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Keep Your Relationship Strong During Infertility Treatments

Keep Your Relationship Strong During Infertility TreatmentsSex can be especially exciting when you’re trying to start a family. You and your partner can enjoy your time together, bond as a couple, and smile to yourselves, wondering if your most recent bedroom encounter will result in a new family member nine months from now.

But if you and your partner aren’t experiencing this fairy tale, sex and relationships can become more difficult. Some couples drift apart during infertility treatments, but it’s important to stay connected – including sexually.

Let’s look at some of the challenges couples face:

Having sex on a schedule. Many couple feel like they have to have sex at a certain time, depending on what the calendar or clock tells them about ovulation cycles. No matter how they feel, they need to take advantage of a window of opportunity. However, the real world doesn’t always work that day. Your fertility specialist might say that October 6 is the ideal time to make a baby, but when that day arrives, one of you might have had a stressful day at work. Or you might be away on business. Or your partner might have the flu. If sex doesn’t work out, you might feel guilty about losing the opportunity.

Try this: Make sure you are still having sex for connection and fun. It might help to plan date nights, explore fantasies, and keep that romantic spark burning. Remember that there are lots of good reasons to have sex. Becoming pregnant is only one.

Coping with disappointment. If you and your partner have been trying to conceive for a long time, it’s natural to feel sad and frustrated if it doesn’t happen. Depression and anxiety can take a toll on all aspects of a relationship, including sexuality.

Try this: Don’t keep your feelings bottled up inside. If you are feeling down, be open with your partner. Don’t blame each other for your situation. Just know that you are in this together. Consider joining a support group in your community where you can talk to other couples coping with infertility. You might also see a counselor or therapist – alone or as a couple - to help keep your relationship strong. It’s okay to seek help.

Dealing with “know-it-alls” and nosy people. Friends and family, no matter how well-intentioned, may ask invasive questions. (When are you going to have a baby? How often do you try? What’s your sperm count?) or make thoughtless comments. (You just need to relax. You’re trying too hard. My co-worker got pregnant after she started using X supplement.)

Try this: You and your partner are in charge of this journey. If someone asks you a nosy question, you do not have to answer it. If someone makes an insensitive comment, don’t take it to heart. You know your situation best. Talk together about how much information you’re willing to share and with whom you’re willing to share it.

Putting your relationship on the back burner. During infertility treatment, it’s easy to get swept away by the whirlwind of doctor’s appointments, hormones, and tests. And all of this takes place in the midst of your daily lives, which can have their own stresses.

Try this: This is the time to make your relationship a priority. You and your partner got together for a reason. Think about what brought you close and what keeps your relationship solid. And don’t forget to have fun. Go out with friends, see a silly movie, make an elaborate meal together. Share a hug or a smile. Keep yourselves connected.

You and your partner might not know what the future holds for your family. But one thing you can know is that you’re in this together, for now and for the future.


Jaeger-Skigen, Beth, LCSW

“Sex & Infertility: How to Reconnect Sexually During Infertility”

The Journal of Sexual Medicine

Gao, Jingjing, MM, et al.

“Relationship between Sexual Dysfunction and Psychological Burden in Men with Infertility: A Large Observational Study in China”

(Abstract. First published: May 20, 2013)


“Men with Infertility”

Sexual Medicine

Winkelman, William D., MD, et al.

“The Sexual Impact of Infertility Among Women Seeking Fertility Care”

(Full-text. Published online: May 7, 2016)


Watson, Laurie J., LMFT

“How to Stay Sexually Connected During Infertility Treatment”

(June 5, 2019)

Sex Health Blog

Sex Health Supplements: Are They Right for You?

Sex Health Supplements: Are They Right for You?We get it. When you have a sexual problem, you might not want to talk about it. Sex is a delicate, private subject, and lots of people don’t want to admit they’re having trouble.

Instead of seeing a doctor, many people turn to the internet and look for products that might help. But are supplements the answer?

Over-the-counter supplements don’t require a prescription, and you can easily get them in pharmacies, in health food stores, and over the internet. And buying them this way saves you a trip to the doctor.

Cost is another important factor. Sexual health treatments, such as pills for erectile dysfunction (ED) aren’t always covered by insurance, and they can carry a hefty price tag. The supplement route can be more affordable.

But before you add a sexual enhancement supplement to your cart, keep these points in mind:

Lack of regulation

  • Supplements aren’t regulated by agencies like the U.S. Food and Drug Administration (FDA). In fact, the FDA considers supplements to be foods, and manufacturers are not required to provide evidence of their products’ safety and effectiveness.


  • Products are often marketed with terms that imply safety, like natural, homeopathic, and organic. These descriptions can be misleading. As Dr. Ryan Terlecki of Wake Forest University told, “Nothing falls from a tree in the shape of a pill or capsule.”

Unlisted ingredients

  • Supplements can contain ingredients that aren’t listed on the packaging label.


Scientists have found supplements that contained prescription drugs for erectile dysfunction (sildenafil, tadalafil) or antidepressants (dapoxetine). Such ingredients may not be safe for everyone, and they aren’t always on the supplement label.

Men who take nitrates for conditions like heart disease and diabetes should never take ED drugs because the interaction can cause a serious drop in blood pressure.

Interactions and side effects

  • Supplement ingredients – whether declared or undeclared - can interact with other medications you take, which can be dangerous.


Fenugreek, a common supplement ingredient, can interact with anticoagulants (medicines that help prevent blood clots).

People who take antidepressants, blood pressure medications, or central nervous system stimulants should avoid yohimbine.

In addition to drug interactions, supplements can have other side effects and may affect lab test results ordered by your doctor.

Lack of evidence

  • There isn’t always scientific evidence to back up the claims made by supplement manufacturers.


In an April 2019 Journal of Sexual Medicine study, researchers reported that in 413 studies of sexual enhancement product ingredients, only 17% involved human subjects.

Some people claim that a product called Zestra boosts sexual desire and improves orgasms in women. But the product has not been tested in men.

Unreliable reviews

  • You might think that a product with hundreds of 5-star reviews is an effective one. But some vendors post fake reviews or paid reviews, which are not always trustworthy.


In the Journal of Sexual Medicine study mentioned above, researchers used a tool called ReviewMeta to filter out suspicious reviews related to six erectile dysfunction supplements sold on After using this software, almost half of the reviews were filtered out, suggesting that they were unreliable.

“The removal of nearly one-half of all reviews associated with these products raises concerns about the veracity of comments linked to these products,” the authors wrote.

(Learn more about sex health product reviews here.)

The bottom line

If you’re coping with a sexual problem, your best bet is to talk to your doctor about it. Remember, doctors are there to help you, and chances are, they’ve had other patients go through what you’re experiencing now. They know your medical history and can guide you on what treatments are most appropriate for you. They might also suggest other ways you can improve your sexual health, like following a healthy diet, getting enough sleep, and staying fit.

Also, some sexual health issues are signs of a more serious health condition. For instance, men with diabetes and heart disease often start having trouble with erections because of poor blood flow to the penis. With a thorough health checkup, your doctor can screen for such conditions and start treating you immediately. Sometimes, treatment for the underlying condition resolves the sexual problem.

Doctors might also know about coupons and promotions that could keep your treatment costs down. It never hurts to ask.

Don’t leave treatment for sex health problems to chance. Ask a board-certified physician about the best path for you.


The Journal of Sexual Medicine

Balasubramanian, Adithya, BA, et al.
“An Analysis of Popular Online Erectile Dysfunction Supplements”
(Full-text. Published online: April 26, 2019)

Harrison, Pam
“Supplements for Sex: What To Know”
(April 22, 2019)

Sex Health Blog

Sexual Effects of ADHD Different in Men and Women

We get it. When you have a sexual problem, you might not want to talk about it. Sex is a delicate, private subject, and lots of people don’t want to admit they’re having trouble. 

Instead of seeing a doctor, many people turn to the internet and look for products that might help. But are supplements the answer? 

Over-the-counter supplements don’t require a prescription, and you can easily get them in pharmacies, in health food stores, and over the internet. And buying them this way saves you a trip to the doctor. 

Cost is another important factor. Sexual health treatments, such as pills for erectile dysfunction (ED) aren’t always covered by insurance, and they can carry a hefty price tag. The supplement route can be more affordable. 

But before you add a sexual enhancement supplement to your cart, keep these points in mind: 

Lack of regulation

  • Supplements aren’t regulated by agencies like the U.S. Food and Drug Administration (FDA). In fact, the FDA considers supplements to be foods, and manufacturers are not required to provide evidence of their products’ safety and effectiveness. 


  • Products are often marketed with terms that imply safety, like natural, homeopathic, and organic. These descriptions can be misleading. As Dr. Ryan Terlecki of Wake Forest University told, “Nothing falls from a tree in the shape of a pill or capsule.”

Unlisted ingredients

  • Supplements can contain ingredients that aren’t listed on the packaging label. 


Scientists have found supplements that contained prescription drugs for erectile dysfunction (sildenafil, tadalafil) or antidepressants (dapoxetine). Such ingredients may not be safe for everyone, and they aren’t always on the supplement label.

Men who take nitrates for conditions like heart disease and diabetes should never take ED drugs because the interaction can cause a serious drop in blood pressure.

Interactions and side effects

  • Supplement ingredients – whether declared or undeclared - can interact with other medications you take, which can be dangerous. 


Fenugreek, a common supplement ingredient, can interact with anticoagulants (medicines that help prevent blood clots). 

People who take antidepressants, blood pressure medications, or central nervous system stimulants should avoid yohimbine. 

In addition to drug interactions, supplements can have other side effects and may affect lab test results ordered by your doctor. 

Lack of evidence

  • There isn’t always scientific evidence to back up the claims made by supplement manufacturers.


In an April 2019 Journal of Sexual Medicine study, researchers reported that in 413 studies of sexual enhancement product ingredients, only 17% involved human subjects. 

Some people claim that a product called Zestra boosts sexual desire and improves orgasms in women. But the product has not been tested in men. 

Unreliable reviews

  • You might think that a product with hundreds of 5-star reviews is an effective one. But some vendors post fake reviews or paid reviews, which are not always trustworthy. 


In the Journal of Sexual Medicine study mentioned above, researchers used a tool called ReviewMeta to filter out suspicious reviews related to six erectile dysfunction supplements sold on After using this software, almost half of the reviews were filtered out, suggesting that they were unreliable. 

“The removal of nearly one-half of all reviews associated with these products raises concerns about the veracity of comments linked to these products,” the authors wrote. 

(Learn more about sex health product reviews here.) 

The bottom line

If you’re coping with a sexual problem, your best bet is to talk to your doctor about it. Remember, doctors are there to help you, and chances are, they’ve had other patients go through what you’re experiencing now. They know your medical history and can guide you on what treatments are most appropriate for you. They might also suggest other ways you can improve your sexual health, like following a healthy diet, getting enough sleep, and staying fit. 

Also, some sexual health issues are signs of a more serious health condition. For instance, men with diabetes and heart disease often start having trouble with erections because of poor blood flow to the penis. With a thorough health checkup, your doctor can screen for such conditions and start treating you immediately. Sometimes, treatment for the underlying condition resolves the sexual problem. 

Doctors might also know about coupons and promotions that could keep your treatment costs down. It never hurts to ask. 

Don’t leave treatment for sex health problems to chance. Ask a board-certified physician about the best path for you. 


The Journal of Sexual Medicine

Balasubramanian, Adithya, BA, et al.

“An Analysis of Popular Online Erectile Dysfunction Supplements”

(Full-text. Published online: April 26, 2019)

Harrison, Pam

“Supplements for Sex: What To Know”

(April 22, 2019)

Sex Health Blog

Most Men Like Their Penile Implants

Are Men Satisfied with Penile Implants?

Mention a penile implant to a man with erectile dysfunction (ED), and you might get a squeamish look. The idea of having surgery on his private parts is likely to make any man squirm. And, naturally, there are questions. Will the implant work? Will there be complications? Will sex feel the same? What do partners think?

These are all valid concerns. However, research over the years has found that implants have high satisfaction rates from men and their partners.

What is a penile implant?

A penile implant (sometimes called a penile prosthesis), is a device that allows a man to get an erection whenever he chooses. The implant is placed inside the body. No part of the implant is visible. Sexual sensations, ejaculation, and orgasm remain the same for most men.

In basic terms, implant surgeons remove the corpora cavernosa – two spongy chambers in the penis. Typically, these chambers fill with blood to form an erection. The tissue is replaced with implant materials, which form erections differently, depending on the type:

  • Malleable (semi-rigid, bendable) implants are rods placed in the shaft of the penis. When a man wants to have an erection, he simply lifts the penis into position. When he is done with sexual activity, he places it downward again.
  • Inflatable penile implants are a bit more complex. Instead of bendable rods, surgeons place two cylinders inside the penis shaft. These cylinders are connected to a pump that is surgically placed in the scrotum. To have an erection, the man activates the pump, which fills the cylinders with fluid, making the penis erect. After sex, he deactivates the pump, and the penis returns to its flaccid (not erect) state. Inflatable implants come in two varieties. Three-piece units include the pair of cylinders, the pump, and a fluid-containing reservoir. With two-piece units, the pump and reservoir are in the same unit.

Why get an implant?

 While less-invasive treatments for ED, such as pills, injections, and suppositories, help lots of men, they aren’t appropriate for everyone. Some men just don’t have success with these options. And others can’t use them. For example, men who take medications containing nitrates cannot take ED pills because drug interactions could cause a dangerous drop in blood pressure.

Are men satisfied?

Experts say yes, for the most part. Here is a brief summary of research conducted over the last two years:

  • In June 2018, BJU International published a study of 142 Italian men with implants. Men tended to be satisfied with their implants one year after surgery. More experienced surgeons were more likely to have satisfied patients.
  • A July 2018 Journal of Sexual Medicine study of 902 men with implants reported that 93% were highly satisfied six months after implantation. Those who experienced major complications were less satisfied.
  •  A November 2018 paper in Sexual Medicine Reviews reported that patient and partner satisfaction rates were over 85%.
  • Research published in the Journal of Sexual Medicine in May 2019 analyzed couples’ satisfaction with implants in a group of 883 men and their partners. About 90% of those with malleable implants said they were “somewhat” or “very” satisfied. Rates for these categories were 96% for men with two-piece inflatable implants and 99% for men with three-piece inflatable devices.Most of the couples said the implant met their expectations and that the device was easy to use. In addition, most said they felt confidence in their ability to engage in sexual activity. 

Implant advantages

Many men enjoy the spontaneity that implants offer. Instead of waiting for other treatments to take effect, they can create their erection in the moment. Some feel more masculine having their erectile function restored and more confident being able to please their partner.

Implant disadvantages

On the other hand, implants can have some drawbacks. As with any surgical procedure, there is a risk for infection. Device malfunctions are rare, but possible. There could be some shortening of the penis (although some men don’t notice). And some men don’t like the “artificial” aspect of a prosthesis.

A big decision

While most men and their partners are satisfied with their implants, only you and your partner can decide what is best for your personal situation. It’s important to be prepared and have realistic expectations. Also, keep in mind that implant procedures are not reversable. Once the corpora cavernosa are replaced, they cannot be restored.

Be sure to let your urologist know if you or your partner have any questions or concerns.


BJU International

Capogrosso, Paolo, et al.

“Satisfaction rate at 1year followup in patients treated with penile implants: data from the multicentre prospective registry INSISTED

(Abstract. First published: June 29, 2018)

International Society for Sexual Medicine

“What if I don’t like the implant? Can the operation be reversed?”

“Will sex still feel the same with a prosthesis?”

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)

Çayan, Selahittin, MD, FECSM, et al.

“Comparison of Long-Term Results and Couples’ Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation”

(Full-text. Published: May 30, 2019)

Habous, Mohamad, MD, FEBU, FECSM, et al.

“Predictors of Satisfaction in Men After Penile Implant Surgery”

(Full-text. Published online: July 15, 2018)

Mayo Clinic

“Two-piece penile implant”

Sexual Medicine Reviews

Barton, Gregory J., et al.

“Sexual Quality of Life and Satisfaction With Penile Prostheses”

(Full-text. Published online: November 29, 2018)

Urology Care Foundation

“What is Erectile Dysfunction?”

(Updated: June 2018)

Sex Health Blog

Marijuana and Male Fertility

Marijuana and Male FertilityMarijuana (cannabis) use laws have been changing rapidly in North America. Last week, Illinois became the 11th U.S. state to legalize recreational marijuana, and such use became legal across Canada last October. Mexico might legalize recreational marijuana later this year.

With marijuana more freely available, people do have health concerns. In regard to sexual and reproductive health, both men and women should know the possible short-term and long-term effects of marijuana on their sexual performance and fertility.

In today’s post, we’ll discuss some recent research of interest to men and to couples who are interested in having children.

Past Research

Before we get started, let’s take a moment to consider past research on marijuana and male fertility. Back in 2011, we reported on ways marijuana might affect sperm cells:

When healthy sperm cells are released, they don’t start swimming toward the egg right away. Instead, they go with the flow of the semen until they are closer to the egg. Then the swimming starts in a process called hyperactivation.

But sperm under the influence of marijuana start swimming immediately. The result? Many tire themselves out and don’t reach the egg at all.

Those that do reach the egg are less likely to fertilize it. This is because THC [tetrahydrocannabinol – marijuana’s active ingredient) hinders their ability to release enzymes needed to pass through the egg cell’s wall.

What do scientists think of marijuana’s effects on sperm now? The answers are mixed.

Increased Sperm Concentrations

In February 2019, researchers reported that men who had smoked marijuana in the past had “significantly higher concentrations of sperm” than men who had never smoked it.

Between 2000 and 2017, researchers collected and analyzed 1,143 semen samples from 662 men who were patients at a fertility clinic. The men also answered questions about their marijuana use.

Over half the men said they’d smoked marijuana at some point in the past. Forty-four percent said their smoking days were behind them, but 11% said they still smoked. About 45% of the men said they had never smoked marijuana.

Semen sample analyses showed that men with a history of smoking marijuana had an average of 62.7 million sperm cells per milliliter of semen. For men who had never smoked, the average count was 45.4 million sperm per milliliter.

The researchers also looked at how many men had sperm concentrations below 15 million per milliliter, the “normal” benchmark set forth by the World Health Organization. Five percent of marijuana smokers fell into this category, but over twice as many – 12% - of the nonsmokers did.

Does this mean that marijuana leads to higher sperm concentrations? Not necessarily. The authors pointed out that the men may have mis-stated their marijuana use, since the drug was illegal for most of the study period.

Also, the results run counter to previous studies that have shown negative effects on sperm. So more research is needed.

“These unexpected findings highlight how little we know about the reproductive health effects of marijuana, and in fact of the health effects of marijuana in general,” said study co-author Jorge Chavarro of the Harvard Chan School of Public Health in a press release.

“Our results need to be interpreted with caution and they highlight the need to further study the health effects of marijuana use,” he added.

Negative Effects on Sperm

Another study, published in April 2019, had some discouraging news for hopeful fathers.

At the annual meeting of the American Urological Association, researchers reported that sperm quality declined in men who used marijuana.

Their study involved 622 men between the ages of 18 and 59. One hundred twenty-five of the participants were infertile, 144 men used tobacco, and 74 men used marijuana. Another 279 fertile men who did not use tobacco or marijuana served as a comparison group.

After analyzing the men’s semen samples, the researchers found poorer semen parameters among marijuana users compared to the men who used tobacco. The marijuana users had fewer sperm cells per milliliter. Their sperm also had worse motility (ability to swim to an egg cell for fertilization) and poorer morphology (defects in size and shape).

The Takeaway

We still have a lot to learn about marijuana’s effects on our general health, as well as our sexual health. In the meantime, couples who hope to become parents should be open about their marijuana use when talking to their doctors. They should also be up front about the use of any other substances that could reduce their chances of conceiving.

Even if you’re not thinking about having children, take a moment to consider your own marijuana use. Do you think it’s impacting your health, even in subtle ways? If so, don’t hesitate to bring this up with your doctor and take steps to get your use under control.


Simon, Darran and Nicole Chavez

“Canada just legalized recreational pot. Here's what you need to know”

(Updated: October 17, 2018)

Stracqualursi, Veronica

“Illinois becomes the 11th state to legalize recreational marijuana”

(June 25, 2019)

Harvard T.H. Chan School of Public Health

“Marijuana smoking linked with higher sperm concentrations”

(Press release. February 5, 2019)

Human Reproduction

Nassan, Feiby L., et al.

“Marijuana smoking and markers of testicular function among men from a fertility centre”

(Full-text. February 5, 2019)

Journal of Urology

Hallak, Jorge, et al.

“MP75-09 Marijuana Consumption Has a Direct Deleterious Effect on Spermatozoa by Increasing Intracellular Reactive Oxygen Species Levels 20 Times More Than Tobacco Smoking: Reasons For Concern On Widespread Use”

(Abstract. Published: April 1, 2019)

Medical News Today

Nall, Rachel, MSN, CRNA

“Normal sperm count: Everything you need to know”

(Last reviewed: March 28, 2019)

Bankhead, Charles

“Studies: Weed Degrades Sperm, Spurs LUTS”

(May 5, 2019)

The Motley Fool

Williams, Sean

“Mexico Aims to Legalize Recreational Marijuana Before October”

(April 28, 2019)

The Science Times

Inocando, Aileen

“Marijuana Use Found to Cause Infertility Among Men”

(May 6, 2019)

“Marijuana and Male Sex Health”

(May 31, 2011)

Sex Health Blog

Multiple Sclerosis: Be Open to Sexual Changes

Multiple Sclerosis: Be Open to Sexual Changes Last year, scientists reported that almost two-thirds of people with multiple sclerosis (MS) experience sexual challenges, with the most common problems being loss of libido, orgasm difficulties, and trouble with arousal (vaginal lubrication and erections).

While this rate is high, it doesn’t mean that people with MS can’t enjoy intimacy. But understanding the challenges, staying patient, and making adjustments will go a long way in keeping sexual relationships strong.


How does MS cause sexual problems? Here are some of the mechanisms:

  • Poor message transmission. MS is a central nervous system disorder that attacks the myelin sheath, the coating that protects nerve cells. The result is a disconnect between the brain and other body parts, including organs involved with sexual function. For example, a man with MS might receive sexual stimulation (such as an erotic image or touch), but his brain might not “get the message” to start an erection. Similarly, a woman’s vagina might not lubricate because it doesn’t “know” about sexual stimuli. For some people, MS leads to decreased – or increased – genital sensation. In some cases, touch might become painful.
  • Depression and anxiety. An illness like MS takes a toll on one’s mental health as well. It can be hard to plan for the future, and people may miss doing things they used to do. They might also worry about their partner’s feelings and reaction to the situation. Communication between partners can break down. Together, these factors can diminish libido and make it more difficult to become aroused.
  • Incontinence. Some people with MS feel nervous about having urinary accidents, especially during sex.
  • Fatigue. With MS, it’s not unusual to feel too tired for sex.
  • Spasticity and muscle weakness. Trouble controlling muscle movements or feeling weak in the muscles may make some sexual activities difficult.

Problems for Women

In November 2018, a study in the Journal of Sexual Medicine provided some insight on how extensive sexual dysfunction is among women with MS. Researchers looked at data from nine other studies on MS and female sexuality. Overall, almost 1,500 women – roughly half with MS – were involved.

In the analysis, women with MS were almost twice as likely to have sexual problems than women who didn’t have MS. Trouble with arousal, lubrication, desire, orgasm, and pain were more common in women with MS. They also tended to have lower sexual satisfaction.

Problems for Men

Erectile dysfunction (ED) is a common problem for men with MS. Erections might not be firm enough for sex, or they might not occur at all.

Fortunately, men with ED have a number of treatment options:

Men might also experience trouble with ejaculation.

Next Steps

If you or your partner is struggling with MS and intimacy, consider these options:

  • See your doctor. As about treatments for sexual issues. For example, the solution for poor vaginal lubrication might be an over-the-counter product. And as noted above, there are several ways to treat erectile dysfunction. Many people feel awkward discussing their sex life with their doctor. But remember, your doctor is there to help you.
  • Seek other professional help. Seeing a counselor or sex therapist, especially one who works with people with MS, can give you some new ideas to try in the bedroom. He or she can also help you cope with any depression, anxiety, or relationship conflict you might be experiencing. (Learn more about sex therapy here.)
  • Talk to your partner. Have an honest, open conversation with your partner about any changes in your sexual relationship and how you’re feeling about them. He or she might be feeling the same way but be hesitant to bring it up. Work as a team to keep your relationship on track, emotionally and sexually.
  • Plan for sex. For people with MS, it isn’t always possible to have sex at the spur of the moment. But you can plan for romance and intimacy. Figure out when you and your partner can have time to yourselves to relax and enjoy being together. It might not be as spontaneous, but having that time to look forward to can be just as exciting.
  • Take your time. If it takes you longer to become fully aroused or to climax, that’s okay. Just enjoy the journey and don’t worry about timetables.
  • Experiment. You might need to try other types of sexual stimulation because what worked for years might not be as effective. Now is a great time to try something new. That “something new” could be a new type of touch, different sexual positions, oral sex, the use of sex toys like vibrators, sex at a different time of day, or sex in a new location. Be open to new ideas.


Vann, Madeline R., MPH

“How to Have a Healthy Sex Life When You Have Multiple Sclerosis”

(Last updated: December 21, 2016)

International Society for Sexual Medicine

“How might multiple sclerosis affect a person sexually?”

The Journal of Sexual Medicine

Zhao, Shankun MD, et al.

“Association Between Multiple Sclerosis and Risk of Female Sexual Dysfunction: A Systematic Review and Meta-Analysis”

(Full-text. Published online: November 1, 2018)

National Multiple Sclerosis Society

“Sexual Problems”

“About Two-Third of MS Patients Have Sexual Problems”


“Maintaining Intimacy With Multiple Sclerosis”

(Reviewed: April 24, 2016)

Sex Health Blog

Testosterone Therapy Guidelines From the Endocrine Society

Testosterone Therapy Guidelines From the Endocrine SocietyHow do healthcare professionals make decisions when diagnosing and treating illnesses? Certainly, their continuing medical education helps, and most attend conferences and keep up with research in their field’s peer-reviewed journals.

But professionals also consult guidelines issued by medical societies, such as the International Society for Sexual Medicine (ISSM) or the American Urological Association (AUA). Society panels take a close look at the latest clinical trials and other studies and use that evidence to develop recommendations.

Over the last few years, testosterone replacement therapy has been a hot topic for medical societies. Back in August of last year, we covered new guidelines from the American Urological Society. Today, we’ll discuss a set of guidelines that were updated by the Endocrine Society, a professional group of over 18,000 hormone specialists.

Since testosterone is an important hormone for men, the list of guidelines can be an essential tool for sexual health specialists and primary care physicians who treat men with hypogonadism (low testosterone).

The Endocrine Society guidelines were originally issued in 2010 and updated in 2018.

(Note: For a primer on hypogonadism, please see the links at the bottom of this post.)

Why were the guidelines updated?

Scientists have conducted a great deal of research on testosterone therapy in recent years. The updated guidelines reflect new findings and address concerns.

In addition, more men are seeking help for issues related to testosterone deficiency nowadays, and “low t” gets a lot of media coverage. As a result, men are asking their doctors whether testosterone therapy could help them. It’s critical that prescribers fully understand the benefits and risks.

What do the updated guidelines say?

Highlights of the Endocrine Society’s updated guidelines on hypogonadism include the following points:


  • In general, men shouldn’t be routinely screened for hypogonadism. However, a diagnosis of hypogonadism is recommended if a man has symptoms (such as low libido or fatigue), and a blood test reveals lower-than-normal testosterone levels.
  • Based on other hormonal measurements, men can be diagnosed with primary hypogonadism (caused by problems in the testes) or secondary hypogonadism (caused by problems in parts of the brain that trigger testosterone production).


  • The recommended goals of testosterone therapy are to “induce and maintain” secondary sex characteristics that are driven by testosterone (such as facial hair and muscle mass) and to alleviate symptoms like low sex drive.
  • Testosterone therapy is not recommended for men who would like to father a child in the near future. Men with certain health problems (such as prostate cancer, breast cancer, untreated severe obstructive sleep apnea, and recent heart attack or stroke) should not take testosterone.
  • Testosterone therapy might not be appropriate for men between the ages of 55 and 69 who are expected to live at least another ten years. Doctors should discuss the benefits and risks with these patients.
  • Men over age 65 shouldn’t be prescribed testosterone routinely. Instead, doctors should consider each individual’s situation.
  • Men with HIV, low testosterone, and weight loss might undergo testosterone therapy to gain and maintain weight.
  • Men with diabetes and low testosterone should not use testosterone as a way to control their blood sugar.


  • Once testosterone therapy has begun, men should have regular checkups to make sure it is working well and there are no side effects.
  • During the first year of therapy, men with abnormal prostate cancer screening results should see a urologist.

What does this mean for patients?

While these guidelines are intended for healthcare professionals, they can be useful for men, too.

Understanding the guidelines for any treatment you receive helps you weigh the pros and cons of therapy as you make health decisions.

“The [updated Endocrine Society] guideline emphasizes the importance of patient engagement in a shared decision-making process, especially with respect to the choice of treatment regimens and prostate monitoring,” said Dr. Shalender Bhasin, head of the guideline development task force, in an interview with Endocrine News.

Learn more

For more information on hypogonadism and testosterone, please see these links:

Low Testosterone

Unpacking the Latest Testosterone Therapy Guidelines

What Should Men Know About Topical Testosterone?

Self-Injectable Testosterone Now Available

FDA Approves Testosterone in Pill Form


Endocrine News

“Q&A: Shalender Bhasin, MD”

(May 2018)

The Endocrine Society

“About the Endocrine Society”

“Testosterone Therapy for Hypogonadism Guideline Resources”

The Journal of Clinical Endocrinology and Metabolism

Bhasin, Shalender, et al.

“Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline”

(Full-text. Published: March 17, 2018)

Sex Health Blog

Should Men with ED Use Telehealth Platforms?

Should Men with ED Use Telehealth Platforms?Justin was 24 years old and in his sexual prime. Or at least, he thought he should be. The last few times he wanted to have intercourse, his erection was rather…lackluster. It wasn’t firm at all, and while his partner didn’t say anything, he was sure his performance disappointed them both.

“I’m too young for this,” he thought. He had seen commercials for erectile dysfunction drugs on television, but the guys always seemed so much older. This type of stuff didn’t happen to younger guys, did it?

He didn’t go to the doctor often, and he couldn’t imagine calling for an appointment for this specific problem. But as time went on, his erections became less predictable. He knew he had to do something.

While surfing online, he found some websites that offered erectile dysfunction (ED) drugs that could be discreetly delivered to his home. He could talk to a doctor through video chat and get a prescription easily. Was this the route to take?

In this post, we’ll consider Justin’s question.

What is telehealth?

Technology has brought people closer together in ways we might not have imagined thirty years ago. And this includes doctors and patients, who can now use the internet to communicate through telehealth (sometimes called telemedicine). Patients can email their doctor, send relevant pictures, and have videoconference discussions of symptoms and treatment options without actually getting together in an office or exam room. These communications can take place on desktop and laptop computers, tablets, and smartphones. In some cases, patients can receive prescriptions through telehealth services.

Why might men with ED consider telehealth?

“Seeing” a doctor online is convenient. Patients can do so in the comfort of their own homes, without the hassle of traveling there, finding parking, or taking time off of work. In addition, many men feel awkward or embarrassed about sexual health problems. Telehealth might offer a degree of privacy, as long as the connection is secure.

Why should men with ED see a doctor in person?

While telehealth has its advantages, it is not a substitute for seeing a doctor in person. For men with ED, this is especially important.

ED is often a sign of more serious health conditions, like diabetes and heart disease. Sometimes, the links are complicated. For example, erections might be impaired by hardening of the arteries (atherosclerosis), low testosterone levels, or autonomic neuropathy (a form of nerve damage). To learn more about these issues, a physical exam is essential. Lab tests may also be ordered, and these can only be done during a traditional office visit.

In fact, ED diagnosis guidelines issued by the American Urological Association (AUA) stress the importance of a physical exam:

Men presenting with symptoms of ED should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing.

In other words, a telehealth doctor may be able to prescribe an ED medication, but he or she will not have all the information necessary to determine exactly why a man has ED.

A comprehensive physical exam can reveal any underlying medical conditions, and treatment can begin immediately. Erections can improve, and the risk of any further complications can be reduced.

Dr. Hossein Sadeghi-Nejad, President of the Sexual Medicine Society of North America (the organization behind contributed to the AUA guidelines on ED. In an interview with Business Insider, he pointed out that while not all men with ED are at risk for more serious health conditions, “but some are.”

“To lose that window of opportunity to address the bigger problem would be a pity," Dr. Sadeghi-Nejad added.

Next steps?

Some men might find it difficult to work up the nerve and mention ED to the doctor. But it’s worth making the call. It can lead to more satisfying, more confident sex. And it can help you and your doctor address any bigger health concerns that need attention.

Check out these links to learn more:

Erectile Dysfunction (overview of ED, including causes and treatments)

Young Men and Erectile Dysfunction

Possible Causes of Early Onset Erectile Dysfunction (ED)

How Do Certain Diseases Lead to Erectile Dysfunction?


American Urological Association

“Erectile Dysfunction: AUA Guideline (2018)”

(Published: 2018)

Business Insider

Court, Emma

“Hot startups like Hims and Roman are marketing Viagra to young men online, but their approach raises 2 big questions”

(February 25, 2019)

Bettencourt, Erica

“TeleHealth Pros and Cons”

(January 11, 2019)


“How Do Certain Diseases Lead to Erectile Dysfunction?”

(January 12, 2016)

Sex Health Blog

Penis Size Unrelated to Fertility

Penis Size Unrelated to FertilityIs it true that men with a smaller penis are more likely to be infertile?

The simple answer is no. A number of factors can contribute to infertility. A man can have a low sperm count, or his sperm might not be fully developed. He could have retrograde ejaculation, which causes semen (including sperm) to travel backward into the bladder instead of forward out of the penis when he ejaculates. Medications could affect his sperm production. But penis size is not a factor.

Last fall, however, some media outlets reported that men with small penises had lower odds of fathering children. Where did this notion come from? The news stemmed from a poster presentation at the 2018 Scientific Congress of the American Society for Reproductive Medicine in Denver.

Unfortunately, not all the facts were reported accruately. What happened? Let’s take a closer look.

The Study

Eight hundred fifteen men between the ages of 18 and 59 participated in the study, conducted by a research team from the University of Utah. Two hundred nineteen men were infertile; the remaining 596 men were not.

The researchers measured each man’s stretched penile length (SPL) – the distance from the pubic symphysis (a joint near the pubic bone, just above the penis) to the meatus (the urinary opening).

The infertile men’s average SPL was 12.5 centimeters (4.92 inches). The average SPL for the other men was 13.4 centimeters (5.28 inches).

The authors wrote the following conclusions:

This is the first study to demonstrate an association between a shorter SPL and infertility. It is unknown if reduced length is a result of genetic or congenital factors associated with infertility such as testicular dysgenesis syndrome or the result of underlying hormonal differences between the two groups. Further investigation is needed to better understand the association of shorter stretched penile length with male infertility.

The Media Coverage

Not long after the presentation, news outlets started sharing the news, sometimes with misleading headlines linking smaller penises directly to infertility.

But that’s not what the study found, lead author Dr. Austen Slade told Medscape Medical News, noting that he had not spoken to any of the reporters who wrote the misleading articles. (His contact information was included on the poster.)

“Headlines such as 'men with short penises can't father children' are just plain wrong," Dr. Slade said. "What we are saying here, and it would have been obvious if any of these reporters had contacted me, is that a shorter length may be an indication of something else going on."

"Fertility depends on many factors, but not on the size of a man's penis," he added.

As the abstract conclusion explains, penis size could be connected to hormonal, genetic, or congenital (present at birth) factors associated with infertility. The authors called for more research to better understand the study’s results.

Why were readers misled?

It’s possible that the news outlets saw the association between penis size and infertility but didn’t look beyond that for further explanation. Dr. Emily Barrett of Rutgers School of Public Health in New Jersey told Medscape, “anything with the word ‘penis’ is like a magnet for reporters.”

How can you know that health information is accurate?

Whether it’s a news piece or health information in general, there are steps you can take to make sure you’re getting accurate reporting.

  • Consider the source. Is it an outlet you’ve never heard of? Is it an organization you trust?
  • Check the date. How current is the information?
  • Look at how the information was gathered. Does it come from a respected medical journal? From scientists or healthcare providers? From patients?
  • Talk to your doctor. Don’t hesitate to show the article to a professional and ask questions.

See more tips for assessing health information (especially on the internet) here.


American Academy of Family Physicians

“Health Information on the Web: Finding Reliable Information”

(Last updated: January 4, 2018)

Fertility and Sterility

Slade, A., et al.

“Stretched penile length and infertility, a new association”

(Abstract presented at the 2018 Scientific Congress and Expo of the American Society for Reproductive Medicine. October 9, 2018)


“Pubic symphysis”

(Reviewed: March 19, 2015)

Medscape Medical News

Lowry, Fran

“Media Sensationalizes Small Penis Study, Upsetting Patients”

(October 16, 2018)

“The Internet and Sex Health Info”

Oaklander, Mandy

“Can You Really Trust the Health News You Read Online?”

(December 9, 2014)

Urology Care Foundation

“What is male infertility?”

Sex Health Blog

Women and Masturbation

Women and Masturbation Back in December, we brought you a blog post on men and masturbation, discussing the benefits, risks, and ways to enhance the experience.  

This month, it’s the women’s turn.

Do women masturbate as much as men do?

Female masturbation is sometimes considered taboo, an activity that isn’t meant for “nice girls” who aren’t supposed to enjoy sexuality. But times are changing.

Female masturbation has become more common over the last few decades. In 2017, a study of 913 French women found that 74% of survey respondents had masturbated at least once in their lives. In 2006, a rate of 60% was reported, and in 1970 the rate was just 19%.

Still, men masturbate more than women do, the study authors explained, noting that 95% of men said they had masturbated compared to 74% of women. Half of the men said they masturbated at least once a week, but only 14% of women maintained this frequency.

Why masturbate?

Masturbation, pleasuring oneself sexually, is a natural, healthy way to achieve sexual release. It can have health benefits, too:

  • It’s a stress reliever and mood booster. Simply taking time for yourself for an enjoyable activity can take your mind off stress and help you focus instead on pleasure. And if masturbation leads to orgasm, the body releases endorphins – powerful neurotransmitters associated with feeling good. (Note: Orgasm shouldn’t necessarily be the end goal of masturbation. If it doesn’t happen for you, don’t worry. It’s fine to just relax and enjoy the experience.)
  • It teaches you about your body. When you’re exploring your body privately, you can try new things that you might not try with a partner. You might find that touching areas like the nipples or ears can be just as exciting as touching the genitals. You might share these discoveries with your partner.
  • It helps keep your genitals healthy. This is especially true for older women. Estrogen is an important hormone for keeping the vagina moist and flexible. When estrogen levels drop at menopause, the vagina can become dry and brittle, making sex uncomfortable. However, masturbation improves blood flow to the area, which might help with lubrication. (Learn more about genital changes at menopause here.)
  • It is (generally) safe. Masturbation is a low-risk sexual activity, and women don’t need to worry about pregnancy or sexually transmitted infections. That said, it’s important to stay safe. Women should wash their hands before masturbating to avoid transmitting any bacteria to the genitals. Sex toys, if used, should be clean and appropriately sized to avoid injury. (Learn more about the sizing of dildos and vibrators here.) Also, if you find that masturbation is interfering with your day-to-day life, be sure to talk to your doctor.

How do women masturbate?

There is no right or wrong way to masturbate, as long as the practice does not hurt anyone. This is a time to treat yourself to new experiences along with the tried-and-true routines.

Here are some ideas to consider:

  • Lie on your back (or stomach) and rub your genitals and other erogenous areas. If you aren’t sure exactly where those areas are, let your hands wander and explore.
  • Squeeze your thighs together.
  • Use your imagination. Fantasize about a particular person or locale.
  • Watch an erotic movie or read a sexually-explicit book while masturbating.
  • Insert a finger or dildo into your vagina.
  • Try using a vibrator.
  • Let water from the shower massage your genitals. (You can also use a hand-held shower head.)
  • Take it slow. You don’t have to rush to orgasm. You don’t even have to orgasm at all. Just enjoy the journey.


McCoy, Krisha

“Health Benefits of Solo Female Sexuality”

(Last updated: October 15, 2014)


Scaccia, Annamarya

“How to Masturbate with a Vagina: 28 Tips and Tricks for Solo Play”

(Reviewed: March 13, 2018)

Psychology Today

Mintz, Laurie, PhD

“Masturbation 102: How Women Pleasure Themselves”

(June 25, 2018)

Zoldan, Rachel Jacoby

“14 Benefits of Female Masturbation and Why Every Woman Should Do It”

(December 31, 2018)

Sexologies via Science Direct

Kraus, F.

“The practice of masturbation for women: The end of a taboo?”

(Full-text. October-December 2017)


Pagán, Camille Noe

“Female Masturbation: 5 Things You May Not Know”

(March 11, 2014)

Sex Health Blog

Female Cancer Survivors and Sex Health Issues

Female Cancer Survivors and Sex Health Issues

If you’re a woman going through cancer treatment, you’ve probably had to adapt to a lot of changes in your life. You might have seen some dramatic changes in your sex life, too – changes you might not have been prepared for.

Maybe you’re not able to have sex the way you used to. Perhaps you’re experiencing hormonal changes that affect your level of desire. Maybe you’re feeling confused about your partner or your relationship. Or you might be feeling anxious about starting a new relationship after cancer treatment.

No matter what you’re experiencing, it’s normal to be concerned about your sex life. Your sexuality is a part of who you are. Today we’ll look at some of the issues female cancer survivors face and some strategies to cope with them.

Physical challenges

  • Hormonal changes.  For some women, cancer treatment causes menopause, the time when a woman’s ovaries stop producing eggs and her menstrual periods stop. Along with menopause come lower levels of two hormones, estrogen and androgen. Estrogen helps ready your vagina for sex by making it longer, wider, and lubricated. Androgen affects your sex drive. After menopause, these hormonal changes can cause vaginal dryness and tightness or a loss of desire. Talk to your doctor if you have any problems. For dryness, you may try water-based lubricants, a vaginal moisturizer, or vaginal hormones. For loss of desire, your doctor may prescribe small doses of androgens.
  • Pain.  Pain during sex is common for many women. Vaginal dryness and tightness or changes in the genitals from cancer treatment are common causes. Be sure to discuss any sexual pain with your doctor. He or she can give advice tailored to you. Talk to your partner about what does and doesn’t work for you. You may need to discover new ways of touching each other or try new positions and techniques to make the experience pleasurable for you. Try to be patient and open-minded.
  • Fatigue. Breast cancer and its treatment can be exhausting. You might just feel too tired for sex. Try planning intimacy for times when you have more energy, such as the early morning or afternoon.

Emotional challenges

Lots of women feel anxious about changes that result from cancer treatment and how they’ll be perceived by others.

  • Body image. Your body might look different from cancer treatment. Losing a breast or your hair, having scars from surgery, changes in weight – these can all make you feel less attractive. You may worry that these changes will turn off your partner. Some women feel better when they accentuate the positive. You might try a new style of clothes or makeup to give you a boost. Some women wear a breast form or try different skin treatments. Don’t forget that healthy eating and exercise can also make you feel better! Remember, too, that you are still you, beautiful inside and out. As the National Cancer Institute says, “Try to recognize that you are more than your cancer. Know that you have worth – no matter how you look or what happens to you in life.”
  • Dating.  Starting new relationships can be fun and exciting, but women in cancer treatment may feel anxious about it. When should you tell your partner about your cancer? How will he or she react? You can start by just enjoying time with your friends and family. Take part in activities you enjoy or try new ones. You might not meet a new partner, but it’ll boost your spirits and confidence to be out and about. When you do meet someone new, enjoy the experience. When the relationship becomes more serious, and when you feel that you trust the person, you can introduce the topic of cancer. Try practicing what you’ll say with a good friend and ask for feedback. Also think about the many ways that person may react and how you’ll handle them. Don’t assume that the person will reject you. If the relationship has a solid base with caring and trust, the person will likely want to be with you, cancer or not.

Other concerns

  • Is it okay to have sex? Many women wonder whether it’s safe to have sex during or immediately after cancer treatment. Your doctor can best answer this question. If you’ve just had surgery, sex could pull at the stitches, so it might be best to wait awhile. Unusual bleeding is another concern. Some cancer treatments, such as radiation and chemotherapy, can interfere with your immune system and make you more susceptible to infections. Ask your doctor about any precautions you need to take.
  • Radiation. Some women who have radiation therapy worry that they can pass along radiation to their partner. Again, this is a concern best addressed by your doctor. Generally, if the radiation comes from a machine outside your body, no radiation remains in your body. So in this case, you wouldn’t be passing radiation along to your partner. However, radiation from a radioactive implant placed in your uterus or vagina can be passed along to your partner, so it’s best to ask your doctor when you can have sex again.

Talk to your doctor.

Your doctor might not bring up sexual issues, but that doesn’t mean you can’t. Don’t hesitate to speak up! He or she may know the remedy. And even if your doctor doesn’t have all the answers, he or she can refer you to someone who does, such as a sex therapist or counselor. And there’s nothing wrong with seeing a specialist.

Talk to your partner.

If changes in your sex life are troubling you, be sure to talk to your partner as well. Together, you and your partner can brainstorm ways to adjust your sexual repertoire. For example, if vaginal intercourse is uncomfortable, try oral sex or kissing and cuddling. (Read more about sexual pain here.) 

You might also need more time to become fully aroused. If so, tell your partner what you need. Take advantage of that time to experiment and just enjoy each other.  

Your partner might be nervous about sex, too, afraid of hurting you or doing something “wrong.”  If an activity hurts, by all means say so. But if you miss an old activity or touch, let your partner know.

Consider therapy.

Know that you are not alone. Depression and anxiety, common in breast cancer patients and survivors, can take a toll on your sex life as well. If you think you need help, consider therapy or a support group. Couples counseling and sex therapy may also help you work out changes in your relationship.

Moving forward

Remember, your sex life was likely important to you before cancer. There’s no reason it shouldn’t be important now. Cancer and its treatment shouldn’t prevent you from having healthy, fulfilling sex.

To learn more about breast cancer and sexuality, see these links:

Breast Cancer Survivors Face Sexual Concerns

The Effects of Cancer on Women’s Sexuality

Cancer and Sex for Single Women

Special Therapy Addresses Body Image in Breast Cancer Survivors

Breast Cancer Treatment Could Preserve Ovarian Function

Breast Cancer Has Sexual Impact on Both Survivors and Partners

For Breast Cancer Survivors, Sexual Concerns May Last Years


Additional Resources

“Changes in Your Sex Life”

(Last modified: June 13, 2017)

Schwartz, Dr. Pepper via PRNewswire

“Breast Cancer and Intimacy: Advice for Survivors to Address Sexual Dysfunction and Regain Confidence”

(October 16, 2018)

Updated: January 2, 2019

Sex Health Blog

What Should Men Know About Masturbation?

What Should Men Know About Masturbation? You might recall a 1992 Seinfeld episode called “The Contest.”

At the beginning, friends Jerry, Kramer, and Elaine are sitting in their favorite coffee shop when fellow friend George walks in, looking upset. He reveals that his mother caught him masturbating and swears he will never do it again – anywhere.

His friends are not convinced, and George proposes a contest. Which friend can go the longest without masturbating? Bets are made, and then Elaine says she wants to join in too.

George and Jerry protest. “It’s easier for a woman not to do it than a man,” Jerry explains, adding, “We have to do it. It’s part of our lifestyle. It’s like, uh . . . shaving.”

Whether masturbating is part of the male lifestyle might be debatable, but research suggests that men masturbate more than women do. A 2010 study from the Kinsey Institute of Indiana University found that 1 in 4 men between the ages of 18 and 59 masturbated a few times a month to weekly. About 20% said they masturbated two to three times a week. In contrast, women masturbated once a week or less.

Masturbation is a healthy activity, for the most part. But there are things men should be aware of, and we’ll go over some of those today, along with ways to make the self-stimulation even better.

What are the benefits of masturbation?

We’ve come a long way from the old wives’ tale telling us that masturbation makes people go blind or gives them hairy palms. In truth, masturbation is natural, normal, and healthy.

Here are some of the benefits:

  • It brings pleasure.
  • It’s (usually) a safe sexual outlet. You can relieve sexual tension without worries of an unplanned pregnancy or sexually-transmitted infection (STI). You can also get some sexual release if you’re single or if your partner is far away or unable to have sex.
  • It offers an opportunity to explore your own body and figure out where and how you like to be touched.
  • It can relieve tension and stress and might help you sleep better.

Could masturbation become a problem?

Some men masturbate more than others, and as long as it doesn’t interfere with your day-to-day life or your relationships, you probably don’t need to worry about the frequency.

However, men should be aware of some concerns:

  • Skin irritation. Masturbating too vigorously can cause the skin on the penis to become irritated.
  • Penile fracture. Excessive force or bending the penis during masturbation can lead to penile fracture, which is an emergency. If you hear cracking or popping sound, or experience bleeding or bruising, seek immediate medical care.
  • Premature ejaculation. Some men who bring themselves to climax quickly might find that their bodies adjust to this timing.
  • Needing more stimulation. If you masturbate more rigorously, or do so while viewing pornography, you might need more stimulation from your partner to become fully aroused and reach orgasm. Porn may also lead to unrealistic expectations for sex, as it does not depict what usually happens with everyday couples.
  • Addiction. Many men masturbate while watching pornographic videos or looking at adult magazines. This can become problematic if the time spent masturbating takes away from daily responsibilities or interferes with work, school, or relationships. Men who think they are addicted to pornography are encouraged to see their doctor or therapist. (Learn more about porn addiction here.)

Are there other ways to masturbate?

The process may seem pretty straightforward. But men can enhance their experiences by mixing things up. Here are some ideas to try:

  • Visualize other scenarios. While masturbating, close your eyes and imagine an erotic scenario that is different from what you usually experience. See where your mind takes you.
  • Use toys or props. Some men find that vibrators and artificial vaginas enhance their masturbation.
  • Use other media. Try listening to soft music or a suggestive audiobook or podcast.
  • Touch other areas of the body. The penis plays an important role in sexual excitement, but it’s not the only location. Try rubbing your chest, testicles, or perineum (the area between your penis and anus).
  • Try other locations or positions. If you typically masturbate in bed, try it in the shower. If you stroke with your right hand, try doing so with your left.

Ultimately, as long as your technique and practice doesn’t hurt you or others, just do what feels right and enjoy the pleasure.


Between Us Clinic

Sher, Daniel

“How to Masturbate Correctly – A Guide for Healthy Male Masturbation”

(November 6, 2018)

International Society for Sexual Medicine

“Does masturbation cause erectile dysfunction (ED)?”

“What are some effects of sustained pornography use?”

“What can be done to help someone who has a problem with pornography?”

“What is the “normal” frequency of masturbation?”

Medical News Today

Nichols, Hannah

“Are there side effects to masturbation?”

(Last reviewed: December 7, 2017)

David, Larry

“The Contest”

(First broadcast: November 18, 1992)

Stritof, Sheri

“What are Some of the Myths About Masturbation?”

(Updated: May 23, 2018)


Griffin, R. Morgan

“Male Masturbation: 5 Things You Didn't Know”

(Reviewed: January 28, 2017)

Sex Health Blog

Cancer and Sexuality: Questions For Your Provider

ancer and Sexuality: Questions For Your ProviderAfter a cancer diagnosis, it’s not unusual to have questions swirling through your mind. How far has the cancer progressed? What is the prognosis? What will treatment be like? How will my family and I cope?

Often, questions about sexuality go on the back burner. It’s easy to understand why, when so many other issues may take priority. But keep in mind that sex is an important part of life. There’s no reason for your sexual relationships to stop just because of cancer.

Cancer and its treatment can have a huge impact on sexual function, even if the reproductive organs aren’t targeted. So it’s best to ask about your situation before your treatment begins.

Below, we’ve listed some questions you might consider asking your cancer care team. While not all of them will apply to you, they might trigger other questions you haven’t thought of. Be sure to bring a pen and some paper to jot down the answers. You might also have your partner or a trusted friend or relative go with you to your appointment. It can help to have a second set of ears, just in case you miss something.

Finally, don’t hesitate to ask questions, especially if your healthcare provider doesn’t bring up sexual health. Some people feel awkward discussing sex, but it’s entirely reasonable to wonder how treatment will affect your sex life.

We suggest that you print out these questions and put a mark next to the ones that apply to you. We’ve also included space for you to write down your own questions and answers at the end.


  • What are the sexual side effects of this treatment?
  • Will I be able to have sex the way I used to?
  • What should I do if my orgasms change?
  • What should I do if I lose interest in sex or have difficulty becoming aroused?
  • How might this treatment affect my sex hormones (e.g., testosterone and estrogen)?
  • Will I have to stop having sex for a period of time? (If so, when can I resume sexual activity?)
  • Are certain sexual activities or positions recommended over others?
  • Will sex feel different?
  • Will it hurt?  
  • Can you recommend some books or websites, so I can learn more?

For Men

  • Will my erections change?
  • Will I have erectile dysfunction (ED)? If so, will it be permanent?
  • What ED treatments would be best for me?
  • Will I need penile rehabilitation? What does that entail?
  • Will my testosterone levels decrease?
  • How does prostate cancer treatment affect gay and bisexual men?

For Women

  • What is surgical menopause?
  • Will I experience vaginal dryness?
  • If I have trouble with lubrication, should I try a lubricant or moisturizer?
  • Would hormone replacement therapy be an option for me?
  • Will surgery or radiation change the shape of my vagina?
  • Can vaginal dilators help stretch my vagina?

Body Image

  • How will cancer treatment change my appearance?
  • Where might I find items like wigs and breast forms?
  • Can plastic surgery help me? oHow wi
  • Should I consider prosthetics (such as prosthetic testicles)?
  • What can I do about surgical scars?


  • What should my partner know about sex and cancer?
  • Can my partner “catch” anything through sexual contact?
  • Is it safe for me to have sex if I’m having chemotherapy or radiation therapy?
  • Is help available for partners?
  • Should my partner come with me to therapy?
  • I’m single. When should I tell a new partner about my cancer treatment?
  • Will this treatment affect the way I speak, eat, or socialize?
  • Will this treatment make it more difficult to kiss my partner?


  • If pregnancy is no longer a concern, do I still have to practice safe sex?
  • What type of contraception is best for me?
  • Can I use hormonal contraceptives?

Pregnancy and Fertility

  • Is it safe for me (or my partner) to become pregnant during my cancer treatment?
  • Will I still be able to have children?
  • Can I freeze sperm or egg cells for future in vitro fertilization?
  • Where can I find reliable information about surrogacy?
  • Where can I find reliable information about adoption?
  • How can my partner and I cope with infertility?

Emotional Health

  • I’m feeling very anxious about the future. Should I talk to a counselor?
  • Can you refer me to a counselor in my area?
  • Can you put me in touch with a support group or other patients who have had this type of cancer?

Your Questions

My Question

My Doctor’s Answer











Learn More

To learn more about cancer and sexuality, these links can help:

Sex After Cancer

Cancer and Sexual Problems

The Effects of Cancer on Women’s Sexuality

Cancer and Sex for Single Women

How Does Cancer Affect Men’s Sexual Health?

Fertility Options for Men with Cancer

How Does Prostate Cancer Treatment Affect Gay and Bisexual Men?

You can also find information by searching for a specific term on our site.

Sex Health Blog

Does Medicare Cover Erectile Dysfunction Treatments?

Does Medicare Cover Erectile Dysfunction Treatments?

It’s no secret that our bodies change as we age. We might not move as quickly, hear as clearly, or see as vividly as we did when we were younger. But while some changes might seem inevitable, getting older doesn’t mean we’re down for the count.

Sexual function is no different. As men get older, they might start having trouble with erections. It can take longer to get aroused or become more difficult to get a fully firm erection. Older men may also be more prone to health conditions that contribute to poor erections, like low testosterone, diabetes, and heart disease. Treatment for certain types of cancer, like prostate cancer, can affect erections, too.

The good news is that men with erectile dysfunction (ED) have many treatment options available. Pills, self-injections, vacuum erection devices, urethral suppositories, and penile implant surgery are all possibilities.

Unfortunately for older men in the United States, Medicare usually does not cover ED treatments, as they are not considered medically necessary.

Today, we’ll discuss some of the basics of Medicare coverage for ED. Please note that this is a brief summary. Medicare has many components, and we encourage you to see the Medicare website for complete details.

What is Medicare?

Medicare is a health insurance program for people age 65 and older in the United States. People under age 65 may qualify if they have certain disabilities. Patients with end-stage renal disease may be eligible at any age.

Generally, Medicare comes in three main categories:

  • Medicare Part A – This part helps cover people when they are in the hospital.
  • Medicare Part B – This part helps cover doctor’s visits and outpatient services.
  • Medicate Part D – This part covers some, but not all, prescription drugs.

ED and Medicare: A General Overview

Medicare’s ED coverage as of October 2018 is as follows:




Medication – Phosphodiesterase type 5 (PDE5) inhibitor pills

Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), Stendra (avanafil)

If prescribed for ED: No


If prescribed for another condition: Maybe

Medication – self-injections

Caverject, Edex (papaverine, phentolamine and/or alprostadil)


Medication – urethral suppositories

MUSE (alprostadil)


Vacuum erection devices



Penile implant (prosthesis)


Under certain circumstances.  See below.  

Note: In general, Medicare covers penile implants when certain criteria are met. Medicare covers penile implants if erectile dysfunction is caused by an underlying medical condition, such as diabetes, coronary artery disease, or Peyronie's disease. It is also covered after radical prostatectomy, a surgical treatment for prostate cancer.

In addition, the patient must try other ED therapies, such as testosterone replacement therapy, injections, or PDE5 inhibitors first. If these approaches do not work, then implants may be covered.

Medications needed in connection with surgery might be covered under Medicare Plan D. 

Replacement of the implant may be covered if it breaks or becomes infected as long as the implant is still medically necessary and is not under warranty.

Patients should always confirm their coverage with their insurance provider before having penile implant procedures.

What can men do?

ED treatments can be expensive, and lack of coverage can be disappointing. But there might still be ways to receive treatment. Here are some steps to consider:

  • Talk to your doctor. ED is linked to a variety of chronic illnesses, such as diabetes and heart disease. Sometimes, treatment for those conditions, or even just changing your lifestyle, alleviates erection problems to some degree. Make sure you are doing everything you can to stay healthy. If you have diabetes, check your blood sugar regularly and follow your doctor’s diet recommendations exactly. If you are overweight, ask your doctor about weight-loss plans and exercise. If you smoke, inquire about smoking cessation programs. Medicare may cover conditions that lead to ED, even if it doesn’t cover ED treatments directly.
  • Talk to your health insurer. Find out if there are any other coverage avenues to try.
  • Look for coupons, discounts, and sales. Some drug manufacturers offer coupons and discounts for their products. For example, as of October 2018, Pfizer, the manufacturer of Viagra, is offering a 50% discount on up to 12 Viagra prescriptions per year. Pfizer also offers an assistance program. Other manufacturers might offer similar deals. Your pharmacist may know of other discount programs. Be sure to ask.
  • Consider contacting your State Pharmaceutical Assistance Program. Some states have programs that help their residents pay for their medications. Eligibility can vary from state to state. See more informationhere.


While Medicare is fairly standard, people’s individual situations are different. What is covered for your neighbor might not necessarily be covered for you - and vice versa - so it’s always important to double check your benefits with Medicare and any other insurance organization.

Medicare planning can be quite complex, and rules can change. If you need help, don’t hesitate to contact Medicare directly. (You’ll also find information translated into over 20 languages.) You might also contact organizations for seniors, such as the National Council on Aging or the AARP. Your local senior center might offer help as well.

For more information about erectile dysfunction, please click here.


Blue Cross Blue Shield of North Carolina

“Medicare Part C Medical Coverage Policy Penile Implants”

(Reviewed: July 12, 2017)

Centers for Medicare and Medicaid Services

“Items and Services Not Covered Under Medicare”

“Medicare Program - General Information”

(Page last modified: June 1, 2018)

“Muse Medicare Coverage” 

(Note: is not the U.S. Government website for Medicare.  That website is

Cross, Jory

“Does Medicare cover penile implants?”

(Updated: September 10, 2018)

Olmos, Mike

“What ‘Medically Necessary’ Means and How It Affects Your Medicare Coverage”

(Updated: September 16, 2018)

Medicare Interactive

“Drugs excluded from Part D coverage”


National Council on Aging

“Medicare Part D Drug Plans: What They Must, May, and Cannot Cover”

(PDF. August 2017)


“Find Assistance That's Right for You”

“Save 50% on brand-name VIAGRA for up to 12 prescriptions per year”


“Self-Injection - Erectile Dysfunction”


“Erectile Dysfunction: Penile Prosthesis”

(September 11, 2017)

Sex Health Blog

ED Drugs and Melanoma: The Latest Research

ED Drugs and Melanoma: The Latest ResearchSildenafil. Tadalafil. Vardenafil. Avanafil. These may sound like complex drug names, but you probably know them by their brands names: Viagra, Cialis, Levitra, and Stendra. They are all in a class of drugs called phosphodiesterase type 5 (PDE5 inhibitors), and for many years now, they have helped thousands of men with erectile dysfunction (ED) get their sex lives back.

But like any drugs, PDE inhibitors have their side effects and risks. In 2014, we reported on a possible link between one of the drugs – sildenafil – and melanoma, the deadliest form of skin cancer. At that time, more research was needed, and men were advised not to change any of their medications without talking to their doctor.

The following year, scientists concluded that ED drugs probably didn’t cause melanoma, although they still found a link. Lifestyle factors could play a role, they said. Here’s how lead investigator Stacy Loeb, MD explained it in a press release at that time:

What our study results show is that groups of men who are more likely to get malignant melanoma include those with higher disposable incomes and education—men who likely can also afford more vacations in the sun—and who also have the means to buy erectile dysfunction medications, which are very expensive.

Where does the issue stand today? In June 2018, the Journal of Sexual Medicine published a new report, which we’ll focus on today.

The Groups

Scientists analyzed information from a health records database, finding 610,881 men and women who were prescribed PDE5 inhibitors from 2007 to 2015. (Note: PDE5 inhibitors are used to treat more than ED. Patients of both sexes with pulmonary hypertension and lower urinary tract symptoms (LUTS) may take them, too. That said, in this study, 99.5% of this group was male.) On average, the patients’ first prescription was filled when they were about 51 years old.

The researchers also looked at records from over 2 million people with ED, pulmonary hypertension, or LUTS who were not prescribed PDE5 inhibitors. These people served as a control, or comparison, group.

The Findings

In the group that took PDE5 inhibitors, 636 – a tenth of one percent - developed melanoma. Among people who didn’t take the drugs, 8,711 melanoma diagnoses were made, representing less than a third of one percent of the total group.

The researchers found no link between PDE5 inhibitor use and melanoma in people who had pulmonary hypertension or LUTS. Similarly, no relationship was found for any of the women.

And the men who took the drugs for ED? Interestingly, the researchers did find a link – and not only to melanoma. The authors also reported higher risk for basal cell carcinoma and squamous cell carcinoma, two other types of skin cancer that are more common than melanoma.

However, the authors explained that lifestyle factors could be involved:

Lifestyle factors, namely sun exposure, in this group of men is the likely cause of this increased risk and not the use of PDE5 [inhibitors] given that there is no common mechanism to account for carcinogenesis [formation of cancer] among these varied cancer types.

They added that people who took the drugs for other conditions were not at higher risk for melanoma compared to the non-users with the same health problems.

“Our findings support the safety of PDE5 [inhibitor] use in the United States,” they concluded.

Protect Yourself from Skin Cancer

While the news is encouraging, it’s still important for people to protect themselves from skin cancer, regardless of whether they take PDE5 inhibitors or not. Here are some tips to reduce your risk:

  • Stay in the shade and wear protective clothing, like long sleeved shirts, long pants, and a sun hat.
  • Use liberal amounts of sunscreen (SPF 30 or higher). The American Academy of Dermatology recommends about an ounce of sunscreen – the amount that would fit into a typical shot glass – for the average adult. Wear sunscreen even on cloudy days and reapply every two hours if you’re swimming or sweating.
  • Keep in mind that water, sand, and snow can reflect the sun’s rays.
  • Don’t use tanning beds.
  • Check your skin regularly and see your doctor if you notice anything unusual.

Ask Your Doctor about ED

ED can be treated in a number of ways. If you’re having trouble with erections, call your doctor and schedule a checkup. And don’t hesitate to bring up any questions or concerns.


American Academy of Dermatology

“Prevent skin cancer”

“Types of skin cancer”

The Journal of Sexual Medicine

Shkolyar, Eugene MD, et al.

“Risk of Melanoma With Phosphodiesterase Type 5 Inhibitor Use Among Patients With Erectile Dysfunction, Pulmonary Hypertension, and Lower Urinary Tract Symptoms”

(Full-text. First published online: June 5, 2018)


“Study: Chances Are, ED Drugs Don’t Cause Melanoma”

(August 11, 2015)

“More Research Needed on Sildenafil/Skin Cancer Risk”

“Sildenafil and Skin Cancer Risk”

(June 24, 2014)

Sex Health Blog

Unpacking the Latest Testosterone Therapy Guidelines

Unpacking the Latest Testosterone Therapy GuidelinesThe American Urological Association (AUA) is a professional organization for urologists. Founded in 1902, the organization now has over 21,000 members. One of its many roles is to provide guidelines on various aspects of urologic health so that doctors can best serve their patients.

In April 2018, the AUA issued a new clinical guideline for the diagnosis and treatment of testosterone deficiency. It includes 31 recommendations. We’ll unpack some of the highlights here today.

What is testosterone deficiency?

You have probably heard about testosterone in light of men’s sexual health. Produced by the testes, this hormone drives libido, gives men their physical characteristics (like facial hair), and helps maintain muscle mass.

Some men’s bodies don’t make enough testosterone. This situation, called hypogonadism, can happen when there are problems with the testes or the part of the brain that triggers testosterone production. Hypogonadism can also be a result of chemotherapy, radiation therapy, inflammation, infection, and obesity. (Learn more about the causes of low testosterone here.)

In addition, men’s bodies make less testosterone as they get older. In fact, testosterone levels drop from 1% to 3% each year after a man’s 40th birthday. As a result, some – but not all – men start to have symptoms like low sex drive, fatigue, moodiness, erectile dysfunction (ED), and diminished muscle mass.

How is testosterone deficiency diagnosed?

According to the new AUA guideline two criteria must be present for a man to be diagnosed with testosterone deficiency:

  • His testosterone levels must be lower than 300 ng/dL. Two total testosterone measurements taken on two different occasions are recommended. Because men’s testosterone levels fluctuate throughout the day, early morning measurements are the rule of thumb.
  • The man must exhibit symptoms of low testosterone, like the ones mentioned above – low libido, low energy, depression, ED, etc.

If a man meets only one of these criteria, then he does not have testosterone deficiency.

What is testosterone replacement therapy (TRT)?

Testosterone replacement therapy (TRT) is prescribed to some men with testosterone deficiency. This synthetic form of testosterone is typically administered through gels, patches, or injections.

What does the AUA recommend?

Some of the recommendations set forth by the AUA include the following:

  • Clinicians should inform testosterone deficient patients that low testosterone is a risk factor for cardiovascular disease. Note: In 2015, the U.S. Food and Drug Administration (FDA) issued an advisory, expressing concerns that men who take testosterone might be at higher risk for heart attack and stroke. (Read more here.) However, the link to such events was considered controversial.
  • Clinicians should inform patients of the absence of evidence linking testosterone therapy to the development of prostate cancer. Note: There have been concerns that testosterone therapy might lead to prostate cancer, but this link has not been proven. However, testosterone can fuel the growth of existing prostate cancer cells, so TRT is not usually recommended for men with prostate cancer.
  • The long-term impact of exogenous testosterone on spermatogenesis should be discussed with patients who are interested in future fertility. Exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive. Note: Testosterone is important for sperm production, but the synthetic form used in TRT might interfere with this process. Sometimes, sperm counts increase after men stop TRT, but this cannot be guaranteed. Men may decide to bank their sperm before starting therapy.
  • Clinicians should discuss the risk of transference with patients using testosterone gels/creams. Men are advised to wash their hands thoroughly after applying testosterone to the skin to avoid transfer to another person. They should also cover the application area before sex. (For example, if testosterone is applied to the shoulder, wearing a T-shirt can reduce the risk of transferring the gel or cream to a partner.)
  • Testosterone levels should be measured every 6-12 months while on testosterone therapy. Note: While on TRT, it’s important for men to see their doctor regularly for follow-up appointments so that testosterone levels can be assessed, and treatment can be adjusted, if necessary.

Is TRT right for you?

As mentioned above, our discussion here covers only some of the AUA’s recommendations. The guideline itself, along with a complete evaluation of your overall health, can help you and your doctor decide whether TRT is appropriate for you.


American Urological Association

“AUA Releases New Clinical Guideline For Diagnosis And Treatment Of Testosterone Deficiency”

(Press release. April 10, 2018)

“Evaluation and Management of Testosterone Deficiency”

(Published 2018)

International Society for Sexual Medicine

“Can testosterone replacement therapy (TRT) make a man infertile?”

“What are some of the side effects and risks of testosterone therapy?”


“AUA: New Guidelines for Diagnosis, Management of Testosterone Deficiency”

(April 10, 2018)

“What Causes Low Testosterone?”

(November 2, 2015)

Sex Health Blog

Cycling and Sexual Health – An Update

Cycling and Sexual Health – UpdateOver the last several years, there has been some debate on whether cycling has a negative impact on one’s sex life. In fact, back in 2012, this blog reported that biking could harm one’s sexual health. Is that still true? Today, we’ll take a look at the latest research.

What is the problem?

For both men and women, biking puts pressure on the perineum – the area between the anus and scrotum (for men) or vulva (for women). The perineum contains blood vessels and nerves that are essential for sexual arousal and urinary function. When those blood vessels and nerves are compressed, they might not work correctly, causing genital numbness and, for men, erectile dysfunction.

The bike seat (called the saddle) is often to blame. Women have also been warned about positioning the handlebars below the saddle, a stance that puts more pressure on the perineum.

New Research for Women

In March 2018, the Journal of Sexual Medicine published a study on the sexual and urinary effects of cycling for women. (Read more about the study here.)

Researchers surveyed over 3,000 women. About two thirds were cyclists, and the remaining third were runners and swimmers.

How did the sexual function of these athletes compare?

Women who were high-intensity cyclists – biking over two years, at least three times a week, with a daily cycling average of at least 25 miles – had betters scores on sexual health assessments. And the scores for low-intensity cyclists (who didn’t meet the high-intensity criteria), runners, and swimmers were about the same.

Still, cyclists were more prone to urinary tract infections, saddle sores, and genital numbness when compared to the runners and swimmers.

Good News for Men

Cycling doesn’t appear to affect men’s sexual function, according to research published in the Journal of Urology in October 2017.

This study compared cyclists with runners and swimmers, too. Almost 4,000 men participated. About 30% were non-cyclists, 47% were low-intensity cyclists, and the rest were high-intensity cyclists (defined with the same criteria as the female cyclists described above).

In this study, both high-intensity and low-intensity cyclists had better scores on sexual health assessments compared to the runners and swimmers. Histories of urinary tract infections were also similar in the men.

However, the cyclists were at higher risk for urethral stricture, a narrowing of the urethra (the pathway in the penis that allows urine and semen to exit the body).

The study also suggested that men could lower their risk for genital numbness if they stood while cycling at least 20% of the time.

“Adjusting the handlebar higher or even with the saddle had lower odds of genital numbness and saddle sores,” the authors added.

Cycle Smart

While these studies have encouraging results, you know your body best. If you’re having sexual difficulties, urinary problems, or genital numbness, make an appointment with your doctor. It’s best to have a full checkup to rule out any medical issues.

If you think the problems are related to cycling, you might try the following strategies:

  • Take a break from cycling for a while.
  • Make adjustments to your bike. A bike shop professional can tell you if your bike is a good fit for you and suggest any changes you may need, such as a different type of saddle or another handlebar position.
  • Consider your stance while riding. Try to sit up straight on your sit bones and avoid leaning forward on your perineum. Also, ride your bike standing every once in a while.
  • Ask your doctor about recommended cycling habits.

Otherwise, cycling is still fantastic exercise, It keeps your blood pumping, builds strength and endurance, and helps you maintain a healthy weight – all important factors for sexual health and general health. (To learn more about the ways exercise can lead to better sex, click here.)


International Society for Sexual Medicine

“Can cycling cause sexual dysfunction?”

The Journal of Sexual Medicine

Gaither, Thomas W. BS, et al.

“Cycling and Female Sexual and Urinary Function: Results From a Large, Multinational, Cross-Sectional Study”

(Full-text. Published online: March 13, 2018)

The Journal of Urology

Awad, Mohannad A., et al.

“Cycling, and Male Sexual and Urinary Function: Results from a Large, Multinational, Cross-Sectional Study”

(Full-text. Published online: October 13, 2017)

Mayo Clinic

“Urethral stricture”

(October 18, 2017)

“Cycling Has No Impact on Women’s Sexual or Urinary Health, Study Finds”

(June 24, 2018)

“Practice Safer Cycling to Protect Your Sexual Health”

(July 17, 2012)

Sex Health Blog

Coping with Mismatched Sex Drives

Coping with Mismatched Sex DrivesYou and your partner probably have a lot in common. Or if you’re not partnered, you likely seek common traits in a prospective mate. Whether it’s a love of baseball, camping, or rock concerts, these commonalities help keep you close as a couple.

So, what happens if your sex drives don’t sync?

Having mismatched sex drives is a frequent problem for couples, especially as their relationship matures. One partner might want sex all the time. The other might not be as interested. Does that mean there is a problem with the relationship?

Not necessarily. Some people are just wired to have higher sex drives than others. And that’s okay – until a mismatch happens. Partners who want more sex may take their partner’s rejection personally and feel frustrated and angry. Partners who don’t want sex may feel guilty about disappointing their partner or annoyed and pressured if they are constantly approached about sex.

If you find yourself in this situation, first consider whether one partner’s libido has changed over time.

Medical Problems

Sometimes, a medical issue causes sex drive to drop:

  • Hormones. Sexual desire is driven largely by hormones, and hormone production – for both men and women – changes over time. As men get older, their bodies start making less testosterone, and some find themselves less interested in sex. A woman’s libido may also decline during and after menopause, when her estrogen levels drop.  
  • Medications. Some medications, like antidepressants, have sexual side effects that can include a dip in sex drive.
  • Hypoactive sexual desire disorder (HSDD).Women with HSDD develop a lack of sexual interest, along with distress, that can’t be easily explained by other factors.

A doctor’s visit and treatment could be all that’s needed to bring one’s sex drive back into the usual range.

Relationship Problems

When people are hurt or angry with each other, they can feel less inclined to have sex. Working out the conflict with a trained counselor or therapist can help couples better communicate with each other and decide on their goals, including sexual goals.

You can learn more about the causes of low sex drive here. You’ll also find lots of helpful links.

Making Compromises

Sometimes, mismatched libidos have nothing to do with hormones or relationships. Some people are just more sexual than others.

Understanding this is the key to compromising. With that clear, couples can talk together about meeting each other in the middle. Some strategies might include:

  • Asking questions. Many couples sweep sexual incompatibility under the rug. But chances are, if you’re sensing a mismatch in sex drive, your partner is too. Have an open discussion about the situation at a time when you’re not feeling angry or frustrated. Ask each other what you want and need. Then try framing a plan.
  • Understanding exactly what your partner’s needs are. It can be easy to say that one partner needs more sex than the other. But it might also be that the less sexual partner needs more non-sexual intimacy to feel sexually inclined. Try working on your friendship and romance. Think of activities that can bring you together and nurture your relationship. You might play games together, cook a great meal, take walks after dinner. This time can reinforce your emotional bond and, eventually, your sexual relationship. You can nurture this bond even when you’re not together. If you’re thinking of your partner during the work day, send a romantic email or text. Or pick up his or her favorite dessert on the way home.
  • Expanding your sexual definitions and repertoire. Touching, massage, and cuddling while watching TV are other ways to be intimate, which may satisfy the more sexual partner. Some people masturbate, either alone or with their partner watching, kissing, or massaging them. In this way, both partners can still be involved in an intimate act.
  • Considering an open relationship. While this idea is not palatable to everyone, some couples decide to expand their relationship to include others while still remaining committed to each other. Such sexual encounters might meet the sexual needs of one partner and provide relief for the other. However, such relationships take negotiation and trust. Couples may decide to set up rules, like prohibiting outside trysts in the marital bed or not repeating a tryst with the same person. Following safe sex practices is essential as well.
  • Staying honest. In some cases, partners feel that ending or straying from the relationship (as opposed to negotiating an open one) is the only solution to sexual incompatibility. They should be honest about their feelings and give their partner a chance to respond and make changes, if possible.

Remember that communication and respect are key aspects of compromise. Staying open with your partner and working out a plan together can keep your relationship strong, even if your sex drives are different.


Business Insider

Lebowitz, Shana

“The single most common problem couples have in bed, according to a relationship therapist”

(December 28, 2017)


Kerner, Ian

“When you and your partner have mismatched libidos”

(March 9, 2018)

Burry, Madeleine

“What to Do If Your Sex Drive Is Higher Than His”

(March 22, 2018)

Medical News Today

Nall, Rachel, RN, BSN, CCRN    

“How does menopause affect sex drive?”

(December 10, 2017)

Psychology Today

Meyers, Seth, Psy.D.

“How Couples Can Cope with Different Libidos, Sexual Desire”

(March 21, 2013)

Weiner-Davis, Michele, MSW

“9 Vital Tips for the Partner With a Higher Sex Drive”

(January 27, 2010)


“What’s Causing Your Low Sex Drive?”

(June 6, 2017)

Sex Health Blog

Do Orgasms Change Over Time?

Do orgams change over time?Like many aspects of sex, orgasms are always changing. You might have one night of passion that feels like an out-of-body experience. You might have another that is pleasant, but not necessarily powerful. And you might have another that is just humdrum. Should you worry?

Not necessarily. While it can be frustrating to see the intensity of orgasms wane, there are many reasons why it happens, and some of these problems have simple solutions. Let’s take a closer look.

Do orgasms become weaker as people age?

Sometimes, people notice that their orgasms are not as strong as they were when they were younger. That doesn’t mean the orgasms aren’t satisfying, just that they are different.

Hormones are often the culprit here. Sex hormone production slows down as we age, and that can change the way we experience sex. For example, a man’s testosterone levels start to decline about 1% each year once he reaches his 40s. (Some doctors call this andropause or male menopause.) He might become less interested in sex, moody, or fatigued. And it might diminish his orgasms, too.

At menopause, women’s estrogen levels decline sharply. In North America, the average age for menopause is 51. Estrogen contributes to vaginal and vulvar health. Without it, the vagina becomes dry and less flexible. Sex can become uncomfortable and less enjoyable. Lower levels of estrogen might also make the clitoris less sensitive to touch, and since many women’s orgasms depend on the clitoris, climax might be less satisfying.

Hormone therapy can help in some cases, but this step should only be taken with a doctor’s advice. Women with vaginal dryness might consider a lubricant or moisturizer to reduce friction and discomfort during penetration.

In contrast, aging could also be good for orgasms. Some older couples find that they enjoy sex more because they have more privacy when the kids are grown and out of the house. They might relax more without the fear of unplanned pregnancy. (Keep in mind that the risk for sexually transmitted infections is present at any age. Always use condoms to reduce this risk, if this is a concern for you.)

How about the pelvic floor?

Sometimes, the pelvic floor is the reason behind lackluster orgasms. The pelvic floor has been compared to a hammock or a trampoline that helps your pelvic organs stay put. This muscle group can weaken after surgery, childbirth, and weight gain. It may also happen in people with diabetes or inflammatory bowel disease.

Kegel exercises were developed to tone the pelvic floor, and some people claim their orgasms improve, too. Learn how to do them here.

Can birth control affect orgasms?

Some birth control methods, such as condoms and oral contraceptives, are thought to reduce orgasm intensity. Your healthcare provider of family planning clinic can help you determine which method of birth control is a better fit for you.

When to see a doctor

If you’ve noticed that your orgasms aren’t what they used to be, and you can’t figure out why, don’t hesitate to give your doctor a call. He or she can give you a complete checkup to rule out any health concerns that could affect your sexuality. You might also consider seeing a counselor or sex therapist – alone or with your partner – who can help you address any emotional or psychological issues that could be interfering with orgasms.

At the same time, remember that while good orgasms are a worthwhile goal, a positive sexual experience has several components. Intimacy with your partner, cuddling, kissing, and bonding can be just as important and exciting.


Continence Foundation of Australia

“Pelvic floor muscles”

International Society for Sexual Medicine

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

“What is vulvar and vaginal atrophy (VVA)?”

The North American Menopause Society

“Decreased Response and Pleasure”

Corinna, Heather

“It's harder for him to orgasm with condoms, so what do I do?”

(Updated: January 27, 2014)


“Need to Tone Your Pelvic Floor? Try Kegels!”

(August 9, 2017)

“Orgasm Problems: What Can Women Do?”

(August 30, 2016)

“What Causes Low Testosterone?”

(November 2, 2015)

Lampen, Claire

“'I Never Orgasmed Until I Quit The Pill And Got An IUD'”

Sex Health Blog

Taking ED Drugs? Watch What You Eat and Drink

Taking ED Drugs? Watch What You Eat and DrinkGavin finally talked to his doctor about his erection problems. He’d been struggling for a while, but he had been too embarrassed to say anything. Then his wife Lila showed him an article about erectile dysfunction (ED) and how common it was, especially for older men. She went with him to his appointment and, with her support, he had a new prescription for a phosphodiesterase type 5 inhibitor, something his doctor called a PDE5i.

So far, it was going pretty well. He took his pill when he and Lila were starting to feel amorous, and in about a half hour, he was ready to go. Sure, they couldn’t be as spontaneous as they used to be, but that was a small price to pay for a better sexual relationship. Lila said she was enjoying their intimacy again, too.

There was just one problem. There were times when the medicine didn’t work so well. Last week, they had their first barbeque of the season. Lila made amazing cheeseburgers, and Gavin had two. Later, after a dip in the pool, they headed to the bedroom, but he couldn’t get an erection. Lila said not to worry about it, but he hated disappointing her.

Did something change with the meds? Not necessarily. Sometimes, foods and beverages affect the way ED drugs work.

What are PDE5 inhibitors?

PDE5 inhibitors are a class of drugs designed to treat ED. They work by increasing blood flow into the penis when a man is sexually stimulated. Good blood flow is essential for a firm erection.

Four of the most commonly-prescribed PDE5 inhibitors are Viagra (sildenafil), avanafil (Stendra), tadalafil (Cialis), and vardenafil (Levitra). Viagra is now available in generic form as well.

Men who take PDE5 inhibitors still need to be sexually stimulated for an erection to occur.

How might foods interact with PDE5 inhibitors?

Foods might limit the effectiveness of PDE5 inhibitors in two ways.

First, the type of food might delay the erection. Some men find that their ED drugs take longer to work after they have eaten fatty foods, like Gavin’s two cheeseburgers mentioned above.

Second, ED drugs, like Viagra and Levitra, work better on an empty stomach. If a man takes them with food, the stomach needs to do double duty: digest the meal and process the pill.

Men might consider taking their pill and enjoying their sexual activity before they eat. But all men are different, so it might take some trial and error to figure out what you can eat – and how much – around that time.

What about alcohol?

Lots of men have trouble getting erections after consuming alcohol, especially in excessive amounts. Some people even call it “brewer’s droop.” Alcohol can dehydrate you, which interferes with blood flow to the penis.

The effect can be similar for men who take ED drugs. Even though PDE5 inhibitors are meant to help with blood flow, using alcohol can work against the process.

If you discover that you have trouble with erections after alcohol, even when taking an ED drug, you might want to reconsider your alcohol intake.

When should I seek help?

If your ED medications aren’t working as well as you thought they would – and you’re taking them exactly as prescribed – call your doctor. You might need to change medications or adjust the dose. Also, remember that not all men respond to ED drugs. Fortunately, there are other ED treatment options, so don’t give up hope. Patience is key; eventually, you will find the solution that works best for you and your partner.


Cleveland Clinic

Ulchaker, James, MD

“Can What You Eat or Drink Cause Erectile Dysfunction?”

(November 30, 2017)

Eli Lilly and Company

“Cialis – Patient Package Insert”

(Revision date: May 2017)

Iliades, Chris, MD

“Why Boozing Can Be Bad for Your Sex Life”

(Last updated: January 4, 2012) (GlaxoSmithKline)

“Levitra – Patient Information”

(Revision date: August 2017)

Harvard Medical School

“Which drug for erectile dysfunction?”

(May 2014)

Morris, Susan York and Cathie Ericson

“Viagra, ED, and Alcoholic Drinks”

(August 3, 2016)

Sgobba, Christa

“6 Reasons Your ED Drug Isn’t Working”

(March 13, 2016)

Sexual Medicine Society of North America

“Alcohol and Male Sexual Function”

“Alcohol and Sex”

(January 27, 2015)

“Patient Information Stendra”

UCSF Health (University of California San Francisco)

“Oral Medications for Erectile Dysfunction” (Pfizer)

“Tips for taking Viagra”

Sex Health Blog

Communication, Sexual Self-Esteem Important for Women’s Orgasms

Communication, Sexual Self-Esteem Important for Women’s OrgasmsBack in December, we started covering an interesting Finnish study about women’s orgasms. A team of researchers compiled the results of five different sex surveys taken over four decades starting in the early 1970s. Over 10,000 men and women participated, and the researchers focused on women’s orgasms. They published their findings in October 2016 in the journal Socioaffective Neuroscience and Psychology.

In our previous blog post, we shared some of the results: women’s first orgasms, how they felt about having orgasms, and what it took to get them there. We’re going to continue the discussion today, highlighting the role of partners, communication, and sexual self-esteem. We’ll also look at some of the factors that inhibit orgasm and talk about the frequency of multiple orgasms.

(Note: Not all of the surveys asked the same questions. In some cases, results pertain to just one survey.)

Role of Partners: Oral Sex and Manual Stimulation

Many women reach orgasms when their partner performs oral sex or manual stimulation (touching the genitals). While not all women climax this way, the researchers found that women who receive these types of sexual stimulation reach orgasm more often. This doesn’t mean that vaginal orgasms through intercourse are less important or pleasurable. It’s more of a reminder that there are many pathways to orgasm.

Oral sex was particularly helpful for women with low sexual desire, as well as women who had trouble talking about sex with their partner, the authors explained. However, many women were reluctant to ask their partner for oral sex.

Good communication between partners was just as important for women’s orgasms as sexual technique, the surveys revealed. While skillful partners were helpful, discussing and finding ways to bring mutual pleasure was also important.

Sexual Self-Esteem

Women with high sexual self-esteem, who felt confident about their abilities in the bedroom, tended to have orgasms more frequently. In fact, one survey found that only 10% of women who did not think they were good in bed had an orgasm at their last intercourse. That said, there were times when good communication with a partner compensated for low sexual self-esteem, which helped with orgasms.

Accepting oneself and one’s body, as well as being able to focus solely on the sexual activities, without distractions, also increased the chances of orgasm.

Factors That Could Inhibit Orgasm

What makes women less likely to reach orgasm? Stress, fatigue, and trouble concentrating were among the most commonly cited reasons. Partners who were less skillful, and those who went “too fast” could also interfere.

Other factors included the following:

  • Feeling that sex was not important for the relationship
  • Lack of physical intimacy in relationship
  • Lack of sexual desire
  • Lack of oral sex or manual stimulation
  • Vaginal dryness, painful intercourse
  • Early orgasm of partner, short duration of intercourse
  • Unhappy relationship
  • Feeling sexually undesirable
  • Partner’s erection problems
  • Illness

Multiple Orgasms

Multiple orgasms are more common for women than for men. In one survey, 12% of the women said they had had two or more orgasms the last time they had intercourse. In another, women who had multiple orgasms said they frequently used sex toys and that their sexual activities lasted over an hour.

“In many respects, multi-orgasmic women displayed strong sexual interests, and were sexually very active,” the authors wrote.


The researchers noticed that women younger than 35 reported more trouble reaching orgasm over time, especially since the 2000s. This finding was interesting, since the internet and other media offer women lots of information on orgasms and enjoyable sex. However, stress, busy lives, and less privacy might be involved, they said.

The Takeaway

Over these two blog posts, we have seen that numerous factors influence women’s orgasms - internal and external, physical and emotional. Still, a woman’s climax is highly personal and what works for one woman won’t necessarily work for another. And some factors, such as resolving painful intercourse, improving communication between partners, and accepting one’s body, may need additional assistance from a doctor or sex therapist.

If you or your partner have concerns about orgasms, we encourage you see the following links and, if appropriate, talk to your healthcare provider.

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

With Technology, Sex Has Come a Long Way

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?

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

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

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?

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

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!

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

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?

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

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

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

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

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

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

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?

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

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?

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

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?

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

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

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?

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

How Do Certain Diseases Lead to Erectile Dysfunction?

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? In December 2015, 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.

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

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

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?

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

Low 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. In 2014, 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!


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

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.

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!


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?

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

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

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

Sleep and Women's Sexual HealthWe 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.

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.Continued...

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?Continued...

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.Continued...

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.


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?

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

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

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

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

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

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

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

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?

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?

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)

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

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?

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

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

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

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

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

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

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?

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

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

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

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

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

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

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

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?

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


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

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