel their vagina is too loose. (This happens to some women after childbirth.) Women may also have vaginoplasty to please partners who prefer a tighter vagina.

·         Labiaplasty. This surgery involves changing the shape or size of the inner lips (labia minora) or outer lips (labia majora) outside their vagina. For some women, large labia can be uncomfortable and easily irritated. Others simply want to make their labia smaller or more symmetrical. Labia majora augmentation is a procedure that makes this area larger.

·         Hymenoplasty (“revirginization”). The hymen is a thin membrane that usually tears during a woman’s first intercourse. Surgery can reconstruct the hymen, giving the appearance of virginity.

·         G-spot amplification. The G-spot is a highly sensitive area inside the vagina that, when stimulated, gives intense sexual pleasure to many women. This procedure aims to enlarge that area with injections of collagen to the vaginal wall.

·         Clitoral hood reduction (“hoodectomy”). Stimulation of the clitoris often brings women to orgasm, but the hood – an area of skin that covers it – can get in the way. Clitoral hood reduction removes some of this skin so that more of the clitoris is available for stimulation.

·         Vulval lipoplasty. Women undergoing this procedure have liposuction to reduce the size of the mons pubis, an area of fatty tissue that cushions the pubic area.


Why do women have genital cosmetic surgery?

There are a variety of reasons. Some women are embarrassed by the appearance of their genitals and feel that changing them will improve their self-esteem and confidence. Others feel that the surgery will make sex more pleasurable.

Why are women sensitive about their genital appearance? Pornography might provide some clues. Comparing their own genitals to those of female models and actresses make some women feel insecure, as if their own genitals are abnormal. They may worry about turning off a partner.

Also, many women remove their pubic hair, which leaves their more of their genitals visible. The mons pubis, for example, is typically covered with pubic hair, but once shaved, its shape and size are more noticeable.

What are the risks?

Genital cosmetic surgery has not been widely researched. In a committee opinion reaffirmed in 2014, the American Congress of Obstetricians and Gynecologists (ACOG) states, “No adequate studies have been published assessing the long-term satisfaction, safety, and complication rates for these procedures.” ACOG opposes genital cosmetic surgery.

Infection, pain, and scarring can sometimes occur. Some women experience changes in sexual sensation or painful intercourse after surgery. Others find that they are still unhappy with their genital appearance.


Are there alternatives?

Many women don’t realize that female genitals come in all shapes and sizes. For example, labia can vary in color and are often asymmetrical. What women consider “abnormal” may very well fall into the “normal” category.

It’s also important that sexual pleasure is not driven solely by anatomy. While exposing more of the clitoris, enlarging the G-spot, or simply feeling more sexually self-confident might increase pleasure, many other factors contribute to sexual satisfaction. Communication with a partner, emotional ties, and intimacy are all important, too. Sometimes, pleasure can be enhanced by addressing these areas first.

What should a woman do if she’s dissatisfied with her genitals? The first step is talking to a doctor. It may be worth trying other measures, such as counseling, sex therapy, or pelvic floor physical therapy.

Talking the situation over with a partner may help, too. A partner may provide reassurance that genital appearance is not as important as the woman herself.

If a woman decides to move forward with surgery, she should make sure her practitioner is qualified and experienced. She should also fully understand the potential risks and know what to expect in terms of recovery and results.

Print this article or view it as a PDF file here: Genital Cosmetic Surgery for Women


American Congress of Obstetricians and Gynecologists

“Vaginal ‘Rejuvenation’ and Cosmetic Vaginal Procedures”

(September 2007. Reaffirmed in 2014.)

The Atlantic

Berliet, Melanie

“Designer Parts: Inside the Strange, Fascinating World of Vaginoplasty”

(April 2, 2012)

Sexual Medicine Society of North America

“Motivations for Labial Reduction Surgery”


“Vaginoplasty and Labiaplasty”

(March 26, 2013)

Women’s Health (Australia)

Braun, Kristen

“Genital cosmetic surgery”


Sex Health Blog

Pubic Hair Removal

Dec 15, 2014

Pubic Hair RemovalToday, we’ll start the blog with a question you may never have considered – have you ever removed some or all of your pubic hair?

We know it’s not the kind of question you’d ask at dinner parties or the gym. But pubic hair removal has become more common, especially over the last ten years or so in the United States, United Kingdom, and Australia.


How many people remove their pubic hair? And why? Some surprising answers here... Click here to tweet.


The practice is not new. Art and artifacts from ancient Egypt, classical Greece, and the Italian Renaissance depict women without pubic hair.

But why do people do it in modern times? How do they go about it? Let’s look at some of these questions.


How many people remove their pubic hair? And why?

Scientists aren’t completely sure how many people remove their pubic hair. However, a recent survey of college students at two United States universities revealed that 95% of the 1,110 subjects (671 men and 439 women) had removed pubic hair at least once in the previous four weeks.

Past research found several reasons for removing pubic hair. Both men and women considered the practice a matter of hygiene. They just felt cleaner after removing, or trimming, their pubic hair. Some reported feeling more sexually attractive with less or no hair. And some feel that doing so is expected by society.

People might remove their pubic hair because of partner preferences, too. For example, if one partner enjoys oral sex, the other may be more comfortable giving it if some or all pubic hair is removed. In the study of college students, 60% of the men said they preferred having a partner who was hair-free. (Half of the women in that study were hair-free compared to 19% of the men.)


How do people remove their pubic hair?

Shaving is one of the most common methods, reported by 82% of the female and 49% of the male college students. Usually, this involves trimming the hair, then using shaving cream and a razor every few days.

Depilatories are another option. This method uses chemicals to remove the hair.

Some people go to a salon to have their pubic hair waxed. Warm wax is placed on the hair and, once it hardens, is removed, taking pubic hair with it by the root. Waxing may not be for the faint of heart – many people find it painful.

Laser hair removal is offered by some medical professionals, such as dermatologists. In this procedure, a technician points a laser beam at the unwanted hair. Heat from the laser destroys the root. It may take a few sessions to remove all of the hair.

Electrolysis usually has the longest-lasting effects, but also requires the most sessions. A needle-shaped electrode is used to remove each hair root with an electric current.


Does removing pubic hair have any health benefits?

Pubic hair removal has no direct health benefits. It is more about personal preference. However, if a person feels more sexually attractive or relaxed with less or no pubic hair, or feels more sexually satisfied after removing it, that could be considered a benefit.

Is it dangerous to remove pubic hair? Are there any risks?

There can be risks. For example, some people cut themselves shaving. These cuts can be hard to see. But they increase the risk for infections. A person with cuts may be at higher risk for sexually-transmitted infections or strep and staph infections. Even the tiniest cut can allow an infection to enter the body. Bacteria on unsanitary tools can also transmit infections.

Burns – from wax, chemicals, or razors – may occur, along with allergies to the products used.

Other problems associated with pubic hair removal include blisters and pimples.

In the study of college students, genital itching was the common side effect. Eighty-percent of the pubic hair removers experienced itching at least once.


Should I remove my pubic hair?

Only if you want to. Removing pubic hair is a personal choice. You can be sexually healthy with or without it.

However, if you do decide to remove pubic hair, be sure to do so safely. Use razors and products that are designed for this purpose. Make sure they are sanitary. Check the credentials of any technician you visit. And if you have a problem with side effects, cuts, or infections, see your doctor as soon as possible. Your doctor can answer any questions you have about pubic hair removal as well.

Print this article or view it as a PDF file here: Pubic Hair Removal


International Society for Sexual Medicine

“Is pubic hair removal related to sexual function or behaviors?”

“Is removing pubic hair now the norm among women?”

“What are some common pubic hair removal methods for women?”

“What are the benefits of removing women’s pubic hair?”

“What are the health risks of removing women’s pubic hair?”

“Why might a woman remove her pubic hair?”

The Journal of Sexual Medicine

Butler, Scott M., PhD, MPH, et al.

“Pubic Hair Preferences, Reasons for Removal, and Associated Genital Symptoms: Comparisons Between Men and Women”

(Full-text. First published online: November 14, 2014)

Sex Health Blog

Quality of Sleep Can Have Major Impact on Men’s Sexual Health

Dec 04, 2014

Sleep and Men’s Sexual Health“Sleep is for wimps,” Larry boasted in the office break room one morning. “I can get by on very little sleep. I worked past midnight last night, in fact.”

Derek poured himself a cup of coffee and rolled his eyes. “It’s not a badge of honor,” he grumbled to himself.

But many people feel that sleep is overrated. There’s a push to go-go-go without stopping to rest.

Unfortunately, lack of sleep takes a toll on the body in so many ways. We need that time to let our body do its repair work and to keep ourselves rested and alert for the next day’s challenges.


3 ways sleep can have a major impact on a man's sexual health. Watch especially for #2! Click here to tweet.


You might not realize that sleep is important for sexual health, too. Both men and women need proper sleep for good sexual function. Today, we’ll focus on some issues particular to men.


Sleep and Testosterone

Men’s bodies produce testosterone during sleep. Produced by the testes, the hormone testosterone is plays a huge role in a man’s sexual function. It drives his libido and contributes to his erections.

In 2011, scientists from the University of Chicago reported on a group of young men who participated in a sleep and testosterone study. After a week of sleeping less than five hours a night, the men’s testosterone levels dropped 10% to 15%.


Sleep and Sexual Judgment

When sleep deprived, men can misjudge a woman’s sexual interest. Researchers from Hendrix College in Arkansas surveyed a group of 60 college students before and after one night of sleep deprivation. The students answered questions about their views on sexual interest, intent, and commitment.

When men had less sleep, they tended to rate women’s sexual interest and intent much higher than they did when they were rested. Interestingly, the opposite was not true for the women. Their perceptions of men’s sexual interest and intent did not change much after a night of poor sleep.


Sleep Apnea and Erectile Dysfunction

Sleep is important for erections, too. Past research has linked obstructive sleep apnea (OSA) with erectile dysfunction (ED) – the inability to get or maintain an erection firm enough for sex.

When a man has OSA, his airway becomes blocked while he sleeps. As a result, he stops breathing for short periods during the night. These episodes occur repeatedly.

In 2011, researchers from Mount Sinai Medical Center in New York reported on a study of over 800 middle-aged men. They found that in this group, men with ED were more than twice as likely to have obstructive sleep apnea. OSA was even more common in men with severe ED.

Fortunately, OSA can be treated. Many patients use a CPAP (continuous positive airway pressure) machine to keep the airway open during sleep so that they can breathe more easily. The device involves a special face mask, which is attached to the machine with a hose.

Some men worry that using a CPAP machine may make them less sexually attractive. But that isn’t necessarily true. A recent study compared two groups of men with ED – one that used their CPAP machine regularly and one that did not.

The men completed questionnaires about their sexual quality of life. After analyzing the data, the researchers found no significant differences between the groups. The CPAP machine did not disrupt the men’s sex lives.


Get Some Sleep!

If you have problems sleeping, consider adjusting your bedtime rituals. Try to minimize stress and relax at night. Some people find it helpful to shut off all electronics for an hour or two before bedtime.

If the trouble persists, talk to your doctor. He or she can suggest some other strategies. You might also consider attending a sleep lab for a few nights to see if there is a deeper problem, such as obstructive sleep apnea.

Print this article or view it as a PDF file here: Quality of Sleep Can Have Major Impact on Men’s Sexual Health


Sexual Medicine Society of North America

“CPAP Device Does Not Interfere With Sex Life, Study Says”

(November 26, 2014)

“Sleep Deprivation & Sexual Judgment”

“Sleep Problems and ED”

(June 14, 2011)

“Testosterone and Sleep”

Sex Health Blog

Ospemifene May Ease Menopause Symptoms Beyond Painful Intercourse

Nov 18, 2014

Ospemifene May Ease Menopause Symptoms Beyond Painful IntercourseIf you’re a woman past menopause, your doctor might have told you about ospemifene, a drug used to treat painful intercourse. Marketed under the name Osphena in North America, recent research suggests that this medication might help with other menopausal symptoms, too. Let’s take a closer look.


Study suggests ospemifene might relieve other menopausal symptoms beyond painful intercourse. Click here to tweet.


Vaginal changes at menopause

For many women, declines in estrogen at menopause bring about changes to the vagina. Estrogen is an important hormone for vaginal health. It keeps vaginal tissue moist and flexible. But when levels drop, vaginal tissue can become dry and brittle, making sex uncomfortable or even painful. The vagina can also become shorter and narrower.

Unfortunately, these symptoms usually don’t improve on their own. Some women try over-the-counter lubricants and moisturizers to make sex more comfortable. Hormone therapy is another option, although estrogen products are not appropriate for all women.


What is ospemifene?

Ospemifene was approved by the U.S. Food and Drug Administration in 2013. Specifically, it was approved to treat moderate to severe dyspareunia – painful sex.  An alternative to estrogen, ospemifene works to keep vaginal tissue healthy and elastic.

Can ospemifene be used to treat other menopausal symptoms?

At the 2014 annual meeting of the North American Menopause Society, Dr. Ginger Constantine of EndoRheum Consultants presented new research on ospemifene. The results suggest that ospemifene might relieve other menopausal symptoms beyond painful intercourse.

In the study, some women reported that symptoms like vaginal dryness, itching, and irritation improved because of ospemifene. The drug also relieved difficult and painful urination and vaginal bleeding during sex in some patients.

It’s important to note that the drug is still FDA-approved for moderate to severe dyspareunia. It’s possible that future research may explore ospemifene’s role in relieving other symptoms and that the FDA may revise the drug’s label. For now, doctors who prescribe ospemifene for symptoms other than dyspareunia are doing so “off-label” at their own discretion.


How might ospemifene affect the endometrium?

One of the biggest concerns about ospemifene is its potential effects on the endometrium – the lining of the uterus.

Before menopause, a woman’s endometrium thickens once a month, in case she becomes pregnant. If there is no pregnancy, the endometrium “sheds” when she has her menstrual period.

After menopause, this no longer happens. However, there have been cases in which ospemifene causes the endometrium to thicken anyway. With this in mind, women taking ospemifene should see a doctor if they notice any unusual bleeding.

Ospemifene may also raise a woman’s risk for blood clots and strokes.


Learn More

If you think ospemifene is worth a try, be sure to talk to your doctor. He or she can guide you on the best treatment options for your personal situation.

And if you’d like to learn more about sex and aging for women, these links may help:

Sex and Midlife Women

Sex Health and Aging for Women

Sex For Women After 50

You can also find a number of other links related to female sexual health here.

Print this article or view it as a PDF file here: Ospemifene May Ease Menopause Symptoms Beyond Painful Intercourse


Medscape Medical News

Tucker, Miriam

“Despite Label, Ospemifene Eases Multiple Menopause Symptoms”

(November 4, 2014)

Sexual Medicine Society of North America

“Ospemifene for Vulvar and Vaginal Atrophy”

(Post for healthcare providers)

Sex Health Blog

Women’s Sexual Health on

Nov 12, 2014

Women, are you looking for sexual health information? You’ve come to the right place!

Below you can find links to our articles on a number of female sex health topics, including pregnancy, aging, diabetes, cancer, pain, and low desire.

Don’t see the topic you’re looking for? We have many ideas in development, but welcome your suggestions, too. Please feel free to contact us and let us know what you’d like to learn more about in the future.

Sex and Pregnancy

Sex During Pregnancy. Is it safe to have sex when you’re pregnant? Your doctor can best answer that question, but this post offers some points to consider.

Sexual Function in Pregnant Women with Gestational Diabetes. In early 2013, we reported on a study that found a greater likelihood of sexual problems in pregnant women with gestational diabetes when compared to non-diabetic pregnant women.

Childbirth and Female Sexual Function Later in Life. This study from November 2013 found that childbirth did not impact a woman’s sexual desire, activity, or satisfaction in later years.

Sex and Aging

Sex and Midlife Women. Middle-aged women who consider sex to be important tend to stay sexually active compared to those who don’t, this February 2014 study found.

Sex Health and Aging for Women. When women reach menopause, they might experience some vaginal changes that make sex uncomfortable.

Sex For Women After 50. How might a woman’s sex life change as she gets older? This post explains painful intercourse, low sex drive, and the need for more time for arousal. It also gives some tips on how to manage these problems.

Sex and Specific Medical Conditions

Diabetes and Female Sexual Satisfaction. Diabetes can interfere with female sexual function in a number of ways. What can women do? This post explains.

Diabetes and Women’s Sexual Health, Female Sexual Dysfunction and Diabetes. Italian researchers found that female sexual dysfunction is more common in diabetic women than in women without diabetes.

Yoga and Sexual Function in Women with Metabolic Syndrome. Some women with metabolic syndrome say yoga helps alleviate sexual problems.

Endometriosis. The physical pain of endometriosis, along with emotional and psychological issues that may accompany it, can lead to sexual difficulties.

Female Cancer Survivors and Sex Health Issues. Pain, hormonal changes, dating, body image, radiation – these are just some of the concerns female cancer survivors face. How can they cope?

Cancer and Sex for Single Women. After cancer treatment, women may be nervous – but excited - about starting new sexual relationships.

Women’s Thoughts on Sexual Health

American Women’s Views on Sexual Health Treatment Options. In a recent survey of American women, almost 60% of the respondents felt that society emphasizes men’s sexual satisfaction more than women’s satisfaction. What else did the women have to say?

Women: One or Two Better Sexual Experiences Each Month Would be “Meaningful”. This post gives more details about the survey referenced above.

Dysfunctional Sexual Beliefs and Women. A woman’s sexual beliefs may be influenced by her sexual orientation, according to this August 2014 study.

Motivations for Labial Reduction Surgery. Some women feel that their labia – the “lips” of their genitals, need to be resized or reshaped. But is surgery really necessary? This article helps healthcare providers whose patients are considering labiaplasty.

Painful Sex

Ospemifene for Vulvar and Vaginal Atrophy. Targeted to healthcare professionals, this article discusses research on the efficacy and safety of Ospemifene, a drug created to treat painful intercourse in postmenopausal women.

Painful Intercourse for Women. Learn more about the types of pain women may have during intercourse and the possible causes.

Pain During Sex – Vaginismus. Vaginismus refers to spasms in the vaginal muscles at the start of penetration. This can make sex extremely painful – or impossible – for women.

Romantic Partners’ Reponses to Entry Dyspareunia. Partners’ reactions to a woman’s intercourse pain can affect the intensity of her pain, this study found.

Hypoactive Sexual Desire Disorder (HSDD)

HSDD. This link takes you to a list of overview articles on HSDD, including its causes, diagnosis, and treatment.

Understanding HSDD. For healthcare providers, this post explains the basics of HSDD and offers strategies for communicating with patients.

HSDD Infographic. Sometimes, seeing information graphically helps us understand it better. This infographic was developed by Sprout Pharmaceuticals.

HSDD and Relationships. How does HSDD affect women’s relationships? Learn what women had to say in this survey.

Talking about HSDD. HSDD isn’t always easy for partners, who may feel frustrated or rejected. This post explains the situation and provides tips for discussing it.

Flibanserin. This drug has been developed to treat HSDD, but it hasn’t been approved by the U.S. Food and Drug Administration yet.

Other Topics

Acupuncture and Female Sexual Dysfunction. Some women find that acupuncture helps relieve sexual problems.

Cycling and Female Sexual Health. What sex health considerations should women make while cycling?

Keep in mind that while we at SexHealthMatters strive to bring you the most complete and accurate information that we can, your doctor can give you the best guidance for your personal situation. If you are having a sexual difficulty – physical, emotional, or psychological – be sure to talk to your doctor about it.

Your doctor can answer your specific questions and provide resources tailored for you. He or she may also refer you to a specialist, such as a sex therapist or couples counselor, if appropriate.

It may feel like an awkward to subject to bring up. But sex is important aspect of life. It’s a conversation worth having!

Print this article or view it as a PDF file here: Women’s Sexual Health on

Sex Health Blog

Sex for Women After 50

Oct 29, 2014

Sex for Women After 50What is sex like for women over 50?

It’s a question many women have, especially as they approach menopause. This “change of life” is driven by declines in the hormone estrogen. The ovaries stop releasing eggs and menstruation ceases.

In North America, the average age for menopause is 51, so it’s fitting that we start our discussion here. But this is just an average. Some women go through menopause later. Some experience it in their thirties or forties. And some may go through surgical menopause if they have had their ovaries removed.

Generally speaking, a woman is considered to be finished with menopause when she has not had a menstrual period for twelve months. Before that, she is said to be in perimenopause, when estrogen levels tend to fluctuate. Her periods may become erratic. They might be heavy one month and light the next. She might feel fatigued, get headaches, have hot flashes, and become moody. And during this time, she can still become pregnant.


Her sex life can change, too. Estrogen is important for sexual health. It keeps vaginal tissues healthy and plays a role in sex drive.

But drops in estrogen levels don’t signal the end of a woman’s sex life. Not at all. In fact, some women say sex is better after menopause, especially when pregnancy is no longer a concern. (However, postmenopausal women can still acquire sexually-transmitted infections – and many do. Safe sex practices are just as important after menopause as before.)

Let’s take a quick look at some of the sexual issues often faced by women after 50:


Painful intercourse. When you were younger, you probably had few problems with vaginal lubrication when you became sexually excited. Unfortunately, this changes for many women as they get older. Declines in estrogen mean the vagina is less moist. It’s also less flexible. As a result, sex can become painful. Friction from penetration can irritate the dry vaginal tissue.

Many women find that a personal lubricant is helpful. Lubricants can be purchased over the counter at the drugstore and come in many varieties. (Be sure to choose a water-based lubricant if you are using condoms.) Moisturizers are also available. You might also consider hormone replacement therapy, if your doctor thinks it is safe for you.

A medication called Osphena is another possibility. This drug acts like estrogen and helps keep the vagina moist and flexible.


Low sex drive. When estrogen levels fall, so can a woman’s sex drive. However, menopause is not the only culprit. Many women over 50 have a lot on their plates. They may be working full time, raising children, preparing adolescents for adulthood, and caring for aging parents. Sometimes, the stress and anxiety of daily life makes a woman so exhausted that she’s not interested in sex.

If you lose some sexual spark, talk to your doctor. He or she can help pinpoint the problem. Hormone replacement therapy might be appropriate.

If you’re feeling stressed, see what you can do to relax. Talk to a friend, ask for help from family, or talk to a counselor. Have a night out with the girls or try a new exercise class at the gym.

Be sure to keep your partner in the loop, too. Chances are, he or she has noticed the changes in your relationship. Talk over your difficulties and try to make time for just the two of you. Keeping lines of communication open may make you stronger as a couple. A counselor or sex therapist may help, too.


Needing more time. You might notice that takes you longer to become fully aroused or to reach orgasm. This is quite common. Try not to worry too much about it. If you need more foreplay, explain that to your partner. Then relax and enjoy the experience.

Sometimes, changing the routine is all that’s needed. You might consider other sexual positions, have sex in other locations, share fantasies, or try out some sex toys. (Remember, too, that your partner might need more time as well. For example, men might need more stimulation to get a firm erection. You can find more information about sexual changes for men over 50 here.)


It’s important to note that while menopause is often a big contributing factor to sexual issues at this age, it is not the only factor. Health conditions like diabetes, heart disease, arthritis, and depression can also cause sexual difficulties. If you are having a sexual problem, be sure to discuss it with your gynecologist. The solution may be something simple, like a lubricant or experimenting with a new sexual position. Or, it may be more complicated and require medication or lifestyle changes.

The following links can help you learn more about sex and aging for women:

Back Pain Isn’t the End of Sexual Satisfaction

Dealing with Arthritis

Osphena Approved to Treat Painful Sex

Sex Health and Aging for Women

Sexual Satisfaction and Aging

STD Tests for the Elderly

STDs and Safe Sex

Vulvar and Vaginal Atrophy

Print this article or view it as a PDF file here: Sex for Women After 50


The North American Menopause Society

“Sexual Health & Menopause Online”

(Complete series. 2014)

The Menopause Book

Wingert, Pat and Barbara Kantrowitz

“Chapter 5 – Sex”
(Workman Publishing. 2009. Pages 97 – 137) (U.S. Department of Health and Human Services)

“Menopause and sexuality”

(Last updated: September 22, 2010)

Sex Health Blog

What if Oral ED Medications Don’t Work?

Oct 15, 2014

What if Oral ED Medications Don’t Work?Ever since the U.S. Food and Drug Administration (FDA) approved Viagra in 1998, pills called phosphodiesterase type 5 (PDE5) inhibitors have become one of the most popular treatments for erectile dysfunction (ED).  Medications like Viagra, Levitra, and Cialis are heavily marketed and sometimes portrayed as a magic pill that can make a man’s erection problems disappear.

But it isn’t quite that easy.

First, not every man can take PDE5 inhibitors. For example, these drugs can interact with nitroglycerin, a medication often taken for chest pain and coronary artery disease. The combination can cause a dangerous drop in blood pressure.

Men with heart problems, diabetes, high or low blood pressure, or a history of heart attack or stroke should be careful if they take PDE5s. Their doctor can best determine whether the drugs are safe.

Second, some men find that PDE5 inhibitors just don’t work for them. Or, the drugs might not be as effective as they expected. It’s also possible for the medications to become less effective over time.

What happens then? Fortunately, there are other avenues for treating ED. Today, we’ll take a look at some of them.


Alternatives to PDE5 Inhibitors

The following is a brief overview of other ED treatments that may help. For further information, just click on the corresponding links.

·         Injections. Some men with ED give themselves injections of a drug called alprostadil, which can improve blood flow to the penis and, in turn, create a firm erection. Injections should be given about five to ten minutes before sex. While the idea of injection a needle into one’s penis may be nerve-wracking, a urologist can show you the proper technique.

For more information:

Self-Injections – Erectile Dysfunction

How Do I Learn the Technique of Penile Injection Therapy? (video)

Penile Injections Sound Painful. Who Would Consider That for ED? (video)

·         Suppositories (MUSE). Suppositories, sometimes called transurethral agents, are another way to administer alprostadil. MUSE stands for Medicated Urethral System for Erection and is currently the only suppository approved by the FDA for ED.

To use MUSE, a man uses a special applicator. Inside this device is a small pellet of medicine. The applicator tip is placed inside the urethra – the tube that allows urine and semen to exit the body – and the pellet is dispensed. Most men get an erection about five or ten minutes after application.

Using transurethral agents can be a bit tricky. A urologist can teach you the best way to administer them.

For more information:

Transurethral Agents – Erectile Dysfunction

Can MUSE Help Me? ED Medication Did Not Work (video)

How Do You Insert the Urethral Pellet Medication for ED? (video)


·         Vacuum erection devices (VEDs). These devices come in three parts: a clear plastic cylinder, a pump, and a constriction ring. The cylinder is placed over the penis and the pump is used to create a vacuum, which increases blood flow to the penis. Once the erection is achieved, a constriction ring is placed at the base of the penis to keep the blood in. This keeps the erection firm. To avoid injury, the constriction ring should be removed within thirty minutes.

For more information:

Vacuum Devices – Erectile Dysfunction

Did You Know? – Vacuum Erection Devices

Blog – Vacuum Erection Devices (includes instructions for using one as well as the advantages and disadvantages)

·         Implants. Penile implants, or prostheses, are usually considered the last resort for men with ED. These devices are surgically implanted and permanent. In the procedure, the corpora cavernosum – spongy chambers that typically fill with blood during an erection – and replaced with artificial cylinders.

Nowadays, most penile implants are an inflatable type. To get an erection, a man activates a pump that is also surgically implanted. The pump causes a saline fluid to travel to the cylinders, filling them until the penis is erect. When the man no longer wishes to have to have the erection, he deactivates the pump.

For more information:

Penile Implants – Erectile Dysfunction

Penile Implant Surgery for Erectile Dysfunction – Resources (includes interactive program)

What Are The Different Types of Penile Implants? (video)

How Long Do Implants Work For? (video)

Who Decides Which Patients Need an Implant? (video)

Will a Penile Implant Make a Difference for my Partner? (video)


Talk to Your Doctor

If you’re taking a PDE5 inhibitor and it doesn’t seem to be working, don’t hesitate to call your doctor. It’s possible that another PDE5 inhibitor brand may be effective. Or, making lifestyle changes, such as losing weight or quitting smoking, may help you get better results.

However, don’t be afraid to ask about alternatives either. While treatments like injections and vacuum pumps may not seem very romantic, they can still allow you to enjoy satisfying sex again.

Print this article or view it as a PDF file here: What if Oral ED Medications Don’t Work?


“7 Ways to Treat Erectile Dysfunction”,,20307067,00.html


“Erection problems”

(Updated: September 19, 2011)


(Revised: August 1, 2010)

Sexual Medicine Society of North America

“Penile Implants – Erectile Dysfunction”

“Self-Injections – Erectile Dysfunction”

“Transurethral Agents – Erectile Dysfunction”

“Vacuum Erection Devices”

(May 30, 2013)

Sex Health Blog

Sensate Focus

Oct 01, 2014

Sensate Focus and Sexual DysfunctionAmanda was nervous about bringing Paul with her for sex counseling. She had struggled with sexual relations for all of her adult life after sexual abuse as a teenager. She had made some progress with therapy. But this was the first time she had ever included a partner; indeed, it was the first time she had ever trusted a man enough to even consider it.

But Paul was different from the other men she’d dated. He was patient and understanding. He was willing to take it slow. And he wanted to help her through this process so that they could enjoy sex together.

She didn’t enjoy it much, she had to admit. As much as he assured her that everything was fine, she was always worried that she wasn’t pleasing him and that he would leave the relationship as a result. These thoughts distracted her from sex, made her body tense, and kept her from enjoying anything.

After a few sessions, when the therapist felt she knew them and their dynamics as a couple, they started a technique called sensate focus. Today, we’ll talk a bit about what this technique involves and how it may help couples.


What is Sensate Focus?

Developed by sex researchers William Masters and Virginia Johnson, sensate focus emphasizes the physical sensations of touch. The technique starts with non-sexual touching and becomes more sexual as weeks go by. It is designed to foster trust and intimacy between partners and can help reduce anxiety by focusing on mutual pleasure.

The stages of sensate focus can vary depending on the sex therapist and couple, but in general, the process goes like this:

·         Stage 1. Partners take turns touching each other in non-sexual ways, focusing on areas like the hands, feet, face, and torso. Couples may be clothed or unclothed. They are free to explore each other’s bodies as much as they like, but are not allowed to touch the genitals or any other sexual areas, such as the breasts or nipples. Intercourse and penetration are not allowed.

·         Stage 2. At this point, couples touch each other’s genitals as well as the other parts of the body touched during stage 1, taking turns. The goal is to bring pleasure and become more aware of how the partner responds to certain types of touching. Again, intercourse and penetration are not allowed, even if the touching session becomes very arousing. Some couples try oral stimulation during this phase and some participants do reach orgasm, but that is not the end goal.

·         Stage 3. During this phase, couples start mutual touching. They may also try gentle penetration, which may occur with a sex toy, finger, or penis. This might just involve inserting the tip of the penis into the vagina. The partner being penetrated controls the depth and force of penetration. Eventually, the couple may proceed to full intercourse.


Why Do Some Therapists Recommend Sensate Focus?

Sensate focus can provide couples with the opportunity to reconnect with each other. For some couples, making intercourse off limits reduces the anxiety to perform. With this pressure lifted, couples can rediscover what they enjoy about intimacy.

For Amanda, sensate focus was a relief. She did not worry about disappointing Paul and found that she could concentrate more on the sexual pleasure they experienced. This helped them bond and made her want to explore other ways to be intimate with him.

Is Sensate Focus for Everyone?

Not necessarily. While sensate focus is helpful for many couples, others find other sex therapy strategies more beneficial. An experienced therapist can guide couples on the most effective techniques for them.

However, if you think sensate focus would be worthwhile for you and your partner, be sure to talk to your doctor, counselor, or sex therapist. He or she can help you tailor the technique for your situation.

Print this article or view it as a PDF file here: Sensate Focus


“Sensate Focus”

Discovery Health

“Sensate Focus”

(April 25, 2005)

University of Notre Dame Marital Therapy and Research Clinic

“Sensate Focus Exercise: Non-Sexual Intimacy”

Sex Health Blog

Sexual Function in Adult Childhood Cancer Survivors

Sep 17, 2014

Sexual Function in Adult Childhood Cancer SurvivorsSeptember is Childhood Cancer Awareness Month and with this in mind, we’d like to talk a bit about the late effects of cancer treatment that can cause sexual problems for patients when they are adults.

If may seem premature to think about sexuality in adulthood when children are undergoing cancer treatment. After all, the most important goal is to manage the cancer.

However, cancer treatment can have repercussions later in life. Late effects are medical issues that occur months, years, or even decades after treatment.

For example, boys who have had radiation therapy to the brain, abdomen, or testes may become infertile. In addition their bodies may not be able to produce enough testosterone, an important hormone for male development and sexual function.


Girls may be faced with infertility and premature menopause, as chemotherapy and radiation can damage the ovaries, which release eggs and produce the hormone estrogen. Lower levels of estrogen can affect the health of the vagina. Estrogen helps lubricate the vagina to prepare it for sex. Women with low levels of estrogen may have vaginal dryness which can lead to painful intercourse.

For both boys and girls, radiation therapy to the head can affect glands involved with hormone production and regulation.

Even if treatment doesn’t specifically target sex and reproductive organs, it can still interfere with sexual function. The emotional consequences of cancer treatment can be powerful and many survivors cope with depression and anxiety. Fears about the cancer coming back – or developing another type of cancer later on – are not uncommon.


How Common Are Sexual Issues?

Recent studies have shed some light on how common sexual issues are for childhood cancer survivors.

Last year, a study by American researchers in The Journal of Sexual Medicine surveyed 291 childhood cancer survivors about their sexual health. Twenty-nine percent of them had at least two symptoms of sexual dysfunction, with women being twice as likely to have issues.

Among the whole group, almost 30% of the participants said they were not interested in sex. About 24% said they had trouble relaxing and enjoying sex. Sexual arousal was difficult for about 23% of the participants.

Nineteen percent of the men experienced erection problems. Orgasm difficulties occurred in 29% of the women.

The researchers suggested that problems were more common for women because sex and relationships caused them more stress and anxiety.


Research for Women                                                 

Last month, a study published in the Journal of Clinical Oncology reported on the experiences of female childhood cancer survivors. Researchers compared a group of 2,178 survivors with 408 female siblings. The women completed a 122-item questionnaire designed to assess sexual health.

The scientists discovered that female childhood cancer survivors were more likely to experience poorer sexual function when compared to their sisters who had not had cancer.

Lack of sexual interest and desire, problems with arousal, and sexual dissatisfaction were the most common issues. Women had had experienced ovarian failure had more problems than those who hadn’t.

Over a quarter of the survivors had not been sexually active in the previous month, compared to 17% of their sisters. Seven percent of the survivors said they had never been sexually active.


Help For Survivors

If you’re experiencing a sexual issue and think it might be related to childhood cancer, please talk to your doctor. Treatments are available and your healthcare provider can help you decide which is best for you.

If you’re in a relationship, be open with your partner about your feelings and concerns. Chances are, he or she will be supportive and work with you on these issues so that you can build a stronger relationship.

Print this article or view it as a PDF file here: Sexual Function in Adult Childhood Cancer Survivors


American Society of Clinical Oncology (ASCO) (

“Late Effects of Childhood Cancer”

(July 2013)

The ASCO Post

Stenger, Matthew

“Poorer Psychosexual Functioning in Adult Female Survivors of Childhood Cancer”

(August 21, 2014)

Journal of Clinical Oncology

Ford, Jennifer S., et al.

“Psychosexual Functioning Among Adult Female Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study”

(Abstract. Published online before print: August 11, 2014)

The Journal of Sexual Medicine

Bober, Sharon L., PhD, at al.

“Sexual Function in Childhood Cancer Survivors: A Report from Project REACH”

(Full-text. First published online: May 16, 2013)

Sex Health Blog

Androgen Deprivation Therapy (ADT) for Prostate Cancer

Sep 04, 2014

Androgen Deprivation Therapy for Prostate CancerIf you or someone you care about has been diagnosed with prostate cancer, it can be an unsettling time. There’s so much to learn while you cope with feelings of uncertainty and anxiety.

Treatment options can be confusing, too. Of course, your doctor is the best person to advise your course of treatment. However, you might see reports in the media about the pros and cons of different types of treatment.

In July, JAMA Internal Medicine, a journal published by the American Medical Association, published an article on survival outcomes for men with prostate cancer who undergo androgen deprivation therapy (ADT). The authors said that when given on its own, this therapy did not improve survival rates for men with localized prostate cancer. (This means the cancer is confined to the prostate gland and has not spread to other parts of the body. Nowadays, about 90% of new prostate cancer diagnoses are localized.)

In this post, we’ll go over the basics of ADT and the concerns of the study authors.


What are androgens?

First, let’s talk about some terminology. What, exactly, are androgens?

Androgens are male hormones, such as testosterone. They give men their male sex characteristics, such as a facial hair and a deeper voice. They’re also important for a man’s sex drive.

These hormones are primarily made by the testes, but the adrenal glands produce them, too.

The problem with androgens is that they help prostate cancer cells grow.

Androgen deprivation therapy, sometimes called hormone therapy or androgen suppression therapy, is designed to either stop the body from producing androgens or stop androgens from reaching prostate cancer cells.


How is ADT administered?

There are a few ways to administer ADT. Some methods are used alone and some are used with other types of treatment.

·         Removal of the testes. In a procedure called an orchiectomy, the testes are surgically removed. As a result, androgen levels decrease considerably, giving prostate cancer cells less “fuel.”

·         Drugs that lower androgen levels. Drugs such as luteinizing hormone-releasing hormone (LHRH) analogs and luteinizing hormone-releasing hormone (LHRH) antagonists work to decrease the amount of testosterone produced by the testes.

·         Anti-androgens. These drugs prevent androgens from binding to androgen receptor cells, a process needed for androgens to do their jobs. If androgens can’t bind to the receptor cells, they can’t spur the growth of prostate cancer cells.


What are some side effects of ADT?

Unfortunately, ADT can have many side effects, including erectile dysfunction, loss of sex drive, osteoporosis, fatigue, and depression.

Other side effects are weight gain, weaker muscle tone, and diabetes. Some men develop metabolic syndrome, which can include high blood pressure, high blood sugar, high cholesterol, and excess body fat.

Some of these effects can be treated or managed. Your doctor can give you more information.


Is ADT right for all men with prostate cancer?

The short answer to this question is “not necessarily.” Other treatments, such as surgery or radiation, might be more appropriate. Much depends on a patient’s health status and the stage of his cancer. A doctor can determine what is best for the individual.

Some scientists, such as the authors of the JAMA Internal Medicine study mentioned above, are concerned that ADT may not be helpful for men with localized prostate cancer, especially when the side effects are taken into account.

This conclusion is based on a study of over 66,000 men aged 66 or older with localized prostate cancer. After following the men for an average of 110 months, they found that primary ADT – given on its own without other types of treatments – was not associated with improved overall long-term survival rates or prostate-cancer-specific survival rates.

Researcher Dr. Grace L. Lu-Yao of the Rutgers Cancer Institute of New Jersey told The New York Times, “There are so many side effects associated with this therapy, and really little evidence to support its use. I would stay that for the majority of patients with localized prostate cancer, this is not a good option.”


What should men do?

If you are concerned about androgen deprivation therapy, be sure to talk to your doctor. He or she can tell you more about the reasons for using it (or not), which side effects might occur, and how you can handle them if they do.

Please click here to learn more about prostate cancer.  

Print this article or view it as a PDF file here: Androgen Deprivation Therapy for Prostate Cancer


American Cancer Society

“Hormone (androgen deprivation) therapy for prostate cancer”

(Last revised: March 12, 2014)

JAMA Internal Medicine

Lu-Yao, Grace L., MPH, PhD, et al.

“Fifteen-Year Survival Outcomes Following Primary Androgen-Deprivation Therapy for Localized Prostate Cancer”

(Full-text. Published online: July 14, 2014)

The New York Times – Well Blog

O’Connor, Anahad

“Study Discounts Testosterone Therapy for Early Prostate Cancer”

(July 14, 2014)

Sex Health Blog

Exercise and Men’s Sexual Health

Aug 20, 2014

Exercise and Men’s Sexual HealthMen, how much do you exercise? Every day? Twice a week? When the mood strikes you? Rarely?

Would you be inspired to exercise more if we told you it could improve your sex life?

Now before you run off to the gym, let’s talk about some of the reasons exercise is good for sex and the types of exercise that can help men the most.


How Does Exercise Improve a Man’s Sex Life?

Here are some of the ways:

·         Better overall health. Combined with other healthy lifestyle habits like eating well, getting enough rest, and not smoking, exercise keeps our bodies in good shape overall. In turn, this helps us avoid medical conditions that can interfere with sex, such as obesity, diabetes, heart disease.

·         Better blood flow. Exercise keeps your blood pumping and your circulatory system strong. This is especially important for erections, since firmness depends on good blood flow to the penis.

·         Increased testosterone. Some types of exercise, such as weight lifting, has been found to raise testosterone levels. Testosterone is an important male sex hormone and plays a role in sex drive and erections.

·         Stamina and endurance. Have you ever exhausted yourself during sex to the point that you couldn’t continue? Getting more exercise might improve your stamina so that you can keep going.

·         Flexibility. Exercise helps you move freely with less pain. This can be a plus when you and your partner are trying different positions.

·         Improved self-esteem. When you’re fit and looking good, your confidence builds, allowing you to feel more relaxed in the bedroom.

·         Less depression and anxiety. Many sexual issues, like lack of desire, stem from depression and anxiety. Exercise may improve your mood. In addition, the endorphins released through exercise can calm us down and give us a sense of well-being.

·         Togetherness. Exercising together could help you bond with your partner.

·         Higher sperm count. If you and your partner are trying to conceive, increased exercise might increase your sperm count.


Types of Exercise

Just about any type of exercise can help. But the following types of exercise could be especially beneficial for your sexual health:

·         Weight-lifting

·         Push-ups

·         Sit-ups

·         Crunches

·         Lunges

·         Yoga

·         Swimming

·         Brisk walking or running

·         Kegel exercises

·         Dancing

·         Rowing


Before you start any exercise program, talk to your doctor. He or she can help you decide what type of exercise is best for you.

Print this article or view it as a PDF file here: Exercise and Men’s Sexual Health


Sheehan, Jan

“5 Exercises Men Can Do for Better Sex”

(Last updated: March 13, 2012)

“Exercises for sex”

(April 20, 2005)

Freeman, Shanna

“10 Exercise Tips for a Better Sex Life”

(November 9, 2010)

Shealey, Greg

“Can exercise improve your sex life?”

(July 21, 2010)

Sexual Medicine Society of North America

“Exercise and Sex Health”


Briley, John

“Exercise for Better Sexual Health”

(Reviewed: June 28, 2013)

Sex Health Blog

High Blood Pressure and Sexual Problems

Aug 06, 2014

High Blood Pressure and Sexual ProblemsYou probably know it’s important to keep your blood pressure under control. High blood pressure (also called hypertension) can lead to all sorts of health problems, including coronary heart disease, heart failure, stroke, and kidney failure.

But did you know that high blood pressure can cause problems in your sex life, too?

What is High Blood Pressure and How Can it Affect Sex?

As blood travels through your arteries, it exerts a certain amount of force along the arterial walls. This force is blood pressure. The higher your blood pressure, the more force your blood exerts against these walls.

Over time, high blood pressure can damage the linings of your blood vessels, leading to plaque buildup and atherosclerosis – hardening of the arteries. When this happens, blood has a harder time flowing to essential parts of the body.

Since blood flow to the penis is an important mechanism for erection, many men with high blood pressure develop erectile dysfunction, which means they can’t get or keep an erection firm enough for sex.

Men with high blood pressure might have problems with ejaculation and desire, too.

Reduced blood flow to the genitals can also be an issue for women, interfering with desire, arousal, vaginal lubrication, and orgasm.

Anxiety over high blood pressure and its associated health problems can affect with the sex lives of both men and women, especially if it weakens relationships. Couples may have less desire for sex. Or they may not feel sexually satisfied.


Sexual Side Effects of Blood Pressure Medications

Unfortunately, medications used to treat high blood pressure can cause sexual problems themselves. For example, diuretics (water pills) can reduce blood flow to the penis and lower levels of zinc, which a man’s body needs to make testosterone. Beta blockers are another type of blood pressure drug that can have sexual side effects.

If you think your medication is causing sexual problems, don’t hesitate to talk to your doctor. It might be possible to adjust your dose or change the drug you take. Don’t make any changes without a doctor’s guidance, however.


Manage Your Blood Pressure

There are many steps you can take to lower your blood pressure and keep it at a healthy level. Sometimes, all it takes is changing your lifestyle a bit:

  • Eat a healthy diet that includes fruits, vegetables, and whole grains. You might also consider fat-free or low-fat dairy products, fish, and nuts. Keep red meat, added sugars, and alcohol to a minimum.
  • Cut back on salt and sodium. The National Heart, Lung, and Blood Institute recommends no more than one teaspoon of salt each day. Check the sodium content of the foods you eat. Remember, processed foods tend to be high in sodium.
  • Keep your weight under control. Being overweight increases your risk for high blood pressure.
  • Exercise regularly. Talk to your doctor about a fitness plan that’s right for you.
  • If you smoke, quit. Avoid secondhand smoke as well.
  • Reduce your stress levels. Blood pressure can rise when we’re excited or stressed. Find ways to relax and try not to overextend yourself with commitments. Ask your friends and family for help if you need to.

Your doctor can help you with these strategies and suggest others tailored to you. If you need medication, be sure to take it as directed.

Print this article or view it as a PDF file here: High Blood Pressure and Sexual Problems


American Heart Association

“Sex and High Blood Pressure”

(Updated: April 23, 2013)

Mayo Clinic

“High blood pressure and sex: Overcome the challenges”

(December 7, 2012)

National Heart, Lung, and Blood Institute

“What Is High Blood Pressure?”

(August 2, 2012)

Sex Health Blog

Sexual Health Among Bisexual Men

Jul 23, 2014

Sexual Health Among Bisexual MenWhat are some of the sexual health challenges faced by bisexual men?

A study published online last month in The Annals of Preventative Medicine has shed some new light on that question. While bisexual men account for only 2% of the sexually active male population, cultural and social issues affect their sexual health in important ways.

Today, we’ll take a brief look at this research.

What is Bisexuality?

In general terms, bisexuality refers to a sexual or romantic attraction to both men and women. This attraction might not be divided equally, however. A bisexual person may feel stronger attraction to men than to women, or vice versa. Or, a person might be attracted to women for a certain period of time and to men for another duration.


The Study

The report was authored by Dr. William L. Jeffries, IV, of the U.S. Centers for Disease Control and Prevention (CDC). He analyzed relevant peer-reviewed research published between January 2008 and December 2013.

The study uses several acronyms, which we will retain here:

•              MSMW – men who have sex with men and women

•              MSM – men who have sex with men

•              MSW – men who have sex with women


Sexual Health Concerns

Dr. Jeffries noted a number of sexual health concerns:

•              About 12% - 21% of MSMW were infected with HIV.

•              MSMW were more likely than MSM to have an undiagnosed HIV infection, increasing the risk of transmitting the infection to male and female partners.

•              One study found that 21% of MSWM had been treated for a sexually-transmitted infection (STI) in the previous year, compared to 12% of MSM and 2.3% of MSW

•              Another study reported that MSMW were more likely to have their first sexual experience before the age of 14.

•              Forced sex was more common among MSMW than among MSM or MSW.

•              MSMW were more likely to have six or more partners in the past year.

•              Drug and alcohol use, which can lead to risky sexual behaviors, figured prominently in the sex lives of many MSMW.

•              Some MSMW do not use condoms if their female partner is on another form of birth control, raising the risk of HIV/STI transmission.


Sociocultural Factors

Dr. Jeffries also discussed how society and culture are involved with MSMW’s sexual health:

•              Biphobia. “Societal biphobia – negative attitudes and behaviors toward bisexual individuals – is more prevalent than anti-gay sentiment,” he explained. Living with biphobia can lead to social isolation, depression and anxiety. These conditions could increase the likelihood of substance abuse and risky sexual behaviors. MSMW might feel they need to have multiple sexual relationships to “prove” that bisexuality is a valid orientation.

Biphobia can also be found in the healthcare system. MSMW may be reluctant to see doctors or seek information or services for fear of how they will be treated by the medical establishment.

Relationships can be vulnerable to biphobia as well. Partners might not accept bisexuality, weakening the relationship. Intimate partner violence is also a possibility.

•              Economic issues. Financial stability and bisexual health were connected in many ways. For example, one study found that adolescent MSMW were more likely to skip school.  Another found that adult MSMW were less likely to have a bachelor’s degree when compared to MSM and MSW. These factors might affect career advancement and earning power.

The research showed that MSMW were more likely than MSM to lack health insurance, which can decrease the chances that their health concerns will be addressed.


What Can Be Done?

Understanding the issues facing bisexuals is key. Dr. Jeffries recommended culturally- and socially-appropriate interventions and education programs where MSMW feel safe and supported. He also encouraged healthcare providers to participate in sensitivity training so that MSMW will feel more comfortable accessing services.

It’s also important to consider the needs of MSMW of color, who may experience racism and have different views on masculinity.

Print this article or view it as a PDF file here: Sexual Health Among Bisexual Men


American Journal of Preventative Medicine

Jeffries, William L., IV, PhD

“Beyond the Bisexual Bridge

(Full-text. Published online: June 22, 2014)

Brown University Health Services

“Bisexual Health”

“Health Concerns for Bisexuals”


“Bisexual Men Face Unique Challenges to Their Sexual Health”

(Press release. June 23, 2014)

Sex Health Blog

Peyronie’s Treatments – Traction Therapy and VEDs

Jul 10, 2014

Peyronie’s Treatments – Traction Therapy and VEDsWhen considering treatment for Peyronie’s disease, there is a lot to think about. Will a man need surgery? Or will nonsurgical therapies work better?

We’ve discussed surgical treatments for Peyronie’s disease in the past. Today we’re going to look at two nonsurgical treatments – traction therapy and vacuum erection devices – that were recently discussed at the 2014 annual meeting of the American Urological Association.


What is Peyronie’s Disease?

Peyronie’s disease is a wound healing disorder. A man could injure his penis during sports activity, from energetic sex, or by an unknown cause. When the injury does not heal properly, areas of hardened scar tissue called plaques develop under the skin. These plaques make the penis lose some of its flexibility.

The hallmark of Peyronie’s disease is a curved penis. Sometimes this curve is slight and looks more like an indentation. But the penis could also take on a distinct curve or an hourglass shape. Men might experience penile shortening. Pain and erectile dysfunction are common in men with Peyronie’s disease, too.

For some men, intercourse is still manageable; for others, it is impossible. Not surprisingly, Peyronie’s disease can have some emotional consequences as well. Men might feel anxious or depressed and miss the easy intimacy they once shared with their partner.

Traction Therapy

In medicine, traction refers to the process of pulling a body part. The goal is to put that part back in the correct position so that it will stay there. Traction therapy for Peyronie’s disease involves the use of a special device that pulls the penis in the opposite direction of the curve. Men wear the device for several hours a day.

In 2013, Spanish researchers reported that a group of men undergoing traction therapy had good results, especially if they wore the device for more than six hours a day with thirty minute breaks every two hours. (Nine hours was the maximum time recommended). After traction therapy, the men’s curvature decreased and penis length increased. They also had less pain and better erections.


Vacuum Erection Devices

Vacuum erection devices, or VEDs, are sometimes used to treat erectile dysfunction. But they work for some men with Peyronie’s disease as well.

A VED includes a plastic cylinder, a hand- or battery-operated pump, and a constriction ring. To use a VED, a man places the plastic cylinder over his penis. He then uses the pump to create a vacuum, which improves the amount of blood flowing into the penis and creates an erection. The constriction ring is then placed at the base of the penis to keep the erection.

Recent Research

In May 2014, a group of scientists presented a comparison of traction therapy and vacuum erection devices in rats to attendees of the American Urological Association’s annual meeting in Orlando, Florida. Their experiment included fifteen rats which were divided into three groups. The first group underwent traction therapy. The second group received VED treatment. The third group had no treatment at all.

After eight weeks, the researchers found that the rats in the traction therapy group had less curvature compared to those in the other two groups. The rats in the VED group had better erectile function.

The researchers concluded that a combination of treatments “might be a good option” for men with Peyronie’s disease.

It’s important to remember that this research was conducted on rats, not humans. Scientists may examine the question again at another time.

The Future

Which treatment is best for you? Your urologist can best answer that question. Much depends on how severe your situation is and where you are in the disease process.

If you think you have Peyronie’s disease, talk to your doctor. It might feel awkward, but it’s an important step. (Please click here for tips on having this conversation.)

Print this article or view it as a PDF file here: Peyronie’s Treatments – Traction Therapy and VEDs


American Urological Association

Lin, Haocheng and Run Wang

“Comparison Of Vacuum Therapy and Penile Traction Therapy on Peyronie’s Disease Rat Model”

(Abstract presented at 2014 AUA annual meeting, May 2014, Orlando, Florida)


Association of Peyronie’s Disease Advocates

“Do I have Peyronie’s disease?”


BJU International

Raheem, Amr Abdel, et al.

“The role of vacuum pump therapy to mechanically straighten the penis in Peyronie’s disease”

(Abstract. First published online: April 23, 2010)




(Last updated: August 30, 2012)


Renal and Urology News

Charnow, Jody A.

“Nonsurgical Peyronie's Treatments Compared”

(May 19, 2014)


Sexual Medicine Society of North America

“Traction Therapy for Peyronie’s Disease”

“Vacuum Devices – Erectile Dysfunction”

Sex Health Blog

What is Asexuality?

Jun 24, 2014

What is Asexuality?Cara opened up her Facebook page and sighed. There was another post from her cousin, a photo of a cat in a knitted outfit with the caption “Instead of a hobby, we need to find you a boyfriend.”

Her cousin was always sending these sorts of photos. And trying to set her up on blind dates. The last time she declined, her cousin asked, “What’s wrong with you, anyway?”

Cara politely changed the subject. But inside, she wondered about herself. She didn’t feel like anything was particularly wrong. She just wasn’t interested in sexual relationships. At all.


In a society that values coupling off, she found it difficult to explain her situation to others. She felt like she was supposed to want sex. She wasn’t afraid of sex, didn’t feel revolted by it, and didn’t consider it immoral. In fact, she had had sex before. But she did so out of curiosity and an effort to please her partner. She didn’t feel inclined to do it again. It just wasn’t for her.

Eventually she realized what her truth was – Cara was asexual.

Asexuality can be a difficult concept to understand for those who are sexual, especially when sex drive is often considered one of the fundamental aspects of being human. In today’s post, we’ll talk a bit about what it means to be asexual.


What is Asexuality?

The Asexual Visibility & Education Network (AVEN) defines an asexual, in basic terms, as “a person who does not experience sexual attraction.” An asexual doesn’t think that sex is a bad thing. He or she just doesn’t feel compelled to have it.

The definition is fluid, however. It is not absolute. Consider the following:

·         Some asexuals experience romantic attraction and love and enjoy dating other asexuals or sexual people (sometimes called “sexuals.”) They just do not feel driven to have a sexual relationship.

·         For most asexuals, lacking sexual interest does not cause distress. Not having sex does not bother them.

·         Some asexuals do have sex because their partners want it. This may be an aspect of the relationship that the couple negotiates. Asexuals don’t necessarily dislike sex. They might just feel neutral about it.

·         Some asexuals do enjoy sex because of the intimacy they share with a partner. However, the enjoyment does not come from a drive to have sex.

·         Some asexuals do have sexual fantasies and masturbate because it brings them pleasure. However, these experiences stay in the realm of fantasy. They would not feel sexual if the fantasy were happening in real life.


A Spectrum

Like other aspects of sexuality, asexuality is a spectrum. Some asexuals have sexual feelings from time to time. For example, demisexuals feel sexual attraction only after they’ve formed an emotional bond with someone. A gray-asexual (also called gray-sexual or gray-a) feels sexual attraction very seldom, to a very small degree, or only in certain circumstances. In contrast, non-libidoists are asexuals that never have sexual feelings.

It’s also possible for a person to feel asexual a certain period of time, then sexual for another span of time.

As AVEN explains on its website, “There is no litmus test to determine if someone is asexual. Asexuality is like any other identity – at its core, it’s just a word that people use to help figure themselves out. If at any point someone finds the word asexual useful to describe themselves, we encourage them to use it for as long as it makes sense to do so.”

Print this article or view it as a PDF file here: What is Asexuality?



The Asexual Visibility & Education Network

“Family/Friends FAQ”

“General FAQ”


“Relationship FAQ”

The Atlantic

Hills, Rachel

“Life Without Sex: The Third Phase of the Asexuality Movement”

(April 2, 2012)

Psychology Today

DePaulo, Bella, PhD

“ASEXUALS: Who Are They and Why Are They Important?”

(December 23, 2009)


Decker, Julie Sondra

“How to Tell If You Are Asexual”

(June 18, 2014)

Sex Health Blog


Jun 11, 2014

SexsomniaYou’ve probably heard stories about unusual things people do during sleep. Walking around the house, eating snacks, and even driving have all been reported. But how about having sex?

It does happen. People with sexsomnia (also called “sleep sex”) have been known to masturbate, fondle a partner, engage in oral sex, and even have intercourse while fast asleep. And most have no recollection of these acts when they wake up.

Today we’ll take a closer look at sexsomnia, its repercussions, and ways to manage it.


What is sexsomnia?

Sexsomnia can occur at any time during the sleep cycle, but usually happens during the first few hours. Sometimes, it happens more than once during the night. It appears to affect more men than women.

Like sleepwalking, sexsomnia is classified as a parasomnia, which is an umbrella term for abnormal behaviors that take place during sleep. According to the National Sleep Foundation, about 10% of Americans have some type of parasomnia.

The term “sexsomnia” was coined by Canadian researchers, who in 2003 described several cases in The Canadian Journal of Psychiatry. For example:

·         While visiting his aunt and uncle, a 16-year-old boy fondled his uncle’s testicles while asleep. The boy had a history of sleepwalking and had once downloaded online pornography during sleep as well.

·         A 26-year-old man sought treatment because he was having sex with his girlfriend while asleep.

·         A man woke up repeatedly during the night because his wife was masturbating.

The study also describes cases involving sexual assault and the sexual touching of children. Sexsomnia is sometimes used as a defense in legal proceedings.


What are the risk factors for sexsomnia?

Experts aren’t sure what causes sexsomnia, exactly. But there are some risk factors:

·         Other parasomnias. Often, people with sexsomnia have other parasomnias. For example, they may sleepwalk or binge eat while sleeping.

·         Family history of parasomnias. These types of sleep disorders can run in families.

·         Sleep deprivation. Episodes of sexsomnia may be more frequent when a person needs more sleep.

·         Obstructive sleep apnea. People with obstructive sleep apnea repeatedly stop breathing for short periods during sleep.

·         Drug and alcohol abuse. For some, episodes are more likely after the consumption of drugs or alcohol.

·         Side effects of other medications.


What can be done?

For some couples, sexsomnia isn’t a big deal. There are partners who don’t mind having their own sleep interrupted for an unexpected rendezvous, even if the initiator won’t remember it.

However, sexsomnia usually has a negative impact on partners and other household members, who become sleep deprived when their own sleep patterns are disrupted. Anxiety over sexsomnia, wondering when the next episode will occur, can make it difficult for others to fall asleep or stay asleep. And when sexsomnia leads to assault, the repercussions are much more serious.

Many patients with sexsomnia feel tremendous embarrassment, guilt, and anxiety. They do not intend to act out sexually.

Sometimes, improving sleep hygiene can take care of the situation. Sticking to a sleep schedule by going to bed and waking up at the same time every day is a good first step. It also helps to have a relaxing bedtime ritual that puts you in the right frame of mind for sleep. Getting enough sleep and managing stress and anxiety are also important. On occasion, antidepressants are prescribed for patients with sexsomnia.

If obstructive sleep apnea is the cause, a patient can be fitted with a special device that helps regulate breathing during sleep. This should promote more restorative sleep as well.

If drug and alcohol abuse are involved, appropriate treatment can be considered.

Above all, it’s important to consider the safety of others in the household. If there is concern about sexual assault, it might be necessary to lock bedroom doors or use a special alarm system, at least until the problem is under control.


Your Turn

Have you or someone you know ever had an episode of sexsomnia? What happened? How was the situation handled?

Print this article or view it as a PDF file here: Sexsomnia


The Canadian Journal of Psychiatry

Shapiro, Colin M., MD, et al.

“Sexsomnia—A New Parasomnia?”

(June 2003)

Myers, Wyatt

“What Is Sexsomnia?”

(Last updated: June 6, 2013)

Libbert, Lauren

“Sexsomnia: It sounds absurd but growing numbers of men claim to suffer from a syndrome that makes them try to have sex while asleep - can it be genuine?”

(October 26, 2011)


Williams, Scott G., MD and Christopher J. Lettieri, MD

“Sexsomnia: Clinical Analysis of an Underdiagnosed Parasomnia”

(May 4, 2012)

National Sleep Foundation

Schenck, Carlos H., MD

“Sleep and Parasomnias”

Psychology Today

Cline, John, PhD


(February 12, 2009)


“'Sleep Sex' Unromantic, Even Dangerous”


Sex Health Blog

Measuring Testosterone Levels for Men

May 28, 2014

Measuring Testosterone Levels for MenMen, have you ever had your testosterone levels checked?

Considering the media buzz about testosterone these days, many men wonder if they should.

We see news stories about testosterone replacement therapy and advertisements for testosterone boosting products that claim to make men feel young and virile again.

So it’s not surprising that men should have questions about testosterone testing. Today, let’s take a closer look.

What is testosterone?

Before we start talking about the test, let’s go over what testosterone is.

Produced by the testes (testicles), testosterone is the male sex hormone. It gives a man his male characteristics, such as facial hair and a deeper voice. It’s also important for his sex drive, erections, and sperm production.

As a man gets older, his testosterone levels start to decline in a natural process called andropause. Some men compare andropause to female menopause, but men’s testosterone declines are less dramatic than women’s declines in estrogen. Around age 40, men’s testosterone levels start to decrease about 1% each year.

How is testosterone classified?

Testosterone is categorized as “bound” and “free.”

About 98% of a man’s testosterone travels through the bloodstream “bound” to proteins called albumin and sex hormone binding globulin (SHBG). Binding to these proteins makes it easier for testosterone to travel to where it is needed in the body.

The remaining testosterone is considered “free” because it is not bound to any substance.

“Total” testosterone measures bound and free testosterone together. When doctors check testosterone levels, they usually look at total testosterone readings, as these are considered the most reliable.

Why might a doctor order a testosterone test?

When a man shows signs of low testosterone (also called hypogonadism), a doctor may suggest testing. Symptoms of low testosterone include fatigue, mood changes, depression, decreased libido, erectile dysfunction, and muscle weakness.

Testing might be ordered for men with fertility problems, as testosterone plays an important role in sperm production.

Also, men with osteoporosis often have their levels checked.

What is the test like?

The test itself is a simple blood test. It is usually performed in the morning, between 8 am and 11 am, when testosterone levels are highest. (Most testosterone is produced during sleep.)

What do the results mean?

This is difficult to answer. Every man is different and what is considered normal for one man might be high or low for another.

Certain factors can affect the results of testosterone tests. For example, levels fluctuate during the day. They can also be influenced by a man’s blood sugar, triglyceride levels, and the medications he takes.

Testing protocols can also vary from lab to lab. The types of collection tubes used and the ways the samples are stored can affect the final measurements.

Generally speaking, levels of total testosterone below 300 ng/dL are considered “low.” Your healthcare provider can help you understand what your results mean for you as an individual.

Looking at the Whole Picture

If you believe you have low testosterone, see your doctor. Symptoms of low testosterone, such as low sex drive and tiredness, can have a number of different causes. Getting a thorough checkup with the doctor is the first step in pinpointing those causes so they can be treated effectively.

Above all, don’t try to diagnose yourself with low testosterone. Some men feel awkward discussing symptoms with their doctor and try to self-treat by using over-the-counter testosterone products. This is unwise. (Click here to learn more about the risks of these products.)

Your Turn

Have you had your testosterone levels checked? If not, do you plan to? Feel free to tell us in the comments.

Print this article or view it as a PDF file here: Measuring Testosterone Levels for Men


International Society for Sexual Medicine

“Standardization in Diagnosing Low Testosterone”



(Updated: March 22, 2012)

Renal and Urology News

Charnow, Jody A.

“Early AM Best for Measuring Testosterone in Younger Men with ED”

(February 17, 2014)

Sexual Medicine Society of North America

“Conditions – Low Testosterone”

“Free and Total Testosterone”

“Overview – Low Testosterone”

“Testosterone and Sleep”



(Last updated: May 17, 2012)

Sex Health Blog

Gender Definitions: Transsexual and Transgender

May 13, 2014

Gender Definitions: Transsexual and TransgenderWhen it comes to gender, definitions can be confusing.

On the surface, it sounds like it should simple. Take biological gender, for example. It’s easy to say that males have penises and females have vaginas. But is that necessarily true?

Not at all. For example, a baby can be born a genetic female but without a fully-formed vagina (a condition called vaginal agenesis). Children with androgen insensitivity syndrome are born as genetic males, but their bodies don’t respond to male hormones as they should, which can give them female characteristics. (Click here to learn more about disorders of sex development.)

Gender has social and cultural aspects as well. For example, cultural traditions may lead us to think that boys play with trucks and girls play with dolls. But that’s not always the case. And such roles change over time. As recently as the 1960s, some newspapers in the United States divided their employment classified ads into “jobs for men” and “jobs for women.” That isn’t common today and many men and women take on professions that, at one time, were not considered appropriate for their gender.

Also, some people consider themselves as bi-gender (switching gender roles based on a situation) or genderfluid (feeling more male or more female at certain times).

So, as we see, gender isn’t as simple as it may seem. In many cases, gender is up to the individual.

Transgender and Transsexual

Transsexual or Transgender?Two terms that often give people pause are transgender and transsexual. What is the difference? Or are they one and the same?

The answer is complex and, again, depends on how people see themselves.

Generally, the term transgender is used to describe people whose gender expression or gender identity is different from their biological gender. For example, a biological male may feel that he is really meant to be a woman. He might decide to dress as a woman or asked to be called by a female name, expressing his gender in ways that work for him.

A person who physically transitions from the gender of birth to the other – male to female or female to male – is often considered transsexual. Such a transition might be done with hormone treatments and/or surgery. Transsexual is a more specific term than transgender. Not all transgender people decide to physically change their gender.

These definitions are open to interpretation, however. And they can mean different things to different people. For example, a person who has transitioned from male to female may call herself a woman rather than a transsexual person. Another may feel that the word transsexual should not always imply a physical or surgical change.

Which Term Should I Use?

The easiest way to answer this question is to ask the person directly. What does he or she prefer? What pronoun does he or she use? Is his or her gender identity situational? If you feel these questions are too personal, you can try following the person’s lead.

Your Turn

What words do you use to describe your gender? Feel free to leave us a comment and tell your story.

Print this article or view it as a PDF file here: Gender Definitions: Transsexual and Transgender



“GLAAD Media Reference Guide - Transgender Glossary of Terms”

Medical Daily

Scutti, Susan

“What Is The Difference Between Transsexual And Transgender? Facebook’s New Version Of ‘It’s Complicated’”

(March 17, 2014)

Montreal Gazette

Page, Jillian

“Transsexual vs. Transgender: What’s the Difference?”

(January 3, 2013)

Planned Parenthood of the Heartland

“Transgender Identity”

University of Colorado Denver – Women’s Resource Center

“Fact Sheet: Transgender, Transsexual, and Intersex”

Sex Health Blog

Drugs and Low Libido (Part 2)

Apr 30, 2014

Drugs and Low Libido (Part 2)Two weeks ago on the SexHealthMatters blog, we discussed three types of drugs that can decrease a person’s sex drive: antidepressants, birth control pills, and finasteride (a drug that can treat an enlarged prostate or male-pattern hair loss.)

We’d like to continue that conversation today with some more examples of libido-lowering medications. If you take one of these drugs and feel your sex drive isn’t as strong as it used to be, talk to your doctor. Sometimes, all it takes is a change in the medication or the dosage. (Do not make medication changes on your own, however. Some drug regimens need to be adjusted gradually. Be sure to follow your doctor’s instructions.)

It’s also important to remember that dips in sex drive can have other causes. Your medication may not be entirely to blame. Hormonal changes, stress, fatigue, and anxiety can all interfere with your libido. Your doctor can assess your symptoms and help you determine whether your problems stem from medication or from something else.

Now, let’s take a brief look at some other medications – aside from antidepressants, birth control pills, and finasteride - that can lower libido:

  • Opioids. These pain-killing drugs, which include hydrocodone, oxycodone, morphine, and codeine, have been found to lower testosterone levels in men. (Testosterone is a hormone responsible for sex drive in both men and women.) Opioids can be short-acting or long-acting. Short-acting opioids release medication quickly and long-acting opioids take more time. While both types can lower testosterone, this effect is more common in the long-acting variety. (Click here to learn more.) Opioids can affect libido in women, too.
  • Antipsychotics. These medications may be used to treat mental health conditions like schizophrenia and bipolar disorder. Older forms of antipsychotics have been associated with low sex drive. Fortunately, newer forms that don’t affect libido as much are now available.
  • High blood pressure medications. High blood pressure itself can lower sex drive for both men and women. However, sometimes medications used to treat it don’t help. For example, diuretics (water pills) can lower levels of zinc in the body. Zinc is needed for testosterone production. Beta-blockers can decease testosterone levels as well as make a person feel too “out of it” for sex.
  • Benzodiazepines. Sometimes called “tranquilizers,” benzodiazepines may be prescribed for anxiety, insomnia, seizures, alcohol withdrawal, or panic attacks. They can make a person too sedated to have much interest in sex. They are also thought to impair the production of testosterone.

Please note that while our two posts on libido-lowering drugs cover many common examples, other drugs may also have this effect. And it’s possible for drugs to have other sexual side effects, such as erection problems for men and vaginal lubrication difficulties for women.

It’s difficult to know how a medication will affect you. When you start with a new drug, be sure to read the detailed leaflet that comes in the package. This leaflet can answer many of your questions about side effects. Your doctor or pharmacist can also address your concerns, so don’t hesitate to ask.

Your Turn

Have you ever taken a drug that decreased your sex drive? What did you do? Feel free to leave a comment and share your story.

Print this article or view it as a PDF file here: Drugs and Low Libido (Part 2)



Neel, Jr., Armon B., MD

“7 Meds That Can Wreck Your Sex Life”

(April 25, 2012)

Gardner, Amanda

 “Low Libido? 11 Drugs That Affect Your Sex Drive”,,20788030_1,00.html

Isaacs, Nora

“What to Do When Pain Medication Is Dulling Your Sex Life”

(Last updated: April 9, 2008),,20189376,00.html

“Are You Depressed, Taking Antidepressants and Losing Your Libido? What You Can Do About It”

(March 2, 2009)


Woolston, Chris, MS

“Medicines and Sex: Not Always a Good Mix”

(Last updated: March 11, 2014)

International Society for Sexual Medicine

“What medications might lower a person’s libido?”

Mayo Clinic

“Beta blockers”

(February 1, 2014)

“High blood pressure and sex: Overcome the challenges”

(December 7, 2012)

Medical News Today

“What Are Benzodiazepines? What Are The Risks Of Benzodiazepines?”

(July 4, 2013)

National Institute of Mental Health

“Mental Health Medications”

Sexual Medicine Society of North America

“Opioids and Low Testosterone”

Sex Health Blog

Drugs and Low Libido (Part 1)

Apr 16, 2014

When your sex drive plummets, it can be difficult to pinpoint why. Could it be low testosterone? Fluctuating hormones due to pregnancy or menopause? Fatigue or stress from a new job? Anxiety or depression? All of these factors can contribute to low libido. So can certain medical conditions like diabetes and cancer.

Another question you might consider is this: Could it be the medications I’m taking?

When you start a new prescription drug, you might be more concerned about side effects like drowsiness or nausea. But many prescription drugs have sexual side effects, including low sex drive.

Today, we’ll take a look at three different types of drugs that have been linked to low libido.


Depression itself can decrease a person’s sex drive. Unfortunately, medications used to treat it do not always help matters. Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants can have sexual side effects.

What can you do? Talk to your doctor about a change in medication. Other types of antidepressants may work better for you. Changing the dose might also help.

However, don’t make any medication changes without talking to your doctor first. Some drugs need to be stopped gradually, under a doctor’s guidance.

Exercise might help, too. A recent study in the journal Depression and Anxiety found that for a group women on antidepressants, exercising helped alleviate sexual side effects. Women who exercised shortly before having sex appeared to have the best results. (Read more here.)

Birth Control Pills

The effect of birth control pills on a woman’s sex drive can be complicated. Some women find they lose interest in sex. Other women actually see their libidos increase.

Some experts believe that birth control pills hinder the production of testosterone in women. Testosterone is a sex hormone usually associated with men, but women’s bodies produce it as well. And it does play a role in sex drive.

However, a 2013 study in The Journal of Sexual Medicine found that this role is unclear.

In the study, researchers analyzed two types of birth control pills. One type of pill was thought to have less of an effect on testosterone; the other was not.

The study participants were women who believed their low sex drive was triggered by the birth control pill they used. The women were randomly assigned to take one of the two pills under investigation for six 28-day cycles.

At the end of the study, the researchers discovered that both treatment groups had improved sexual function. This lead them to question whether testosterone was the culprit.

Women who suspect they have sexual side effects from birth control pills are encouraged to see their doctor. Another type of pill might be more suitable. Or, women might need to change to a nonhormonal method of contraception, such as intrauterine devices (IUDs) or condoms.

Finasteride (Proscar and Propecia)

The third type of medication we’ll talk about today is prescribed to men. Both contain the active ingredient finasteride, but in different amounts and for different purposes. Proscar is used to treat problems caused by an enlarged prostate. Propecia is intended for patients with male-pattern hair loss.

Both drugs have been associated with decreased libido and erectile dysfunction, which may last even after patients stop taking the drug. Some men who take Propecia also have trouble with ejaculation and orgasm.

Men who feel their sexual problems may be caused by Proscar should speak to their urologist. There may be other medications and treatment avenues to explore for an enlarged prostate.

Men who take Propecia may consider other hair loss treatments if low libido becomes an issue.

Your Turn

How about you? Has a medication ever affected your libido? If so, what did you do about it? Feel free to tell us your story in the comments.

Print this article or view it as a PDF file here: Drugs and Low Libido (Part 1)


Gardner, Amanda

 “Low Libido? 11 Drugs That Affect Your Sex Drive”,,20788030_1,00.html

“Are You Depressed, Taking Antidepressants and Losing Your Libido? What You Can Do About It”

(March 2, 2009)

International Society for Sexual Medicine

“What are some common sexual side effects of oral contraceptives (birth control pills)?”

“What should a woman do if she thinks oral contraceptives are causing sexual problems?”

Sexual Medicine Society of North America

“Exercise Helps Women With Antidepressant-Induced Sexual Side Effects”

(January 22, 2014)

“FDA Announces Sexual Side-Effects Labeling Changes for Two Drugs”

(July 13, 2012)

Sex Health Blog

Gender Dysphoria in Children

Apr 02, 2014

Back in January, we wrote about gender dysphoria, a situation in which a person feels uncomfortable with or distressed about the gender of birth, preferring to live as the opposite gender. (Gender dysphoria is sometimes called “gender identity disorder” and a common adjective is “transgender.”) Our post discussed ways that adults manage their gender identity.

Some decide to live as their desired gender. For example, a man may dress as a woman or ask others to use his preferred female name. Others undergo cross-sex hormone therapy to suppress the secondary sex characteristics of their biological gender and promote the characteristics of their preferred gender. Some choose to have gender-reassignment surgery (a “sex change operation”), which could involve removing or creating breasts and genitalia.

But what happens when children feel they’ve been born in the wrong gender?

It’s unclear just how many children feel this way. And it’s not a situation that is openly discussed that often.

Gender dysphoria in children presents challenges to families. Today, we’ll discuss these briefly.

Challenges for Children

Transgender children are usually very clear about which gender they’re meant to be. They know which gender feels “right” to them.

But “right” is sometimes difficult to assert in a world that expects them to look and act according to their biological gender. If they have been living as their biological gender for several years and decide to start living as the opposite gender, they may find the following:

·         Unacceptance. Transgender children may find that their friends don’t understand where they’re coming from. Some parents may no longer allow their children to play with a transgender child. In addition, some sports teams and school clubs might not allow the child to participate as the desired gender. For example, a biological girl who wants to be a boy may still be expected to wear a traditional girl’s bathing suit on the swim team.

·         Frustration with their biology. A biological boy who wants to be a girl might be distressed when the voice deepens or when facial hair appears. A biological girl who wishes to be a boy may find menstruation especially upsetting.

·         Bullying. Transgender children are often teased, ridiculed, or bullied.

·         Anxiety and depression. Not surprisingly, all of the above can contribute to overwhelming anxiety and depression. Counseling is recommended for many transgender children.

Challenges for Parents and Guardians

Parents and guardians of transgender children are often faced with difficult questions:

·         Should I let my child live as the preferred gender? If so, what is the best way to do this? And when should it happen?

·         How can I explain this to our other children, our extended family, our friends, and our community? How can I help them understand?

·         What will happen at school? Will my child be accepted? Will teachers and administrators be accommodating?

·         Will my child be teased or bullied? How can I help him or her cope if it happens?

·         What will happen when my child reaches puberty?

·         Should we consider “puberty blockers”? These are special medications that suppress the changes of puberty. Many parents see puberty blockers as a way of buying time as the child makes decisions about gender identity. Puberty blockers are reversible. If they are stopped, the child will go through the puberty of the biological gender.

·         Should we consider hormonal treatment later on? (Older children might take hormones to facilitate their gender transition.)

·         What if my child wants gender-reassignment surgery?

·         While I love my child, I feel a sense of loss for my biological son or daughter. Is this normal? How can I work through these feelings?

·         Will my child decide to “go back” to his or her biological gender? If so, what happens then?

What Should Families Do?

Every child is different and every family goes on its own journey. Still, if you feel that your child might be transgender, there are some steps you can take:

·         Talk to your pediatrician. He or she can help you assess your child’s behavior, guide you on next steps, and refer you to appropriate professionals, such as therapists or endocrinologists.

·         Talk to other families with transgender children. Look for support groups either in person or online. Talking to others who share your experience can help you cope with situations like loneliness, bullying, school policies, and helping siblings adjust. Other families can also suggest helpful resources, such as websites, DVDs, or print materials that can help you learn more.

·         Most of all, support your child. Make sure your child knows that he or she is loved, respected, and safe. If you think your child is experiencing anxiety or depression, be sure to seek professional help.

Your Turn

Have you had any experiences with a transgender child? What happened? Feel free to tell us your story in the comments.

Print this article or view it as a PDF file here: Gender Dysphoria in Children


American Academy of Pediatrics

“Gender Identity and Gender Confusion In Children”

(Last updated: May 11, 2013)

Gender Spectrum

“Frequently Asked Questions”

The Kansas City Star

Adler, Eric

“ ‘I am a girl’: Transgender children face a society slow to accept them”

(February 8, 2014)

New York

Green, Jesse


(May 27, 2012)

Spiegel, Alix

“More Children Struggle With Gender Identity Disorder”

(February 21, 2012)

Sexual Medicine Society of North America

“Gender Dysphoria”

(January 22, 2014)

The Washington Post

Dvorak, Petula

“Transgender at five”

(May 19, 2012)

Sex Health Blog

Can Pornography Improve a Sexual Relationship?

Mar 19, 2014

What comes to mind when you think of pornography?

Can Pornography Improve a Sexual Relationship?Your first response to that question might be negative. For many of us, the word conjures up “dirty” film clips downloaded from the Internet or movies that used to be sold in a room behind a velvet rope at the video store.  It might make us think of the adult magazines sold behind the register at the convenience store or the books teenagers secretly pass around with the sexually explicit passages marked.

In other words, for many people, pornography is associated with shame and distaste.  But is that always true?

Some couples find that using pornography together improves their sex lives.

To be clear, we are not talking about pornography that depicts violent sexual acts or any acts that involve children.  Instead, we mean pornography as Merriam-Webster defines it: “the depiction of erotic behavior (as in pictures or writing) intended to cause sexual excitement.”  For this discussion, we mean couples using porn together to enhance their sex lives together.

Why Use Porn?

There are many reasons to consider using pornography in a sexual relationship.

·         It may add spice.  Sexually explicit images – whether on a screen or in the mind – can simply put couples in the mood.  It can also give them ideas to add to their own sexual repertoire, adding variety and excitement.

·         It can open dialogue.  Many couples feel uncomfortable discussing sex. Pornography may start a conversation each partner may long to have and provide an opportunity to share fantasies.  It might be easier to say, “You know that scene from the story we read last night? Want to try something like that?” than “I want to use handcuffs.”

·         It can help couples understand attraction. It’s human nature to be sexually attracted to someone who isn’t your partner. Using pornography can help one partner understand what attracts the other.  It may also make partner’s less likely to seek sexual variety outside of a committed relationship.


Before using pornography to enhance their sex lives, couples need to be open about their feelings and what they expect.  For some partners, pornography is not acceptable at all.  Others might prefer different types or different amounts.  For example, one partner might enjoy videos while the other prefers reading an erotic novel together.  One might want to watch a pornographic video during foreplay.  Another might want to watch it at a time when the couple is not being sexual.

As with other aspects of sexuality, communication is key.  Discussing when, how, and why to incorporate porn into their sexual experiences is critical to using it well.

Being honest can further a sense of intimacy that will enrich what happens in the bedroom. 

And, once they decide to use porn, partners should quickly address anything that makes them feel uncomfortable. For example, a woman may feel inadequate or worry that her partner is comparing her to a porn character. Her speaking up allows her partner to reassure her.

When Porn Becomes a Problem

While many couples find pornography to be beneficial, it can be a double-edged sword.  Too much pornography can make people have unrealistic expectations of their partners and their sexual activities. Their relationships can start to suffer and they might start to substitute pornography for real-life intimacy.

Pornography can lead to physical problems, too.  For example, men who masturbate while viewing pornography can develop erectile dysfunction and delayed ejaculation because they need that extra stimulation.  They may find that they need pornography in order to perform with a real-life partner.

If you or your partner has a problem with pornography, help is available.  Your healthcare provider can refer you to the appropriate specialist.

Your Turn

What do you think? Do you and your partner use pornography to enhance your relationship?  Has it made things better or worse?  Feel free to tell us more in the comments.

Print this article or view it as a PDF file here: Can Pornography Improve a Sexual Relationship?


Archives of Sexual Behavior

Daneback, Kristian, et al.

“Use of Pornography in a Random Sample of Norwegian Heterosexual Couples”

(Abstract. October 2009)

Huffington Post

Nelkin, Stacey

“5 Reasons Why Watching Porn Together Can Be Good For Your Relationship”
(March 7, 2013)

International Society for Sexual Medicine

“What are some effects of sustained pornography use?”

“What can be done to help someone who has a problem with pornography?”

Psychology Today

Kolod, Susan, PhD

“Fifty Shades of Porn”

(May 1, 2012)

Sexual Medicine Society of North America

“Fifty Shades of Grey Shines Light onto Sex Health”

(June 13, 2012)

Sex Health Blog

HSDD Infographic

Mar 04, 2014

Hypoactive sexual desire disorder (HSDD) can be a complicated condition. The prefix “hypo” means “under” or “lacking.” Women with HSDD are lacking sexual desire, to the point that they’re troubled about it. HSDD can cause women a great deal of anxiety and relationship stress. Unfortunately, some women are unaware of HSDD and don’t realize that they can seek treatment.

Not long ago, Sprout Pharmaceuticals developed this helpful HSDD infographic that includes some interesting facts. For example:

  • 10% of women have low sexual desire with distress.
  • 43% of women have some degree of sexual dysfunction, compared to 31% of men.
  • The brain is involved with HSDD. Other issues, like hormones and job stress, can contribute to it also.

We’ve covered HSDD extensively here on and thought it would be useful to round up this information so you (and your partner) can learn more.

If you think you might have HSDD, be sure to see your doctor. It may feel awkward to do so, but remember – your sexual health is an essential part of your overall health. It’s important to take care of yourself. 

HSDD Infographic

HSDD – The Basics

Overview - HSDD. It’s normal for women to lose interest in sex from time to time. What makes HSDD different is the distress it can cause.

Conditions - HSDD. Physical, psychological, and emotional conditions can all lead to HSDD. This post explains these links.

Diagnosing HSDD. How do doctors know when a woman has HSDD? Distress is a key concept, but it can be different for every woman.

Treating HSDD. HSDD treatment often involves dealing with causes. For example, a woman with diabetes may need to get her blood sugar under control. If a woman’s low desire stems from problems with her partner, couples counseling may be suggested.

Understanding HSDD. Targeted to healthcare providers, this article explains HSDD and offers guidance for clinicians who may not be well-versed in sexual medicine.

Do I Have HSDD?

Looking at HSDD. This blog post is for women with low sexual desire and explains why seeing a doctor can help.

Decreased Sexual Desire Screener. This questionnaire helps women assess their symptoms.

HSDD and the Brain

Female Sexual Health.  What is the most important sex organ in a woman’s body? The vagina? The clitoris? How about the brain?

Brain Activation Patterns in Women with HSDD. Scientists discovered that when shown sexually explicit images, the brains of women with HSDD react differently than those without HSDD.

HSDD and Brain Anatomy. Researchers have also found that women with HSDD have structural differences in the brain when compared to women without the condition.

HSDD and Partners

Talking About HSDD. HSDD can be difficult for partners to cope with and talk about. Many fear that they are no longer attractive to their female partner. This blog post helps partners better understand HSDD and provides tips for talking about it.

HSDD Treatment

Latest News on Lybrido/Lybridos. Clinical trials on two drugs designed to treat HSDD are underway. If the trials are successful, medication could be available by 2016.

Print this article or view it as a PDF file here: HSDD Infographic

Now it’s your turn. Have you or your partner ever had HSDD? How did you handle it? Was treatment successful? Feel free to tell us about your experience in the comments.

Sex Health Blog

Premature Ejaculation

Feb 19, 2014

Luke was nervous about his date with Stephanie. They had been out several times now. Every time he saw her, he sensed that they were getting physically closer. He found himself wondering what sex would be like with her. And he got a vibe from her that she was thinking along those lines, too. Tonight could be the night.

There was a problem though. In the past, Luke had had problems with premature ejaculation (PE). He couldn’t last much more than a minute before he climaxed. He worried that he disappointed past partners because of it. The situation embarrassed him and was very concerned about Stephanie’s reaction if it happened with her.

Luke isn’t alone. PE is estimated to affect between 3% and 30% of men. In more specific terms, PE occurs when a man ejaculates before he and his partner wish it to happen. That time frame can vary depending on the couple, but many definitions use one to two minutes as a guideline.

Unfortunately, PE can make men quite insecure. They may feel ashamed and awkward. They may fear being ridiculed or perceived as inexperienced, too eager, or lacking self-control.

Many men with PE are too embarrassed to seek help and too distressed to discuss the situation with a partner. Some single men avoid relationships because they’re afraid of a partner’s response.

But a study from last year could put men’s minds at ease.

In January 2013, the Archives of Sexual Behavior published a study that involved 461 men with PE and 80 partners. Using an online questionnaire, the researchers surveyed the participants about their experiences with PE, their levels of distress over it, and their sexual satisfaction.

The researchers found that the men were more distressed about PE than their partners were. The men also tended to think their partners were more distressed and dissatisfied than they actually were.

So men with PE can relax a little. But that doesn’t mean that PE isn’t a problem.

What can be done?

Here are some tips. Keep in mind that involving your partner with your treatment decisions can be helpful. Work together as a team.

  • See a doctor. PE can be treated. Sex therapy can help men better understand PE and the reasons behind it. Therapists can also suggest ways to develop ejaculatory control. They might assign “homework” – but that can be fun. Drug therapy may be another option. Topical medications, applied to penis before sex, can desensitize the penis – not so much you won’t feel sexual sensations, but just enough to put off ejaculation for a bit. Other drugs are taken in pill form and work on brain mechanisms associated with ejaculation. If you decide to take medication for PE, be sure to do so under a doctor’s care. Only a qualified physician can prescribe the appropriate medication for you.
  • Talk to your partner. It’s very possible that your partner is not bothered by your PE, or at least not as much as you think. Be open and honest. If you feel inadequate, say so. Chances are, your partner will reassure you. And remember, your partner is there to have a pleasurable sexual experience with you. Ejaculation is just one part of that experience. Don’t be afraid to discuss PE with a new partner. Sharing your feelings can go a long way in building trust and you might find yourself more relaxed, leading to a better experience for both of you.
  • Remember that PE is subjective. Every couple is different. There’s no definitive time frame for ejaculation and no reason to compare yourself to others. No matter when a man ejaculates, if both partners are satisfied, there’s no problem.

What do you think? Have you or your partner experienced premature ejaculation? How did you feel about it? Did it affect your relationship? Feel free to tell us your story in the comments.

Print this article or view it as a PDF file here: Premature Ejaculation


Archives of Sexual Behavior

Kempeneers, Philippe, et al.

“Functional and Psychological Characteristics of Belgian Men with Premature Ejaculation and Their Partners”

(Abstract. January 2013)

Everyday Health

Berman, Laura, PhD

“Must Read! 5 Men’s Sexual Health Breakthroughs of 2013”

(December 14, 2013)

International Society for Sexual Medicine

“Patient Information Sheet – Premature Ejaculation”

(December 2010)

Omololu, Wunmi

“Premature Ejaculation”

(Blog post. September 13, 2012)

Sex Health Blog

Modern Life and Sex

Feb 05, 2014

Do any of these scenarios sound familiar?

It’s 10:30 p.m. You and your partner are getting ready to retire for the night. Each of you has a tablet or smartphone. One of them beeps. “Was that you or me?” you ask.

You notice an email from an overseas client, who says he knows it’s late where you live, but if you could just answer one question, he could get on with the project that’s due this week. You respond, even though you have to look through some files to find the answer. You feel that if you don’t, your boss will be upset and you want to make sure you keep your job and your income.

In the meantime, your partner is texting with a friend from work, playing an online game, and watching funny videos. An hour passes before you finally turn out the light, but you keep the TV on. You and your partner are too tired to even talk, let alone have sex.

Or, imagine it’s midday. You have lunch with someone you’re dating, but you both check your phones multiple times before the meal is over. If you’re single and eating alone, you could be so involved with your phone that you don’t notice the prospective partner at the next table, who is trying to catch your eye.

These examples may be exaggerated. And, of course, it’s not just technology that consumes us. People have busy lives, with increased work expectations, child-rearing, caring for elderly relatives, and other daily responsibilities.

However, while technology keeps us connected to the world around us, does it physically disconnect us from our partner or from the opportunity to meet a new partner? What effect does that have on our sex lives?

It’s hard to measure and can vary from place to place, but a recent survey in Britain can give us some ideas.

In November 2013, the results of the National Survey of Sexual Attitudes and Lifestyles were announced. This survey takes place every ten years. The most recent survey covered the period of 2010 to 2012 and included men and women between the ages of 16 and 74.

The results showed that both genders are having sex less frequently than before. In previous surveys, which covered 1990-1991 and 1999-2001, both men and women were having sex over six times a month, on average. In the 2010-2012 survey, these rates dropped to fewer than five times per month.

Why did this happen? There could be many reasons, but recession and the Internet could be to blame, at least partially.

In an interview with the BBC, Dr. Cath Mercer of University College London explained, “People are worried about their jobs, worried about money. They are not in the mood for sex.”

She added, "But we also think modern technologies are behind the trend too. People have tablets and smartphones and they are taking them into the bedroom, using Twitter and Facebook, answering emails."

What can couples do? A reader named Elizabeth offered one solution in her comment to the BBC website:

We are first time parents and have a beautiful (unplanned) three-month-old daughter. She was a love child - the result of what was once an incredibly active sex life. Now, we haven't had sex in about five months. It hasn't impacted too much on our relationship - we are still happy and in love, but it's concerning. Neither of us are interested, for various reasons (mainly having a baby constantly attached to me!) but recently we've made an agreement that we need to spend less time on social media sites. We don't like the fact that our daughter has started to stare gormlessly into the screens of our lap tops and phones, and we hate the fact that we can spend almost a whole evening sat beside each other but interacting only with our computers. Maybe this change will help us to re-ignite our life between the sheets, who knows. But I can relate to what this article is saying about technology affecting peoples sex lives.

It’s important to remember that many factors influence how much we have sex. Health conditions, such as diabetes and arthritis, can take a toll on our sex lives. So can menopause and erectile dysfunction. Stress, anxiety, and fatigue cannot be ignored either. If you think a health condition may be contributing to sexual problems, be sure to see your doctor.

Also, one couple’s typical sexual frequency might be low for another. That does not necessarily signal a problem. It just means that each couple has different preferences. They need different amounts of sex to be happy.

What do you think? Has technology ever interfered with your sex life? Is there more to the story? Why do you think sexual frequency rates have dropped in Britain? Do you think rates have dropped in other parts of the world? Feel free to leave us a comment and share your view.

Print this article or view it as a PDF file here: Modern Life and Sex


BBC News

Triggle, Nick

“Modern life 'turning people off sex'”

(November 26, 2013)

The Independent

Withnall, Adam

“National sex survey: Distractions of modern life mean people have less sex”

(November 26, 2013)

The Lancet

“The Third National Survey of Sexual Attitudes and Lifestyles”

(November 26, 2013)

The Mirror

Adams, Sam

“Study finds Brits are 'too busy using Facebook and Twitter' or worrying about money to have sex”

(November 26, 2013)

National Surveys of Sexual Attitudes and Lifestyles


The Telegraph

Collins, Nick

“Britons having less sex in 21st Century”

(November 26, 2013)

Sex Health Blog

Gender Dysphoria

Jan 22, 2014

Not long ago, in the Did You Know? section of our website, we briefly discussed some ideas on gender identity. We talked about genderfluid individuals, who may feel masculine one day, feminine the next, and somewhere in between at other times. We also mentioned bi-gender people, who switch gender roles depending on the situation. For instance, a person may identify as a woman at work and as a man with family and friends.

Today, we’re going to go a step further and look at gender dysphoria (GD), sometimes called gender identity disorder. People with GD feel uncomfortable and distressed with the gender of their birth and identify strongly with the opposite gender. They often feel they were born the “wrong” sex.

Each person with GD handles it differently. Some relieve their distress by living as the opposite sex. For example, they may dress or behave in ways that are typical for their desired sex. They may ask to be called a different name and be treated as a member of the opposite sex.

Others feel that changing their bodies to align with their desired sex is especially important. They may feel that they aren’t meant to have a penis or vagina, facial hair or breasts. Making physical changes may be the way to make them feel comfortable with who they are.

One might think that a person in this situation might immediately seek gender-reassignment surgery (a “sex change operation”). For males transitioning to females, this might involve surgically removing the penis and creating a vagina and breasts. For women who wish to become men, it could mean a mastectomy (removal of the breasts) and phalloplasty (creation of a penis).

But not all people with GD have surgery. Some find that cross-sex hormonal treatment alone is sufficient for their goals. Such treatment can help suppress the secondary sex characteristics of the biological sex and promote the development of characteristics of the desired sex.

In a study published in the Journal of Sexual Medicine in December 2013, Italian researchers reported on their work with 125 individuals with GD who had not had gender-reassignment surgery. Some of the participants took hormones to aid their transition and some did not.

Sixty-six participants were undergoing a male-to-female transition. In this group, 42 patients were taking hormones, mainly estrogens (“female hormones”) and antiandrogens (hormones to suppress male characteristics). Twenty-four took no hormones.

Fifty-nine people were transitioning from women to men. Twenty-six were undergoing cross-hormone therapy (taking forms of testosterone) and 33 took no hormones.

Using a variety of assessment tools, the researchers learned more about the participants’ levels of distress and how uneasy or dissatisfied they felt with their bodies.

The results were different depending on the transition. In the male-to-female group, those who took hormones were more comfortable with their bodies than those who didn’t.

However, for people transitioning from female to male, there were no significant differences in body uneasiness between those who took hormones and those who did not.

Why? One possible explanation involves the degree of bodily change that hormones can deliver for this group. For example, people transitioning from male to female may find that hormones increase the size of their breasts, a desired effect. However, for those moving from female to male, hormones may not necessarily decrease the size of the breasts, leading to dissatisfaction.

What do you think? Have your or someone you know gone through cross-hormonal treatment for gender dysphoria? Did the treatment bring about the desired changes? Or was surgery the next step? Please feel free to tell us your story in the comments.

Print this article or view it as a PDF file here: Gender Dysphoria


The Journal of Sexual Medicine

Fisher, Alessandra D., MD PhD, et al.

“Cross-Sex Hormonal Treatment and Body Uneasiness in Individuals with Gender Dysphoria”

(Full-text. First published online: December 16, 2013)


“Gender Dysphoria Symptoms”

(Last reviewed: May 26, 2013)

Sexual Medicine Society of North America

“Gender Identity”


“Gender Identity Disorder”

(Reviewed on March 4, 2010)

Sex Health Blog

Low Sexual Desire in Men

Jan 09, 2014

Greg was losing his interest in sex and he couldn’t figure out why.

It didn’t make sense to him. After all, he was a guy. Wasn’t he supposed to want sex all the time? In his teens and twenties, he thought about it constantly. When he first married Bonnie, it was still exciting. They liked to have sex in different places, like the laundry room or the back yard. Those were the good old days.

But now, twelve years later, things were different. The kids came along and it was tough find the time and energy for sex. He was worried about making it through the next round of layoffs at work and that was certainly a distraction. Bonnie was stressed too, with all the extra responsibilities piled on her at work. Sex was no longer adventurous; it was the same old routine. Sometimes he couldn’t get a firm erection and that bothered them both. They didn’t talk about it though.

We often hear about women losing interest in sex. In fact, the Society for Women’s Health Research calls hypoactive sexual desire disorder (HSDD) the most common sexual dysfunction in women.

Low sexual desire in men doesn’t seem to get as much attention. But it happens. In the United States, for example, the National Health and Social Life Survey found that 14% of men between the ages of 18 and 29 had lacked sexual desire at some point during the previous twelve months. For men aged 50 - 59, the rate was 17%.

Why might men lose interest in sex? Recently, a group of European researchers examined this question. Let’s take a look at some of their findings.

The Study

The researchers surveyed over 5,000 heterosexual men who had had at least one sex partner in the previous year. The men were between the ages of 18 and 75, but their average age was 36. They were from Portugal, Norway, and Croatia. Most of them were in a committed relationship.

The men answered a variety of questions about their sex lives, addressing issues like sexual satisfaction, sexual problems, interest in sex, and level of sexual boredom. They also addressed body image, self-confidence, the status of their relationships, personal distress over sexual problems, anxiety, and depression.

About 14% of the men said that over the past year, they had had a distressing lack of sexual interest that lasted two months or longer. This was more common in men who were married or living with a partner.

Men who had less confidence in their ability to have erections were more likely to lose sexual interest, along with those who didn’t feel attracted to their partner and those who were in long-term relationships.

The men also gave their own reasons for lack of interest, which included the following:

·         Tiredness and fatigue

·         Work stress

·         Boredom with sex life

·         Relationship problems, such as a sexually passive partner, conflicts, or poor communication

·         Being with a partner for a long time

What can men do?

Fortunately, there are steps a man can take to alleviate some of these issues.

·         See the doctor. A man might not like to admit he has a sexual problem. But a sexual health specialist can help him pinpoint the reasons behind it and suggest ways to manage it. For example, there are many reasons a man might have trouble with erections and it’s important to get treatment. Couples with relationship problems may benefit from counseling. A sex therapist can suggest ways to add some novelty to a couple’s sexual routine. (For help in finding a sexual medicine specialist in your area, click here.)

·         Talk to his partner. Sex might be awkward to talk about, but starting the discussion can make both partners feel relieved. Honesty and openness can go a long way.

·         Add some spice. It’s easy to get in a sexual rut, especially when partners have been together for a long time and are busy and stressed. Couples can find ways to make sex more interesting. This could mean having sex at a different time of day or a different location. It might mean incorporating sex toys or role playing fantasies. It could also mean scheduling a date night or a romantic weekend getaway for two.

·         Manage stress and anxiety. Doing so is good for a man’s general health, not just his sex life. Taking steps to work fewer hours, get more exercise, and have more fun with friends can do wonders. A healthcare provider can suggest strategies, too.

What do you think? Have you or your male partner ever lost interest in sex? What happened? Did the spark return? Feel free to tell us your story in the comments.

Print this article or view it as a PDF file here: Low Sexual Desire In Men


The Journal of Sexual Medicine

Carvalheira, Ana, PhD, at al.

“Correlates of Men's Sexual Interest: A Cross-Cultural Study”

(Full-text. First published online: October 28, 2013)


Pappas, Stephanie

“Low Sexual Desire Plagues Men, Too”

(November 7, 2013)

Sexual Medicine Society of North America


Sex Health Blog

Being Sex-Positive

Dec 24, 2013

Do you consider yourself to be sex positive?

To answer this question, stop and consider your feelings and attitudes about sex. Do you think your sexuality is part of your identity? Is having sex part of a healthy lifestyle? Do you feel open about sex or does that subject make you feel awkward? Do you think certain sexual practices are “right” or “wrong”?

Being sex positive is not necessarily a new concept, but it’s been gaining momentum over the last few decades. And while definitions may vary from person to person, being sex positive generally embraces the following ideas:

  • Acknowledging that sex is a healthy part of life that contributes to your overall well-being. It’s meant to be enjoyed.
  • Educating oneself about one’s body, sexual health, and sexual activities. This can happen in a variety of ways: courses, websites, books, videos, self-exploration, or exploration with a partner.
  • Knowing how to have sex in ways that are physically and psychologically safe. This can include understanding how sexually-transmitted diseases pass from partner to partner and using condoms correctly. But it can also include being understanding and supportive of a partner with a sexual dysfunction or one who has experienced sexual trauma.
  • Being open about sex and feeling free to discuss sexual feelings in a straightforward way. For sex positive people, sex isn’t taboo. It’s nothing to feel awkward about.
  • Understanding that it’s okay if you don’t want to have sex. It’s also okay if someone doesn’t want to have sex with you.
  • Accepting other people’s sexual practices, as long as they are safe and consensual among the participants. This means refraining from making moral judgments on behaviors like having many sex partners, having affairs, or having sex with strangers. Activities like threesomes, BDSM, and swinging (“partner-swapping”) would be accepted, too – again, as long as they are done safely and with the consent of all participants. At the same time, being “vanilla” or not particularly sexually adventurous would also be fine. Being sex positive often involves a “live and let live” mindset.
  • Being supportive of all sexual lifestyles and attitudes and accepting those who are homosexual, bisexual, heterosexual,asexual, transgender, bi-gender, or genderfluid, among others.

For some, it might be easy to say, “Yes, I’m sex positive.” But others may feel uncomfortable with the concept. Culture, religion, and past experience may influence the way we feel about sex. If we’re brought up to believe that sex should not occur outside a committed relationship, then we probably won’t accept an open relationship. If we have experienced past sexual abuse, we might be skittish about having sex with a new partner or uncomfortable being touched in a certain way.

Being sex positive can mean different things to different people. The definitions are fluid. However, having discussions on what it means to be sex positive, or to feel positively about sex, is one step toward discovering what sexuality means for us as individuals.

How about you? Are you sex-positive? Feel free to tell us your thoughts in the comments.

Print this article or view it as a PDF file here: Being Sex-Positive


The Buzz (Good Vibrations Online Magazine)

Royse, Alyssa

“Are WE Sex Positive?”

(September 25, 2012)

The Daily Californian

Cho, Nadia

“Think sex-positive”

(October 2, 2012)

The Frisky

White, Rachel Rabbit

“8 Ways To Be Positive You’re Sex Positive”

(May 9, 2012)

Huffington Post

Coady, Deborah and Nancy Fish

“Our Definition of 'Sex-Positive'”

(October 2, 2012)

Pflug-Black, Kelly Rose

“Why ‘Sex-Positive’ Feminism Is Negative For Me”

(October 7, 2013)


Zar, Rachel

“What Does ‘Sex Positive’ Mean, Anyway?”

(November 17, 2013)

Sex Health Blog

Disorders of Sex Development for Boys

Dec 10, 2013

Over the last couple of months, we’ve looked at disorders of sex development (DSDs) here on the Sex Health Matters blog. DSDs are congenital conditions (present at birth) that affect a baby’s reproductive organs. Sometimes, the organs are absent or not fully developed. Or, a baby might have both male and female organs.

There are many different types of DSDs and we discussed some of them in this recent post. We’ve also talked about vaginal agenesis, a condition in which girls are born without a properly formed vagina.

Today, we’re going to cover three types of DSDs that affect boys: Hypospadias, Klinefelter syndrome, and micropenis.

DSDs – Some Background

First, however, let’s do a little review of how DSDs can form.

When a human fetus develops, it has genetic material from both the mother and father. Each parent contributes a sex chromosome. Females have two X chromosomes (XX) and males have an X and a Y chromosome (XY).

These chromosomes, and the genes located on them, provide the “road map” for genetic males and females. For example, they dictate whether an embryo develops testes or ovaries.

But sometimes, there are problems. An embryo may have an extra chromosome or a defective gene that interferes with hormones. These issues are at the root of DSDs. There are also times when doctors really aren’t sure exactly why a DSD occurs.


Hypospadias affects the position of the urethra – the tube that allows urine to exit the body. Normally, the opening of the urethra is found at the tip of the penis. But for boys with hypospadias, the opening might be on the underside of the penis, at the base, or on the scrotum (the sac that contains the testes). Most of the time, the opening is somewhere near the tip.

Usually, hypospadias is discovered when a newborn baby is still in the hospital. Milder cases might not be found until later, however.

Hypospadias can be corrected with surgery. The Mayo Clinic suggests that this take place when the baby is between four and twelve months old, but it can be done in adulthood as well.

With treatment, hypospadias has a good prognosis. Most boys have no problems with urination and no issues with sexual activity when they get older.

Left untreated, however, a boy can have trouble using the toilet. Men with hypospadias may develop erectile dysfunction (ED), the inability to get and keep an erection firm enough for sex.


As the name suggests, “micropenis” refers to a small penis. Doctors stretch the penis to its full length to measure it. If the measurement is 0.75 inches or shorter, the child is diagnosed with a micropenis.

A micropenis may happen on its own or it might be part of another DSD. Often, it is caused by hormonal problems that originate in the pituitary gland or in a part of the brain called the hypothalamus.

The condition is usually treated with testosterone therapy, which can help the penis grow. Other hormones might also be used, especially if the child has hormonal deficiencies. In rare cases, gender reassignment surgery is considered.

Most boys with a micropenis do well with testosterone treatment and have normal penile function when they grow up. However, many are infertile.

Klinefelter Syndrome

Klinefelter syndrome occurs when a child has a Y chromosome and more than one X chromosome. In other words, his genetic makeup might be XXY instead of XY. While Klinefelter syndrome involves chromosomes, it is not inherited. Instead, it happens by chance in a parent’s reproductive cell. Sometimes it happens when a cell does not divide correctly.

The extra X chromosome makes it more difficult for male characteristics to form. As a result, boys with Klinefelter syndrome have smaller testes that don’t make the normal amount of testosterone, the male sex hormone. Boys may have late puberty or not reach puberty at all. They might have less facial hair and body hair. Breast development, like that of a female, is also possible and there is an increased risk of breast cancer. Many boys with Klinefelter syndrome grow up to be infertile, but some can father children through artificial reproductive technologies.

Learning disabilities and delayed speech and language development are also common.

When children have more than one extra X chromosome, they are said to have a variant of Klinefelter syndrome. In these rare cases, the typical symptoms are more severe, worsening with each additional X chromosome present.

It’s also possible for boys with Klinefelter syndrome to have an extra X chromosome in only some cells. This is called mosaic Klinefelter syndrome.

Treatment for Klinefelter syndrome usually includes hormonal therapy, speech and behavioral therapy, physical and occupational therapy, and counseling. Some men who develop breasts decide to have them surgically removed.

Coping with any type of DSD can be tough for families. A child’s doctor can suggest resources for further information and support.

Print this article or view it as a PDF file here: Disorders of Sex Development for Boys


Accord Alliance


Genetics Home Reference

“Klinefelter syndrome”

(Reviewed: January 2013)

Mayo Clinic


(January 22, 2011)

Medscape Reference

Chen, Harold, MD, MS, FAAP, FACMG

“Klinefelter syndrome”

(Updated: February 22, 2013)

Vogt, Karen S.


(Updated: April 18, 2013)

University of Rochester Medical Center


Sex Health Blog

Sexual Functioning of Pregnant Women

Nov 27, 2013

This week, our sex health poll question asks, “Has pregnancy affected your sex life?”

We imagine some readers are nodding their heads in a knowing way. Sex during pregnancy is different for every couple, of course. But many couples need to make some adjustments during this time.


Let’s think about the first trimester for a moment. Women’s bodies are getting used to pregnancy. They may be too tired for sex, feel fatigued and nauseated, and have breast tenderness that makes physical closeness uncomfortable. Fear of harming the fetus or causing a miscarriage can make couples anxious. (Click here to learn more about the safety of sex during pregnancy.)

The situation often changes during the second trimester, when couples may have more sex. Women may find that their nausea subsides and their libido increases. Vaginal lubrication may improve, too.

Sexual frequency usually wanes during the third trimester. At this point, couples may need to try different positions, such as “woman on top” and “side by side.” Others focus their intimacy on other activities that bring them pleasure, like kissing, massage, and cuddling.

Keep in mind that the above descriptions are what many couples experience, but your situation might be different. Also, some health issues, such as backache, constipation, and cramps can affect a woman’s sexual function throughout her pregnancy.

Scientific Research

In October 2013, theJournal of Sexual Medicine published a report by Turkish researchers who studied the sexual function of pregnant women. They recruited 306 Turkish women at various stages of pregnancy for this research. The women completed a questionnaire called the Female Sexual Function Index (FSFI), which assesses six areas of women’s sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain. Lower scores indicated poorer sexual function.

The researchers discovered that sexual problems were common in this group of women:

  • 89% had sexual desire disorders
  • 87% had problems getting aroused
  • 43% had issues with vaginal lubrication
  • 70% had trouble with orgasm
  • 48% weren’t satisfied with their sexual activity

Physical factors can account for many of these problems. But the researchers looked at some social factors as well.

For example, women with less education and low economic status tended to have lower FSFI scores. Those who had been married for ten years or more were also more likely to have problems, as were women who had arranged marriages (71% of the group.)

It’s important to remember that the results of this study apply to a group of Turkish women and can’t be generalized to all women. Still, it gives us a helpful snapshot of the social aspects that might affect a pregnant woman’s sexuality.

For example, it’s possible for low economic status to interfere with a couple’s sexual relationship during pregnancy. Stress over the cost of caring for a child – food, diapers, healthcare, and housing – can put strain on a couple’s relationship and, ultimately, their sex lives.

Help for Couples

What can couples do? Here are some ideas:

  • Expect to make adjustments. Talk about how your sexual relationship might change. Communicate and be open-minded. For example, if a certain position is uncomfortable, suggest another one.
  • Take care of your relationship. Stress and fatigue are common at this time. Try to find ways to relax and have fun. Have a babysitter take care of older children so you can have a date night. Or set aside time to talk about your hopes for the future.
  •  Don’t be afraid to ask for help. This could mean asking a friend to help around the house or asking a relative to prepare some meals. Often, friends, family, and neighbors want to help but aren’t sure how. Go ahead and ask! This could also mean seeing a counselor or therapist. Pregnancy can put strain on the best of relationships and seeking help from a professional third party can help couples keep things in perspective. Also, some women experience severe depression during pregnancy and the postpartum period. It’s important to have help available.
  • Be sure to talk to your doctor. Your obstetrician can answer all your questions about pregnancy, including the sexual ones. Don’t be embarrassed. Your doctor can also suggest ways to improve sex during pregnancy and refer you to other specialists that can help, like a therapist, if necessary.

What do you think? Did sex change for you or your partner during pregnancy? In what ways? Feel free to tell us your story in the comments.

Print this article or view it as a PDF file here: Sexual Functioning of Pregnant Women


International Society for Sexual Medicine

“Female Sexual Function During Pregnancy and Postpartum”

“How do depression and anxiety during pregnancy and the postpartum period affect a woman’s sex life?”

“How does pregnancy affect sex?”

“When should sex during pregnancy be avoided?”

“Will having sex during pregnancy hurt the fetus?”

The Journal of Sexual Medicine

Güleroğlu, Funda Tosun, MSc, RN, and Nalan Gördeles Beşer PhD, RN

“Evaluation of Sexual Functions of the Pregnant Women”

(Full-text. First published online: October 24, 2013)

Sexual Medicine Society of North America

“Sex During Pregnancy”

Sex Health Blog

Disorders of Sex Development

Nov 13, 2013

If you saw our blog post from October 15th, you met Jocelyn and her 16-year-old daughter Abby. They were concerned that Abby hadn’t started menstruating yet and were shocked to discover that she had vaginal agenesis. Even though she went through puberty like other girls her age, she had been born without a fully-developed vagina. She would need to either create one by self-dilation or have surgery to create one.

Vaginal agenesis is a disorder of sex development (DSD), a condition a child is born with. DSDs start when a baby is growing in the mother’s uterus and are usually the result of genetic or hormonal problems. This does not mean the mother did something wrong during her pregnancy. Sometimes, DSDs just happen and we never know why.

Some DSDs are diagnosed at birth. Others, like in Abby’s case, don’t become evident until the child is older. A child may not have fully formed reproductive organs. It’s also possible for a child to have mixed genitalia, resembling both a boy and a girl. Genetic testing may be necessary to determine the child’s true gender.

The Accord Alliance estimates that DSDs occur in about one in every 1,500 births.

There are many different types of DSDs, all with their own challenges and treatment options. Some children have surgery. Some have hormonal treatment. Counseling is often recommended for both children and their families, as a DSD diagnosis can have an emotional and psychological impact.

We’ve already talked a bit about vaginal agenesis. Today, we’ll look at some other examples of DSDs.


Before we start, let’s go over some basic genetics.

You probably remember from high school biology class that when a sperm cell fertilizes an egg cell, an embryo is formed. That embryo contains chromosomes – genetic material – from each parent.

The embryo develops into a boy or a girl based on sex chromosomes. Girls have two X chromosomes (XX) in each cell. Boys have an X chromosome and a Y chromosome (XY). It’s the Y chromosome that helps make a boy a boy; it contains the genes or “blueprint” for the development of male organs like the testes and penis.

Not all DSDs are caused by genetic problems. As we mentioned above, sometimes they stem from hormonal issues. However, understanding X and Y chromosomes can help us sort through different types of DSDs.

Examples of DSDs

Now let’s look at some examples.

·         Turner syndrome. Girls with Turner Syndrome are either missing an X chromosome or one of their X chromosomes is incomplete. Their ovaries do not work properly and they are usually infertile.

·         Klinefelter’s syndrome. Boys with Klinefelter’s syndrome have an extra X chromosome. Their genetic makeup is XXY instead of XY. Their testes are small and their bodies don’t produce the typical amount of testosterone. During puberty, they may not develop the same degree of secondary sex characteristics, like facial and body hair and increased muscle mass.

·         Congenital Adrenal Hyperplasia (CAH). CAH concerns the adrenal glands – a pair of glands located on top of the kidneys. These glands normally produce several types of hormones, including cortisol and aldosterone. But in children with CAH, the glands don’t function normally. As a result, there is a hormone imbalance. CAH can be life-threatening.

·         Androgen insensitivity syndrome (AIS). Children with AIS are genetically male, but their bodies don’t properly respond to male sex hormones. They may grow up to look female or they may have both male and female characteristics.

·         Micropenis. Hormonal problems during fetal development can cause a boy to have a very small penis. It is formed properly, but very small.

·         Swyer syndrome. People with this condition are genetically male. They have an X chromosome and a Y chromosome. But they have female genitalia, a uterus, and Fallopian tubes. They do not have properly formed gonads – either testes or ovaries.

·         True gonadal intersex. In the case of true gonadal intersex, people have tissue from ovaries and testes. They may have one gonad that is a combined ovary and testis. Or, they may have one of each type of gonad.

As you can see, disorders of sex development vary widely. This list just scratches the surface, but we plan to provide more information on DSDs in future blog posts.

Have you or someone you know had experience with a DSD? Would you like to share your story? Feel free to leave us a comment. You may do so anonymously.  

Print this article or view it as a PDF file here: Disorders of Sex Development



Accord Alliance

“Handbook for Parents”


Cincinnati Children’s Hospital Medical Center

“Disorders of Sex Development (DSD)”

(Last updated: March 2013)

Genetics Home Reference

“Swyer Syndrome”

(November 4, 2013)

Intersex Society of North America

“Klinefelter Syndrome”

The Johns Hopkins Children’s Center

Migeon, Claude J. MD, et al.

“Syndromes of Abnormal Sex Differentiation: A guide for patients and their families”

(Updated: May 21, 2001)

Medline Plus

“Androgen insensitivity syndrome”

(Updated: July 19, 2012)

“Klinefelter’s Syndrome”

(Updated: July 23, 2013)

“Turner syndrome”

(Updated: July 23, 2013)

University of California San Francisco Department of Urology

“Disorders of Sex Development”

(March 18, 2013)

University of Michigan Health System

Boyse, Kyla, RN and Talyah Sands

“Congenital Adrenal Hyperplasia (CAH)”

(May 2011)

“Disorders of Sex Development Resources”

(Updated: November 2012)

Sex Health Blog

Sex for Men after 50

Oct 30, 2013

Think about sex for men over 50 and what comes to mind? Erectile dysfunction? Low testosterone? If you pay lots of attention to television and magazine advertising, you may think these are the hallmarks of men’s sexual health at midlife.

It’s true that older men are more likely to develop erectile dysfunction – the inability to get or keep an erection firm enough for intercourse. And men’s testosterone levels do start to decline in middle age, which can lead to a decreased sex drive.

But these issues don’t happen to every man. Sex changes as we age, but this doesn’t mean it can’t be fulfilling and exciting. Today, we’ll look at some of the sexual positives for men in this age group.


Many men worry about developing erectile dysfunction later in life. A firm erection is thought to represent manhood, virility, and youth. But it’s not realistic for men in their fifties or sixties to expect the same kind of erections they had in their twenties or thirties.

Erections change. It might take a bit longer to get one. A man might need more stimulation. Erections might not be as rigid as they used to be.

And that’s okay. Once men accept this change, the extra time and effort can become pleasurable – and maybe even better – than the quick erection-ejaculation pattern of youth. There can be more quality time with a partner, more emotional connection, and more intensity.

It’s also possible for men to reach orgasm without having an erection. Manual stimulation and oral sex can do the trick if a man is patient and relaxed.

The key is understanding the changes, then accepting them and embracing them. Releasing some of the anxiety associated with erections can help men and their partners focus more on what really counts – pleasing each other.


In their younger days, men are often finished with their arousal-orgasm pattern before a female partner has even started hers. This mismatch in timing can be a problem for many couples.

But older men who take sex at a slower pace become more in sync with their female partners. Couples can take their time, allowing themselves more opportunities to explore each other’s likes and dislikes and maybe even incorporate some new practices into their standard routine.

Men might find that their midlife partners prefer the slower pace, too. In an article called “Why I’d Rather Sleep with a Man over 50,” sexuality educator Katherine Anne Forsythe writes:

Men over fifty, sixty, seventy-five, even ninety can be great lovers for three basic reasons. Primarily, they are not in a hurry. Secondly, they put their partner's needs first. Thirdly, they have learned that great sex doesn't have to include intercourse at all -- it's only one option.

People often equate sex with penetrative intercourse. But it’s more than that – and this is good news whether men have erection problems or not.

Good sex can include intercourse. But it can also include kissing, touching, massage, cuddling, and oral sex. Some couples start using sex toys or play sexual games to keep the spark going.

Shifting attention from intercourse to new and different sexual activities can actually rejuvenate the relationship and make it more exciting.

Good Health

As we often say here on, good sexual health is part of good overall health and vice versa.

So for men over 50, as at any time of life, it’s important to stay fit to keep your sex life going strong. Healthy eating, exercise, and taking care of conditions like diabetes and heart disease are essential. If you have questions on your own situation, be sure to see your doctor.

The following links can help you learn more about sex and aging for men:

Diabetes and Erectile Dysfunction

Dealing with Arthritis

STD Tests for the Elderly

STDs and Safe Sex

Discussing Erectile Dysfunction with Your Partner

Back Pain Isn’t the End of Sexual Satisfaction

Erectile Dysfunction and Heart Trouble

Andropause or “Low Testosterone”

Exercise and Sex Health

Are you or your partner a man over age 50? How has sex changed for you? Have you needed to make adjustments? Do you enjoy it more? Feel free to tell us your experiences in the comments.



Castleman, Michael

“How Sex Changes for Men After 50”

(October 12, 2010)

Forsythe, Katherine Anne

“Why I’d Rather Sleep with a Man over 50”

(September 14, 2008)

Huffington Post

“Sex Over 50: 3 Ways Intimacy Changes For Post 50 Men Beyond Erectile Dysfunction”

(March 25, 2013)

Psychology Today

Castleman, Michael, MA

“Erection Changes After 50: The Facts”

(May 1, 2012)

Sex Health Blog

Vaginal Agenesis

Oct 15, 2013

Jocelyn’s daughter was growing up fast. Now sixteen, Abby was active in her school theater program, played softball, and worked at the local diner on the weekends. Her grades were good and she was thinking about college. And she had her first serious boyfriend.

Jocelyn was proud of her daughter and so pleased that Abby was happy and healthy. There was one thing, though, that puzzled her. Abby hadn’t started her menstrual periods yet. It was strange, since everything else about Abby’s puberty had seemed normal.

Jocelyn knew that some girls started their periods late, but it troubled Abby. She felt awkward at school, especially during gym class when other girls shared their experiences with menstruation.

“We’ll call the doctor,” Jocelyn told her. “Just to make sure everything is all right.”

Jocelyn and Abby weren’t prepared for the diagnosis: vaginal agenesis. Abby had been born without a properly-formed vagina. She would need treatment to create one, if she ever hoped to have sexual relationships and, if possible, children.

Vaginal agenesis is rare. According to the Urology Care Foundation, it affects about 1 in 5,000 females. But it can be difficult for families to accept. Today, we’ll cover some of the basics of vaginal agenesis and how it is treated.

What is vaginal agenesis?

Vaginal agenesis is a birth defect in which girls are born either without a vagina or with a remnant of one. There might be a “dimple” where the vagina is supposed to be. Some girls with vaginal agenesis are born without a fully-formed uterus as well.

Often, vaginal agenesis isn’t caught right away. In fact, for many girls like Abby, the condition isn’t found until their teen years when they haven’t started menstruating.

Why? Girls with vaginal agenesis do have functioning ovaries, which secrete hormones. As a result, girls with vaginal agenesis go through puberty just like girls without it.

One of the most common types of vaginal agenesis is called Mayer-von Rokitansky-Küster-Hauser syndrome (MRKH). Some girls with MRKH also have kidney problems, hearing loss, and spinal curvature.

What causes vaginal agenesis?

Unfortunately, no one knows what causes vaginal agenesis. It is a congenital condition - a birth defect - that just happens. It is not hereditary. And there is nothing a pregnant woman can do to prevent it.

What can be done about vaginal agenesis?

There are several treatment options for vaginal agenesis. Treatment decisions often depend on the severity of the condition and the maturity and readiness of the girl.

Many girls with vaginal agenesis start treatment in their teenage years, when they are old enough to handle both the physical and emotional aspects.

  • Self-dilation (the Frank method)is usually the first treatment considered. This procedure involves pressing a tampon-shaped plastic tube called a dilator against the area where the vagina should be. This process stretches the area. Larger dilators are introduced gradually. Using this method for 15-20 minutes a day, a new vagina is created over the course of several months to a year.
  • Continuous dilation (the Vecchietti procedure) creates a vagina in about ten days through a combination of surgery and dilation. With this method, an olive-shaped bead is placed where the vagina should be. This bead is attached to strings that are surgically implanted in the abdomen. The strings then exit the body and are attached to a traction device. Each day, the patient “cranks” the device, pulling the bead upward to create the vagina. Once finished, the equipment is surgically removed.
  • Surgery for vaginal agenesis can take many forms. For example, a new vagina may be created with a skin graft from the buttocks. The tissue is placed over a mold and inserted where the vagina should be. Another surgical procedure uses part of the bowel to create a vagina. Recovery after surgery takes time. Bed rest and catheterization might be necessary. Some girls need to wear a dilator almost continuously for a few months. Girls who have a bowel vagina will likely need to wear pads for the rest of their lives, as chronic vaginal discharge is a common problem.

No matter what treatment path a girl takes, emotional and psychological support is critical. The diagnosis takes time to sink in and the treatment might be difficult. Patient respect and privacy are important, but so is being willing to listen and talk. Some girls find counseling helpful as they enter this new part of their lives and process what it may mean for the future.

What about the future?

It may take some time, but women who have been treated for vaginal agenesis can go on to have satisfying sexual relationships. Sometimes, male partners aren’t even aware that women have a surgically constructed vagina.

However, fertility might be difficult. If a woman treated for vaginal agenesis does have a fully-formed uterus, she might be able to have fertility treatment and carry a baby.

If she doesn’t have a uterus – or if the one she has is too small – carrying a baby won’t be possible. Fertility experts may be able to harvest eggs produced by her ovaries and fertilize them with a partner’s sperm. But the baby would need to be carried by a surrogate. Some couples in this situation consider adoption as well.

Vaginal agenesis can be a trying situation for girls and their families. With proper care and solid support, however, girls can move forward.


Advanced Reproductive Medicine – University of Colorado

“Vaginal Agenesis”

American Congress of Obstetricians and Gynecologists

“Müllerian Agenesis: Diagnosis, Management, and Treatment”

(Committee Opinion. May 2013.)

Center for Young Women’s Health

“MRKH: A Guide for Parents and Guardians”

(Updated: October 20, 2011)'s%20of%20Broken%20Out%20Guides/MRKH%20Parent_Full.pdf

Fertility and Sterility

Kimberley, Natalie, B.Med.Sci, et al.

“Well-being and sexual function outcomes in women with vaginal agenesis”

(Full-text. January 2011)

Article in press accessed via MRKH Canada Blog:

Johns Hopkins Medicine

“Treating all facets of a rare malformation: vaginal agenesis”

(March 1, 2011)

North Shore LIJ Health System

“Vaginal Agenesis”

Urology Care Foundation

“Vaginal Abnormalities: Vaginal Agenesis”

(Last updated: April 2013)

Sex Health Blog

Parenthood and Sex

Oct 02, 2013

If you’ve ever brought a new baby home, you know how much your life changes. Planning around your baby’s feedings and naps, trying to catch up on your own sleep, and working out childcare can be exhausting and stressful, no matter how happy you are with your new bundle of joy. And many parents need to make sexual adjustments.

Much has been written about the sexuality of birth mothers after delivery, especially on a physical level. Hormonal shifts, breastfeeding, fatigue, and anxiety can all play havoc with their desire for sex.

But what about their partners? How does childbirth affect their sexuality?

Researchers from the University of Michigan looked at this question and published their findings online in August in the Journal of Sexual Medicine. They used the term “co-parents” explaining that their study subjects were in romantic and sexual relationships with birth mothers and acted as parents to the new baby. (In other words, the term “co-parent” did not apply to birth mothers in this study.)

One hundred fourteen co-parents (95 men, 18 women, and 1 unspecified) completed a questionnaire, answering questions about the three months following their youngest child’s birth. These questions addressed feelings about labor and delivery, their parenting experiences during the postpartum period, and their sexual activities during this time.


It turned out that the co-parents’ sexual desire waxed and waned much like that of birth mothers. The co-parents tended to have higher levels of desire when their partner expressed sexual interest in them and when they felt particularly intimate and close with their partner. Not surprisingly, their desire levels decreased when they felt fatigued and stressed or when there wasn’t much time for sex.

Sexual Behaviors

In the 3-month postpartum time frame, over 80% of the co-parents started having intercourse with the birth mothers again. During the first six weeks, many avoided activity involving the birth mother’s vagina, but this gradually changed.

Seventy-three percent of the co-parents said they masturbated during this time. Many co-parents started masturbating before resuming oral sex or intercourse with the birth mother. Oral sex on the co-parent tended to occur earlier than oral sex on the birth mother.

Gender and Social Support

The researchers acknowledged that the group of female co-parents in this study was small and that related findings should be interpreted carefully.

However, they did observe some differences in the ways male and female co-parents viewed social support. They suggested that female co-parents had a larger network of friends and confidantes that they could go to for advice or support. Men, in contrast, might have seen the birth mother as their primary source of support.

Your Turn

The results of this study can’t be applied to all situations, of course. Still, they provide some insight on co-parents and couples as they adjust to the “new normal” that occurs after a baby’s arrival.

What do you think? What were your experiences as a co-parent after your child was born? How did parenthood affect your sexuality? Feel free to leave us a comment and share your story.

Sex Health Blog

HPV Vaccine

Sep 04, 2013

Has your child been vaccinated against HPV?

It’s a question that comes up often among parents of adolescents. Vaccines for HPV (human papillomavirus) have not been around for long. The first, Merck’s Gardasil, was approved by the U.S. Food and Drug Administration (FDA) in 2006. Three years later, GlaxoSmithKline’s Cervarix came on the scene.

The vaccines are not quite the same, but are generally designed to provide some protection from certain (but not all) strains of HPV, one of the most common sexually-transmitted infections in the United States.

HPV is actually an umbrella term for over 100 types of viruses. Over 40 of them are transmitted through sexual contact. And most of the time, people don’t know they’re infected. Usually, the infection goes away on its own with no treatment.

But not always. Some persistent, long-lasting types of HPV are linked to cervical, vaginal, and vulvar cancers in women and penile cancer in men. Both sexes can develop anal, oral (in the mouth), and oropharyngeal (involving the throat) cancers as well as genital warts.

Vaccination Rates

It would seem that a vaccine that could help prevent cancer and genital warts would be on a parent’s list of planned immunizations for their child. However, vaccination rates do not reflect this.

In July 2013, the CDC published a report on HPV vaccination rates among girls based on the National Immunization Survey – Teen (NIS-Teen). To understand the results, it helps to know that HPV vaccines are given in three doses. To be fully protected, a child must have all three before his or her first sexual encounter.

For 2012, researchers estimated the following rates for girls:

          One dose or more            53.8%

          Two doses or more          43.4%

          Three doses                    33.4%

Why are rates of full coverage so low?

Reasons for Not Vaccinating

A March 2013 study published in Pediatrics, the journal of the American Academy of Pediatrics, looked at this question. Researchers examined the reasons parents gave for not vaccinating. They found that the number of parents with safety concerns had increased over the years. Many parents thought that the vaccines weren’t needed at all or weren’t necessary because their daughters weren’t sexually active.

Let’s take a closer look at these reasons.

“HPV vaccines aren’t safe.”

Both federal agencies and vaccine manufacturers evaluate the safety of vaccines. Between June 2006 and May 2013, over 56 million doses of HPV vaccine were administered in the U.S. About 99% of these doses were HPV4 (Gardasil, which protects against 4 types of HPV).

The CDC examined the safety data for HPV4 and found 21,194 reported problems – less than one percent of all doses. Of that number, 92% were classified as “nonserious.” These included incidents of fainting, dizziness, nausea, headache, fever, and hives. Some girls had pain at the injection site, redness, and swelling.

The remaining 8% of reported problems, labeled “serious,” most commonly involved headache, nausea, vomiting, fatigue, dizziness, fainting, and generalized weakness.

HPV vaccines are generally considered safe. But parents are encouraged to talk to their child’s pediatrician, who can address any concerns.

“HPV vaccines aren’t necessary.”

As explained above, HPV infection is one of the most common sexually-transmitted infections in the United States. The CDC estimates that 79 million people in the U.S. are currently infected with HPV and 14 million are estimated to become infected each year. While most infections clear on their own, some do not. So, the extra protection is considered worthwhile.

“My child isn’t sexually active.”

HPV vaccinations are usually recommended for girls at age 11 or 12, although a young women can be vaccinated up until her mid-twenties. Many parents wonder why the vaccine is targeted to such a young age.

It’s best to vaccinate before any HPV exposure. HPV can be transmitted the very first time someone engages in sexual activity, including oral sex.

If a person is already infected with one type of HPV, the vaccine is less effective toward that type. It can still protect against another type, however.

What About Boys?

Most of the news and research about HPV vaccines have been about girls. But what about boys? HPV infection affects males, too.

In February 2012, the American Academy of Pediatrics (AAP) recommended that both girls and boys be vaccinated against HPV at age 11 or 12. However, only Gardasil, not Cervarix, has been approved for males. (Clickhere to read more about the AAP recommendation.)

What Can Parents and Guardians Do?

Navigating the sea of information on HPV vaccines isn’t easy. How can parents and guardians learn more and make the best decision?

First, and most important, talk to your pediatrician. He or she should be able to answer all of your questions about any vaccine you consider for your child.

Second, educate yourself about HPV and the vaccines. But be careful about where the information comes from. Consider the source. Is the information based on solid research? Does it come from a doctor? From a celebrity? (For tips on finding reliable sexual health information on the internet, click here.)

Finally, talk to other parents. What decisions have they made? What have their experiences been? Finding support among others who have been through the decision-making process might help you come up with other questions to ask your pediatrician.


American Academy of Pediatrics

“AAP Recommends HPV Vaccines For Both Males and Females”

(Press release. February 27, 2012)


Norton, Amy

“Parents' Worries About HPV Vaccine on the Rise: Study”

(March 18, 2013)


Darden, Paul M., et al.

“Reasons for Not Vaccinating Adolescents: National Immunization Survey of Teens, 2008 – 2010)

(Full-text. First published online: March 18, 2013)

Sexual Medicine Society of North America

“HPV Vaccines in the News”

(October 12, 2011)


Ohlheiser, Abby

“Why Are Parents Increasingly Fearful of the HPV Vaccine Even Though It's Safe?”

(March 18, 2013)

U.S. Centers for Disease Control and Prevention

“Human Papillomavirus Vaccination Coverage Among Adolescent Girls, 2007–2012, and Postlicensure Vaccine Safety Monitoring, 2006–2013 — United States”

(Morbidity and Mortality Weekly Report. July 26, 2013)

Sex Health Blog

Cancer and Sex for Single Women

Aug 21, 2013

Maria looked in the mirror and was troubled by what she saw.

She knew it would take time for things to get back to normal after treatment for breast cancer. But sometimes, she thought life would never be normal again. The image that stared back at her looked exhausted. Her face was chubbier than it used to be. Her hair, which used to be long and flowing, was starting to come back in uneven patches.

She was thirty-two years old and wondered what was next for her life. Her family and friends had told her how brave she was during treatment. But she didn’t feel so brave right now. She was grateful to have this second chance, but wasn’t sure how to go about getting what she wanted.

What she wanted was a relationship and maybe, down the road, a family. But the thought of dating again, especially now, terrified her. Would men still find her attractive? Would they want to date a woman who had been treated for cancer? Would they be turned off when they realized she had only one breast? Would they stick around if she decided to have reconstructive surgery – or even worse – if the cancer came back?

And what about sex? How would that change? Would it hurt? Would she even feel like having sex again?

Maria’s concerns are common. Cancer can have huge implications for sex and relationships, from body image issues to sexual function. And healthcare providers don’t always talk about it.

It can get complicated when you don’t have a partner, too. People in long-term relationships know each other well and support each other. But what if you’re starting from scratch?

Today we’ll look at some of these concerns.

Women, Cancer, and Sex

Cancer and cancer treatment can take a toll on women’s sexuality. Hormonal changes may lead to vaginal dryness, tightness, pain, and a diminished libido. Surgical treatment may change some genital anatomy.

The emotional impact of cancer can also affect sexuality. Many women struggle with body image, especially if they’ve lost a limb or a breast. Some gain weight or have surgical scars.

If you have questions about how your specific cancer or cancer treatment might affect your sex life, be sure to speak to your doctor. Having cancer doesn’t stop you from being a sexual person. Your doctor can tell you when it’s okay to start having sex again and let you know of any precautions or adjustments you may need to make. For example, you may need to use a lubricant to take care of vaginal dryness. Or, you might need to try different positions to make intercourse more comfortable.

Learning more about sex and your personal situation can help you prepare for anything unexpected.

Your doctor can also refer you to counseling or a support group if you need one. It’s normal to feel apprehensive about starting relationships again. A therapist and support group can help you rebuild your confidence.


When should a woman reveal to a new partner that she’s had cancer? The answer is a personal one with no right answer. You might decide to tell your new partner early in the relationship. Or, you might wait until you know the person better and have developed a level of trust.

Either way, you should be prepared. Try having a friend role play the conversation with you. Practice different scenarios, from a completely accepting partner to one who is more skittish. Think about how you’ll feel and respond. Be ready to answer any questions that arise.

Unfortunately, rejection does happen sometimes. Some potential partners just can’t handle being with someone who has had cancer. It’s easier said than done, but try to remain positive. Don’t let fear of rejection keep you from dating.

Remember Your Strengths

As you transition into dating again, stay connected to your friends and family. Go out and have fun. Don’t be afraid to try new things. Take a class on a subject that interests you or volunteer for a cause you support. You might meet a new partner this way. But even if you don’t, you’ll be with people who make you feel good about yourself. That confidence will go a long way when you start a new relationship.

The American Cancer Society makes this recommendation:

You can form a more positive view of yourself when you get objective feedback about your strengths from others. Make a list of your good qualities as a mate. What do you like about your looks? What are your good points? What are your special talents and skills? What can you give your partner in a relationship? What makes you a good sex partner? Whenever you catch yourself using cancer as an excuse not to meet new people or date, remind yourself of your assets.

Remember, the right partner will want to be with you no matter what. He or she will value who you are regardless of any sexual challenges or bodily changes.


American Cancer Society

“The single woman and cancer”

(Last revised: February 25, 2013)


“Painful sex, low libido, and no more orgasms: One cancer survivor opens up about the distressing side effects of chemotherapy that doctors don't talk about”

(July 3, 2013)

Memorial Sloan-Kettering Cancer Center


Sexual Medicine Society of North America

“Cancer and Sexual Problems”

(February 12, 2013)

“Female Cancer Survivors and Sex Health Issues”

(April 21, 2011)

Sex Health Blog

Lifestyle Changes – Obese Women with Type 2 Diabetes

Aug 06, 2013

If you’re a woman with type 2 diabetes, you might be familiar with the sexual problems that can result. Poor lubrication, painful intercourse, decreased desire and arousal, and emotional issues are all common. Some problems are easier to work through than others.

Many experts advise lifestyle changes like a healthier diet and increased exercise. But just how effective are such changes in alleviating sexual issues?

Recently, a study published in Diabetes Care considered this question. Today, we’ll take a closer look at this research and see how it might apply to your own sexual health.

The Study

For the study, researchers from medical institutions around the United States worked with 375 overweight and obese women with type 2 diabetes. Their average age was 61 years and their mean body mass index (BMI) was 36.4. (According to the National Institutes of Health, a person with a BMI greater than 30 is considered obese.) The study period lasted a year.

About two thirds of the women were sexually active. Of this group, about half had some form of sexual dysfunction as determined by an assessment tool called the Female Sexual Function Index.

The women were randomly divided into two groups. One group, called the Diabetes Support and Education (DSE) group, attended three meetings in which they learned about diet, activity, and social support. However, these women did not given any behavioral strategies.

The other group, called the Intensive Lifestyle Intervention (ILI) group, had many meetings throughout the year. Each woman learned how to cut calories and fat from her diet and aimed to lose 10% of her body weight. The women also increased their physical activity.

How did the study turn out? The women in the ILI group generally fared better. ILI women who had been diagnosed with sexual dysfunction at the start of the study were more likely to stay sexually active over the study period. They were also more than twice as likely to have their sexual dysfunction in remission.

Lifestyle Changes

Can similar lifestyle changes help you? What kinds of lifestyle changes should you make? These questions are best answered by your doctor, who knows your personal situation. Before making any dietary changes or starting any exercise program, you need to make sure that path you choose is the right one for you. Your doctor can help you learn more about good nutrition and physical activity.

Of course, it’s fine to say, “Eat right and exercise.” How can you stay motivated? Here are a few things to keep in mind.

  • Choose physical activities you enjoy. If you don’t enjoy a certain kind of exercise, it’s going to be a lot tougher to stay motivated. Do you prefer exercising outdoors? At the gym? With a group of people? By yourself? Whatever you choose, make sure it’s something that suits you.
  • Work out with a buddy. Exercising with a friend can make it a lot more fun. Find an activity both of you like and stick to a schedule. Perhaps you’ll walk in your local park first thing every morning. Or you might meet for a group exercise class twice a week after work. Be sure to keep up a routine. Being accountable to each other can be a powerful motivating force.
  • Experiment with new meals. Your doctor or nutritionist may recommend foods or ways of cooking that you’re not accustomed to. Ask for recipes and look for cookbooks that reflect healthy choices.
  • Socialize. Have your friends and family join you on this journey. For example, if you find a new recipe you love, have people over for dinner. You’ll likely find that you have a great cheering section rooting for you. Socializing can also help alleviate depression, which can interfere with your sex life.
  • Consider a support group. While friends and family can be wonderful supporters, they might not always understand what you’re going through. Some people find it helpful to join a group of similar individuals who can understand the successes and setbacks. Your doctor or clinic can help you find one. If there isn’t a group available, think about starting one of your own.

Remember, too, that these changes can also lead to better sex and that can be quite a motivating factor in itself. Think ahead to the intimacy you’ll share with your current partner (or a new one, if you’re single). The lifestyle changes you make can benefit your overall health, your sexuality, your relationships, and your happiness.


Diabetes Care

Wing, Rena R., PhD, et al.

“Effect of Intensive Lifestyle Intervention on Sexual Dysfunction in Women With Type 2 Diabetes - Results from an ancillary Look AHEAD study”

(Full-text. Published online before print: June 11, 2013)

Nugent, Brenda

“Lifestyle Change Can Lessen Sexual Dysfunction in Type 2 Women”

(June 29, 2013)

National Heart, Lung, and Blood Institute

“Calculate Your Body Mass Index”

Sexual Medicine Society of North America

“Diabetes and Female Sexual Satisfaction”

(August 23, 2012)

“How is Diabetes Affecting Your Sexual Health?”

(March 12, 2013)

Sex Health Blog

Female Sexual Desire

Jul 10, 2013

In his 2009 article for The New York Times Magazine, writer Daniel Bergner describes a conversation he had with psychology professor and sex researcher Marta Meana of the University of Nevada Las Vegas. The two were discussing female sexual desire:

“What women want is a real dilemma,” she said. Earlier, she showed me, as a joke, a photograph of two control panels, one representing the workings of male desire, the second, female, the first with only a simple on-off switch, the second with countless knobs.

The image is apt, as is the title of Bergner’s new book on female desire What Do Women Want? Adventures in the Science of Female Desire. Bergner describes the work of sexologists trying to answer this elusive question.

It’s a mystery that has been discussed for years. How do the sex drives of men and women compare? Today we’ll look at some different perspectives on the subject.

Do Women Have Weaker Sex Drives?

Traditionally, at least in American culture, we hear that men have stronger sex drives and that women’s desire is weaker.

Not so, says Huffington Post sex and relationships researcher Dr. Kristen Mark.

In “5 Myths About Women’s Sexual Desire, Decoded”, Mark writes, “Research has found that women and men are equally likely to be the partner less desirous of sex. This hasn't been found in just one study, either. In my own research alone, I've found a non-significant difference between men and women in three different samples of couples.”

She might disagree, however, with the control panel image discussed above. “In the research I've conducted in the area of sexual desire, the most surprising (and perhaps interesting) result has been that there is just as much variation in desire within men and women as there is between men and women.”

She adds, “I've found that variations in sexual desire are much more of a relationship issue than a gender issue.”

Are Women’s Sex Drives More Complicated?

Bergner discusses the work of Canadian psychology professor Meredith Chivers, whose experiments involved measuring men’s and women’s physical and subjective reactions to a variety of sexually explicit videos. These videos depicted different types of sexual acts: heterosexual sex, men with men, women with women, and masturbation. Chivers also included clips of a naked man walking on the beach and a nude woman doing calisthenics. In addition, sex between bonobos, a type of ape, were shown.

The study participants had plethysmographs attached to their genitals. These devices measured physical arousal. The participants also had keypads to indicate how aroused they felt.

The men, Bergner reports, had fairly straightforward reactions. Heterosexual men were more aroused by the videos of men with women, women with women, and women masturbating and exercising. The gay men were more aroused by the videos of men with men. None of the men seemed aroused by the bonobos. Both physical and subjective measurements concurred.

The data was harder to pin down for the women, as their physical and subjective assessments often didn’t match. Physically, straight women were about equally aroused by male-female, male-male, and female-female sex. But they said they were more aroused by the videos of men with women and not so much by the others. Lesbian women’s readings matched when watching videos depicting women. But for the clips of men with men, lesbians’ physical readings showed they were more aroused than they said they were. (Like the men, the women were generally not aroused by the bonobos.)

What does this mean? It’s hard to know for sure. But the example does show some of the complexity between men’s and women’s sexual desires.

What Role Does Culture Play?

Many researchers believe that women want sex just as much as men, if not more. But how does culture affect sex drive? Can women be direct – or even aggressive – about their desires?

Maybe, but maybe not. In her review of Bergner’s book, Ann Friedman writes in The Cut:

Even in research about appropriate dating behavior among adults today, “men and women both agree that men should actively pursue female partners and that women should be passive recipients to their advances,” says Jessica Carbino, a Ph.D. candidate in sociology at UCLA who studies online dating and relationships. “For example, women and men overwhelmingly state that men are supposed to plan dates, ask out the woman, and pick her up. Moreover, when women do not adhere to these scripts they are viewed negatively. For example, women who initiate dates are viewed by men as more promiscuous and not interested in forming a serious relationship.”

What Do You Think?

Do you think men’s and women’s sexual desire is similar? Different? How does culture come into play? And how might other cultures around the world consider these questions? Feel free to share your point of view in the comments.

Sex Health Blog

Vulvar and Vaginal Atrophy

Jun 26, 2013

Menopause is often called “the change of life” and with good reason. Women at midlife can experience a number of changes, both physical and emotional. It’s all a part of aging, but some changes are tougher than others.

One physical change common in postmenopausal women is vulvar and vaginal atrophy (VVA). The decline in estrogen at menopause leads to cellular changes in the vagina and vulva (the genital area outside of the vagina). Tissues become thinner and drier and lose their flexibility. There is also a decrease in vaginal pH. VVA is chronic and progressive. It doesn’t get better on its own.

What does this mean for women?

For many, VVA makes sex uncomfortable, even painful. Vaginal walls don’t secrete fluid the way they used to and poor lubrication can lead to irritation, tearing, and bleeding during penetrative sex. The vagina may also become narrower and shorter, especially if a woman doesn’t have intercourse on a regular basis.

Discomfort from VVA is not limited to sexual activity. Many women have itching, burning sensations, pain, and vaginal discharges throughout the day.

VVA can make life a challenge. Sexual difficulties and loss of intimacy can test relationships. Some women avoid intercourse altogether or avoid starting new relationships. Others may have trouble sleeping, working, playing sports, or enjoying time with friends.

It’s estimated that up to half of postmenopausal women have symptoms of vulvar and vaginal atrophy.  VVA affects an estimated 32 million women in the United States alone. Unfortunately, many women aren’t aware of VVA and don’t discuss it with their doctor. And many doctors don’t bring up the subject either.

What can be done? Today we’ll look at some ways to cope with VVA.

Over-the-Counter Treatments

Some symptoms of VVA can be treated with over-the-counter products like lubricants and moisturizers.

  • Vaginal lubricants can reduce friction during intercourse and are not absorbed into the skin. They are short-term solutions, applied before sex, and come in several varieties:

Water-based lubricants are a popular choice, as they are usually inexpensive and easy to wash off. However, they may need to be reapplied during sex.

Silicone-based lubricants tend to last longer than the water-based kind, but aren’t as easy to wash off.

Oil-based lubricants are usually not recommended. This type can weaken latex condoms, increasing the risk of breakage. While postmenopausal women don’t need to worry about pregnancy, sexually-transmitted infections are still a concern.

Some over-the-counter lubricants contain warming ingredients, dyes, perfumes, or glycerin that can irritate vaginal and vulvar tissue. If you experience this type of irritation, stop using the product and see your doctor.

  • Vaginal moisturizers are similar to lubricants, but they are applied regularly, usually every three to four days. Moisturizers are absorbed by the skin and stick to the vaginal lining, keeping it moist. These products are a good option for women who have ongoing problems with vaginal dryness.

Prescription Treatments

  • Low-dose vaginal estrogen may be dispensed as a cream, tablet, ring, or suppository that is applied directly to the vagina. Unlike vaginal lubricants and moisturizers, this therapy isn’t temporary. The medicine helps improve blood flow to the vagina and makes vaginal tissue thicker and more flexible. Vaginal estrogen should be prescribed at the lowest effective dose to limit the hormone’s effects on other parts of the body. Women who have had breast cancer should discuss their situation with their healthcare provider before considering this type of treatment.
  • Osphena (ospemifene) is an oral medication that was approved for postmenopausal women by the U.S. Food and Drug Administration (FDA) in February 2013. This drug acts like estrogen to thicken and strengthen vaginal tissues. It is prescribed for women who have moderate to severe pain during sex.
  • The FDA cautions that Osphena can cause the endometrium (lining of the uterus) to thicken. Women who experience any unusual bleeding should see their doctor as soon as possible.

Keep Having Sex

Having sex regularly can help keep the vagina moist, flexible, and healthy. It also helps prevent vaginal narrowing and shortening.

Speak Up!

Some women don’t feel comfortable discussing sexual issues or genital problems with the doctor. Likewise, some doctors feel awkward bringing up these topics with their patients. However, having the discussion is the first step in finding relief from VVA.

Even if you’ve talked to your doctor about VVA, don’t hesitate to speak up if a certain treatment isn’t working for you. It may take time to find the best solution, so don’t be discouraged if the first option isn’t the best. Another treatment may be more effective.


International Society for Sexual Medicine

“What is a lubricant?”

The Journal of Sexual Medicine

Kingsberg, Sheryl A., PhD, et al.

“Vulvar and Vaginal Atrophy in Postmenopausal Women: Findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) Survey”

(Full-text. First published online: May 16, 2013)

Medscape Education

Krychman, Michael L., MD

“Vaginal Atrophy: The 21st Century Health Issue Affecting Quality of Life”


The North American Menopause Society

“Changes in the Vagina and Vulva”

“Vaginal and Vulvar Comfort: Lubricants, Moisturizers, and Low-dose Vaginal Estrogen”

U.S. Food and Drug Administration

“FDA approves Osphena for postmenopausal women experiencing pain during sex”

(Press announcement. February 26, 2013)

Sex Health Blog

Penis Length and Partner Satisfaction

Jun 11, 2013

“It’s not the size of the boat, but the motion of the ocean.”

You might have heard this expression in relation to penis size. It explains, rather euphemistically, that the size of a man’s penis really doesn’t matter for partner satisfaction. What’s important is his performance in the bedroom, which may involve skill, or intimacy, or any number of things.

But is the saying true?

That question has been debated for years. And there isn’t an easy answer. Today we’ll look at some of the research on penis size and women’s sexual satisfaction in penile-vaginal intercourse.


The Size of the Boat

Why might women prefer a longer penis? For some, the movement of longer penis stimulates more of the vagina and even the cervix, which connects the vagina and uterus. This stimulation can bring great pleasure.

The number of women who prefer longer penises was studied by a group of researchers from Europe and the United States. Last fall, they reported on their survey of 160 women who had vaginal orgasms and were sexually experienced enough to comment on penis size.

One of the questions they answered was:

"All things being equal, are you more likely to have an orgasm from penis-in-vagina intercourse with a man who has a somewhat larger than average penis length? (Assume that average erect penis length is the length of a £20 note or any U.S. dollar bill).”

About 34% of the women said a longer penis was more likely to bring them to orgasm. About 6% said they were less likely to have an orgasm from a longer penis. Sixty percent said that penis size wasn’t important. They could reach orgasm from a longer or shorter penis.


The Motion of the Ocean

Many men feel insecure about the size of their penis and these study results may make them even more anxious about pleasing their partners. But there’s no need for worry. Here are some things to consider:

  • While the study above shows that penis size is indeed important to some women, it is not important to all women. Sixty percent said penis size didn’t matter.
  • Women reach orgasm in several different ways, not just through penile-vaginal intercourse. Clitoral orgasm is common, but some women can reach orgasm by having their nipples stimulated or even by having a sexual fantasy.
  • Some women don’t even have vaginal orgasms. This does not mean they’re not enjoying sex. Women’s vaginas vary; some might have better nerve function than others. Some scientists believe that learning plays a role in vaginal orgasms. If women are “taught” that orgasms can start in the vagina, they may be more likely to have vaginal orgasms. Sometimes, these lessons start early. Research has shown that women who stimulated their vagina during their first masturbation are more likely to have regular vaginal orgasms in adulthood.
  • A longer penis doesn’t take the place of a good relationship. Feeling emotionally and intimately connected to a partner is important to many women when they have sex.

Leaving Concerns at the Bedroom Door

While men may feel uneasy about the size of their penis, women have their insecurities as well. Some women feel pressured to have vaginal orgasms and are distressed over finding the “G-spot” – the area of the vagina reputed to be a source of great sexual pleasure.

In the end, however, couples may find sex more enjoyable if they leave these concerns at the bedroom door. What matters most is that they pleasure each other in the ways that work best for them.


The Journal of Sexual Medicine

Brody, Stuart, PhD

“More Frequent Vaginal Orgasm Is Associated with Experiencing Greater Excitement from Deep Vaginal Stimulation”

(Full-text. First published online: April 9, 2013)

Costa, Rui Miguel, PhD, et al.

“Women Who Prefer Longer Penises Are More Likely to Have Vaginal Orgasms (but Not Clitoral Orgasms): Implications for an Evolutionary Theory of Vaginal Orgasm”

(Full-text. First published online: September 24, 2012)

Sexual Medicine Society of North America

“Experts weigh in on vaginal orgasm”

(April 27, 2012)

Sex Health Blog

Vacuum Erection Devices

May 30, 2013

Have you heard about the vacuum erection device, used to treat erectile dysfunction (ED)?

It might be a new term for you. Over the last fifteen years, oral medications have become a more popular way to treat ED. And that’s how most men with ED start their treatment. For many men, pills are very effective.

But sometimes, oral medications don’t work as well as we’d like. They might have side effects that are hard to tolerate. Some men, such as those who take nitrates for conditions like heart disease, cannot take ED pills at all. Doing so could cause a dangerous drug interaction, resulting in a critical drop in blood pressure.

A vacuum erection device, also known as a VED, can be a helpful alternative. There is no medication involved and using the device is fairly easy with practice.

Today, let’s take a look at VEDs and the ways they can help men with erectile dysfunction.

How does a man use a VED?

VEDs usually have three parts: a clear plastic cylinder, a pump (either manual or battery-operated), and an elastic ring.

A doctor can give instructions for a specific device, but generally, using a VED involves the following steps:

1.   Apply a water-soluble jelly at the base of the penis to create a water-tight seal.

2.   Place the cylinder over the penis and hold it firmly against the pubic bone.

3.   Activate the pump while keeping the cylinder steady. The pump creates a vacuum that allows more blood to flow into the penis. This blood is what creates a firm erection.

4.   When the erection is ready, place the elastic ring at the base of the penis. This keeps the blood inside and maintains the erection. Once the ring is in place, the cylinder can be removed.

5.   After sex, remove the ring. It should not remain on the penis longer than 30 minutes. Sometimes, men need to experiment with different types of rings to find the one that works best for them.

Using a VED takes practice. However, most men can achieve a full erection in 10 – 20 minutes.

Advantages of VEDs

For most patients, using a VED is a safe, simple way to achieve an erection. Studies have shown that satisfaction rates for both patients and partners are over 80%. Research has also found that some couples’ relationships improve.

Disadvantages of VEDs

VEDs do have some disadvantages, however. They can be cumbersome, unromantic, and interfere with spontaneity. Some men find that their erect penis is cooler to the touch once the constriction ring is on. Men who are not in long-term relationships may feel embarrassed about using a VED and feel anxious about a new partner’s reaction.

Side Effects

Men who use vacuum erection devices might have some pain, irritation, or bruising. If the band is too tight, there could be problems with ejaculation.

Who shouldn’t use a VED?

VEDs aren’t recommended for men who take blood thinners or have bleeding disorders. Men with Peyronie’s disease (penile curvature or “bent penis”) or a history of priapism (an erection lasting longer than 4-6 hours) should be careful when using a VED.

Is a VED right for you?

Do you think a VED might be right for you or your partner? Be sure to discuss it with a doctor. Only a doctor can prescribe a VED. You might see devices being sold online or through mail-order companies, but in most cases, these devices have not been approved by the FDA and could injure the penis.


The Journal of Sexual Medicine

Brison, Daniel, MD, et al.

“The Resurgence of the Vacuum Erection Device (VED) for Treatment of Erectile Dysfunction”

(Full-text. January 24, 2013)

Sexual Medicine Society of North America

“Vacuum Devices – Erectile Dysfunction”

“Vacuum Erection Devices”

(May 20, 2013)

Weill Cornell Medical College

“Vacuum Devices”

Sex Health Blog

Dangers of Counterfeit ED Drugs

May 15, 2013

The recent news of Pfizer’s decision to sell Viagra online has prompted lots of discussion on counterfeit drugs and buying medications over the internet. And drugs for erectile dysfunction (ED) are in the spotlight.

According to Pfizer, Viagra is its most counterfeited drug and it’s not hard to imagine why. Having problems with erections isn’t something most men like to discuss, even with a doctor. And, clicking around the internet, there seems to be some great deals. Why not skip the hassle of going to the doctor and save some money in the long run?

Doing so is a bad idea. Buying ED medications online is risky. You need to know that the drugs are safe and the retailers are reliable. Unfortunately, research has shown that, often, neither is true.

Keep in mind that while much of the information that follows concerns Viagra, it can apply to other ED drugs, Cialis and Levitra, as well.

What are the risks of buying ED medications online?

If you’re thinking about buying ED drugs online, consider the following:

  • There’s a good chance they’re counterfeit. In a 2011 study, Pfizer, the maker of Viagra, tested samples of drugs purchased from online retailers. The retailers claimed the drugs were Viagra, but 77% of them were counterfeit.
  • They may contain harmful substances. Pfizer officials have found lead paint, rat poison, printer ink, floor wax, drywall, and boric acid in samples purchased online. Drugs may be made in dirty factories with no quality control.
  • They may not contain the standard amount of active ingredient. The Pfizer researchers found that 30% - 50% of the counterfeit Viagra samples they tested did not have the correct amount of sildenafil citrate, the drug’s active ingredient.
  • The packages may leave out critical information. Legitimate Viagra is shipped with a product information sheet that provides instructions on taking the drug and warnings about side effects. This sheet also explains who should not take Viagra. For example, men who take nitrates for conditions like heart disease should not take Viagra, as doing so can cause a dangerous drop in blood pressure.
  • Seeing a doctor for ED is important. ED can be more than a sexual problem. For some men, ED is a symptom of heart disease or diabetes. Catching these conditions early and treating them properly can improve overall health.

Is your ED medication counterfeit?

Sometimes it’s almost impossible to tell. Counterfeiters work very hard to make sure their product looks like the real thing and an unsuspecting consumer may never know the difference.

In the Pfizer study, researchers found subtle visual differences between real and fake Viagra. The font used on the counterfeit versions may be slightly different. There might be different colors used in the Pfizer logo. But the average person may not notice these differences, especially if they haven’t seen legitimate Viagra before.

So how can you tell if your medication is counterfeit? There are some red flags you can watch for:

  • Unusual packaging. Counterfeits may be packaged in unsealed containers, like a plastic bag. Blister packs may be unsealed.
  • The package does not include a patient information sheet. Legitimate medications will include information on how to take the medicine and what side effects to watch for.

If the medication or packaging just don’t look right, or you have a funny feeling about them, don’t take the drug. Notify your doctor or pharmacist.

Staying safe when buying medications online

If you’re thinking about buying ED medication – or any medication – online, be sure to buy from a legitimate pharmacy.

How can you know if the pharmacy is safe? As with the drugs themselves, it’s sometimes difficult to tell. Anyone can put up a website and sell products. A counterfeiter’s website may look professional and include testimonials and comments that appear real but are completely fabricated.

Here are some things to watch for when evaluating an online pharmacy:

  • Is a prescription required? ED medications always require a prescription.
  • Does the seller claim to sell “generic” Viagra? While generic Viagra is available in some countries, it is not available in the United States.
  • Does the seller offer a health screening with an online doctor? You may find sites that don’t require a prescription, but do ask you to go through an online screening, sometimes at a cost. This may make them appear more legitimate. But there is no way of knowing if the “doctor” on the other end is an actual MD. And the only way for such a doctor to evaluate your need for medication is through a face-to-face visit and thorough examination.
  • Does the site list a physical address or phone number? Many counterfeiters do not disclose their actual location and only provide e-mail support.
  • Does the seller require a waiver? Some online pharmacies ask you to sign legal documents that clear them if there’s a problem.

BeSafeRx and VIPPS

Two organizations are making it easier to evaluate online pharmacies.

In the United States, The U.S. Food and Drug Administration (FDA) is now offering BeSafeRx, a web resource with information on how to spot an online pharmacy and the risks involved in ordering from one. It also provides links to each state’s board of pharmacy license database, allowing users to ensure that the pharmacy they’re considering is in fact legitimate and licensed.

VIPPS (Verified Internet Pharmacy Practice Sites) is a program sponsored by the National Association of Boards of Pharmacy (NABP). The NABP covers the 50 United States, the District of Columbia, Guam, Puerto Rico, the Virgin Islands, eight Canadian provinces, and New Zealand.

VIPPS is a certification program. To be included, pharmacies must comply with the licensing and inspection rules of their jurisdiction. Consumers can identify a VIPPS-certified pharmacy by finding the VIPPS seal on its website.

Consumers can also look up their pharmacy by verifying its URL here.

As we mentioned earlier, if you have any doubts about either your medication or an online pharmacy, be sure to talk to your doctor or pharmacist. They can point you in the right direction to safely find quality medications.


Associated Press via Huffington Post

Johnson, Linda A.

“Viagra Online: Pfizer To Sell Popular Erectile Dysfunction Pill Directly To Patients On Its Website”

(May 6, 2013)

Bloomberg TV

“Viagra Delivery: Pfizer, CVS to Sell Drug Online”

(Video. May 2013)

Drug Store News

DeArment, Alaric

“CVS handles back-end functions as Pfizer sells Viagra online”

(May 6, 2013)

International Society for Sexual Medicine

“Counterfeit Drugs”

“How can you tell if a medication is counterfeit?”

“Is it safe to buy erection-enhancing drugs over the internet?”

The Journal of Sexual Medicine

Campbell, Neil, et al.

“Internet-Ordered Viagra (Sildenafil Citrate) Is Rarely Genuine”

(Full-text. First published online: August 27, 2012)

National Association of Boards of Pharmacy

“Is that Pharmacy Safe?”

“VIPPS Information and Verification Site”

“Why Not Recommended?”


“Facing Off Against Counterfeit Online Pharmacies: Pfizer Launches New Purchasing Website To Help Alleviate the Guesswork Around Buying Legitimate Viagra® (sildenafil citrate) Online”

(Press release. May 6, 2013)

Sell, David

“Pfizer to begin selling Viagra online”

(May 8, 2013)

U.S. Food and Drug Administration

“About BeSafeRx”

(Page last updated: September 28, 2012)

“Buying Prescription Medicine Online: A Consumer Safety Guide”

(Page last updated: October 4, 2012)

Sex Health Blog

Low Testosterone Linked to Rheumatoid Arthritis Risk

May 07, 2013

New research out of Sweden has shed some new light on the link between the sex hormone testosterone and rheumatoid arthritis (RA).

Previous research had shown that men with RA tended to have low testosterone. However, scientists didn’t know when, exactly, a decrease happened. Could low testosterone signal a future RA diagnosis? Or did RA trigger a decrease in testosterone levels?

The study was published online in April in the Annals of the Rheumatic Diseases. But before we look at the study in more detail, let’s get some background on RA.

Rheumatoid Arthritis

According to the Arthritis Foundation, there are over 100 types of arthritis, a disease that can damage joints, bones, and related tissues. Rheumatoid arthritis is an autoimmune disease. This means that a person’s body is attacked by his or her own immune system. In the case of RA, the membrane that lines the joints is attacked, causing fluid to accumulate.

Symptoms of RA include inflammation, pain, fatigue, limited range of motion, and swelling. Some patients go into periods of remission, when they have no symptoms. Others have symptoms all the time.

Scientists are not sure what causes RA. Genetics may be involved, as certain gene markers have been found. The roles of bacteria, viruses, and smoking are also being investigated.

The Arthritis Foundation estimates that 1.3 million people in the United States have RA. The disease is more common in women, who tend to develop it in their thirties, forties, or fifties. Men usually develop it later in life.

There is no cure for rheumatoid arthritis, but medications and physical therapy benefit some patients.

The Study: Rheumatoid Arthritis and Low Testosterone

To learn more about testosterone and RA, the Swedish researchers turned to the Swedish Malmo Preventive Medicine Program, which started in 1974 and included health data on over 33,000 people born between 1921 and 1949.

Participants in this program underwent medical testing, completed questionnaires, and gave fasting blood samples, which were stored for many years. Using this data and other national registers, the researchers were able to determine which program participants developed RA after giving their blood sample.

The researchers measured the levels of testosterone in samples of 104 men who had been diagnosed with RA. They also looked at samples of 174 matched controls – men of similar age who did not eventually get RA. Blood samples were taken around the same time. On average, the samples had been stored for about thirteen years.

After accounting for smoking and body mass index, two factors that may increase a person’s risk for RA, the researchers found that the men who ha