Women's Health

Work woes: sex difficulties in busy people

2009-04-03T00:48:00.000-07:00

Written by Dr David Delvin, GP and Christine Webber, psychotherapist

Growing numbers of people are finding their sex life suffers because they work too hard. Find out what you can do to redress the balance.

Working too hard can take its toll on your relationship.

Britain's long hours work culture means we are seeing an increasing number of people whose sex lives are going badly because of their jobs.

They say they are not making love as often as they used to and don't seem to have the energy for it either.

One high-powered exec told us: 'When I first moved in with my husband, we had sex almost every night. Now we only do it once a month. I think it's because both of us are exhausted.'

The effect of long hours on sex drive

Ebb and flow of desire

Less sex doesn't automatically point to a problem in the relationship.
Human desire tends to ebb and flow quite a bit.
Sometimes we feel really sexy and sometimes we don't.
Also, there is a natural tendency in relationships for sex to get less frequent as time goes by.
This is due to two things:
as the couple grow used to each other, the novelty of the relationship wears off
the desire for sex tends to decline with age, particularly for men.
A study published in the Journal of Sexual Medicine confirms that couples tend to have less sex as they get older, especially after the age of 50.

If you are tired, you are unlikely to have much strength left for sex - whether you are a man or a woman.

When a job is very stressful, the effect of that stress will be to diminish the amount of energy you have for sex.

You may be so stressed out, you don't even think of sex for quite long periods.

The above has always been true, but in recent years we would say long hours have become commonplace and this is having a damaging effect on a lot of people's sex lives.

We first noticed this among patients who work in the financial sector. Some of our clients start work at six in the morning, and carry on for more than 12 hours.

Often, they do not stop for lunch and many of them have a long commute at either end of the day.

So when we see a man or a woman who leaves home at 4.30am and gets back at 8.30pm, it's not surprising that they're likely to have trouble with their sex life.

Sexual difficulties caused by excessive work

No matter what your job, excessive work can cause the following sexual difficulties.

You will have less time for sex.

You will be tired so it may be difficult to summon up much interest.

You may find it more difficult to climax.

You will find it difficult to relax in bed.

If you're female, you may find it hard to produce adequate lubrication pre-intercourse.

If you're male, you may not be able to get erections easily.

Feelings of stress may make you less likely to give your partner sufficient romance and love play.

You will probably opt for doing the same things during sex.

Your partner may show disappointment or even anger towards you because of these work-induced symptoms.

Letting things continue as they are could lead to the breakdown of your relationship.

If work is affecting your love life, you need to do something about it fast. Doing nothing and just hoping things will sort themselves out is folly.

What changes can I make?

Short of giving up your job, there are no instant or magical solutions. But everyone can make small changes in their lives – no matter how busy they are.

These changes need to be ones that will bring some sort of balance into your lifestyle that does not exist currently. Such changes should help your health as well as your love life.

1. Be honest with your partner

The first thing you can do is to be honest with your partner.

We have had clients who have no desire for sex on weekdays. What they want during the week is a loving companion who will snuggle up to them and listen to what has happened in their day, but not demand sex.

If the busy person has never discussed this with their partner, it can cause a lot of upset and rowing because, understandably, the other person tends to feel rejected.

It may not be ideal to only have sex at the weekends or during holidays, but at least if both parties know this, there will be fewer unrealised expectations and fewer quarrels. In other words, the relationship should become more relaxed.

2. Give your partner some attention

It has to be said that honesty is not going to be enough to fix a rocky relationship, unless you pay your partner some real attention. He or she needs to feel affirmed and important – despite the paucity of sex.

3. Think about how you talk to your partner

It's easy to take workplace language into the home, but it can be abrupt and terse. Try not to bark out instructions to your beloved.

Use the journey home from the office to unwind and to get into a softer frame of mind. Instead of working on your laptop all the way, read a book or do a Sudoku puzzle.

You need to change gear from working mode to something a little more empathetic and human if you are to have a healthy romantic life at home.

4. Don't let work encroach on weekends and holidays

If you want to maintain your relationship, your partner will want to feel that you put him or her first at weekends and holidays. This means a complete change of pace.

Try not to bring work home or to keep checking your emails – and switch off your mobile phone.

5. Make sex special

When you do make love, try to wind down first so that you are in a more relaxed frame of mind. Partners do not want to feel that they're being used as a substitute for quick masturbation and all you care about is a swift climax.

Partners want to feel cared for and loved, so cuddle up together first or have a romantic meal. And then spend half an hour giving your loved one a massage, or have a bath or shower together.

6. Add variety in the bedroom

Try to vary your lovemaking. In our experience, very busy people tend to get into a set sexual pattern. They find a routine that works and is fast - and then use it every time.

This is boring and unimaginative. If you keep doing it, it's likely you'll both go off sex and this can spell doom for your relationship.

Lifestyle changes to reduce stress

You also need to make some lifestyle changes that will benefit your mental and physical health – and impact positively on your love life.

Eat breakfast

It is crazy to skip breakfast when it only takes three minutes in the microwave to make some porridge. This is a good way to start the day.

Oats give you a slow-release of energy and line your stomach before a tension-packed day. Or eat some muesli or another healthy cereal. If you can't face that, at least eat a couple of bananas.

Take a lunch break

You may say no-one in your office takes lunch, but why not be the exception? If you can get out of the workplace for half an hour and get some fresh air, you will feel more relaxed.

On days when you have to eat in the office, try ordering in salads, fruit and nuts. This is good fuel for your hard working body.

Drink more water

Make full use of the water cooler. People often get more tense and irritable when they are dehydrated. You will feel better if you drink water all day and cut down your coffee intake to a maximum of two or three cups a day.

Exercise more

Somehow you need to get some exercise. If you look carefully at your timetable, you should be able to find the odd half hour where you can fit in a workout or go for a swim.

If none of this is possible, get off the bus or train two stops early or park your car a few streets away and walk to work. At the office, take stairs instead of lifts between floors.

What if I don't have time to make these changes?

When you are busy and your career is going places, you probably feel you must put work first.

But unless you strive to bring some balance into your life - and you find the time to be loving and close to anyone who matters - you may find that your life begins to feel rather empty and meaningless, despite your healthy bank balance.

Further help

Specific sex problems may be disrupting your sex life that can only be resolved with specialist help. See the factsheets below for more information.

Erectile dysfunction (inability to get or maintain an erection).

Premature ejaculation (ejaculating too quickly to satisfy your partner).

Retarded ejaculation (male inability to climax).

Difficulties in climaxing (women).

Pain on intercourse.

Who to contact for sex therapy.

Who to contact for sex therapy

2009-04-03T00:47:00.002-07:00

Written by Christine Webber, psychotherapist and Dr David Delvin, GP and psychosexual specialist

In 2009, more and more people are seeking help with their sex lives.

Whether sex and relationship problems are on the increase, or whether numbers have grown because of people's willingness to seek help, is unclear. What is clear is that if you have concerns regarding any area of your sex life, there are plenty of ways in which you can get assistance.

However, our research suggests that you may have to try pretty hard to get that help – particularly in areas of the country where therapists are rather thin on the ground.

Current NHS policy means there is very little money available for treatment of sex problems. So in most parts of the UK, you will probably have to pay for therapy or counselling.

We've put together a quick checklist of the best professionals and organisations to approach.

Your GP

For most problems, a good starting point is to visit your GP for a preliminary chat about your issues.

Of course it’s not always easy to speak about sex problems. In fact, it can be downright embarrassing. And unfortunately, it’s not only the patients who are embarrassed. Some doctors are not at all comfortable talking about sex difficulties. But it is important to speak frankly to your doctor.

If you find that your own GP isn’t very helpful, it might be worth asking to see one of the other doctors who work at the same surgery. Usually the medic who is responsible for family planning in the practice is a good bet as he or she will be used to talking about sex.

Most GPs allow 10 minutes per patient these days, but as talking about sexual problems can take a while, it might be a good idea to book a double appointment (usually 20 minutes), if this is permitted in your practice.

Your doctor may be able to offer you some immediate help. For instance, in recent years GPs have started prescribing erection drugs such as Cialis (tadalafil), Levitra (vardenafil) and Viagra (sildenafil), although the government places severe restrictions on who can receive them free of charge.

If your family practitioner can't help you, then he or she should discuss the viability of you getting free treatment on the NHS. Unfortunately, in large areas of the UK, no such free treatment is available. Nevertheless, your GP may know of private therapists in your region.

Family planning clinics

NHS family planning (FP) clinics used to be the main providers of psychosexual advice in the UK, particularly for women.

However, the current situation is that the clinics are mostly working under great pressure, so they tend to concentrate on their main job, which is providing contraception.

Many of the nurses and doctors do still have an interest in sexual problems, and will try to help you if time permits. They’re particularly good with the following difficulties:

vaginismus

low libido

poor technique

difficulty reaching orgasm

not being able to conceive.

FP clinics make no charge for giving help.

NHS hospitals

In some areas of the country there are psychosexual units at large hospitals - London and Sheffield are relatively well off in this respect.

There is invariably a waiting list, but people eventually get seen and helped. When you do get an appointment, it may be for some time well in the future. Please try to summon up the courage to attend your appointment. A lot of people get ‘cold feet’ and don’t turn up, which means a wasted appointment slot.

Treatment is free, but you will need to be referred by your GP.

Genitourinary medicine (GUM) clinics

GUM clinics treat sexually transmitted infections and can also help on all sorts of sexual issues.

They have good knowledge and lots of common sense, although the doctors are not generally highly trained in psychosexual issues because their forte is diagnosing and treating infections. In 2009, we have found that a number of clinics have doctors or nurses who offer psychosexual advice to women, but they will often specify that they do not treat erectile dysfunction (ED) or prescribe Viagra, Cialis and similar drugs.

There are concerns that waiting times for GUM clinics are growing, but it should be possible for you to see a doctor within two weeks to get some general advice. However, specialist psychotherapy and marriage guidance are definitely not provided.

All consultations are free. Your nearest GUM clinic is likely to be situated in your nearest big hospital. Ring that hospital for details of opening times. Or you can simply google ‘GUM’ – plus the name of your home town/city –and often nowadays a clinic near your home will then pop up.

NHS gynaecologists and urologists

The NHS should be able to help if a sex problem is essentially physical, for example a too wide vagina after childbirth or a bent penis.

Women are generally referred by their GPs to a gynaecologist and men to a urologist.

Some gynaecologists and urologists now provide psychosexual counselling services, and many urologists are prescribing erection-inducing drugs.

Treatment is free. Your GP should be able to advise you about who to go to and, most essentially, write you a referral letter.

Relate and Relationships Scotland

Relate is not just a relationship counselling agency.

A number of Relate counsellors have specific psychosexual training, mainly in the school of Masters and Johnson. So when you phone (0300 100 1234), make it clear that you are looking for sex therapy rather than guidance concerning relationship issues.

Relate sex counsellors are highly rated for doing an excellent job in treating various ‘technical’ bedroom problems such as:

premature ejaculation

lack of sex drive

inability to climax.

But they are not doctors, and therefore cannot examine you or prescribe medication.

Relate's fees are relatively modest and are means-based.

Relationships Scotland (until recently known as Relate Scotland) does similar good work to Relate, but north of the border. The number of your nearest clinic will be in your local phone book. The central number is 0845 1196088.

Institute of Psychosexual Medicine

The Institute of Psychosexual Medicine is an organisation of family planning doctors who have had special training in sex problems, particularly:

vaginismus

poor libido

difficulty in climaxing.

Some work in family planning clinics; others treat clients privately. Some of the latter will see a patient without a GP's referral – but not all will do this. Fees can be up to £ 150 an hour in the more expensive parts of large cities, so make sure you check beforehand.

Call the Institute on 0207 580 0631, or email them: admin@ipm.org.uk

British Association for Sexual and Relationship Therapy

The British Association for Sexual and Relationship Therapy consists mostly of non-medical personnel though some of its members are qualified doctors. All the association’s accredited members have had extensive training.

The best way to find out about a therapist in your area is to email info@basrt.org.uk

Therapists charge fees, which vary greatly in different parts of the country.

Always check what the costs will be before booking yourself in. Currently, you are likely to pay anything from around £45 to over £100.

Prices vary enormously according to the therapist’s experience and also to his or her location. Obviously, Harley Street and other central London areas are very expensive as the therapist is having to pay very high rents for a consulting room. If therapists work from home, clearly they don’t have rental costs and this tends to keep their fees down.

Sexual Dysfunction Association (SDA)

Formerly the Impotence Association, the Sexual Dysfunction Association is a national charity that tries to help both men and women find a suitable therapist or clinic for sex problems. It doesn't provide treatment or see patients, but it does have some good factsheets.

You can contact them on 0870 77 43571.

Sex, heart disease and physical disability

2009-04-03T00:47:00.001-07:00

Reviewed by Dr Neal Uren, consultant cardiologist and Dr David Delvin, GP and sex and relationships expert

There are a many medical conditions and disabilities that make it difficult to enjoy a normal sex life.

For example, sexual intercourse may be difficult for people with any of the following conditions:

paralysis (following a stroke or a spinal injury)

severe arthritis

heart failure

severe respiratory problems (such as chronic bronchitis or emphysema)

kidney (renal) failure.

Numerically, the problem which most often affects people’s sex lives is heart disease.

Heart attacks and heart failure (cardiac insufficiency) are common, and can easily make patients feel frightened about re-starting sexual intercourse.

Unfortunately, a lot of people are embarrassed about discussing such issues. So a disabled person may find it hard to talk about his or her sexual problem or to ask for any kind of help. A reluctance to discuss things often makes the problem worse.

So do try and talk matters over with your partner and (if necessary) your doctor.

Heart disease

A patient's sex life may suffer following a heart attack or other form of heart disease, even after recovery. The patient or their spouse may be afraid that the physical strain of sexual intercourse will provoke serious heart problems.

In fact, the exertion of sexual intercourse does not usually exceed that of climbing four floors of stairs at an easy pace, provided people take things easily.

If the patient can climb four floors without breathing difficulties, significant palpitations or any much chest pain (angina), they should be able to have sex as well. Having sex may even restore their faith in their health.

After the shock of heart disease, and the natural fear of losing each other, a couple may find that their relationship is made stronger by resuming their sex life. Anyone who has had a heart attack and is concerned about having sex should ask their doctor for guidance.

Based on a text by Dr Erik Fangel Poulsen, specialist

Sex and neurological disorders

2009-04-03T00:46:00.000-07:00

Written by Dr David Delvin, GP and family planning specialist

What is a neurological disorder?

A neurological disorder is a disease or injury of the nervous system – which is the ‘communications network’ of the body. Common neurological disorders include strokes, multiple sclerosis (MS), Parkinson’s disease and spinal injuries – mainly caused by road accidents. Head injuries are also common, and may interfere with sexual function.

It is important to realise that the vast majority of sexual problems are not caused by any kind of neurological disease.

However, nerve disorders which can cause sexual difficulties include all the above conditions.

Strokes

Strokes (cerebrovascular accidents or CVAs) are tremendously common, and affect well over 100,000 people each year in the UK.

Many of them make a good recovery. Quite a few CVA survivors do want to continue with their sex lives – particularly men.

With the help of a cooperative and loving partner, it is often possible to continue with a reasonable amount of sexual activity, though lack of mobility may be a problem. Some couples successfully get round this with the use of vibrators.

Multiple sclerosis (MS)

Free treatment

MS is one of the few disorders which entitle the patient, under the NHS, to free treatment with drugs for erection problems.

Many men and women who have multiple sclerosis (MS) do manage to maintain a rewarding sex life. However, some patients do have difficulty in achieving orgasm. Men may sometimes have problems in getting an erection.

Fortunately, the recently developed ‘erection helping’ drugs have proved a great boon to many male MS sufferers.

Viagra (sildenafil) works in about half of these patients. If it is not successful, then it’s well worth trying its newer successors: Cialis (tadalafil) and Levitra (vardenafil).

If these drugs fail, there is also the possibility of penile injections, or of using a vacuum pump.

Parkinson’s disease

Parkinson's disease is extremely common, and has become more so as people have started to live longer.

It causes trembling and incordination in various parts of the body. The difficulty in coordination may cause problems with intercourse, and sometimes with erection.

Fortunately, the oral treatments for erectile dysfunction (ED) can help these patients, and they are not contraindicated in men with Parkinson's disease. Under the NHS regulations, these drugs are available free if you have Parkinson’s disease.

Spinal injuries

Serious spinal injuries – most commonly sustained in traffic, riding or aircraft accidents – are likely to cause paralysis and loss of sensation in regions of the body below the level of the damage to the spinal cord.

Unfortunately, sexual function is very often affected. Men may lose the ability to get an erection – and obviously this may make it very difficult for them to have children.

However, many people with spinal injuries do manage to have a fairly active sex life – particularly if they have a considerate, loving and inventive partner.

Furthermore, the new drugs to treat ED will help many men who have sustained spinal trauma. NHS rules allow free prescription of these drugs if you have a spinal cord injury.

If the man wants to father children, this may sometimes be possible using recently developed methods of obtaining sperm, such as electro-ejaculation – in which an electric stimulus is applied to the prostate area, via the rectum.

The cost of this treatment is considerable, but if you were injured in an accident through no fault of your own, your compensation payment may cover it.

At a conference we attended in 2008, it was stated that a cheaper alternative to electrotherapy is the use of a male specially-designed vibrator, operating at a particular frequency.

Useful organisations

Organisations which can provide further information that may help your sex life include:

The Stroke Association: helpline: 0845 3033100.

Multiple Sclerosis Society: helpline: 0808 800 8000.

Parkinson's Disease Society: helpline: 0808 800 0303.

Spinal Injuries Association: helpline: 0800 980 0501.

Outsiders Sex and Disability helpline: telephone: 0707 499 3527.

Sex and diabetes

2009-04-03T00:45:00.001-07:00

Reviewed by Dr David Delvin, GP and psychosexual specialist, Christine Webber, Psychotherapist and Dr Dan Rutherford, GP

If diabetes causes sexual problems, talk to your GP.

Twenty-five per cent of all women with diabetes and about 50 per cent of men will experience some kind of sexual problems or loss of sexual desire as a result of their condition.

What problems does diabetes cause?

In men

Long-term diabetes can cause damage to the nervous system, which is involved in the complex process of erection.

This means men with diabetes may suffer from erectile dysfunction (ED) and be unable to get or maintain an erection. As many as a third of men with diabetes eventually experience ED.

Some men only discover they have diabetes when they seek treatment for their erectile dysfunction.

Once diabetes has been regulated through diet, pills or insulin injections, sexual problems often disappear and the ability to get an erection is restored.

In women

A number of women with diabetes may suffer from recurring vaginitis (inflammation of the vagina), which is usually due to yeast (thrush) infection. This makes sex painful. You may suffer itching or burning sensations, and a white discharge.

Women with diabetes may also get recurring cystitis.

There is also some suggestion that women with diabetes have problems with arousal, and just as the penis fails to become erect in the man, the clitoris in a woman may not respond to stimulation in the normal way.

Can you make your sex life work when you have diabetes?

If you feel diabetes is causing problems with your sex life, talk to your doctor.

While no-one relishes talking about sexual problems with a doctor, these issues can only be addressed if you seek help.

Your GP will try to find out whether sexual problems are caused by defects in the nervous or circulatory system as a result of the diabetes, or whether they are of a more psychological nature. Often this distinction is difficult to make.

In any case, when sexual dysfunction begins to happen on a regular basis it tends to get worse unless it is properly treated, so the psychological element inevitably builds up.

An increasing number of men who have diabetes and ED are being helped by medicines such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra).

If tests confirm that your nervous system hasn't been damaged by diabetes, and there are no associated circulatory problems, there's no reason why your sex life shouldn't recover.

Sometimes a little help and support from your partner and doctor is all that's needed.

What can be done about sexual problems that are not caused by diabetes?

This is a sensitive issue, but help is available.

Generally the most useful first port of call is your family doctor, who can refer you (and your partner) to a psychosexual therapist – or relationship counsellor if this is more appropriate.

Try not to dwell on the fact diabetes can cause sexual problems – just because it can, doesn't mean it will.

And if you do experience difficulties, be reassured that nowadays there is a lot of help available:

Diabetes UK

Relate

British Association for Sexual and Relationship Therapy.

Based on a text by Dr Erik Fangel Poulson, Specialist

Sex and cancer

2009-04-03T00:44:00.000-07:00

Reviewed by Christine Webber, psychotherapist and lifecoach and Dr David Delvin, GP and family planning specialist

Does cancer cause sexual problems?

Yes, very frequently. You see, it is always a shock for people to be told that they have cancer or any other serious illness. Their lives are suddenly dominated by medical examinations and treatment – and quite naturally all of their attention is focused on the disease.

In this frightening situation, it's not unusual for sex to take a back seat for a time. But after a while, when the patient has gathered enough strength to look forward and to take an interest in good health and a normal life once again, he or she will almost certainly rediscover an interest in sex. But it may be difficult to resume sexual relations - particularly if you are tired or in pain.

Does cancer cause problems in a relationship?

In most relationships, serious illness can result in anxiety and uncertainty. Furthermore, the patient may be afraid that sex could cause physical injuries.

Even after patients recover, they may worry that having sex will cause the illness to break out again. People may also have irrational fears that the illness may be contagious or sexually transmitted.

These kinds of thoughts and misconceptions can make a relationship come to a standstill. It's vital for couples in this situation to talk to each other - and to a doctor - to dispel any fears or uncertainties.

They may also benefit greatly from being referred to a medical expert specialising in psychosexual medicine, or from getting some counselling with a sex or relationship therapist.

Can it be dangerous to have sex when you have cancer?

Unless the cancer affects the genital area, there is usually no reason why the patient should not have sex.

It is a good idea for cancer patients to discuss with their doctor whether or not they can have sex. If possible, this question should be raised early in the illness before any potential operation or complicated medical treatment such as chemotherapy has begun.

Unfortunately, it has to be said that – even today – not all doctors are comfortable talking about this subject. Sometimes a nurse, or a counsellor, is a better person to chat to.

It is extremely important that patients are kept well informed about their illness and its immediate consequences in the short term and in the long term.

They will want to know what impact it will have on every aspect of their life – including their sex life. For instance, people need to know whether the treatment will have any effect on their sexual function or fertility.

Are the patient's sexual problems caused by factors other than cancer?

If a patient experiences difficulties with sex after cancer or any other serious disease, it may help if they ask themselves the following questions: 'Are my sexual problems a result of the disease itself or are they caused by other things in my relationship?'

If a person is not sure that he or she is capable of functioning sexually it might help to try to achieve orgasm by masturbation. If this ‘works', then that is a sign that the basic mechanics of the sexual apparatus are functioning properly.

If sexual difficulties arise, it is essential that you ask a GP or specialist whether the problem is due to:

the cancer

the treatment of the cancer

other factors such as psychological causes.

What can be done if cancer has led to a physical disability that affects the performance of the sex organs?

Remember that loss of sensation does not mean loss of feelings. If the illness has resulted in a male patient becoming impotent he should bear in mind that there are many highly effective treatments for impotence these days.

But he should also realise that he can still be loving towards a partner and help him or her have orgasms by methods other than intercourse. It is very possible for people to have sexual relationships even if the function of their genitals has been lost.

Any cancer patient – male or female – who has sex or relationship problems will also probably benefit from being involved in one or other of the excellent cancer patients' support groups. It is very useful to chat to other people who are going through similar problems to your own. This communication will help you feel less hopeless and less isolated.

Based on a text by Dr Erik Fangel Poulson, specialist

Sex and alcohol

2009-04-03T00:43:00.002-07:00

Written by Dr David Delvin, GP and family planning specialist

Alcohol affects people’s sex lives in many ways. We can divide its effects into ‘bad’ and ‘good.’

Good effects of alcohol

Small amounts of alcohol oil the social wheels and reduce shyness – thereby making it easier for people to meet up.

Similarly, a little wine or a cocktail will often make a person feel romantic – or perhaps less ‘uptight’ about sex.

Also, a very small ‘dose’ of alcohol can extend the time which a nervous young man takes before he climaxes – thus combating any slight tendency to come too soon or experience mild premature ejaculation (PE). However, alcohol is not a treatment for this condition.

Bad effects of alcohol

Unfortunately, the list of ‘bad’ effects of alcohol is much longer! Here they are:

Alcohol makes people far more likely to have unwise sex with the wrong person – and therefore to get pregnant, to catch infections, and to embark on affairs that cause marriage break-ups. In fact, booze is the main reason why in 2005, there is a massive demand for the ‘morning-after pill’ on Saturday, Sunday and Monday mornings.

Alcohol makes people fuddled, so that they don’t take proper contraceptive precautions.

Alcohol is bad for the unborn baby – so it should only be taken very sparingly in pregnancy. During 2008, there have been conflicting reports about how safe it is for pregnant women. Some authorities feel that during pregnancy it should be avoided totally. At present we don’t know whether alcohol taken on the night of conception could be bad for the baby.

Alcohol is a major cause of impotence (erectile dysfunction). A lot of younger males don’t realise this, because they think that booze boosts ‘horniness'. But as Shakespeare says in the Scottish play: ‘It increases the desire, but it takes away the performance.’

A lot of men who are hooked on alcohol develop permanent ‘Brewer’s droop’ – and often loss of interest in sex as well.

We do not yet know if excessive alcohol use can cause female sexual problems, but on the basis of probabilities it does seem likely that some cases of diminished libido are due to excessive alcohol consumption.

If you have problems with excessive alcohol use or think you may be suffering from alcoholism, we suggest you contact Alcoholics Anonymous.

Sex after abdominal diseases

2009-04-03T00:43:00.001-07:00

Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist and lifecoach

Do abdominal diseases affect your sex life?

Yes, they certainly do! Almost all of the diseases which occur in the abdomen can affect a couple's sex life. This is because symptoms such as pain, soreness, burning, discharge and bleeding may cause discomfort during sexual intercourse.

The very thought of having an abdominal disorder can also psychologically affect your sex life and reduce your sex drive. When trying to make love, you may find it difficult to switch off and relax.

After having an operation on your abdomen you might experience after-effects that make you uncomfortable.

For instance, the area that has been ‘cut’ may feel strange and painful for several months. So even if the rest of your body is healthy and working normally, your desire for sex may be low. This means that at first you may not be able to have sexual intercourse or feel the kind of pleasure you used to.

It is also important to realise that in some major abdominal operations the nerve supply to the genital area may possibly be cut through. If you are going to have lower abdominal surgery, do discuss this possibility beforehand with the surgeon.

The very thought of having such a disease can also psychologically affect your sex life and reduce your sex drive. When trying to make love, you may find it difficult to switch off and relax.

How do you recommence your sex life?

It is important that you talk to your partner about your low sex drive and also let them know when desire returns. If you don’t tell them, they have no way of knowing how you feel or what you are capable of doing.

If you say nothing, your partner may initiate sex before you feel ready. In such a case, it's likely you'll either refuse or agree through a sense of duty. Either way, sex may not go very well.

On the other hand, your partner may be overly hesitant about initiating sex through consideration for your feelings. He or she may assume you don't feel like it and you, in turn may conclude that your partner has lost interest in you. Consequently, nothing happens and neither of you knows how the other is really feeling.

What to do after pelvic inflammatory disease (PID)

It can be difficult for women to resume their sex life after having a bout of pelvic inflammatory disease PID. They may feel discomfort for months or believe that the infection has returned. During this time, any attempt to have sexual intercourse is likely to run into trouble.. However, most women will eventually feel like returning to sex.

Talk to your partner about it. Find a time when you are both in the mood and begin by kissing and caressing. Then you can very gradually progress to loveplay.

Don't move on to sexual intercourse before you are completely ready. In other words, you should feel like making love – and in addition, your vagina should also feel moist enough for your partner to enter you easily.

If there is pain or discomfort, do not attempt further penetration but continue your lovemaking with sexual stimulation that does not involve intercourse.

Painful intercourse (dyspareunia)

2009-04-03T00:42:00.000-07:00

Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist

Do you get pain during intercourse? If so, then the odds are that you're a woman – though at the end of this article, you'll find advice for the small number of men who get intercourse pain.

It's not much fun having pain during sex. After all, sex is meant to be an enjoyable and happy experience. If you get pain, it isn't.

Fortunately, the trouble will often resolve if the man takes more time with love play so that the woman's vagina relaxes and her natural lubricant flows, and if the couple use one of the newer sex lubricants like Eros or Liquid Silk.

When to seek help

You can safely disregard one isolated episode of pain during sex. It's easy to feel pain when a sensitive part of you is being prodded quite hard.

But if the pain keeps on happening, you shouldn't feel you have to put up with it. Get something done to improve things.

How? If you know that your GP is skilled at dealing with these matters, then he or she would be a good person to consult. But we have to admit that most family doctors are not trained in dealing with pain during intercourse.

It might be more realistic to go to your local family planning clinic. Many family planning clinic doctors (usually women) have spent a long time being trained by the Institute of Psychosexual Medicine (IPM) to deal with this type of pain.

Unfortunately, family planning clinics have become rather swamped with patients needing help, and they don’t have as much time as they used to for helping women with intercourse difficulties.

An alternative is to see a female IPM-trained doctor privately. There are also excellent NHS psychosexual clinics in some parts of the country - notably Sheffield, Preston, Paddington and Tooting.

A very good low-cost sexual counselling service is provided by both Relate and Relationships Scotland – formerly known as Relate Scotland.

The emotional factor

In a minute, we'll look at the possible cause of intercourse pain, or dyspareunia, to give it its medical name. But it's important to realise that there is usually some emotional element in this problem.

If you experience pain during sex, it's almost certain to be distressing for you. This distress may well make you tighten up down below. And this tightening up will very likely make the pain worse next time.

Unfortunately, painful intercourse can often have a destructive emotional effect on a relationship. Sometimes couples split up because of it. So that's a clear reason why you should get the problem sorted out as soon as possible.

What causes it?

There are dozens of possible causes of dyspareunia. Fortunately, many of them aren't too serious, but a few are.

Ideally, the assessment should be done by a doctor who is skilled in the technique of vaginal examination.

One of the first things to establish is: is the pain deep inside you? Or is it near the outside?

This may not be easy for you to say. Sometimes a pain is both superficial (near the outside) and deep. But deciding which it is can help sort out what's wrong.

Vaginismus

Vaginismus can cause both deep and superficial pain and is a common cause of pain during sex. It's a spasm of the vaginal muscles, caused mainly by fear of being hurt.

This spasm is often so painful that intercourse is impossible – sometimes for years.

Some women with vaginismus have never been able to have full sex or even use tampons. They also tend to be very fearful of vaginal examinations and so may never have had a smear test.

Vaginismus arouses strong emotions, and women who have it are often very angry with partners, doctors and themselves. But the condition is no one's fault.

Common causes include:

a restrictive upbringing, in which the woman was brought up to view sex as nasty or dirty.

an upbringing in which the woman was given the idea that the vagina is very narrow and so sex must be very painful.

a background where rape or childhood sexual abuse has taken place. Experiences like these understandably make women fearful of sex and of being hurt.

painful vaginal infections.

unease with their partner – perhaps at an unconscious level.

It is a common misconception that women with vaginismus dislike sex altogether.

In fact, many women with this condition enjoy closeness with their partners.

Many get great pleasure from love play and some are able to reach orgasm in this way. But the enjoyment ceases when penetration is attempted or suggested.

In the UK, women doctors who have been trained by the Institute of Psychosexual Medicine have by far the greatest experience of treating vaginismus.

What are the other causes of deep pain during sex?

Problems with your cervix: the man's penis hits the cervix at the farthest extent of his thrust. So infections of the cervix and tender places on it can cause pain during deep penetration. This is called 'collision dyspareunia'.

Womb trouble: various womb disorders, including fibroids, can cause deep intercourse pain.

Endometriosis: this very common disorder often affects the womb and surrounding tissues. It makes them very tender, particularly near period times. The pressure of the penis on an area of endometriosis may cause intense, deep pain.

Ovary problems: cysts on the ovary can cause deep pain. Pain may also be caused if the tip of the penis hits an unusually positioned ovary.

Pelvic inflammatory disease (PID): this is caused by infection, and has become more common in the UK largely thanks to the bug called chlamydia. If chlamydia isn't treated, there is quite a chance of PID developing. In PID, the tissues deep inside become badly inflamed and so the pressure of intercourse causes deep pain.

Ectopic pregnancy: this means a pregnancy outside the womb, usually in the Fallopian tube. Pressure on it can be very painful.

What are the other causes of more superficial pain?

Lack of lubrication

This can be due to nervousness, hang-ups and failure to relax. Unskilled foreplay by the man is a common cause, especially when it doesn't go on long enough. (Many women would like half an hour – but don't get it!)

Well-endowed partner

Some women complain that their partner’s penis is too big.

In fact, when a woman is aroused and relaxed, the vagina extends by several inches – so any female should be able to accommodate any male.

But being unused to a larger man or previous problems with bladder infections or endometriosis can lead to anxiety and tension about sex.

A recent invention may be of use here. It's called the 'Come Close' and is a kind of cushioned ring that the man wears on the base of his penis. This reduces the length of the penis that goes into the vagina. For more details, visit: www.comeclose.co.uk. Currently, the 'Come Close' retails at £24.99.

Menopausal or post-menopausal dryness

This is usually due to a fall in female sex hormones. Treatment with HRT pills or hormone cream will usually put matters right. Ordinary sex lubricants will help, too.

Vaginal infections

These are very common. The one that huge numbers of women get is thrush. But there are numerous others, such as trichomonas. The blisters of herpes can also be really painful.

Injury

Injury to the vulva or vagina can occur during rape or sexual assault and later cause dyspareunia.

Much more commonly, injury is caused by a childbirth tear or the episiotomy cut that is often made during labour. Badly healed stitching can also cause pain.

Genital warts

These are awfully common in these days of fairly promiscuous sex. Occasionally the warts can cause pain, especially if they get infected.

Vulvitis

This means inflammation of the vulva (the opening to the vagina). It can be due to all sorts of causes, including chemicals in bubble-baths or soaps.

Haematoma of the clitoris

I first encountered this about 30 years ago, but it's still not widely known. It's a bruise (or collection of blood) in the clitoris, caused by excessive friction. It nearly always gets better within a few weeks.

Urethral caruncle

This is a tender patch that develops at the urinary opening.

Foreign body in the vagina

The usual culprit is a forgotten tampon. It may cause pain, especially if the tampon leads to an infection.

Vulvodynia

A distressing and long-lasting condition in which the outside part of the sex organs (the vulva) is so sensitive, just touching the area makes the woman jump with pain.

Its cause is not yet known, but it can often be successfully treated.

The experts in dealing with it are the doctors at genitourinary medicine (GUM) clinics.

Cancer

This is a rare cause of intercourse pain, but it must be borne in mind for a woman who develops this kind of pain for the first time after the age of 40.

Does intercourse pain affect men?

Sometimes men experience pain during intercourse.

Common causes are skin disorders on the penis such as eczema or psoriasis.

It can be that the woman's vagina is too tight for her partner. A good sex lubricant can help here.

Occasional causes of male pain include:

thrush – in which case the female partner will probably have thrush too

a forgotten stitch left in the woman's vagina after childbirth

an IUD thread or a displaced IUD in the vagina

Peyronie's disease – a male disorder that causes bending of the penis.

Depression - how it affects sex and relationships

2009-04-03T00:41:00.001-07:00

Written by Christine Webber, psychotherapist and lifecoach

Most people who are depressed lose interest in sex, but it's unlikely your partner's depression has anything to do with you.

Depression adversely affects every aspect of our lives - including our relationships - and when one partner is depressed, the relationship may suffer very badly.

This is a great shame as a good relationship is very therapeutic for somebody with depression, because when we're really low we need love, support and closeness more than ever - even if we’re not very good at showing it.

What is likely to happen if your partner has depression?

Depressed people usually feel withdrawn. They don't feel they can raise enough energy to pursue their normal routine, do things with the family or even notice when their partners are being attentive.

This can quickly lead to the non-depressed partner feeling that he or she is in the way, unwanted, or unloved. It can be easy to misinterpret the low moods as hostility, or as evidence that the depressed person wants out of the relationship.

Frankly, it’s really hard to stay calm and confident when the person you thought you knew is acting strangely and appears to be so unhappy. So if you’re finding your partner’s depression a real pain, try to take heart from the fact that this is natural.

Being the partner of a depressed person is very, very difficult. So, even if you're at your wits' end because your loved one has lost the ability to concentrate on what you're saying, or to raise a smile, or to appreciate any of the good moments in life, try to accept that all these things are part of the illness.

Sex and performance

We don't know enough about the chemical changes that occur in the brain during depression and little research has been done on how these changes affect sex.

From a clinical point of view, however, it's clear that a depressive illness tends to affect all the bodily systems, dislocating them and often slowing them down.

This effect is most marked with regard to sleep, which is invariably disrupted. But there can be adverse effects on any activity that requires verve, spontaneity and good co-ordination – and that includes sex.

So many people who are depressed tend to lose interest in sex. Admittedly, this isn't always the case, and some depressed people manage to maintain normal sex lives - sometimes even finding that sex is the only thing that gives them comfort and reassurance.

In men, the general damping down of brain activity causes feelings of tiredness and hopelessness, which may be associated with loss of libido and erection problems.

In women, this diminished brain activity tends to be associated with lack of interest in sex, and very often with difficulty in reaching orgasm.

All these problems tend to diminish as the depressive illness gets better. Indeed, renewed interest in sex may be the first sign of recovery.

Sex and antidepressants

It's not just the illness that affects a person's sex-life - antidepressant medicines such as Prozac can interfere with sexual function.

One of the most common side-effects is interference with the process of orgasm so that it's delayed or doesn't occur at all. If this happens – and you are keen to have and enjoy sex – you should ask the doctor about changing medication.

How depressed people can help themselves and their relationship

Some days will seem better than others. On your better days, try to make an effort to show love and appreciation to your partner.

Try to go for a walk every day, preferably with your partner. Walking not only gets you out in the fresh air, which will give you a bit of a lift, but like other forms of exercise it releases endorphins in the brain. These are 'happy' chemicals that rapidly elevate your mood.

Even on your worst days, try to spot happy moments like a bird singing or a new flower blooming in your garden. Try to train yourself to notice three of these heart-warming moments per day.

You may have an odd relationship with food while you're depressed (you could have little appetite or constantly comfort eat), but try to eat five pieces of fruit per day. This is a caring thing to do for yourself and is good for your physical and mental health.

Listen to music that matters to you.

Have faith that the depression will pass, and that you will enjoy your life again.

Even if you don’t feel like full-on sex, do make the effort to have a cuddle. If you are worried that cuddling will project you into full sex when you don’t want it, just tell your partner that you’re not feeling like having sex, but that you would really like to cuddle up. If you do this, you may both feel a lot better. Touch and closeness can keep a relationship intact.

How to help your depressed partner

Don't keep saying that you understand what your partner is going through. You don’t. Instead say: 'I can't know exactly how you're feeling, but I am trying very hard to understand and help.'

Many people who are depressed lose interest in sex. Try to remember that this loss of interest is probably not personal, but connected with the illness.

Don't despair. Some days you'll feel your love for your partner doesn't seem to make any difference to them at all. But hang on in there. Your love and constant support should be of great help in persuading your partner of his or her value.

Do encourage your partner to get all the professional help available. Nowadays, there are plenty of alternatives to anti-depressants. Cognitive behaviour therapy (CBT), for example, is becoming much more readily available on the NHS. In fact, the government is committed to providing 10,000 extra therapists. Many GP practices can also provide CBT by means of Internet programmes. These can have a good effect quite quickly in many cases.

Try to act as though your partner were recovering from a serious physical illness or from surgery. Give plenty of tender loving care. But don't expect improvement to be rapid.

Do something nice for yourself. Being around a depressed person is very draining, so make sure you look after yourself. Have some time alone, or get out to a film or to see friends. Depressed people often want to stay home and do nothing, but if you do this too, you'll get terribly fed up.

Remember that this period in your life will pass and that your partner is the same person underneath the depression that he or she was before.

Try to take some exercise together. Most depressed people feel an improvement in their spirits if they do something active. And doing something that will raise the heartbeat – for example, sport or dancing – may well help you too.

Women's sexual response

2009-04-03T00:40:00.000-07:00

Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist

Do all women have the same sexual feelings? No they don't. In actual fact, women vary enormously in their sexual drive. Some don't feel very interested in sex at all – whereas others are passionate and wild about it.

But an extraordinary change has taken place in the last 50 years or so. Back in the mid-20th century, it was generally felt by doctors that most women fell into the 'not very interested' group - and that only a few were enthusiastically sexy.

By the 21st century, all that had changed. Today, it is widely assumed by the media - and by many of the public - that most women are easily aroused by sexual stimuli and that only a minority have little interest in sex.

In fact, that isn't really true. Our research indicates that although most modern females are much more 'open' about sex, and are keen to enjoy it; it takes them time to learn how to do this.

Indeed, a small study which we completed in 2005 indicated that a considerable proportion of young women just starting at university have thus far developed very little interest in sex (or knowledge about it), and have not even learned to reach orgasm yet. However, many of them do become very much more ‘sexually charged’ as the years progress.

Learning how to reach orgasm

We have found that younger females frequently have no real knowledge of the process of sexual arousal. In particular, women often need quite a lot of help to learn how to reach orgasm.

Unlike males – most of whom can 'come' easily from the moment they reach puberty – females will often spend a couple of years experimenting with their sexual feelings before they eventually learn how to come regularly and reliably.

But once women have learned to cast off their inhibitions and enjoy sex, they tend to respond to sexual stimuli in very much the same way.

What are women's sexual reactions?

A woman's first response to sexual stimulation is usually a nice, warm feeling all over her body – as she begins to let herself go.

At the same time her pulse rate starts to go up, and the pupils of her eyes get bigger. Incidentally, this widening of the pupils makes her more attractive sexually. In the olden days, drugs like belladonna ('beautiful woman') were used to produce this effect.

What happens to her sex organs as she gets aroused?

Laboratory studies carried out in Holland in 2004 show that as s soon as a woman starts thinking with interest about sex, her vagina begins to moisten. (This is the female equivalent of erection in men.)

The reason for this moistening is to lubricate her vagina, in preparation for possible sexual activity.

At the same time, various other things happen:

her clitoris – the most erotically sensitive part of her body – swells up.

her labia (the lips of the opening of her vagina) also swell up. The effect of this is to open up her vaginal opening slightly, in preparation for intercourse.

inside her, her vagina opens up – making room for the possible entry of a penis.

What happens next?

As she gets more and more aroused, her breasts will swell a little and her nipples will become more prominent. Her breathing gets faster and she starts to gasp. Her eyes tend to become glazed and she is likely to lick her lips - thus making them even more attractive to her partner.

If she is fair-skinned, a faint pink 'rash' will develop at the base of her neck and over her breasts.

And finally?

And finally, she climaxes. What generally happens here is that she experiences a series of waves of ever-increasing pleasure, till eventually the last one is so mind-blowing that she nearly passes out.

At that moment, nearly all women cry out – sometimes very loudly! The muscles of their faces and bodies contract violently (but very enjoyably) – and then after a while everything relaxes.

So that's the end?

No, not really. These days, most women can – if they want to - go on to have further climaxes. But this will only happen if:

they are happy and relaxed

they are being skilfully stimulated

they have learned how to have multiple orgasms.

This is of course, a dramatic difference between the sexual response of females and males. Nearly all men have no chance whatsoever of enjoying multiple climaxes!

For women: things your Mum never told you about sex

2009-04-03T00:38:00.000-07:00

Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist

What did your Mum tell you about sex?

Even today, many British women say that they never got enough sexual information from their mothers (and fathers!). So no wonder so many UK females are less than satisfied with their love lives.

Here are four facts that you almost certainly weren't told by your mother. But knowing them could help you to a more enjoyable sex life.

Fact one: climaxing isn't that easy

For most females, learning to climax is quite a difficult and time-consuming business. Nowadays, men tend to suggest to women that they should be able to reach orgasm very easily. The media – and that includes romantic novels and erotic films – often give the same impression. And nowadays the proliferation of porn online has given men some very strange ideas about what is pleasurable for women. In a lot of this material the woman squeaks with orgasmic passion the moment a guy enters her. In real life, this very rarely happens.

Our research shows that the average British female doesn't start having reliable orgasms until about two years after she first has sex with a man!

However, there are many women who don't conform to this pattern: for instance, a lot of teenage girls learn to climax on their own - through masturbation – long before they ever go near a guy. But in general, the ability to 'come' has to be learned over a considerable period of time.

So if you haven't managed it yet, don't be downhearted – as you almost certainly will get there. Some of our patients first ‘rang the bell’ when they were in their 40s!

Fact two: almost any woman can ‘come’

Practically any woman should be able to have orgasms - and indeed multiple orgasms - if she really wants to.

Back in your mum's day, sex was still quite a taboo subject and talking about orgasms was even more taboo.

Even as late as the early 1990s, it was widely felt among middle-aged women that for a 'lady' to want orgasms badly wasn't quite 'nice'. And for her to want multiple orgasms was a bit outrageous!

Furthermore, when your Mum was young, many so-called 'experts' suggested that multiple orgasms were almost impossible for most females.

However, we now know that:

virtually any woman can have an orgasm – if her clitoris is stimulated long enough and expertly enough (and of course provided that she's in the right mood!).

similarly further intense stimulation after the first orgasm will usually produce another.. and another... and another...

We're not saying that you can achieve all this overnight but, if you stimulate your own clitoris for long enough over a period of time, you are quite likely to eventually achieve as many orgasms as you like. Clearly you can also have multiple orgasms if you have a partner - male or female - who is devoted to giving you pleasure, and who you love and cherish.

Fact three: masturbation is OK

There is nothing wrong with 'do it yourself sex'.

Indeed, sex experts now agree that masturbation can be enormously useful in helping a woman:

to learn how to reach orgasm

to learn how to reach multiple orgasm.

So don't hesitate to go for it. It is particularly useful and healthy to enjoy masturbation if you are widowed or divorced or single. Masturbation is a lot more reliable and safe than having sex with a stranger!

Fact four: oral sex is OK too

A generation ago, oral sex was widely considered to be something rather ‘dirty'.

One of us worked with a professor of bacteriology who actually refused to process ‘throat swabs’ for sexually transmitted infections – because he couldn’t believe that people were doing such things …

So your mum probably didn’t tell you that:

oral sex is a great help to many women in reaching a climax

it’s very helpful to men who have erection difficulties

for a lot of people (admittedly, not everyone), it’s jolly good fun!

If you haven’t attempted it before, then can we assure you that it’s well worth a try!

You mum may also have never spelled out to you how desire can fluctuate according to where you are in your menstrual cycle, and also depending upon how well you are currently getting on with your partner.

Sustaining a long-term relationship is not just about sex but about companionship and sharing chores and laughing together and so on. All these things can affect our sex lives.

Also, stress and tiredness have big adverse effects on sex. Your mum may not have known this – let alone have thought to tell you – because perhaps her life was not quite as complicated as yours. Today’s woman is so often juggling a full-time job, children, elderly parents, maybe step-children and so on – which is an awful lot to cope with. No wonder sex sometimes slips down our list of priorities.

There are a lot of articles in the sex and relationships health centre that will give you plenty of up to date information on every kind of sex and relationship problem. You are likely to find this more comprehensive than anything your mum told you!

The G-spot

2009-04-03T00:37:00.000-07:00

Written by Dr David Delvin, GP and Christine Webber, psychotherapist

If you think the G-spot equals mind-blowing orgasms, think again. With Italian research the latest to lay claim to this fabled female erogenous zone, our experts explain why medical opinion remains to be convinced.

What is the G-spot?

Some experts say a zone called the G-spot can help a woman to orgasm.

There is still much controversy about whether the female G-spot really exists. Few doctors will give you a definite answer to this query.

Most standard gynaecological textbooks make no mention of the G-spot at all.

Anatomy manuals used by medical students and postgraduates do not show such a structure.

No gynae surgeon has seen a G-spot during an operation.

No anatomist has yet found one while dissecting a human body.

On the other hand, there is quite a lot of evidence from women’s personal experiences of sex that there is a particular area, located very close to the front wall of the vagina, which seems to give some females a remarkable amount of pleasure.

And there are women who claim that stimulation of this area helps them to reach orgasm – and sometimes an orgasm of an unusual kind.

So it does seem likely there is, at the very least, a collection of highly sensitive nerve-endings in the region that has come to be known as the G-spot.

What is the evidence that it exists?

1944: Gräfenberg makes discovery

In 1944 a German gynaecologist called Ernst Gräfenberg discovered a new erogenous zone, located somewhere near the front wall of the vagina.

He published his conclusions in the International Journal of Sexology in 1950 in a paper called The Role of the Urethra in Female Orgasm.

The urethra is the female urinary pipe and is about four centimetres long. It carries urine from the bladder to outside the body.

The important thing to grasp is that the urethra is embedded in the front wall of the vagina. Therefore, pressing on the lower part of the anterior vaginal wall will create pressure on the urethra.

Dr Gräfenberg claimed that stimulating this area would cause the tissues to swell up, and would give the woman intense sexual pleasure and orgasm. He also linked this erogenous zone to the phenomenon of female ejaculation.

In 1950, few people paid Gräfenberg any attention. Throughout the fifties and sixties, his name was only known to doctors as the inventor of the coil (intra-uterine device).

1981: the spot is named

The spot started attracting attention again in 1981, when Dr Addiego and his colleagues published an article in the Journal of Sex Research called Female Ejaculation: A Case Study.

This report was based on a study of just one woman, who said she experienced 'a deeper orgasm' when the front wall of her vagina was rubbed.

The authors started calling this area of the body the G-spot in honour of Gräfenberg.

1982: the phenomenon begins

In 1982, US researchers Ladas, Whipple and Perry published a bestselling book called The G Spot and Other Discoveries About Human Sexuality.

This attracted headlines all over the world, and millions of people got the idea that you would have wonderful orgasms if you could find this fabled spot.

1983-2007: a modern gynaecological myth?

During the 1980s and 90s, a lot of scientists tried to establish what the G-spot actually was, but with fairly inconclusive results.

Their studies were limited by the fact that scanning of female genitalia was still in its infancy.

In 2001 this led to the American Journal of Obstetrics and Gynecology calling the Gräfenberg spot 'a modern gynecologic myth'.

2008: ultrasound breakthrough

In March 2008 the G-spot again caused a worldwide sensation when an Italian team from the University of L'Aquila reported they had done ultrasound scans on 20 women.

They found about half of the women had a 'thickened area' between the vagina and the urethra.

Females who had this thickened area were more likely to say they experienced vaginal orgasms.

Vaginal orgasms are those caused by stimulating the vagina alone, as opposed to direct stimulation of the clitoris.

This somewhat ambiguous finding has been interpreted by many to mean 'the Italians have found the G-spot'.

But this was a very small sample of women, so the majority of scientists and doctors remain skeptical. A far more significant number of women would need to be scanned before this research is taken more seriously.

What about future research?

Possible future lines of investigation include the following.

Is the G-spot really made up of Skene's glands - tiny glandular structures that are rather like the male's prostate?

Is the spot really part of the wall of the urethra that contains erectile tissue?

Is the G-spot actually part of the 'roots' of the clitoris, which an Australian doctor has now shown to extend far further than had previously been thought?

What does all this mean for your sex life?

At the moment, more research needs to be done to confirm where the G-spot is and whether all women have it.

Women: if your partner is able to stimulate your G-spot, you may find it gives you new and exciting sensations. It's unlikely you'll be able to stimulate yourself in this way, because it's hard to reach the right area unless you've got very long fingers.

Men: knowing how to stimulate this area with your fingertips may be a useful addition to your bedtime repertoire and give extra pleasure to your partner. But trying to reach the G-spot with your penis during sex is not easy. You might have success if the woman is sitting astride you and facing you, and then leans backwards, so the penis presses against her front vaginal wall.

You can also buy G-spot vibrators. They have a kink in the end so the tip can reach the front wall of the vagina. But they are quite difficult to use, unless you have a good knowledge of female anatomy.

What will it feel like?

If you or your man are trying to rub the G-spot, it may at first just feel uncomfortable and give you an overwhelming desire to pee.

If you try to ignore this feeling for a few seconds, you may be lucky and suddenly experience quite a thrilling sense of building excitement.

But we cannot stress too much that this is not the case in all women.

Some women say they definitely have a G-spot and it's something that gives them enormous pleasure when it's stimulated.

Others tell us they hate having this area rubbed.

Plenty say its okay, but not nearly as good as clitoral stimulation.

And contrary to what you may have heard, stimulation of the G-spot alone is not very likely to bring the woman to a shattering orgasm. In our experience, few women will climax unless the clitoris is being stimulated at the same time.

So, in conclusion, you may want to have a go at finding your G-spot and giving it some attention - but we cannot guarantee that it will be your cup of tea.

For the average person, the most important thing to know about the G-spot is how to find it - or at least, how to find the place where it's supposed to be.

Both partners should agree they are going to search for the G-spot. The man shouldn't spring it on the woman as a surprise.

The woman should lie on her back and make sure she is comfortable, relaxed and well-lubricated.

With his palm upwards, the man should gently insert his index finger into her vagina.

When it is fully in, he should make a 'beckoning' movement until his fingertip comes into contact with the front wall of her vagina.

He should then rub that area.

If he is in the right zone, she will immediately experience a desire to pee.

With luck, she will also experience considerable pleasure.

Masturbation for women

2009-04-03T00:36:00.000-07:00

Written by Christine Webber, psychotherapist and lifecoach

What is masturbation?

To masturbate means to stimulate yourself in a sexual way. This can be done by hand, or with sex aids - some highly-sexed women can even do it by rubbing their thighs together. And a tiny minority of women can do it with no genital contact at all, but simply through caressing their breasts.

Such stimulation often leads to orgasm, but not invariably, as many women enjoy stroking themselves and experiencing pleasure that does not necessarily culminate in a climax.

Most men have masturbated, often beginning at a fairly young age.

Women tend to start masturbation later however, and it does not tend to be such an automatic activity as it is for most men and boys.

Furthermore, even once a woman has learned to masturbate, she will probably do it less than the average man - and it seems that far fewer women than men do it regularly.

Various people have speculated on why this is the case. But most agree that it is to do with basic sex drive.

It does appear that if you compare the sex drive of an average young woman and an average young man, then the man is likely to be the more highly sexed of the two. This is partly because a woman’s fluctuating hormones tend to mean that her desire for sex is not as constant as a man’s is.

Another reason for masturbation being less important to women than men is that a man’s sexual apparatus is all outside his body and he is focused on the pleasure his penis provides him from a very young age.

Women’s sex organs are less obvious. For example, the clitoris - which is the main organ of pleasure in most women - is hidden away under the labia. Also, though this is less the case now than it used to be, girls have traditionally been brought up to be more modest and secretive about their bodies.

Even so, many young women nowadays will enjoy masturbation prior to experiencing love play or intercourse with a partner. But vast numbers of females do not discover masturbation till their late teens – and some never do it at all.

Is masturbation a good thing?

Years ago, girls were told that masturbation was an ‘immature’ activity and that it was important not to get too fixated on it and that if you did, then you might be unable to progress to ‘proper’ lovemaking with a man.

Most experts now regard this sort of advice as nonsense.

Indeed, most clinicians and counsellors working in the world of sex and/or relationship therapy believe that a woman can learn a great deal about her own sexual response through masturbation, and that she can then pass on what she knows to any partner - male or female - she may have.

So, masturbation should not be regarded as immature or shameful. It is something that most normally-sexed women do. They may reserve it for when they feel in need of a treat, or they may do it very regularly – even when they are in a relationship.

Some women choose to masturbate in order to ease abdominal cramps during their periods. Others only ever do it if they feel seriously frustrated. And yet others do it both privately and also as part of the loveplay they share with their partners. All this is normal.

What's the best way for women to have an orgasm?

If you don't know exactly what it is you like or what it takes for you to reach orgasm, it's a good idea to practise on your own.

For some people the very idea of stimulating themselves can seem worrying, or unappealing, or something to be ashamed of. It’s a good idea if women can rid themselves of these feelings.

Masturbation is a great way to lessen tension in your body. It’s a very safe way to have an orgasm. And it’s probably the best way to learn about how your body likes to be loved. . But masturbation, like most things, takes practice. And the only way to learn about your own sexual response is to try it.

If you have never tried masturbation, or you want to do it in such a way that will be more pleasurable and satisfying then it has been in the past, then you might need to plan how and when to do it, rather than leave it to chance. For a start, you need to ensure that you’re going to have adequate time to yourself and that you won't be interrupted

Begin by taking a shower, or a long, luxurious, scented bath. Soap your body all over and enjoy touching your breasts and your genitals in particular.

Dry yourself carefully, then rub your favourite lotion all over your body. Keep touching your body everywhere - it might be a good idea to stand in front of a mirror while you do it. This is your body – a body capable of giving you great pleasure – so enjoy looking at it and getting used to the sight and feel of it.

At this point, as long as you know that you're in no danger of being disturbed, move to your bedroom. Make sure that it is warm and comfortable. Put on some relaxing music if you like. And just enjoy yourself.

Lie down on your bed and use a mirror to look at your private and intimate places. Gently spread your labia: you may want to use a spot of lubrication There are very nice modern ones that increase the sensuouness of the occasion – such as Wet, Liquid Silk and Pjur. But if you don’t have any lubrication, then use saliva.

Try to tighten and relax the muscles at the base of the pelvis.

If you find it difficult to know whether you're doing this successfully, try inserting a couple of fingers inside your vagina. That way, you'll be able to feel whether you're tightening and relaxing the muscles or not. Many women much prefer masturbation if they can feel some bulk in the vagina at the same time as they stimulate the clitoris – so touching yourself internally might feel very good indeed.

If you now tighten and relax the muscles in rapid succession you will feel contractions of the kind that many women experience when having an orgasm.

You might also notice a warm sensation in your abdomen. Try touching yourself all over your body, including the breasts and your genitals where you will quickly find the most sensitive spots. In particular, experiment near the opening of the vagina and clitoris and stimulate yourself in whatever way feels best. So long as you do not rush, and you are keeping relaxed, then your own fingers will automatically do the right thing and will move with the right amount of speed and intensity for you.

Try to familiarise yourself with exactly how touching yourself makes you feel. Ignore everything around you. Just think about what is going on inside you, or fantasise about making love with someone you care for, or with a celebrity, or in some gorgeous and romantic place.

While you touch yourself, you might like to look at something that turns you on - pictures, perhaps, a film; even a sexy book. Interestingly men and women differ somewhat is what they find arousing. Most men like graphic pictures of sexy women or of people having sex. Women are frequently much more turned on by words – so an erotic novel can often increase a woman’s pleasure.

If, as is likely, your sexual tension rises, keep going. If you have never previously masturbated to orgasm, you might suddenly feel tired and want to stop. Or you may be nervous about the build up of excitement in your body. Don’t worry about this. Just take your time. And if you don’t want to go on right now, then that’s fine. You can always try again another day. Eventually, the pleasant feelings will build up and you’ll be comfortable with this and increasingly excited and you won’t want to stop. When that happens, you will almost certainly suddenly experience a huge rush of ecstatic feeling and you will bring yourself to orgasm.

For some women it is not enough to just use their fingers - they like to use sex aids as well. A vibrator may be useful, or you could try stimulating yourself with the hand spray when you are in the shower. Use your fingers at the same time.

If they follow the guidelines above, almost everyone should be able to learn to masturbate and have an orgasm. But remember, these are only guidelines. Experiment, and you may well find a better way to turn yourself on.

Like other sexual activity, masturbation can be improved by varying how you do it.

This is particularly true for women who are between relationships and for whom masturbation is the sole sexual activity at that period in their lives.

Most women find that their fingers do the trick wonderfully – as they instinctively match their speed or weight to our requirements. But a vibrator can help someone who finds it hard to get to orgasm and can also be useful as a change from digital masturbation.

When it comes to vibrators, don’t necessarily assume that something that is a market-leader is necessarily going to be the best thing for you. It might not be. We all have different likes and dislikes.

And do remember that not all vibrators now look like lurid penises! Some are quite different nowadays. Those which work on a suction principle can be very effective. And there are others that have been designed by women sex therapists that have quite unconventional shapes. One range, called Emotional Bliss, has been designed by Julia Cole, who is one of the UK’s most eminent sex and relationship experts.

Buying vibrators and other sex aids including lubrication and erotic literature is now much easier for women than it was in the past as there are a number of online sex shops run by women for women that are a pleasure to ‘shop’ in.

My favourite sites are:

Emotional Bliss: www.emotionalbliss.com

Gash: www. directory.co.uk

Passion 8: www.passion8.com

Sh!: www.sh-womenstore.com

Tickled: www.tickledonline.co.uk.

Female ejaculation

2009-04-03T00:35:00.000-07:00

Written by Dr David Delvin, GP

Dr David Delvin explains why the phenomenon of female ejaculation causes a great deal of distress to many women and is much misunderstood by people of both sexes.

What is female ejaculation?

Female ejaculation is a controversial subject.

Female ejaculation is when fluid shoots out of the vagina at the moment of orgasm. It is sometimes known as 'she-jaculation' or you may have heard the terms 'gushing' or 'squirting'.

It's a controversial subject, not least because pornography writers (most of whom are male) have repeatedly suggested that all women ejaculate at orgasm.

Even today, erotic novels tend to give the impression that every woman produces a jet of fluid when she climaxes - just like a man. As a result, some younger males are puzzled if their partner doesn't.

How common is female ejaculation?

The reality is female ejaculation isn't all that common. Some women do it once in a lifetime, but never again.

The actual percentage of females who ejaculate is uncertain. However, in Masters and Johnson's famous lab experiments with over 400 women, they did not record anyone who ejaculated at climax.

Nevertheless, the experience of gynaecologists and family planning doctors indicates there is a substantial minority of women who ejaculate regularly.

Agony aunts, too, get many anguished emails from females who are deeply embarrassed by the fact they wet the bed when they come.

How much fluid is produced?

I have heard claims that highly-sexed women can produce litres of fluid in a single orgasm. This seems very unlikely - where could such an amount be stored in the female body?

More realistic is the estimate of Beverley Whipple, American sex guru and co-author of the original G-spot book. At a recent conference, she told me that in most cases, the amount of fluid secreted is around 'half a coffee cupful'.

What effect does it have on women?

When a woman first discovers that she suddenly drenches the sheets when she climaxes, it's natural for her to feel anxious and embarrassed.

And because most women initially think the fluid they produce is urine, they assume what they are doing is dirty or nasty.

Their feelings are - quite understandably - linked to childhood prohibitions about not wetting the bed.

Unsurprisingly, quite a lot of these women tend to go through life avoiding sexual relations with other people.

Some have the unfortunate experience of going to bed with men who react negatively when they climax - but this is not the reaction of most males.

Is female ejaculation caused by urine leakage?

Until the 1980s, most doctors who were aware of the phenomenon of women ejaculating used to assume the fluid must be urine. As a treatment, they would tend to recommend exercises to build up the pelvic muscles.

And many women do leak a little urine during sex and during other activities as well. This is called 'stress incontinence' and it happens to vast numbers of females when they sneeze, cough or laugh. It is particularly common in those who have had children.

However, when urine leaks during sex, it's often during foreplay or vigorous intercourse rather than at orgasm.

In 1982 the publication of a highly influential book by sex experts Whipple, Perry and Ladas changed these views. They suggested the fluid wasn't urine, but was instead a 'juice' secreted by glands that were said to be the equivalent of the male prostate.

What research has been done on the fluid?

There hasn't been enough research on the fluid (ejaculate) - partly because it's difficult to obtain adequate supplies of it for investigation. Also, scientific funds tend to be available for life-threatening diseases rather than for sexual problems.

However, recent research suggests the ejaculate is an alkaline liquid that isn't like urine, because it doesn't contain urea or creatinine, which are normal urinary constituents.

The fluid tends to be clear coloured and doesn't stain bedclothes - again, unlike urine.

Researchers have claimed that it contains some chemical ingredients similar to those produced by the male prostate - notably PSA (prostate-specific antigen). It is also said to contain two sugars: glucose and fructose.

Since 2000, an increasing number of researchers have suggested the liquid may come from Skene's glands. These are tiny secretory structures which lie around the female urethra (the urinary pipe).

Is female ejaculation connected with the G-spot?

A vast amount of material on the internet suggests there is such a phenomenon as a G-spot orgasm, which is likely to be accompanied by a gush of fluid from the urethra.

The G-spot is said to be an erotic zone at the front of the vagina, and this area is intimately connected with the urethra. Indeed, pressure on the G-spot area will invariably produce a desire to pee.

There is no doubt that pressing on the area of the G-spot would affect the above-mentioned Skene's glands, which are said by some to be the source of female ejaculate.

However, much of what has been written over the last 25 years about the alleged link between the G-spot and female ejaculation is unscientific and has not be proven.

For example, there is no clear evidence that pressure on your G-spot will make you produce female ejaculatory fluid.

What does this mean for women?

It's now clear that a substantial minority of women do ejaculate when they climax. This could be urine in some cases, but in other cases it seems that it isn't.

Clearly, much more research needs to be done on the contentious subject of female ejaculation, and on the nature of the fluid.

Finally, women who experience ejaculation need to realise that many men have a positive attitude towards it. After all, if a woman ejaculates, the man can regard it as a tribute to his virility and skill in bed!

Are you having trouble reaching orgasm? A guide for women

2009-04-03T00:34:00.000-07:00

Written by Christine Webber, psychotherapist and lifecoach and Dr David Delvin, GP and family planning specialist

'Coming' isn't all that easy - if you're a woman! Nearly all men can climax without difficulty, but women just aren't built that way.

But most people don’t realise that fact.

Let's face it, books, films and teen and women's magazines paint a very different picture in which today's females are hot, raring to go and effortlessly orgasmic.

So for women who are not all of those things - and that is a great many of them - this type of media portrayal is, at best, unhelpful and, at worst, painful and damaging. Indeed, today's teens and 20-somethings tend to believe that there's something wrong with them - or even that they're frigid - if they can't climax to order. This is not the case. In fact, mostly they're absolutely normal.

Interestingly, however, only a generation ago many doctors used to believe that a high proportion of the female population simply couldn't climax at all. Why did they think this way? Simply because most of them had had little or no training in sexual medicine. Also, the great majority of them were so embarrassed about sex themselves that they tried to avoid discussing it with their patients. Furthermore, since women don't need to climax in order to conceive, most doctors didn't rate the importance of the female orgasm very highly.

New attitude

Nowadays, fortunately, medics have a very different attitude. This is largely because they are now familiar with the results of sexual studies conducted by American researchers Kinsey, Masters and Johnson, Shere Hite and others.

In addition, the last 15 years have seen a number of sexual surveys conducted with large samples of people through newspapers and magazines. Indeed, our own company – the Medical Information Service – has designed many of these.

The results of these surveys have taken the lid off the sex life of the great British public. Now we know that virtually any woman can climax - and indeed have multiple climaxes - if the circumstances of her life are right. And these circumstances usually include having a caring, understanding partner who is knowledgeable about sex, and who uses that knowledge to help her relax and to reach orgasm.

As we've already said, orgasm is a much more automatic response for men than for women. It seems that even though there are plenty of deeply caring and decent guys around, their ability to climax does not necessarily have to be linked to feelings of love and romance. Women of all ages, by contrast, tend to find that their sexual confidence and competence flower in a climate of appreciation and deep affection.

Of course nowadays there are young 'ladettes' - females who set out to have as much uncommitted and uncomplicated sex as young men - but they are in the minority. And we have discovered that many of these youngsters are secretly quite miserable.

But to understand more about the female orgasm let's go back to the very start of a woman's sexual life.

The beginnings

A lot of very young women are worried about their lack of ability to climax. But the fact is, unlike males, most females have to learn to reach orgasm.

Our research shows that most younger women do not manage to climax until some considerable time after they have started sexual activity. Moreover, when they do 'come' for the very first time, they do so in a variety of ways. In a survey we conducted for our book The Big 'O', we found that:

47 per cent climaxed for the first time through masturbation

32 per cent through sexual intercourse

20 per cent through petting

1 per cent while sleeping.

In the same survey we found that the most common age of first orgasm was 18, but that it could be as late as the 40s!

The 20s and 30s

Even in their 20s and 30s, a lot of women have difficulty reaching that elusive orgasm. These days, most sex therapists believe that if you can't climax (or don't climax easily) it's a good idea to start by practising on your own.

This may seem obvious, but many women, even today, feel very inhibited about self-love and can't help feeling that it isn't something they should be doing. But the fact is, masturbating helps you to learn just exactly which pressures and rhythms you need in order to bring you to orgasm. In particular, you need to explore your own body in order to find out precisely how to stimulate your clitoris.

However, it's important that, if you are using masturbation to help learn about orgasm, you should always do it when you are warm, cosy, relaxed... and, above all, alone. Learning to love your own body should be a delicious experience, but it can't be if someone is hammering on your bedroom or bathroom door demanding that you come out and get their tea!

A good 'reaching orgasms' video (such as Betty Dodson's Selfloving) is very helpful in this respect.

Once you have learned to climax easily, you can then show your partner exactly what you need in order to make you come.

Of course this may feel embarrassing at first, but it's important that you learn to communicate your feelings and also to communicate how you like your body to be touched. When you can't find the words, use caresses. But try also to build up a vocabulary with your partner that is easy to use. A lot of couples find their sex lives fail simply because they don't have the right language. And saying: 'Could you rub my ...er ...er?' isn't specific enough to be helpful.

Some women, incidentally, find achieving orgasm much easier with the help of a vibrator. But for many females actually getting hold of a sex aid that they can rely on isn't easy.

If this applies to you, we'd like you to know that several excellent online mail order businesses have been set up in the last decade or so that are run by women for women. Their sex aids really work. And it's a great help for women to be able to buy such things without having to venture out into some kind of seedy sex shop where they're surrounded by men - and often not very attractive ones at that! These online sex shops also sell lingerie, and erotic literature and lubrication and are equally helpful to gay and heterosexual women.

These companies are:

Gash www.gash.co.uk.

Sh! www,sh-womenstore.com.

Passion 8 www.passion8.com.

Tickled www.tickledonline.co.uk.

Emotional Bliss www.emotionalbliss.com

30 plus

By the time you're in your 30s, 40s or 50s, you should be able to reach orgasm quite easily provided that you have a loving, understanding partner.

But do remember that most women find that their ability to climax varies according to what part of their menstrual cycle they're in. It's quite common for a woman to feel especially orgasmic half-way through her cycle. But some women feel particularly turned-on just before a period. Others notice that they don’t really feel like sex at all during some times of the month. All this is normal.

However, if you are still not having any orgasms at all, or if you're still having enormous difficulty 'getting there', then it's definitely time to seek practical help. In the UK, one way of doing this is to talk to a woman doctor at a Family Planning Clinic. Many of these medics have had special training in helping their patients to relax and to achieve orgasm. Unfortunately, it is not so easy nowadays to get this treatment as it was, because many clinics have had to cut back on their services. But it is always worth asking at your local clinic if they are able to help you.

So what can you expect if you pluck up courage to go for an appointment at an FPC? The woman doctor will take a history - which means that she'll ask you all about your sex life and relationships and your physical health as well. She'll then examine you to make sure that everything is okay physically and she'll then counsel you over a period of several weeks.

Other forms of sex therapy help are available – both private and NHS.

Various types of orgasm

Thanks to Freud, the father of psycho-analysis, people used to believe that vaginal orgasms were what mature women had, while clitoral orgasms were what immature women had.

Experts no longer believe this. And many of today's sex experts as well as ordinary women say that they really don't know the difference between a vaginal orgasm and a clitoral one.

The majority of women need clitoral stimulation in order to climax. This applies whether they're enjoying loveplay or intercourse.

Some women, on the other hand, believe they can 'come' through intercourse with no manual stimulation of the clitoris and claim that it is the vagina itself that sparks off the orgasm. However, many sex experts reckon what is happening during intercourse is that the clitoris is being stimulated by being pulled down or being rubbed by part of the man's torso.

There is also the G-spot to consider. Some women experience a particularly intense orgasm when that part of their anatomy is stimulated (you can find the G-spot inside you on the front vaginal wall). Indeed, many women who enjoy having their G-spots touched claim that they ejaculate during these intense orgasms. So, there may be a case for saying that there is a G-spot orgasm, as well as possibly a vaginal one, and one that originates in the clitoris.

Our feeling about all of this is that it really doesn't matter whether or not there are different types of orgasms. The important thing is that you should be having good, reliable orgasms whenever you want them - and that you should be enjoying them hugely.

Simultaneous orgasm

A lot of women write to us complaining that they can't reach simultaneous orgasm with their partners.

But in fact, simultaneous orgasm is quite uncommon. Surveys done by the Medical Information Service and others have found that most women rarely climax at exactly the same time as their partners.

However, it is certainly nice when this happens. And it can be achieved, if the man has good control of his own orgasm, and if he is skilled at using his fingers during intercourse to bring the woman to a climax just at the same moment as he comes.

Multiple orgasms

Until quite recent years doctor believed that only a tiny minority of women could have multiple orgasms. But research by the Medical Information Service and others has shown that in fact, the majority of females can have a series of climaxes, one after the other if, that is, they are happy and relaxed in the relationship and if the partner is willing to stimulate them to 'come' again and again.

Please note that the ability to have multiple orgasms increases with age. It's unusual at the age of 20, but many women in their 40s, 50s and 60s can do it.

Orgasms in mid-life

As we have already said, a woman's ability to climax tends to improve with age.

But we know that some women get well into mid-life before they manage to have an orgasm. However, the important thing is that you should never regard it as ‘too late’. Time and again we have heard of women who have learned to orgasm when they were in their 40s, 50s – and even later.

In February 2009, Danish psychosexual therapist called Pia Struck presented the results of a study at the Royal Society of Medicine she had made of 500 women.

These women all had long histories of difficulties with orgasm and 25 per cent of them had never climaxed. Their ages ranged from 18 to 88.

They were helped through the Betty Dodson method (see above) and were treated by use of group therapy, where they were encouraged to think more positively about their genitals and to learn acceptance of their sexuality through touch. They also embarked on practical sex-therapy by using clitoral vibrators.

Of these women, 465 (93 per cent) had an orgasm which was witnessed by a therapist. And it was reported that the post-menopausal women among them were just as able to achieve orgasm as the younger participants in the study. So, clearly, you are never too old to become orgasmic.

There can of course be other problems in midlife around the time of the menopause. Most of these difficulties occur because of all the hormonal changes going on in the body. And it's extremely common for women to 'go off' sex temporarily simply because it becomes too dry and uncomfortable.

Fortunately, there are all sorts of ways to remedy this nowadays. There are good over-the-counter lubricants like Wet, Silk, Astroglide, Senselle and K-Y Jelly. These are all suitable, by the way, for any age of woman.

In mid-life there is also the option of going on HRT, but this is something that any woman should think about very carefully indeed. Until recently, it was widely believed that HRT commonly helped a woman to feel much better generally, and to feel more sexy in particular. However, the picture has now changed significantly.

Extensive research into HRT now suggests that though it is still very effective for ridding a woman of unpleasant menopausal symptoms such as hot flushes and sweating attacks, it is not safe to use long term. So it should definitely not be viewed as a magical youth elixir that you start taking at the menopause and continue using till you’re a very old lady.

Nowadays, many women find that health supplements such as soya and red clover also alleviate menopausal symptoms, and actually help them to feel younger and fitter too. You can take these by mouth - Aria One-a-Day Soya tablets and Novogen Red Clover tablets are examples of the brands available – and there are also ‘natural’ oestrogen products for lubricating the vagina, such as Phyto Soya Vaginal Gel Pessaries.

However, it must be stressed that the use of these supplements is in its infancy, and you may want to consult a nutritionist before putting yourself on them. These sorts of supplements are readily available in high street pharmacies such as Boots and Lloyds and also in health food shops.

How can men help?

Remember that most women need stimulation of the clitoris. This is the part of them that would have turned into a penis had they developed as males - and it's just as important to women as the penis is to a guy.

Remember that love, romance, cuddling and a good atmosphere turn women on in the early stages of a sex session just as much as your caresses do.

Take your time.

Caress her breasts - a few women learn to climax through breast fondling alone.

Give her oral sex. Most women adore this and some claim that they cannot come unless a man 'goes down' on them.

Don't be too proud to ask her to show you what she wants.

Have some sex sessions where you encourage her to take the initiative and to decide the agenda.

If you lose control and come before her, do try to summon some energy to kiss and stimulate her so that she can climax, too.

Do tell her that she's marvellous, sexy and beautiful.

Summing up

Having an orgasm is a lovely feeling. You are entitled to it, but it's not easy to do if you are uptight, tired, stressed or unhappy in your relationship. If in doubt, seek help from an expert advisor.

Further help

Your GP.

Brook (if you are under 25). Call 08000 185023 for more details.

Family Planning Clinics.

NHS Psychosexual Clinics. Your GP will need to refer you.

Relate.

A private therapist from the British Association for Sexual and Relationship Therapy (BASRT).

A private medical therapist from the Institute of Psychosexual Medicine: www.ipm.org.uk.

If you fancy a trip to Denmark you can sign up for a course at the orgasm academy: http://www.orgasmacademy.eu.

Spots on the penis

2009-04-03T00:33:00.000-07:00

Written by Dr John Dean, specialist in sexual medicine

Men are understandably concerned when they notice spots on the penis. They are frequently worried they may have a sexually transmitted disease or some form of cancer. They may equally be worried about the appearance of their penis and what their sexual partner might think of it.

Are they common?

Spots on the penis are very common and most do not have a serious cause. However, some do and it is important to seek prompt medical advice if you are concerned.

This article describes some of the causes of spots on the penis, but reading it and examining your own penis is no substitute for examination by a doctor!

What should I do?

Unless you think you have a sexually transmitted disease (STD), the first place to seek advice about spots on the penis is from your GP.

If you are too embarrassed to discuss it with your family doctor, or think you might have an STD, you can seek confidential advice from your local genito-urinary medicine (GUM) clinic. You don't need a referral letter from your GP, but it is advisable to first telephone the clinic. To find out when they are open, and whether you need an appointment.

In the UK, they are usually listed in the telephone directory under 'Health Service' or 'Hospitals'. Or you can ring your nearest large hospital and ask where the GUM clinic is.

Types of spots

Spots on the penis can be divided into groups according to their appearance.

Ulcers: ulcers appear as craters on the skin and represent a full-thickness loss of skin (epidermis). There is frequently a crust, clear liquid (serum) or pus in the crater.

Papules: papules are small (less than 1cm diameter) lesions (lumps) raised above the skin surface.

Plaques: plaques are raised, flat-topped lesions, greater than 1cm in diameter.

Ulcers

Single penile ulcers frequently have a serious cause and it's important to seek prompt medical advice.

Possible causes:

primary syphilis: a single, round, painless ulcer on the penis or scrotum is characteristic of the first attack of syphilis (primary syphilis). It is caused by a spirochaete (spiral-shaped) bacterium called Treponema pallidum. The diagnosis must be confirmed by laboratory tests. It is an infectious STD.

chancroid, granuloma inguinale, lymphogranuloma venereum: these are tropical diseases that cause a single, painless, foul-smelling ulcer. The diagnosis must be confirmed by laboratory tests. They should be suspected in men with a history of sexual contact in tropical areas. There has been a mini-outbreak of lymphogranuloma venereum (LGV) in Britain in 2008-9 especially in London and Brighton. They are all infectious STDs.

penile cancer (squamous cell carcinoma): may appear as a painless, irregular genital ulcer. Early diagnosis and treatment is essential and may be life-saving.

Multiple penile ulcers are more common and may have a less serious cause. However, seeking prompt medical attention is still important. They can be divided into two groups: acute - present for less than two weeks - and chronic - present for more than two weeks.

Acute

Herpes simplex: this is the commonest cause of genital ulceration. It is caused by Herpesvirus hominis type two, or sometimes type one - the virus usually associated with oral herpes or cold sores. Herpes is characterised by recurrent bouts of genital vesicles, like small blisters, which rapidly break down to form small, painful ulcers. It is highly infectious and usually sexually transmitted. The first episode is usually associated with an acute feverish illness, which may be quite severe. The diagnosis must be confirmed by laboratory tests. Acute episodes can be effectively treated with antiviral medicines, such as aciclovir, although recurrences are common. Stress or other feverish illnesses may precipitate such recurrences.

Secondary syphilis: multiple irregular, shallow, painless grey ulcers, sometimes described as 'serpiginous', like a snail track on the penis, are characteristic of secondary syphilis. It is caused by a spirochaete bacterium called Treponema pallidum. A flu-like illness and a blotchy, red rash usually accompany it over the body. As with primary syphilis, the diagnosis must be confirmed by laboratory tests. It is an infectious STD.

Apthous ulcers: these are small, shallow, painful ulcers that most commonly appear in the mouth, but can also affect the penis. Typically, they have a grey centre surrounded by a bright red halo. They occur in crops and resolve without treatment. They can easily be confused with herpes simplex ulcers, so laboratory tests are necessary to reliably distinguish the two. They are not infectious and their cause is unknown.

Chronic

Pemphigus: this usually affects other parts of the body, frequently starting in the mouth, but may be restricted to the penis. It appears as fragile, thin-walled blisters that break down to form ulcers. These are often painful and may itch. There are a variety of different forms; the most severe type may affect the whole body and is life threatening. It is caused by a breakdown in the adhesion between different layers of the skin. Prompt diagnosis and treatment is essential.

Behçet's disease: an inflammatory disorder affecting the skin, joints, nerves, eyes and other body systems.Symptoms may include large, deep and painful ulcers on the penis and scrotum, but is always accompanied by mouth ulcers. It is a potentially serious condition and prompt diagnosis and treatment is essential. It is not infectious.

Reiter's syndrome: an inflammatory condition that occurs with generalised arthritis. About a quarter of affected men have small, ulcerated plaques around the glans and foreskin. It can also affect muscles, the eyes and nails. It is caused by an abnormal immune response to a gut or genital infection. It may follow a prolonged, relapsing course, but can be treated. Reiter's syndrome is not itself infectious, but the germs that might cause it are. Some of them can be sexually transmitted.

Papules

Most penile papules do not have a serious cause, but some are infectious and may lead to more serious conditions. An early penile cancer may also appear as a papule before ulcerating. It is important to seek prompt medical advice about penile papules.

Molluscum contagiosum: a common, benign, infectious viral disease affecting the skin and mucous membranes. It is a common skin condition in childhood when it is transmitted through ordinary peer contact. In adults it may be sexually transmitted and this is probably the commonest cause of penile molluscum in adult men. It appears as multiple, small, dome-shaped papules, often with a central depression or plug. A curd-like discharge can be squeezed from them. It may disappear without treatment, but freezing or cautery will usually get rid of it. Molluscum contagiosum is a marker for 'unsafe' sexual practices in adulthood and those affected should be screened for HIV

Hair follicles and sebaceous (sweat) glands: these are a normal part of the skin's anatomy and are commonly found on the penile shaft, particularly on the ventral surface (underside). They may be visible as small nodules or might only be felt as small lumps in the skin. They will have a hair arising from them that reveals their true nature. They are quite normal.

Pearly penile papules: multiple, small (about 1-3mm) papules running around the circumference of the crown of the glans penis. They typically develop in men aged 20 to 40, and around 10 per cent of all men are affected. They may be mistaken for warts, are not infectious and require no treatment.

Fordyce spots: small (1-5mm) bright red or purple papules that can appear on the glans, shaft or scrotum and usually affect younger men. They may occur as a solitary lesion, but frequently appear in crops of 50 to 100. They are painless and not itchy, but may cause embarrassment because of their appearance, or a fear that they might be sexually transmitted. They are abnormally dilated blood vessels, covered by thickened skin. They may bleed if injured or even during intercourse. They are not infectious and their cause is unknown. Although a number of approaches have been tried, there is no simple, reliable treatment to remove them. Troublesome bleeding spots can be sealed with a device that uses a small electric current (electrocautery).

Psoriasis: most commonly affects other parts of the body, particularly the knees, elbows and scalp, but occasionally first appears on the penis, usually on the glans or inner surface of the foreskin. Psoriasis appears as thickened red papules or plaques with a well-defined edge. In uncircumcised men, and at other sites, it has a scaly surface. It rarely causes irritation. It is caused by an abnormality of skin production and can be inherited. It is unsightly, but rarely serious. There are a number of effective treatments available, such as steroid creams and calcipotriol cream (Dovonex).

Warts: a number of different types of wart may appear on the penis. Genital warts are caused by human papilloma virus (HPV) and are infectious. They may be single or multiple, skin-coloured, pink or brown, with a moist surface. HPV infection is associated with the development of cervical and anal cancer, so it is important that sexual partners are screened for evidence of infection. They can be treated in a variety of ways, from skin paints to cautery, but are sometimes very difficult to eradicate.

Plaques

Penile plaques do not usually have a serious cause, but some are infectious and others may develop into more serious conditions: Erythroplasia of Queyrat, lichen sclerosis and balanitis xerotica obliterans may lead to the development of penile cancer.Make sure you seek prompt medical advice about penile plaques.

Balanitis and posthitis: balanitis is an inflammatory condition of the glans penis. Posthitis is an inflammatory condition of the foreskin. Symptoms include local irritation, burning and a red rash. Sometimes the skin appears to be peeling off as if scalded. Bacteria and yeasts such as candida can cause it. It is more common in older men and those with diabetes. Balanitis is infectious and may be sexually transmitted. It can be treated with appropriate antimicrobial creams.

Erythroplasia of Queyrat: appears as a sharply demarcated bright red plaque with a velvety surface. It is usually painless, and not itchy. It is an early manifestation of penile cancer and needs prompt diagnosis and treatment. Excision of the affected area is usually curative. It is not infectious.

Zoon's plasma cell balanitis: Zoon's balanitis appears as a bright red, shiny-surfaced plaque on the glans or inner surface of the foreskin. It is usually painless but may be accompanied by itching. The cause is unknown. It may respond to application of steroid cream, but frequently recurs. Circumcision is curative, but not essential. It is a harmless condition but can be confused with the much more serious condition of Erythroplasia of Queyrat. It is not infectious.

Lichen sclerosis and balanitis xerotica obliterans: lichen sclerosis appears as white plaques on the glans, foreskin or shaft of the penis. It usually has no symptoms, although burning and irritation have been reported. Balanitis xerotica obliterans is a severe form of lichen sclerosis affecting the foreskin of uncircumcised men. The opening or edge of the foreskin is firm and has a white scarred appearance. It is quite inelastic and will not pucker open as it is retracted. This may interfere with passing urine or sex. Both conditions may, rarely, lead to penile cancer and circumcision may be necessary. They are not infectious.

Psoriasis: see above, under papules.

Eczema: most commonly affects other parts of the body, but occasionally it may first appear on the penis. In such cases, it may be a skin reaction to an irritant that is better be described as dermatitis. Eczema appears as diffuse red plaques with a poorly defined edge and finely scaled surface. It frequently causes quite severe irritation. It can be caused by infection or local reaction to skin injury from chemicals or radiation. There are a number of effective treatments available, such as steroid creams. It is not infectious.

Men's sexual response

2009-04-03T00:32:00.002-07:00

Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist

Even today, many females don’t understand male sexuality. So this article is for women – especially women who find it hard to understand what makes men 'tick' sexually.

But men will also find it useful to read what follows and to find out how they compare with the rest of male humanity!

Male sex drive

It's difficult for a female to understand just how powerful the average man's sex drive is.

Although males vary a lot on how keen on sex they are, they do tend to be much more 'driven' sexually than women are. (This applies to gay men as well as to straight guys – but in fact this article just deals with heterosexual males.)

In 2005, one of Britain’s top sex experts told the media that in general, men are on a ‘five day cycle’ where sex is concerned (ie wanting it every five days) – whereas women are more likely to be on a ‘10 day cycle'. There is some truth in this.

But please be aware that plenty of males – particularly young and virile ones – would really like to have sex every day – and maybe much more often than that, if their bodies would ‘allow’ it!

Indeed, in the era of anti-impotence drugs we have actually seen middle-aged men who had been using these medicines to satisfy three ladies in a single afternoon. While this is pretty unwise behaviour, it does offer an insight into male sexuality …

Nature's programming

One of the reasons why the human race has survived for hundreds of thousands of years is the fact that nature has 'programmed' men to be mad- keen on penetrating women – and getting sperm into them.

That may not sound very nice, but it's the truth. The primary sexual objective of a human male is to get his penis inside a woman – and to discharge his sperm into her.

And even though many guys succeed in being faithful to their partners, the scientific truth is that males are really 'programmed' to inseminate as many attractive females as possible.

So the fact of the matter is that the human race has survived in the main because primitive men went round fertilising a lot of women – thus ensuring the continuance of the species.

Your man today

But let's bring it up to date. What about your man today?

Well, it should be the case that recent centuries of civilisation have had an effect on him – so that he does not try to impregnate every nice-looking woman he meets.

Nonetheless, the following are fairly safe assumptions:

your man is very keen on sex.

he thinks about it a lot – much more often than you do!

however romantic and gentle he may be, deep down one of his major objectives in life is to get his penis inside you.

and once it's in there, he has a deep, driving 'biological imperative' to reach a climax - and pump his sperm into you.

Oral and rectal sex

So ingrained is this instinct to impregnate a woman that many men appear keen to accept any available female orifice – even if it’s not the vagina. That’s why a very high proportion of men desire oral sex and a substantial minority (and it does still appear to be a minority) are keen on anal sex.

Conclusion

So, the average male is more interested in sex than the average female and is much more likely to:

feel very strong urges to have intercourse

take sexual risks, regardless of the consequences

be unfaithful

try 'commercial' (ie paid for) sex.

The slightest thing can set a man off – for instance:

the sight of a woman's cleavage

a well-shaped bottom

a good pair of legs

even a whiff of perfume.

So, female readers, never underestimate the power of a man's sexual response.

You have been warned!

How to help your female partner have orgasms

2009-04-03T00:32:00.001-07:00

Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist

These days most women want orgasms. That wasn't always the case. Not much more than a generation ago, many adult females simply didn't have climaxes - and a lot of them weren't bothered about it.

Some doctors claimed that, for a huge proportion of women, it was 'normal' to have no experience of orgasm. Indeed, as late as the 1970s there were still some who maintained that the female orgasm didn't exist - and was simply a myth made up by the media.

All that has changed now. These days, medical opinion is that every woman should be able to have orgasms - if she wants to. Furthermore, the view of most sex experts is that the majority of women are capable of multiple orgasms - if they wish to have them. In general, the ability to have multiple orgasms is greater in more mature women.

What is a female orgasm?

We're writing this explanation in the assumption that you - the reader - are male. But what follows will be of interest to a lot of female readers too.

What happens in a woman's body during a climax is very like what happens in your (male) body when you ejaculate. In other words, there's a feeling of increasing excitement, building up to a point where everything 'blows' in a great blast of ecstasy. This 'orgasmic moment' is characterised by surges of contractions in the sex organs, occurring almost every 0.8 seconds.

Men are well aware that these throbs of pleasure are accompanied by the pumping out of spurts of seminal fluid. Obviously this doesn't happen in women.

A few females do produce some fluid at orgasm, but the impression given in so many erotic stories that most women 'ejaculate' is not correct. Only a minority of females do this.

Multiple orgasm

The other big difference between male and female orgasm is this: after the first climax, many women can 'come' again, often within a minute or two.

This ability is extremely rare in males. Relatively few young women can achieve multiple orgasm, because it's an ability that usually has to be learned. But with the help of a skilled lover, most women can eventually achieve the capacity for multiple orgasms - if they so desire.

Bringing women to a climax

For men perhaps the most important thing to realise about female climaxes is that with women, it's not a mechanical thing - as it generally is with men.

You see, most males will ejaculate quite quickly if they have their penises rubbed. This applies even if the circumstances aren't very romantic - or even if they don't particularly like the person who's doing the rubbing! Women are not like this. Female orgasm isn't a push-button response. The conditions have to be right.

Although females vary, many women need the following if they're going to reach a climax easily:

a romantic atmosphere

pleasant, comfortable surroundings

a partner who they really like

a feeling of being wanted and appreciated

a good flow of natural lubrication - so that the delicate female parts don't get sore

a skilled partner who knows how to stimulate the clitoris.

Unless you can provide the above, you are not going to have great success in giving your partner orgasms.

Please bear in mind that - contrary to what many men think - sexual intercourse by itself is not likely to produce an orgasm. This is because intercourse alone is not very good at stimulating the woman's clitoris. Nearly all females need additional stimulation of the clitoris by fingers or mouth.

What to do

In summary, here's what to do if you want to bring your partner to orgasm regularly:

don't be in a rush.

don't be too demanding - it's not an Olympic event.

talk to your partner, and ask her what she wants you to do to her.

always create a romantic atmosphere.

make sure that everything is comfortable and nice for her.

give her lots of kisses and cuddles before you even think about making any approach to her sexual area.

when you do start to stroke, rub or kiss her genitals, don't rush into 'attacking' her clitoris. Take things gently, and see what she wants.

use her own natural lubrication to moisten her clitoris. (If she is over 40, it may be a good idea to use some additional lubrication from a chemist or a sex shop).

remember that stimulation of the clitoris is the key to female orgasm.

sometimes encourage her to 'run' your sex sessions. You can learn a lot by watching how she stimulates herself or by really listening to her when she suggests a sex position, or a particular caress.

Further information

There is a companion article to this one on our site. It's for women who are anxious to learn how to achieve orgasm and is called: 'Are you having trouble reaching orgasm - a guide for women'.

For women who have real problems in reaching orgasm, counselling might be an answer. The are a number of places that women can contact for sex therapy.

You can definitely increase the likelihood of orgasm in your partner, by keeping your love life as varied as possible. To that end, you might like to encourage her to visit some of the sex shop sites that are run by women for women. These sites have videos, sex- education books, sex toys and various other items for sale that might help to give your sex life a boost. Our favourites are:

Gash: www. directory.co.uk/gash

Passion 8: http://www.passion8.com

Sh!: http://www.sh-womenstore.com

Tickled: http://www.tickledonline.co.uk

Facts about penis size

2009-04-03T00:29:00.000-07:00

Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist

Even in this supposedly enlightened century, men fret about penis size. Though the vast majority of guys have more than enough bulk to perform well as lovers, there is a widespread masculine obsession that 'more would be better'.

We get a constant flow of emails and letters from males who are worried that they are 'too small'. Vast sums of money can be made by exploiting this obsession, but other than surgery, there is little that is clinically proven to increase penis size.

Any woman reading this article may find it puzzling that so many men are concerned about the length of their penis and wish they had 'just a couple of inches more'. But that's the way that a lot of men are.

Size matters

To the average man, his penis is, consciously or unconsciously, one of the most important things in the whole world. At an early age he discovers it and immediately becomes fascinated by it.

But then a note of uncertainty enters his mind: 'Isn't mine rather small?' Look at Dad's, look at big brother's, look at those in the men's changing room - and he asks himself if he will be as big as that.

And so he goes on through life, always a tiny bit sensitive about the size of his organ, always convinced that it would be nicer if it were just that little bit longer.

No matter how often it's written that penile size doesn't matter, and that women aren't attracted to a man because of the length of his organ, the average male continues to think the same way.

The average female cannot understand this obsession with penile measurement. So if you're a woman, never belittle a man's penis in bed, even as a joke, or say anything to indicate that you think it's small. The guy may take you seriously, and if he does, he'll be deeply hurt.

We have known men who have gone on to have problems with impotence (erectile dysfunction) after someone made an unthinking remark about their dimensions. But almost all of these men had a perfectly normal male organ. Each one just thought he was very small compared with other men.

It is also worth noting two points about women:

some women really dislike the idea of a large penis, and may be frightened by one that is too long.

some women are much more impressed by the thickness of a penis, rather than its length. This is because some females like the sense of feeling stretched round the entrance to the vagina – so if a guy is quite broad at the base of his penis, this can feel very exciting and satisfying to such women

A question of perspective

The trouble is that every man sees his own penis in a foreshortened view. The angle at which you look down inevitably makes your penis seem shorter than it is.

But when you glance at another man's organ, there's no such foreshortening effect, so very often it'll look as though the other guy is slightly better endowed.

A lifetime of comparison of this sort (and virtually every male does a quick mental check on each naked man he sees) can easily make you feel a bit inadequate. But it's important to realise the facts about penis length.

Average penis length

A non-erect penis usually measures between 8.5cm and 10.5cm (3-4 inches) from tip to base.

The average figure is about 9.5cm (3.75 inches), but this kind of precise measurement is rather valueless. Many factors can cause a temporary shrinkage of two inches or more, for instance cold weather or going swimming, so you needn't worry if you happen to fall short of the average figure.

Of course, it's true that some men have big penises and some have smaller ones, just as some men have small feet and some have big feet, but the measurement is not - repeat not - an index of virility.

Most people think that a tall man will usually have a large penis, but this is not entirely true. The distinguished American researchers Masters and Johnson measured the penile lengths of more than 300 men.

The largest organ was 14 cm (5.5 inches) in the flaccid state. It belonged to a slim man who was 5' 7" tall (170 cm).

The smallest penis measured 6cm (2.25 inches). It belonged to a fairly heavily built man of 5' 11" (180cm).

It's also worth pointing out that there is no correlation between penile size and race.

Average size of erections

We've talked about the length of the penis in its ordinary non-erect state, but how long should it be when it's erect?

Interestingly, most penises are very much the same size when erect.

The man whose non-erect penis is smallish will usually achieve about a 100 per cent increase in length during sexual excitement.

The man whose non-erect penis is on the largish size will probably manage about a 75 per cent increase.

This means the great majority of penises measure between 15cm and 18cm (6-7 inches) when erect, with the average figure being about 16.5cm (6.5 inches).

So you can see that even if a man has got a 'small' penis, he's got a built-in compensating factor that will bring him up to about the same size as the guy who appears to be 'better equipped' in the shower room.

Sex and women

Virtually every man forgets that it doesn't matter how long or how short your penis is, because the vagina will accommodate itself to any length.

The vagina of a woman who hasn't had a child is only 7.5cm (3 inches) long when she's not sexually excited. The figures for women who have had babies are only slightly different.

Even when aroused, a woman's vagina usually extends only to a length of about 10cm (4 inches).

This means any man's penis will fill her vagina completely, unless you happen to be one of those rare guys with an erect penile length of less than four inches.

You're probably now wondering how the average man with an erection of six inches manages to insert his penis into the vagina at all.

The vagina has the most remarkable capacity for lengthening if something is introduced into it gradually.

So the exceptional man whose erect penis is eight inches long can still make love to any woman, providing he excites her properly and introduces his organ very slowly. If he does this, her vagina will lengthen by 150 or 200 per cent to accommodate him.

What if I'm not happy about my penis size?

If you're really worried that your penis is the wrong size, go and see your doctor.

If you're not happy about consulting your GP on such an intimate matter, you could see one of the medics who spend their entire day checking men's penises. You can find these doctors at:

private 'well-man' clinics, but take care: a few of these are run by quacks

NHS urology clinics

NHS sexual medicine clinics

NHS genitourinary medicine (GUM) clinics

NHS family planning clinics, although these tend to be oriented towards women and don’t have much time to deal with males.

Brook advisory clinics (for the under 25s).

What treatments are there to increase penis size?

Many companies claim they know how to enlarge your penis - for a price.

We have recently been to several medical conferences at which leading experts have spoken about penis size and penis enlargement.

Their opinions on the various methods that are so widely advertised to the public can be summed up as follows.

Pills or patches for increasing penis size: a complete waste of time.

Penile enlargement surgery: of uncertain value and sometimes dangerous.

Penile enlargement exercises: probably pretty futile.

Penile suction devices: probably of little use.

Several European experts say that the relatively new stretcher or extender devices may sometimes be of value in giving a man a little extra length.

Surgery to increase penis size

A number of private clinics now offer operations that claim to make the penis look bigger. The expense of this type of surgery is very great and there is a risk of complications like bleeding, infection or deformity.

One surgical procedure that has become popular since 2005 is slicing through the ligament that supports the penis.

This makes the penis dangle more, so it looks longer when not erect. But it will make no difference to the size of your erection - and furthermore it won’t come up as high as it used to before the op.

Another type of surgery involves injecting your own fat into your penis to make it more bulky. This may not work, and it can lead to complications.

We recommend that you do not agree to undergo any surgery unless you have seen an NHS consultant urologist who feels that you really need penis enlargement surgery.

Penis stretchers (extenders)

Some urologists are beginning to use a special extending frame to try to stretch the penis.

These ‘stretchers’ are small rectangular frames that you wear on your penis for hours at a time, every day. They pull your organ out to its maximum length, and the idea is that it will gradually remain longer.

The devices are said to be undetectable under trousers.

There have been several reports from Italy and Spain by surgeons who claim a modest degree of improvement in length from this kind of traction.

We don't think these devices are some sort of miracle discovery, but one surgeon reported that a group of men achieved an average increase in length of 1.8cm after using the device daily for four months. This is less than three-quarters of an inch, but for some men this would be significant.

Stretchers cost between £150 and £200.

What treatments are there to reduce penis size?

Occasionally, a man with a big penis feels that he wants it reduced in size. This can be done, but there is quite a risk that the operation might go wrong.

Again, we advise you not to have this operation unless an NHS consultant urologist has said it is necessary.

Sexuality throughout life

2009-04-03T00:28:00.000-07:00

When does sexuality start?

Recent research has confirmed what Freud said so long ago – that to a certain extent, we are sexual beings from the very start of our existence.

Some American scientists have even claimed during the last few years that with the aid of special X-rays, male babies can be seen rubbing their penises while still in the womb. However, not everyone agrees with their interpretation of these images.

Nonetheless, these days pretty well all experts agree that your sexuality has already begun when you are a baby.

Psychologists say that even the youngest infants feel warmth, closeness, bodily contact and pleasant sensations when snuggling up to their mothers and sucking at the nipple. Sigmund Freud stated that the learning of sexuality commences at the mother’s breast.

Medical personnel have found by careful observation of small boys that they often get erections – particularly after the age of about seven. But sexuality does not exist only in the genitals. It is part of everything surrounding you and who you are. That is why youngsters may become passionately fond of (say) a film star, or a pop singer – or a teacher.

So children are sexual beings in the same way that teenagers, adults and the elderly are sexual beings. Sexuality just manifests itself differently at different ages. But it is not till puberty – or sometimes considerably afterwards – that sex becomes a really powerful force.

Unfortunately, the fact that children have an inherent sexuality does make them vulnerable to predators. Parents should be aware of this fact – and try to be on their guard against those who want to exploit a child’s sexual curiosity.

When does masturbation start – and finish?

Many boys begin to touch and caress their sexual organs regularly when they are seven years old and by the time they reach puberty more than half of all males have tried to masturbate - either on their own or sometimes through play with their friends.

Females tend to begin to masturbate later in life, even though many little girls are quite curious about their genitals. Around the time that girls reach puberty, they may possibly begin to masturbate but often this does not occur till much later in their teens - or even 20s.

While 80 per cent of all boys have masturbated regularly by the time they are 16, only half that percentage of 16-year-old girls have masturbated. But some studies suggest that by the time they reach the age of 20, 80 per cent of girls have tried masturbation.

It is noteworthy that some females have now got the idea that if they don’t go in for regular self-stimulation, there must be something wrong with them! However, a woman who doesn’t masturbate is not abnormal. It’s just that we’re all different, and have differing sex drives, and express our sexuality in diverse ways.

What about the middle and later years of life? In general, people tend to masturbate rather less when they get married or form other permanent relationships. (However, recently we have found that in the 21st century, quite a lot of adults do sometimes go in for self-stimulation as part of their love-play with their partners.)

Masturbation becomes less common in middle age, though it is very likely to occur when (say) someone is away from his/her partner on a business trip. Naturally, it often becomes more frequent after a divorce, or a relationship break-up, when the person is left on her/his own in life.

It is clear that many older people feel the need to masturbate after they have been widowed for some time. They often feel very guilty about this, and need reassurance that there is nothing ‘perverted’ about them!

It is believed that 25 per cent of people in their 70s may masturbate though there are few reliable surveys of older people.

At what age does sexual intercourse start?

By the time they reach the age of 25, the vast majority of people will have experienced sexual intercourse - heterosexual or homosexual.

Only a very small percentage of men and women remain virgins throughout their lives.

The age at which sexual intercourse first occurs has dropped during the last few decades. While figures vary from country to country, it is thought that in the UK girls are likely to have sex for the first time at a slightly younger age than boys.

About a third of all boys and girls have had sex by the age of 16. About another third has had sexual intercourse by the time they have reached 18, and most of the rest will have sex in the following three to four years.

Regrettably, the age of first intercourse is continuing to drop. Although studies vary, most suggest that in Britain the average age when a boy or girl loses her/his virginity is now about 16.

Unfortunately, many of these teenagers don’t use contraception – and they may have no idea at all about the risks of sexually transmitted diseases.

A lot of youngsters aren’t aware that under the Sexual Offences Act of 2003, under-age intercourse is actually illegal. In England and in Wales, the ‘age of consent’ is the 16th birthday. The Law is slightly different in other parts of the UK.

How often do most people have sex and do they have hundreds of partners?

Many people brag and exaggerate about their sexual lives. As a result a lot of youngsters feel totally lost because they think that everybody else is having a wild and intense sex life, every night of the week, with lots of different partners.

As far as the number of partners is concerned, the truth is that throughout their lives most people will only have a few sexual liaisons - maybe five or possibly 10, though recent studies suggest that the average number is gradually increasing. Some people don't have that many, but a small group of highly sexed men and wome do have much more than that.

Boys in their teens tend to have orgasms three, or even four, times per week. Young adults are likely to have sex at least three times a week – if it is available.

Our recent (2004) studies suggest that for couples in their 30s or 40s, twice a week is about average.

After 50 it is more likely to be once a week, or less

When are you too old to have sex?

Never. Many men and women continue to have a satisfying sex life when they get older. If a person feels like it, there is no reason why sex should not continue into the 70s or 80s. There aren't any limits, providing the desire is there for both partners.

We have recently seen patients of almost 90 who were still enjoying a loving and happy sex life together. And we wish them the best of luck!

Sexual health checks

2009-04-03T00:27:00.000-07:00

Sexually transmitted diseases are soaring and a test is the only way to confirm whether you’re infected. If you’re at risk, isn’t it time you bit the bullet and got yourself a sexual health MOT?

Using condoms can prevent a trip to a GUM clinic.

It doesn’t matter who you are – your age, sexual preference or number of partners – visiting a genitourinary medicine (GUM) clinic may help you deal instantly with a disease that could have severe long-term effects on your health.

If you have ever had unprotected sex, oral sex or even intimate sexual contact in the past, there is a risk that you may have caught a sexually transmitted disease (STD). As was famously made plain in the AIDS/HIV ads of the 1980s, when you sleep with someone, you sleep not only with that person, but all their sexual partners, and everyone they have slept with.

With the cautious atmosphere fostered by AIDS now faded, and modern sexual habits including more partners, higher levels of concurrent relationships and people starting to have sex at a younger age, STDs have rocketed.

Claiming anonymity

Many young people are scared, ignorant or feel they have no right to go to a GUM clinic. A huge number of adults are embarrassed to do so. Many more are intimidated or don't know where to ask or what will happen.

This, finally, is where the good news comes in. The health service is only too aware of people's concerns concerning sexual habits. For this reason, it has made testing and treatment for STDs as simple and hassle-free as it possibly can.

You can make an appointment with, or even walk into, any clinic in the UK and have the tests. They never disclose your identity – you can even give a false name as long as you remember it – and the test results will be given only to you. It is entirely free, as is any treatment.

What happens? Pretty much the same as for a normal doctor's appointment. You will be asked what you want to be tested for, advised what each infection is and asked for a brief sexual history. Then you give a urine test (so don't go to the toilet for a few hours before the visit) and a blood test if you want to be tested for hepatitis A, B and C and/or HIV.

Then, if you're a man, you will be given a penile swab; for women, it's a cervical swab – neither is anything more than briefly uncomfortable. You may also have a throat swab or anal swab, depending on your sexual habits, and women may have a brief internal examination.

Some results will be available almost immediately, others may take a week. You may be asked to return to pick the results up or be able to telephone the clinic for them.

Win-win situation

What if you get the tests back and you do have an STD? Don't worry: chlamydia, gonorrhoea and syphilis are all quickly and easily treated with antibiotics – miraculous when you consider they could make you infertile or even kill you.

Herpes and genital warts will never disappear, but treatment is such that symptoms are kept to an absolute minimum. For more serious diseases, early knowledge is something that will make a huge positive difference to your life and any treatment you may need. The hardest part will probably be telling your partner.

While the whole experience of going for a sexual health MOT can hardly be called fun, it is no worse than many other aspects of life.

'Contemplating a visit to a GUM clinic can bring on stressful thoughts and fears, but since you are likely to get a clean bill of health, these feelings will seem foolish in retrospect. And if you do find you have an STD, you should be thankful you found out sooner rather than later. Your partner certainly will be.

Further information

Sexual Health Direct (for information on your nearest GUM clinic): 020 7837 4044

fpa: www.fpa.org.uk

NHS National Strategy for Sexual Health and HIV: www.doh.gov.uk/nshs/strategy.htm

Sexual dreams

2009-04-03T00:03:00.000-07:00

Even in this sexually ‘open’ age, people are often worried because they've had dreams with a sexual content. In particular, it can be very disturbing if, in a dream, you do something that would be totally shocking for you in real life! For instance, a woman who leads an extremely chaste and respectable life may be troubled by dreams in which she has rampaging sex with dozens of handsome males.

Similarly, a man who prides himself on being 'straight' and who actually dislikes homosexuals, may be quite shattered to find that he has dreams in which he is engaging in sexual fondling with some good-looking guy!

However, a lot of people are not disturbed by their sexual dreams and simply enjoy them for what they are. This is normally the best attitude to take.

Why do we have sexual dreams?

We dream because of the intense activity that is constantly going on in our subconscious minds. And since sex is one of the most powerful of all human drives, it's not surprising that so many dreams have a strong sexual content.

If we have deep urges to do certain things, they are highly likely to come out in our dreams – where our consciences cannot prevent them happening.

But isn't it true that our consciences 'censor' sexy dreams?

Yes. The mind has something called a 'dream censor', which tends to 'clean up' dreams.

So, if a person who has a very strict puritanical outlook starts to have a sexy dream, their dream censor may alter that dream so that very 'rude' things are replaced by symbols.

Thus, a man of strict sexual morals may have a deep, unconscious desire to have sex with beautiful women. Instead of dreaming about vaginas, he will keep dreaming about tunnels and subways. Instead of dreaming about breasts he will dream about pleasant hillocks and mounds - and so on.

Similarly, a woman whose sexual morality is very strict won't dream of penises. Instead, she'll dream of penile symbols, like:

church spires

rockets

cigars

tall chimneys.

However, in our experience, this kind of 'dream symbolism' seems to be less common than it used to be. People are less 'hung up' than they were a generation or so ago - which is why they tend to dream about explicit sex, rather than symbols.

Do people have orgasms in dreams?

Definitely! Women don't do this very often, but it does happen - especially at times when they're 'highly charged' sexually.

When we were writing our book The Big 'O' (Hodder: 1995), a sizeable number of women reported to us that their first ever orgasm was in a dream.

However, it's more common for women just to get very excited during a dream – and then to wake up on the brink of orgasm and 'finish themselves off' by self-stroking.

What about men?

Most males (though not all) have many erotic dreams in their teens, 20s and 30s. The frequency of these dreams tends to get less with age, but a lot of sexually-charged males continue to experience pleasant erotic dreams far into their 60s and 70s.

In men, erotic dreams are very commonly 'wet dreams' – in other words, ones in which the guy reaches orgasm and ejaculates.

This can be quite an embarrassment for a young man, especially if he keeps on staining the sheets. But there is nothing that can be done to stop wet dreams. If stains are a problem, it's not a bad idea to wear shorts in bed.

However, in the case of very young males who produce large quantities of semen, staining of the sheets is almost impossible to avoid. Sleeping on a really thick towel may be helpful.

Are wet dreams harmful?

A lot of young men who are of Asian extraction believe that they are. They have been told – often by friends – that loss of semen weakens the body or shortens one’s life. But this is quite untrue. Wet dreams are just the body's natural response to its hormones – much as periods occur in women.

What should you do about disturbing sex dreams?

Most sex dreams are fun, and should just be enjoyed. Sometimes they involve activities that you may feel you'd never get up to in real life – like lesbianism or homosexuality. But this doesn't matter.

However, some people do get very distressing sex dreams – about such disturbing subjects as incest, violence or rape. If this keeps on happening to you, then there must be some psychological reason behind it.

If you are upset by these dreams, and you want to find out the reason for them, then it would be best to consult a therapist. Traditionally, those therapists with analytic backgrounds have been more in tune with – and experienced in – people's dream worlds. But some hypnotherapists are adept at helping a person gain control of their dreams by 're-designing' them during hypnosis so that they end differently and are therefore less disturbing.

There are two articles on this site that will help if you want to find a suitable therapist.

Who to go to for sex therapy.

Private therapy.

Dreams of love

Sometimes people have dreams where they are being taken care of, or loved very deeply, or cuddled – dreams that are not overtly sexual but which leave the dreamer feeling very drawn to the person in the dream who was being so affectionate.

These dreams can leave an individual feeling very shaken up and confused because often the 'love interest' in the dream is not a regular partner.

In our experience, these dreams can tell us a great deal. We believe that they are often there as some manifestation that all is not entirely well with our current situation. They often express a hankering for a loving experience that is absent from a marriage or long-term relationship.

If you have this kind of dream and feel disturbed by it, you may want to see a relationship therapist to explore why you are having these dreams.

Of course we all have dreams in which incongruous things happen with people we are not attached to in real life, but when these dreams haunt our waking moments through the next day and beyond, it is wise to take note of the possible message behind them.

Sexual desire and your hormones

2009-04-03T00:02:00.000-07:00

If you’re a woman, have you noticed that whenever you feel angry, tearful, headachy, a bit below par, or lacking in sex drive, someone – helpful or otherwise – will tell you that: 'it must be your hormones'?

Most of us are fed up with this kind of generalisation. We want precise answers to all sorts of questions, especially to do with how our hormones affect our sex lives. That's what we want, but the harsh truth is that there are very few precise answers to be had.

Our wish to understand our hormones and our bodies is a pretty modern phenomenon. Little more than 100 years ago, women had no reliable contraception and, as a result, had babies most years. These women only had a 50 per cent chance of reaching the menopause, and I don't think that too many of them had the time or inclination to worry about their libidos, or whether a better understanding of their hormones would help.

Nowadays, women can expect to live to an average age of 85. They remain fitter longer, they limit their families, and the majority of them will have several significant sexual relationships in their lives

So today's woman has better health and more options – and with this improved state of things she wants a superior quality of life, especially in the bedroom.

There are many women who feel that their hormones must be responsible for the things that are going wrong in their sexual relationships.

Today, one of the commonest female sexual problems is loss of desire.

Indeed, in North America drug companies have been claiming since 2006 that no less than 43 per cent of women have what they term ‘female sexual arousal disorder’ or ‘FSAD'. I must say that in the UK, many doctors and psychosexual experts take that claim with a large pinch of salt!

Nonetheless, we do see a lot of women who complain of lack of interest in sex – and so do all of our colleagues. But why does it happen?

It's become very fashionable to blame our hormones for loss of libido. But is there any evidence that hormones are the real culprits?

The truth is that although lots of research has been done no one has managed to come up with anything very definite on the relationship between female hormones and desire. Why? Because:

until recently researchers would have considered it too embarrassing or controversial.

this isn't a life-threatening area of medicine.

until recently, no drug company realised that there was money to be made from such research.

it's very difficult to measure desire scientifically (there aren't any units of desire).

It's interesting that, while most women believe that loss of libido is something to do with their hormones, vast numbers of adult females haven't a clue about which hormones they have, and what they actually do. Perhaps this is unsurprising since it's very complicated. Frankly, I don't think that most doctors truly understand it, so what chance have the rest of us got! But it seems to boil down to this:

our ovaries produce large amounts of the female sex hormones - oestrogen and progesterone

they also produce small amounts of the male hormones - testosterone and androstenedione.

Both men and women also have two important hormones, both secreted by the pituitary gland, called FSH and LH.

FSH (which stands for follicle stimulating hormone) controls the formation of eggs by the ovary.

LH (which stands for luteinising hormone) controls the production of sex hormones by the ovaries. A Swiss gynaecologist (see below) told us that he believes LH is strongly linked to desire.

Day one of our cycle is the first day of a period. In a monthly cycle, two main things happen:

the level of oestrogen rises slowly during the first half of the month, often dips sharply at ovulation - which occurs around about day 14 - and gradually falls off just before the period.

the level of progesterone rises sharply after ovulation, and then falls off just before the period.

But what does all this have to do with our level of desire?

If you ask a number of women whether they feel sexier at any particular time of the month, they will usually agree that they do, but they will not agree on when. About half of the women who notice fluctuations say that they feel most 'turned on' half way through their cycle. However, just as many women say they feel randiest just before - or even during - their periods.

But since we all go though the same hormonal changes, why don't we all feel sexy - or not sexy - at the same point in the cycle? The truth is that nobody knows.

My own personal – and totally unscientific – theory about those of us who claim to feel increased desire just before the period is that what we're really thrilling to is the sensation of having sex when our womb lining is thickest.

We seem to feel extra sensitivity in our vaginas – possibly because of some kind of pressure or sense of engorgement resulting from the thicker womb lining – and this enables us to enjoy the feeling of a penis inside us more than usual.

This enjoyment, however, may have little to do with increased libido. Instead it may simply be a response to different physical feelings in our genitals.

What about libido?

It's important to realise that libido (desire) is a completely different thing from physical arousal in the genitals.

This might seem incredible, but many women who say they have no libido are actually able to become physically aroused and have orgasms without much difficulty. What they do find difficult - or impossible - is to feel any passion or any desire for sex.

Often women ask if Viagra could help 'turn them on' to sex. The answer is no. In men, Viagra is used to treat erectile dysfunction - that is to say a lack of ability to get an erection. Viagra is of little use to men who are not interested in sex, because it has no effect on desire.

Currently, trials are progressing to test Viagra on women, but the research is about whether Viagra causes helpful physical changes in the sex organs. It has been reported that in a few women, the drug will increase vaginal lubrication and swelling of the tissues round the vulva. But there is no possibility that it will turn uninterested women into sex bombs. And to date, Viagra is still not licensed for the treatment of women.

Professor Alan Riley of the University of Central Lancashire - one of the UK's leading experts in sex problems - says that lack of desire is the number one sex problem in women today and that it's extremely difficult to treat.

Over 25 years ago, the American professor Dr Helen Singer Kaplan wrote a ground-breaking book called Disorders Of Sexual Desire. In it she stated that: 'In human females, (o)estrogen does not enhance sexual desire.' She also said that testosterone is the 'libido hormone' for both genders. Furthermore, she speculated that the hormone LH might in time be used clinically to increase libido.

Well, what has happened in the world of female sexuality since?

In 2006 the drug companies started to promote the idea of testosterone and various papers have been published which suggest that testosterone might be the answer to what the Americans now routinely call ‘FSAD’ (see above).

In actual fact, doctors have been trying out testosterone on women for about 40 years, rarely with much benefit. Side-effects include hairiness, spots, a deep voice and enlargement of the clitoris.

However, there is some clinical evidence to support the use of testosterone as a treatment for low sexual desire. And in 2007 a testosterone skin patch called Intrinsa became available in the UK.

But, this patch is only licensed on the NHS for women who have had an early surgically-induced menopause. Obviously, this is quite a small number of women.

We do know that Intrinsa is being prescribed privately for other women with low libido, or hypoactive sexual desire disorder (HSDD) as it is now being termed. But so far, reactions to this drug are mixed.

Finally, as for the female hormone LH (luteinising hormone), in 2006 Dr David Delvin and I were contacted by the noted Swiss gynaecologist Dr Michel Jemec, who has come up with a theory that LH is strongly linked with libido.

David later visited him at his clinic in Lugano, where he explained that his work has suggested that high levels of LH make a woman ‘horny', while low levels make her apathetic about sex.

We await with interest publication of Dr Jemec’s results in a medical journal. However, at the present moment I must stress that no treatment with LH is available.

Hit and miss

So, at the time of writing, the situation is still extremely muddled and women in this country (the UK) who have loss of libido are quite unlikely to find a doctor who will test their hormones, or offer them hormonal treatment on the NHS.

However, there is one small exception in the case of loss of libido at the menopause. For this problem, an HRT-type drug called ‘tibolone’ does now have an official licence in Britain.

But in general, since we cannot absolutely attribute lack of sex drive to hormones - and since there is very little hormone treatment available even if we could – perhaps we need to look at the problem another way.

The first thing to say is that if you feel very definitely sexier on some days of the month than others, make sure that you and your partner capitalise on them! These are the times of the month when you should come home and go straight to bed with your loved one, some smoked salmon sandwiches and a bottle of wine - or a tub of luxury ice-cream. And if you have children, you should arrange for them to go to Granny's or to a sleep-over at a friend's house.

By planning to have lots of sex when it's going to be great, neither you nor your partner should mind so much that there are days when all you want to offer is a quickie or a cuddle.

But what if your sex drive is pretty dormant all through the month?

Well, the sorry fact is that you may be a bit bored in your relationship, or tired, or feeling resentful towards your partner.

When we are newly in love, we usually have no problems with libido. In fact we often feel as if we're permanently 'on heat'! (There are a few women who have no apparent desire in the early stages of a relationship, but they tend to have psychological problems about allowing themselves pleasure through sex.)

Of course, when we first start a relationship, everything is new and exciting so our brains are very stimulated. So maybe the answer is to work on our brains - not our hormones - to spark off our sex drives. And perhaps we need to modify our lifestyles if we are to keep our desire for sex in tip-top shape.

Unfortunately, there is a tendency for relationships to become routine after a while. Sex, which before happened on occasional dates, is there on tap once people move in together. Interestingly, once we get used to the idea that we can 'have it' anytime, we tend to have it less.

Also, both partners in a relationship generally go out to work, with many working extremely long hours. So masses of people are tired, stressed and don't get round to eating properly - they are in a rut.

It does seem likely that loss of libido has as much to do with these factors as it has to do with hormones. So any woman whose sex drive isn't up to much should take a very careful look at her lifestyle.

Here are some tips that should improve the situation.

Try to add some fresh romance into the relationship and spend quality time together.

Visualise your partner as he used to look in your early days of dating and allow yourself to feel the excitement you used to feel.

Exercise your mind sexually by reading erotic books or thinking sexy thoughts - especially on the days you think you might make love

Assess how much sleep you're getting as fatigue is the biggest enemy of libido.

If you're tired all the time see your doctor in case you need an iron supplement.

If you're overweight and very lethargic, see your doctor in case you have an underactive thyroid.

If your diet is composed of rushed sandwiches and processed foods, buy a book on nutrition and re-think what you are fuelling your body with.

If nutrition seems likely to be at least part of your problem, consider contacting the Natural Health Advisory Service – formerly knows as the Women's Nutritional Advisory Service.

Our expectations

Another problem nowadays may be that we expect far too much of ourselves. We, and our partners, see films and read books where women are always up for sex. But do people make films or write stories in which the women can't relax enough to have an orgasm, or when they've got a messy period, or when they're exhausted with juggling marriage, children and a demanding job? Not usually.

Many sex experts trying to deal with loss of libido believe that hidden hostility towards the partner has a great deal to do with a lack of sex drive.

Often when a woman is blaming her hormones for her lack of desire, closer inspection of the relationship reveals all sorts of stresses, strains and anger. If such a woman is fed up because her man is never romantic to her, or never takes her out, or never thanks her for a beautifully cooked meal, or always expects her to take responsibility for contraception, it's hardly surprising that she doesn't feel like rewarding him in bed. Therefore, she loses interest.

Addressing this kind of problem is much harder than deciding 'it's all to do with hormones'. The unpalatable truth is that it's the relationship that needs changing - and that cannot be done hormonally.

We often see patients who come to us because they believe that hormonal problems are at the root of their unsatisfactory love lives. After some counselling, it’s common for us to find that the woman has gone off sex because of some flaw in the relationship. Perhaps the man is too bossy, or overbearing, for example. Sometimes therapy can put this right especially if both the man and the woman can accept that this is in effect a relationship rather than a purely sexual problem.

Occasionally, one or both partners refuse to face up the fact that there is no magic pill to cure their problems and that they need instead to make changes in the relationship – and when that happens, they usually stop coming for therapy.

Of course, there are specific times in a woman's life when she may have most difficulty with lack of desire. For example: after the birth of a child, after a termination, after miscarriage, when suffering from pre-menstrual tension and around the menopause.

After giving birth

Women are told to abstain from penetrative sex after the birth of a child – until they have their full medical check when the baby is about six weeks old. But many women feel a complete lack of desire for sex for several months after that. This is likely to be due to a number of reasons such as fatigue, poor nutrition, anxiety and depression.

It's also because a woman frequently becomes almost obsessed with her child and doesn't seem to have much time for her partner, especially sexually. This is clearly what nature demands. It ensures that the child is well looked after. It also helps to prevent a further pregnancy so that the new baby won't have to share mum with other new siblings too soon.

But is any of this to do with hormones? Many experts think that it is. They particularly attribute postnatal depression to an upset in hormones and tend to believe that the loss of libido is part of that illness. However, no one has yet managed to find any measurable change in blood hormone levels.

Some specialists do offer hormonal help at this time, but it is certainly not freely available all over the country. The best thing to do in this situation is to ask your GP, the practice nurse, or your health visitor what's available on the NHS in your area. There are also a few private clinics that offer hormone treatments.

However, many other doctors, psychiatrists and scientists believe that depression and loss of desire in the postnatal period can best be treated by anti-depressants - whatever its cause.

When I hear from a depressed young mum, I always put her in touch with the Meet-A-Mum-Association (details below), which is an organisation for women with postnatal depression. They can help by getting you support from other mums who understand what you're going through. They also keep an eye on treatments for PND up and down the country.

Generally speaking, the loss of libido gradually goes away as the mother gets used to being a mum, and as she grows stronger and less tired. Men can help by being romantic and kind. The article on postnatal depression covers many aspects of the problem.

After a termination

Is lack of libido a hormonal problem after a termination? Well, it may be - especially in the days immediately following the procedure. After all, one minute you were pregnant - with all sorts of hormonal changes going on - and the next minute you weren't. Again, it's interesting to note that most doctors do not discuss this factor with their patients.

However, longer term, it's much more likely that lack of desire following a termination is more closely bound up with guilt and grief.

Nowadays, women frequently expect to sail through a termination believing that everything will be OK and that it's 'a woman's right to choose'. Some women in fact do sail through the experience. But plenty do not.

I see many women in my own psychotherapy practice who are suffering from depression and loss of desire after a termination, and I find that they recover best when they allow themselves to think about the pregnancy and the life that was once growing within them, and then to devise some kind of ritual for commemorating that life.

Once this process of acknowledgement and grieving has taken place, they tend to get better quite quickly.

For more help with this have a look at my article coping with a termination of pregnancy.

After a miscarriage

As after a termination, after a miscarriage a woman also has to adjust quickly to the fact that she was pregnant, but isn't anymore. This is a big psychological shift. It is also probable that her hormones are very upset at this time. Unfortunately, there's little information available about this.

It is normal after a miscarriage to feel very low and to lose your sex drive, but this is probably because of natural feelings of loss. It can often help to remember your dead baby's life in some way, for example by planting a rose tree or sponsoring a child overseas.

You can find out more by reading the factsheet on miscarriage.

Pre-menstrual syndrome

This is a big problem for many women and most doctors now agree that it is something to do with a woman's sex hormones.

One theory – put forward by the late Dr Katharina Dalton – has been that PMS is connected with progesterone. As we have already seen, this is one of our main sex hormones and we have high levels of it during the second part of our cycle until just before we begin to menstruate.

Some specialists believe that problems occur when the levels of progesterone are not high enough. However there is no consistent alteration in progesterone levels in PMS, and clinical trials have provided conflicting results.

Still, a considerable number of doctors do prescribe progestogens (synthetic forms of progesterone) even though the British National Formulary says that: 'no convincing physiological basis for such treatment has been shown'.

Unfortunately, progesterone itself doesn’t work by mouth. Dr Dalton herself used to prescribe natural progesterone, in the form of rectal suppositories – particularly if there was an element of pre-menstrual tension. They are still available via the NHS, under the trade name ‘Cyclogest'. (Please note that they can have side-effects; do not try them without discussing possible untoward effects with your doctor.)

Lack of sex drive pre-menstrually is just one of many problems experienced by women with PMS. Incidentally, there is some evidence to show that if a woman does make love at this time - even if her inclination to do so is not strong - then she will actually feel better, because sex brings considerable release from tension.

Earlier I mentioned the role of nutrition in the treatment of loss of desire. And when it comes to loss of desire pre-menstrually there is now an increasing amount of help and advice on offer in the alternative sector.

Many health food shops can recommend food supplements and minerals that improve the condition. And the Natural Health Advisory Service (formerly known as the Women's Nutritional Advisory Service, or WNAS, claims success in treating PMS. By doing so, they found, almost by accident, that they were vastly improving women's levels of sexual desire, too. Their belief is that today's woman is simply not taking in the nutrients that she requires, and that this has a bad effect on the woman's hormones. They educate the woman about nutrition and claim a very high success rate. It should be noted however that this is not a free service. Full details of this organisation’s charges can be found on the website - see the end of this factsheet for more information.

A word here about phytoestrogens (natural plant oestrogens). These are nothing new, but in the past 10 years there has been a real surge of interest in them, particularly in relation to menopausal women. However, it may be that changing your diet to include more natural plant oestrogens could help your general health and sex drive prior to the menopause. Although, as we have seen, some experts think that PMS occurs because of insufficient progesterone, some women have found that by taking plant oestrogens, like red clover, they have experienced a reduction in PMS symptoms.

Does this mean then that PMS might not be caused by a lack of progesterone and could instead be something to do with oestrogen levels dropping too far before the period? No one seems to know. Some women who get very spotty during the pre-menstrual phase - and this can be very upsetting and lead to loss of confidence and desire - have reported that eating a phytoestrogen enriched diet, or taking food supplements like red clover, actually reduces the number of spots they get.

Menopause

By the time you reach the menopause, there is a lot more information available about your hormones. However, much of it is unclear and conflicting. And, as I have already said, doctors are much keener to try to prevent bone loss or heart disease than to discuss whether or not our sex drives have failed.

A complicating factor is the question of side-effects of hormone replacement therapy (HRT). During the period 2002 to 2005, it became clear that the risks of HRT were considerably greater than we had been led to believe.

What about sex? When HRT first came on the market there was a lot of nonsense written about its sexy qualities. Nowadays experts play this aspect down. They tend to say that HRT makes a woman feel much healthier and more energetic and that her sex drive increases because of that.

Many menopausal women are now also experimenting with a diet rich in plant oestrogens and are taking food supplements like soya or red clover. One of the benefits of these dietary changes is that the vagina becomes much more moist. And though a dry vagina is not in itself indicative of loss of sex drive, it certainly makes sex uncomfortable and as a consequence a woman may turn against sex and lose interest in it.

The use of natural oestrogens in this country is in its infancy, but many women are claiming to feel various benefits from changing their diets to include them.

However, please note that in 2006 the Royal College of Obstetricians and Gynaecologists issued a report which warned that untoward effects and drug interactions can occur with some widely-used natural preparations for the menopause, notably St John’s wort, vitamin E and Black Cohosh.

Conclusion

So, is loss of sex drive a hormonal problem?

Well, the jury is still out on that one – though some clinicians certainly appear to believe that testosterone can ‘cure your lack of libido.’ One thing is clear; there are a number of ways that this widespread difficulty can be improved – and I hope that having read all this information you will find some ways that you feel you can tackle the problem

Further information

Meet-a-Mum Association - an organisation for women with postnatal depression.

The Menopause Amarant Trust - an organisation for women who need help while going through the menopause, and advice about various hormonal options. Tel. 01293 413 000.

The Natural Health Advisory Service ( formerly the Women's Nutritional Advisory Service. Tel. 01273 609699. Website: www.naturalhealthas.com.

Safe sex

2009-04-03T00:01:00.000-07:00

Health risks associated with sex

In this first decade of the 21st century the various risks connected with having sex have (alas) increased. The figures for HIV, chlamydia and gonorrhoea are all going up. This is almost entirely because so many people – whether they're heterosexuals or homosexuals or 'bi' -- don't practise safe sex.

Britain is a pretty promiscuous place.

A survey published by Bradley University in late 2008 showed that the UK is the ‘one-night stand’ capital of western industrialised nations. In Europe, the order was:

UK

Germany

Holland

Czech Republic.

Statistics show that men and women are taking more and more sexual partners. Crazy practices like going to orgies, joining sex clubs and indulging in ‘dogging’ (multiple sex in car parks) are quite widespread. In the male gay world, ‘cottages’ and multi-partner saunas continue to be fairly popular.

And in many of these situations, people don’t use a condoms!

As for teenagers, unfortunately they are now losing their virginity very young – and frequently at an age where they don’t have any idea about how to protect themselves against the unwanted consequences of sex. So inevitably, there are times when teenage love-making, instead of being beautiful and fulfilling, leads to disaster.

Understandably, in all age groups a lot of men and women think that ‘it won’t happen to me'. But in the year 2009, there is so much sex infection around that you really do need to be very careful. Unless you are totally faithful to one partner – and he or she is totally faithful to you – you are at some risk.

What are the risks of unsafe sex?

The chief ones are:

unwanted pregnancy.

venereal diseases (such as gonorrhoea and, much less commonly, syphilis).

other sexually transmitted infections (such as herpes, pubic lice, and viral warts and especially the 21st century‘s major risk - chlamydia).

HIV - the virus which can cause AIDS.

cancer of the cervix.

female infertility – due to pelvic infection caused by sex with an infected guy.

It’s almost inevitable that other sexual infections will arise during this century – especially if the human race keeps going in for unsafe sex!

Germs have a nasty way of exploiting people’s behaviour, which is why – soon after the swinging 60s and 70s – herpes and HIV suddenly emerged.

Back in the 20th century, many people, both straight and gay, enjoyed sex with a variety of partners assuming that there was very little danger. Unfortunately, this is no longer the case – since disease rates have increased so much. Today, it’s only common sense to practise safe sex.

What is safe sex?

You could say that the only totally safe form of sex is masturbation. Technically, all sexual activity with a partner carries some risk, though the danger of infections is practically non-existent if the two people are completely faithful to each other.

‘Petting’ with the hands is a relatively safe form of sex, and is certainly much less risky than intercourse. So if you’re a teenager and you can keep to hand-petting (rather than ‘going all the way’), you will definitely be safer.

What about ‘petting’ with the mouth? This is a bit more risky, since it can pass on infections like gonorrhoea and herpes (and very rarely syphilis). But at least it can’t get you pregnant! It is now known that oral sex can pass on HIV, though a UK Government committee has assessed the risk as relatively low – and therefore not as great as that associated with vaginal or rectal intercourse.

Condoms

If you are going to have sexual intercourse with someone who is not a regular, faithful partner, you should always use a condom. This can be either a male condom or (much less commonly) a female one. The condom should be worn throughout the entire act of intercourse – putting it on when you are halfway through is simply asking for trouble.

Other 'barrier methods' of contraception, such as the diaphragm or cap, do offer some but very little, protection against the transmission of infection.

Another form of barrier is a ‘dental dam,’ which quite a few people now use when giving or receiving cunnilingus – that is, oral sex given to a woman by her partner (male or female). It certainly provides at least some protection against germs.

Alcohol and other drugs

One of the greatest risks to your health is having sex when you've drunk too much alcohol. Many people who would normally practise safe sex do become pregnant, or else catch HIV or venereal diseases, through having unprotected sex while drunk.

Some other recreational drugs do also ‘lower your resistance’ – and so make you more likely to run into trouble sexually.

Women should be especially aware of the recent rise in ‘drink-spiking’ – the practice in which a man slips a drug into your glass with the intention of making you so woozy that you won’t be able to resist sex.

But overall, alcohol is probably the UK’s most important cause of unsafe sex. If you are on a boozy night out, and you’re in doubt as to whether it would be safe to have sex with someone - don't!

Four final sex tips to remember

Avoid casual sex.

If you don't want to have a baby, use contraception.

If you do have sex with someone who is not your regular, faithful partner – use a condom throughout.

Remember that alcohol can make us forget all we know about practising safer sex.

Petting

2009-04-03T00:00:00.000-07:00

What is petting?

Petting generally means stimulating another person's sex organs or breasts - usually with your hand or mouth. However, some people do use it in a slightly less ‘rude’; sense, simply to mean ‘cuddling’ or ‘snogging'.

It's actually an American word – originally meaning to stroke or caress (as one would stroke a 'pet' cat).

There was no equivalent word in 'polite' (British) English, so the US word 'petting' gradually became used worldwide during the late 20th Century and is still employed – particularly by middle-aged people. In fact, the expression 'petting' and 'to pet' have now become a little old-fashioned - so that in the UK it's now much commoner to speak of:

'touching someone up'

'frigging someone'

'rubbing someone up'

'bringing someone off' (if petting proceeds to climax).

All these are still slang expressions, and the only non-slang English expression is 'masturbating someone'. In practice, this phrase is hardly ever used - because of the fact that most people only employ the word 'masturbation' to mean self-stimulation.

Instead of saying 'petting', many of today's couples talk about 'love play'.

'Heavy petting' is an American expression that usually implies petting below the waist - rather than just involving the breasts.

What does petting involve?

The idea of petting is to stimulate your partner's body, in order to give them sexual excitement.

Fortunately, this activity is also usually nice for the person who is doing the petting!

Petting (love play) very often continues until the partner who's on the receiving end actually climaxes.

Bringing someone to a climax by petting is often referred to as:

'bringing them off'

'fetching them off'

'tossing them off' (only used when the recipient is male).

Petting is often referred to in older books as 'foreplay' – meaning that it's something you can do before starting intercourse.

Doing it before intercourse is actually an excellent idea, because it prepares the body for actual penetration.

Indeed, nearly all women need plenty of petting before intercourse - in order to get their genitals 'ready'.

To be specific, petting before intercourse will:

make the vagina open up

make the 'love juices' flow

get the woman excited so that she really enjoys intercourse.

Failure to give enough petting before intercourse is one of the commonest male mistakes - and very often leads to sex becoming unsatisfactory for the woman.

Can you go in for petting without going on to intercourse?

Definitely! Plenty of couples – particularly young ones – go in for petting 'sessions' for half-an-hour or an hour, but don't go on and have intercourse.

These sessions are particularly useful for young people who need to express their emotions and find sexual relief, but who don't want to progress to intercourse (or perhaps can't progress to intercourse because of their circumstances).

What happens when a woman 'pets' a man?

She can do any of the following:

stroke the man's penis

rub his penis

kiss his penis

lick his penis

suck his penis - this is often described as a 'blow job' (but please do not blow – this is dangerous!)

use a vibrator on him (though in practice vibrators are much more commonly used by men on women).

What happens when a man 'pets' a woman?

He can do any of the following:

caress her breasts and nipples

kiss them

lick them

suck them

stimulate her clitoris, vulva and vagina with his fingers

stimulate these areas with his lips or tongue

use a vibrator (or other sex aid).

Is there any risk of catching STDs or getting HIV?

There is a very small risk of acquiring infection through petting, but it is much less than with full sex. Statistically, the biggest is of catching herpes, through being given oral sex by someone who has a 'cold sore ' on their lips. There is also some risk of catching gonorrhoea ('clap') through oral love play.

The danger of catching HIV is believed to be low, but is not zero. There has been at least one case in the USA in which oral petting led to the transfer of the HIV virus. Under no circumstances should you pet with a person who is HIV-positive unless both of you have been given expert counselling about the risks. For a full discussion of the risks of oral sex please see the complete article on this subject.

Conclusion

Generally, petting is great fun and very safe. Learning to do it skillfully is well worthwhile – especially as skilled love play is essential for helping most women to reach a climax.

Masturbation

2009-04-02T23:59:00.000-07:00

Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist and lifecoach

Masturbation means producing sexual arousal (and often orgasm as well) by manual stimulation of the genitals.

Generally, the word indicates self-stimulation, but it is worth noting that in 2009 some sexologists use the expression to indicate pleasuring of another person by hand, in phrases such as ‘the husband can masturbate the wife to help her achieve a climax'. However, in this article we shall deal only with self-stimulation.

This is the form of sexual behaviour that most of us learn first – quite instinctively. And, until recently, it was probably the type of sex least talked about. In fact, in the early part of the last century masturbation was widely considered to be a sin - and something to be avoided at all costs. Gradually society became more tolerant of it as an activity, but it still had shameful connotations and was generally seen as a bit sad. Even in 2009, there are loads of bad jokes or disparaging remarks featuring the word 'wanker', which is of course a slang word for masturbator.

Till far into the 20th century, there were many doctors, educators and youth leaders who strongly disapproved of masturbation, and who wrote books which claimed that it had terrible health consequences – like insanity! This was all nonsense.

But until around the 1960s, there were doctors and pundits who advised people to avoid masturbation. They suggested that it was immature or undesirable and that if someone got fixated on it, they might not learn more 'grown up' responses.

Nowadays, experts have a completely different view of masturbation - and a very much more positive one. One of the reasons for this is the big change in people's lifestyles.

In this 21st century, most of us can expect to have a much more changeable and flexible life than our grandparents did. We will live longer and we'll almost certainly have far more sexual and co-habiting relationships.

But between these relationships we will find ourselves returning to single status. During these single periods, we'll most probably continue to have normal sex drives - and the most obvious form of sexual relief and satisfaction available to us at those times will be masturbation.

So masturbation needs to be seen in this modern context, and viewed as an activity that is pleasant, fulfilling, acceptable, normal - and very safe. In fact, masturbation is the safest form of sex there is, and very much safer - and often more satisfying - than one-night stands.

The only time masturbation is not safe is on those rare occasions when young men decide to experiment by masturbating with potentially harmful objects - such as a vacuum cleaner! This is extremely dangerous, and definitely not to be recommended.

Men and masturbation

The vast majority of men masturbate sometimes – even if they're in a long-term and happy sexual relationship. It’s commonest if they’re away somewhere on a trip, and have been without female company for a while.

Masturbation comes pretty naturally to most guys. Let's face it; a male child discovers that his penis feels good before he can talk! So it's not surprising that boys fondle this area of their bodies a lot, and then, at the age of around 14, discover that masturbation can lead to orgasm and ejaculation - all of which they find extremely exciting and pleasurable.

There are some men who don't masturbate, but these are mainly people who don't want to do it because of religious reasons, or because they're a bit uptight about sex. Also, some guys who have a fairly low sex drive don't masturbate.

Some men - mostly from eastern cultures – try to avoid masturbating, as they believe it depletes their energy, and may shorten their lives. But there is no truth whatsoever in this belief.

Most men masturbate by rubbing the penis with their ‘dominant’ hand – slowly at first and then more vigorously. Many guys grasp the shaft of their penis by wrapping their whole hand round it. Others grasp it between their thumb and first or middle finger. But however they do it, they don't usually have much doubt that they'll achieve orgasm as a result. This is quite a contrast to women, who may experience considerable anxiety about whether they will actually 'make it'.

Some young men worry that they masturbate too much. The fact is that it's almost impossible to do this. Obviously, if a young guy is staying home and masturbating on the hour every hour, one might want to try to persuade him to get out more! But when a teenager first discovers sex it's quite common for him to want to masturbate several times a day, on some days. And this certainly won't do him any harm. However, masturbating constantly over a period of hours can produces some swelling or ‘puffiness’ of this penis. This is called ‘oedema’ and is due to fluid leaking into the tissues; it will disappear after some hours, as the fluid goes back into the bloodstream.

Other boys will masturbate quite rarely, especially if they don’t have a high sex drive - but that is normal for them.

Some men in their 70s and 80s are still masturbating several times a week, but in general terms, men masturbate most in their teens and gradually do it less and less as their life progresses - depending partly on whether or not they have a partner at the time.

As we have already indicated, many men still like to masturbate even when they are involved with a partner. They often feel that the orgasm they achieve through masturbation is less complex and more locally intense than climaxes achieved through sexual intercourse. Furthermore, they can control the pressure and speed of movement very accurately.

In recent years, we have encountered a number of couples who achieve considerable satisfaction through the woman watching the man masturbate in front of her (or vice versa). Also, this practice is certainly helpful when – for some medical reason – intercourse is difficult or impossible.

Masturbation and pornography

At some point in their lives, almost all men will masturbate while looking at newspaper pin-ups, top-shelf magazines, or sexy DVDs.

For a single guy,viewing porn is seen as a pretty normal activity nowadays. Some single men do worry that they might get fixated on it, but the majority of them have no trouble in transferring most of their sexual focus to a real, live, warm, sexy female when they meet one.

Masturbation using porn is more of an issue when a guy who is in a committed relationship. Some of these men worry that what they're doing is wrong – even if they don't want to stop. And of course many female partners have a problem with this sort of activity and can feel bitterly rejected and threatened by it.

However, most men who are in relationships are able to compartmentalise this kind of sexual behaviour. They may only do it occasionally, and they feel it has no bearing whatsoever on their love and desire for their partners.

But - and this is important - this kind of sexual indulgence ceases to be normal when a man actually prefers it to having sex with his partner. When this happens, the relationship is usually in some trouble. Today, it is increasingly common for Internet porn to create that kind of relationship problem (see below).

In such cases it's not uncommon for men to use porn more and more for relief, rather than face up to sorting out sexual or relationship difficulties. This kind of avoidance behaviour almost invariably worsens an already problematic situation.

If a man wants to save his relationship, but feels increasingly dependent on pornography, then he should seek help. (See Further information for more details.)

Masturbation and the Internet

Since round about the beginning of the 21st century, more and more men have been masturbating while using the Internet. When this involves viewing the sort of pornographic images you can also get on video, then the situation is much the same as it is when the guy uses magazines or blue movies – in other words, he’s not getting involved with anybody else.

However, when the activity involves masturbating to orgasm while 'talking' by use of the keyboard with another person, then this cannot honestly be judged as a solo activity, or as simple masturbation. In fact, it can be seen as an act of infidelity – if the man in question is married or committed to a serious sexual relationship.

Male masturbation and its use in helping sex problems

Two of the common sex problems that men experience can be helped to some extent by masturbating.

Premature ejaculation (PE), which is the condition where the man ejaculates too quickly when he has sex with a partner, is an enormously common problem.

PE usually needs some sort of specialist help, but some men are able to help themselves to some degree by gaining more control over their climaxes while masturbating.

What such a man should do to is to practise beginning to masturbate and allowing himself to get almost to the point of no return, but then stopping and calming down a bit, before carrying on. If a guy can do this several times before giving in and having a climax, it may well help him to develop the necessary control he's been lacking to delay his climax during intercourse – especially if he practises this stop-start technique on a regular basis.

The other male sex problem that can be helped to some extent by masturbation is 'delayed ejaculation', 'ejaculatory incompetence', or as it's also called, 'retarded ejaculation'.

When men have this particular problem they can maintain an erection for a long time during sex, but they can't relax enough to let go and climax inside their partner. Many such men are quite uptight about sex. And if they can learn to masturbate with their partner, this can help them a great deal. Again this is a problem that needs specialist help. But if a man can first of all learn to masturbate in the next room to his partner and then after a week or so manage to do it the same room, they will both feel he is making progress.

Eventually he should be able to masturbate right beside her, and in time masturbate so close to her that he can place his penis into her vagina at the crucial moment.

Women and masturbation

Teenage girls do not tend to masturbate as automatically as boys do. Of course plenty of girls do discover that they get pleasant feelings from their genitals at quite an early age. And many of these girls do discover how to masturbate to orgasm in their mid to late teens.

But many girls and young women simply do not feel many strong sexual urges. Indeed it is quite common for a woman not to reach orgasm until she is about 19 years of age. And there are plenty of females who don't reach one for years after that - either through sex with a partner, or by masturbating.

When we wrote our book The Big 'O', our research showed that a few women did not learn to achieve orgasm until their 40s - but when they did, they were very pleased about it, and quickly made up for lost time! So it's never too late to learn.

But why is there this discrepancy between male and female orgasmic ability? One reason seems to be that a woman's sex drive simply appears to take longer to develop than that of men. Of course a woman's orgasm is not essential in nature - that is to say a woman does not need to orgasm to conceive, whereas a man does have to climax to produce the all-important sperm.

Another reason for women's slower development may be that their genitals are much more hidden away than the male genitals - and this in turn may be why women do not have the same emotional and mental focus on the vulva that men have on the penis.

Methods of female masturbation

The average woman masturbates by stimulating her clitoris. She usually does this in little circular motions, either with her index or middle finger. Generally, women begin by touching themselves just above or below the clitoris, but as their excitement mounts they can tolerate more intense stimulation right on top of it.

Some women find they like the feeling of 'bulk' created by having something in the vagina at the same time. This could be two or three fingers of her other hand, or some kind of object. One word of caution: it is best to use fingers, or a sex aid designed for the purpose. Women sometimes get into trouble if they use unwashed fruit, or other items that may introduce infection into the vagina. And they should definitely always avoid anything that is breakable, like glass - for obvious reasons.

In recent years, there has been a bit of a vogue among some young women for using an electric toothbrush in the vagina. Pleasant though this may be, it could certainly cause damage to those delicate tissues and should be avoided.

Whether or not anything is introduced into the vagina - and this certainly does increase the excitement in a lot of women - the vast majority of females need to keep stimulating their clitoris at the same time in order to have a climax.

A few women are so highly sexed they can orgasm simply by rubbing their nipples - but this is just a tiny minority of highly-talented females! Other women discover that they can bring themselves to a climax through squeezing their thighs together. Again they are in the minority.

Vast numbers of women nowadays enjoy using a vibrator some or all of the time. There are some truly amazing products around these days and the fair sex is becoming much less timid about trying them. When a vibrator is used, sometimes a woman will use it to stimulate her clitoris. At other times she will use it in her vagina. There is no right or wrong way of pursuing solo pleasure - and a woman should experiment to find what she likes best.

Fortunately, it is now quite easy to purchase good sex aids from reputable companies. (See Further information for more details.)

The use of female masturbation in achieving orgasm

As we have already mentioned, the female orgasm in not as reliable or as automatic as the male orgasm generally is. For that reason many women consult psychosexual specialists, family planning doctors and so on in the hope that they can be helped to achieve the elusive 'Big O'.

Nowadays most experts agree that if a woman can reach orgasm through her own efforts, she can then learn to climax with a partner either during love play or intercourse. Learning to climax through masturbation gives a woman confidence and satisfaction - and also educates her about how she likes to be touched and stimulated. Once she knows these things, she can communicate them to a loving partner.

Some females have a real problem in touching their genitals. This is usually because they had restrictive upbringings where they were taught that 'nice girls don't touch themselves there'. Or that 'sex is for beasts'. Or that 'sex is dirty'.

However, if a woman is prepared to give time and effort to learning about her own body, she can often overcome these unhelpful beliefs.

If you are a woman who has trouble in reaching orgasm - even through masturbation - you might like to follow the advice given below.

How to achieve orgasm through masturbation - even if you've never managed it before

Allocate some time - at least an hour, twice a week - when you know you'll have the house to yourself and can guarantee being undisturbed. (Arranging this can be the hardest part of the exercise!)

Take a leisurely bath, using your favourite bath oil. Relax. Enjoy soaping your whole body. Give your breasts and your genitals plenty of attention.

Dry yourself with love and care and continue to explore your body as you do so.

Move to the bedroom. Make sure it's warm and that it looks nice and is a pleasant place to be. Put some favourite music on if you'd like. Lie on the bed and carry on touching yourself, anyhow and any place that you like. All sorts of parts of your body might give you pleasant feelings. Find them! Give them attention. Be aware of pleasure.

Rub baby oil into your breasts and into your neck and throat. Enjoy the feeling.

Gradually allow you hands to travel lower in your body. Caress your abdomen, and then use some more baby oil and touch yourself between your legs. There is no wrong or right way of doing this. Just let your instinct take over.

Slip your fingers into your vagina. Try tightening your muscles round your fingers. Then relax. Try gently stretching the vaginal opening - this is something that gives exquisite pleasure to many women.

Start circling the area where your clitoris is. Don't hurry this. As you become more focused on your genitals, you may well find that you start applying more and more pressure to your clitoris, and that your breathing is quickening, and - best of all - that you're really enjoying yourself.

Don't worry if you don't get any further than this on the first few occasions. So long as you feel that you are loving your body and appreciating it and experiencing some good sensations, then that's fine.

Don't forget that the most powerful part of a woman's arousal equipment is in her mind. So it can be helpful to introduce some mental stimulation into the exercise. Try thinking of things that turn you on. Or, while you're stimulating yourself, read from one of those erotic novels written for women. You might even like to try caressing yourself while viewing a sexy DVD – if you have a DVD player in your bedroom or somewhere else in the house where you can feel uninhibited and comfortable. One of Betty Dodson’s famousDVDs on assisting women to reach orgasm through masturbation may help.

You may like to use a vibrator - as many women find this increases their arousal quite magically. If you don't know where to get good books, videos or sex aids, see the Further information section.

Each time you start caressing your body, try to keep going for longer and to increase your delight in what you're finding out about yourself. Don't panic if you still sometimes have feelings that what you're doing is wrong. Just breathe deeply and tell yourself that it is every woman's right to love and enjoy her own body - and that masturbation is healthy and good and normal.

One day you will find that your caresses become more insistent and that you are breathing heavier and that you feel a desperate urge to carry on what you're doing. It's common to feel a bit frightened at the intensity of what's happening if you've never felt it before, but go with the feelings. You deserve to have them. If rubbing your clitoris alone doesn't quite get you to your climax, try putting one or two fingers of your other hand into your vagina. Or use a vibrator in your vagina or on your clitoris. Your instinct should take over and tell you what to do.

Hopefully these powerful feelings will lead to your first orgasm. And once you've had one - you'll find you can have others - maybe even on the same day!

Many women like to practise having orgasms a few times on their own before involving a partner, but once you do choose to try with the person you care for, make sure you incorporate what you've been doing into your love play. Show your partner what you like and let him or her help you to experience this great joy.

If you follow this plan, without putting pressure on yourself to succeed you will become more sexually aware, and it shouldn't be too long before you join the ranks of the orgasmic. Good Luck.

Further information

For women who have not yet managed to experience orgasm, there is more advice and help for you in our article: 'Are you having trouble reaching orgasm? A guide for women'.

If you have other specific sexual problems – including emotional ones – and you want to get some professional help, please refer to our fact sheet 'Who to contact for sex therapy'.

If you have problems with sex addiction – including dependence on porn – it would probably be worth contacting one of several self-help groups which have become prominent in 2009. They include:

Sex and Love Addicts Anonymous: www.slaauk.com

Sex Addicts Anonymous Scotland: www.saascotland.org.uk

New Life Ministry (a Christian group): www.newlifeministry.org

Sex Addicts Anonymous: www.saa-recovery.org

For supplies of DVDs, erotic/sex education books, lubricants, sex aids, etc there are now several reliable and helpful companies run by women, for women (and their partners). They include:

Passion 8. Now an extensive mail order business, run very efficiently by its ebullient boss, Stephanie. Check out their website on: www.passion8.com.

Sh! This is a shop in North London, for women. It is also open to any man, so long as he's accompanied by a responsible woman! It's also a mail order business.Call for more details on: 020 7613 5458. Their website is www.sh-womenstore.com.

Tickled. A very jolly shop in Brighton’s famous ‘Lanes’ district. Men may enter the top floor unaccompanied, but the lower floor is for females (and accompanied males) only. Telephone: 01273 628725. Website: www.tickledonline.com.

Anal sex

2009-04-02T23:58:00.000-07:00

What is it?

Anal sex means sexual activity involving the bottom – in particular, the type of intercourse in which the penis goes into the anus. It is often referred to as ‘rectal sex'. Anal sex does carry some health risks, so please read our advice carefully.

Other types of sexual activity which involve the anus include:

‘postillionage’ – which means putting a finger into the partner’s bottom.

insertion of ‘butt plugs’ – which are sex toys that dilate the anal opening and create a sensation of fullness.

use of vibrators on or in the anus (please see cautionary note below).

'rimming’ – which is oral-anal contact; this carries a significant risk of infection.

‘fisting’ – which means putting the hand into the rectum; this activity is rare among heterosexual couples.

Taboos and infection

There are taboos surrounding the various types of anal sex – and particularly anal intercourse.

These may arouse strong feelings of moral indignation, guilt and anxiety.

It is important to remember that while some people find these activities repugnant, others may find them stimulating, exciting, and a normal part of their sexual intimacy.

Research shows that, whether we like it or not, the anal area is equipped with many erotic nerve endings – in both men and women. So it is not surprising that many couples (including a lot of heterosexual ones) derive pleasure from some form of ‘bottom stimulation'.

What about infection? Most sexual activities carry a risk of transmission of sexually transmitted diseases (STDs) from gonorrhoea and herpes, to hepatitis B and HIV. There is evidence that anal intercourse carries a higher transmission risk than almost any other sexual activity. Information about these risks is given below.

Consent

What consenting adults enjoy sexually in the privacy of their homes is their own business provided that the law does not prohibit it.

The key issues are legality and consent. In the UK, anal intercourse is a legal activity between consenting men and women aged 16 and over, in both heterosexual and homosexual relationships, except in Northern Ireland where it's 17 and over.

In some countries it is still a criminal offence punishable by long custodial sentences, corporal or even capital punishment. It remains forbidden in some states of the USA, and in some former colonies of Britain – including for instance Jamaica.

Consent freely given by both partners is an essential feature of sexual activity in a loving relationship. Many individuals, both men and women, may have secret fantasies involving anal intercourse but feel unable to discuss them with their partner.

Some may try and pressurise their partner to have anal intercourse, even though the partner does not share their interest. Some partners will reluctantly acquiesce, others may be pressured or even physically forced to allow it.

Forcing or pressurising a partner to submit to an activity that they find distasteful or degrading is completely unacceptable behaviour.

Intoxication with drugs or alcohol is associated with lowering inhibitions and experimentation with unusual or unsafe sexual behaviour - and can lead to serious consequences.

It should be remembered that in the absence of freely given consent, the very serious criminal offences of assault and rape are committed. Therefore, it is essential that both partners agree that they wish to try anal sex as a part of their sexual repertoire and that they are sure of the legal position on anal intercourse in the country that they are in.

Who does it?

There is a common misconception that anal sex is practised almost exclusively by gay men. This is certainly not the case. An estimated one third of gay couples do not include anal intercourse in their lovemaking. About one third of heterosexual couples try it from time to time.

It is thought that about 10 per cent of heterosexual couples have anal intercourse as a regular feature of their lovemaking. In absolute numbers, more heterosexual couples have anal sex than homosexual couples.

Is it safe?

Anal sex, if practised with care, is possible for most couples. It does, however, carry additional health risks and there are safer sexual practices that couples can enjoy. The main health risks, which affect both heterosexual and homosexual couples, are described below.

Human immunodeficiency virus (HIV): there is no doubt that anal intercourse carries a greater risk of transmission of HIV - the virus that can cause acquired immunodeficiency syndrome (AIDS) - than other sexual activities, particularly for the receptive partner.

Human papilloma virus (HPV, wart virus): can be transmitted during anal intercourse and lead to anal warts, which in turn could perhaps predispose infected individuals to cancer of the anal canal.

Hepatitis A (infectious hepatitis): is a viral infection that can cause jaundice and abdominal pain. Hepatitis A is not usually a very serious illness, although sufferers can feel quite ill. It can be transmitted by oral-anal contact.

Hepatitis C: is a cause of progressive and sometimes fatal chronic liver disease. Hepatitis C may be transmitted by anal intercourse, although this seems to be a rare occurrence. Sharing of equipment for intravenous drug use is a far more important risk for transmission.

Escherichia coli (E. coli): may sometimes cause mild to severe, or even (rarely) fatal, gastroenteritis. It is one of many viruses and bacteria that can be transmitted by oral-anal contact. Some E. coli strains (uropathic E. coli) can also cause urinary tract infections (UTIs), ranging from cystitis to pyelonephritis - a serious kidney infection. E. coli very readily crosses the short distance between the female anus and the female urinary opening, so causing a urinary infection. Anal intercourse could facilitate this ‘transfer’ – particularly if it is immediately followed by vaginal intercourse.

Protection

Avoiding anal sex altogether is of course the best way of avoiding these risks. There are other, safer sexual practices that can be exciting and rewarding, but many couples may still wish to try the anal route.

The use of condoms and water-based lubricants, such as K-Y Jelly, will offer some protection. Other lubricants may cause condoms to split, as will over-energetic thrusting without adequate lubrication. Specially toughened condoms designed for anal intercourse may offer more protection.

How to have anal intercourse safely

Anal intercourse involves the penetration of the anus and rectum with the erect penis for the purpose of sexual stimulation. It is possible for both men and women to ‘receive’ it, although care is needed for it to be safe and comfortable.

Ensure the anal area is clean and the bowel is empty. This is important both aesthetically and practically. If the bowel is empty, there is no risk of the receptive partner passing faeces.

The 'receptive' partner must be able to relax their anal sphincter in order to accommodate the erect penis. The anal sphincter is a ring of muscle that can be contracted or relaxed under voluntary control. Forced penetration may result in tearing of the sensitive skin around the anus or the sphincter itself. This may result in severe anal pain or even faecal incontinence.

Try gently inserting a lubricated finger, perhaps covered by a condom or glove into the anus first. This will enable the receiving partner to find out whether penetration is comfortable and enjoyable. Having managed to accommodate one finger, you can run the finger around the anal canal - gently stretching it. This must be done delicately so as not to cause pain or injury.

Next, you can, if you wish, try and insert two fingers. If this is successfully achieved, the couple may agree to try with a well-lubricated penis or with a butt plug (a broad-based anal dilator), dildo or vibrator (see below about the risks of sex aids and anal sex).

Gentleness, care, adequate lubrication and anal relaxation are required, not the insertive partner pushing harder! If condoms are used for penile penetration, which is advisable to reduce the risk of sexually transmitted disease, it is important to use a water-based lubricant. The insertive partner must control their thrusting, so as to give the receptive partner time to allow their sphincter to relax. With time and practice, this will become easier.

Drugs and anal sex

Muscle relaxant drugs (amyl nitrate, butyl nitrate, glyceryl trinitrate) have been tried to make anal intercourse easier or more comfortable. We do not recommend this. Amyl nitrate 'poppers' sold in small bottles for inhalation, are popular in the gay community and have a reputation both for enhancing the intensity of orgasm and helping relax the anal sphincter. There is no real evidence to support these assertions and its use is not recommended by medical authorities. It is important to remember that amyl nitrate is a potent drug with many side effects, including facial flushing, headaches, dizziness and low blood pressure, which may lead to faintness and loss of consciousness. Amyl nitrate, when taken with Viagra (sildenafil), may cause a catastrophic drop in blood pressure with potentially fatal consequences. Other nitrates may have the same effect. All erection-inducing drugs, including Viagra (sildenafil), Cialis (tadalafil)and Levitra tablets (vardenafil), can be very dangerous if you are using nitrates.

Local anaesthetics, such as lignocaine (lidocaine) cream or even locally applied cocaine, have been used to reduce anal pain during intercourse. Again, we strongly advise against this. By numbing the anal skin there is a real risk of causing serious injury to the anal sphincter through over-vigorous thrusting. By following the steps above it is possible to gently dilate the sphincter for comfortable intercourse. The purpose of pain is to make us aware that we are causing injury and, therefore, local anaesthetics should be avoided. Another problem with local anaesthetics is that they may make the penis of the insertive partner numb. This may lead to problems with erection, orgasm and ejaculation.

Fisting

This involves the insertion of the whole hand or forearm into the anus (or indeed the vagina) for sexual stimulation.

With adequate relaxation it is physically possible and may be acceptable and enjoyable for some couples. But the diameter of the hand or forearm is so much greater than that of the penis there is an increased risk of anal injury.

Good anal relaxation in the receptive partner and care by the insertive partner are essential.

In practice, anal fisting is very rarely used by heterosexual couples.

Rimming

Rimming involves oral contact with the anus for sexual stimulation. In order to reduce the risk of transmission of infection, good anal hygiene before sex and good oral hygiene after sex is essential.

Sex aids and anal sex - a cautionary note

Some couples like to use some form of sex aid for insertion into the anus. Some individuals may use them for solitary sexual stimulation.

The same principles apply as for genital insertion in that anal relaxation is essential. Sex aids must be kept clean and and washed carefully between use. Condoms may be placed over sex aids as an additional precaution.

One additional risk from the use of sex aids in anal sex is that of losing the aid into the rectum.

Most medical school pathology museums have a wide selection of novel foreign bodies recovered from the rectums of both men and women, ranging from vibrators to milk bottles.

Human ingenuity seems to know no bounds in this area, but it is incredibly foolish to insert potentially breakable objects into the anus and terrible injuries may result.

If you do lose a sex aid into the rectum you should attend the Accident and Emergency department of your local hospital as soon as possible, however embarrassing it may be. The situation will only get worse if it is neglected and the object may break or become more difficult to recover.

In general, you should only use a sex aid which is designed for the anus. Butt plugs and anal vibrators have a broad base which makes it very difficult to ‘lose’ them inside the rectum.

Vaginal vibrators are not designed in this way, and can easily slip inside and buzz their way up the colon. Some have been recovered by surgeons from far inside the abdomen. If they are still vibrating when the patient arrives at the hospital, they produce an interesting but alarming phenomenon called ‘the rotating umbilicus sign'. Don’t let this happen to you.

Sex and relationships

2009-04-02T23:56:00.001-07:00

Most relationships go through patches where everything is not as it should be. The key to solving issues is good communication and knowing when to seek help. Here you'll find tips for a fulfilling sex life plus advice on STDs, contraception and common sex problems.

Selenium added to broccoli compound combats melanoma

2009-04-02T23:09:00.001-07:00

In an article published in the March, 2009 issue of the journal Clinical Cancer Research, researchers at Pennsylvania State University College of Medicine report their finding of a potent effect of a compound consisting of selenium and isothiocyanates from cruciferous vegetables such as broccoli against the potentially deadly cancer known as melanoma.

Previous research conducted by Penn State associate professor of pharmacology, pathology and dermatology Gavin Robertson and his colleagues found that isothiocyanates target a protein known as Akt3 which is increased in approximately 70 percent of tumors. Recognizing that the known cancer fighting ability of isothiocyanates would require the administration of impractical amounts of the compounds, the team replaced isothiocyanantes’ sulfur bonds with selenium to create new compounds called isoselenocyanates. "Selenium deficiency is common in cancer patients, including those diagnosed with metastatic melanoma," explained Robertson. "Besides, selenium is known to destabilize Akt proteins in prostate cancer cells."

When mice injected with melanoma cells were treated with isothiocyanates or isoselenocyanates, animals that received the selenium-containing compound had approximately 60 percent less tumor development compared with those that received isothiocyanates. In additional experiments with human melanoma cell lines, tumor growth was decreased by 30 to 70 percent. "We found that the selenium-enhanced compounds significantly reduced the production of Akt3 protein and shut down its signaling network," Dr Robertson stated.

"There are currently no drugs to target the proteins that trigger melanoma," Dr Robertson noted. "We have developed drugs from naturally occurring compounds that can inhibit the growth of tumors in mice by 50 to 60 percent with a very low dose."

"We have harnessed something found in nature to target melanoma," he remarked. "And since we only need tiny amounts to kill the cancer cells, it means even less toxic side-effects for the patient."

—D Dye

March 02, 2009

Green tea helps protect gums

2009-04-02T23:02:00.001-07:00

In the March, 2009 Journal of Periodontology Dr Yoshihiro Shimazaki of Kyushu University in Fukuoka, Japan and his colleagues in the Department of Preventive Dentistry report their discovery of a protective effect for green tea against periodontal disease, a chronic inflammatory disorder of the gums and bone surrounding the teeth. The drink, which is traditionally consumed in Asia, has increasingly been the subject of research that has revealed a variety of positive effects.

"It has been long speculated that green tea possesses a host of health benefits," Dr Shimazaki observed. “And since many of us enjoy green tea on a regular basis, my colleagues and I were eager to investigate the impact of green tea consumption on periodontal health, especially considering the escalating emphasis on the connection between periodontal health and overall health."

The study included 940 Japanese men aged 49 to 59. Self-administered questionnaires obtained information on daily green tea intake, toothbrushing habits, and other factors. Periodontal disease was evaluated during oral examinations which assessed probing depth, bleeding on probing, and clinical attachment loss.

For each cup of green tea consumed by the participants, a decrease in all three indicators of periodontal disease was observed. The apparent protective effect of the drink on the gums observed in the study may be due to antioxidants in green tea known as catechins, which help reduce the mouth’s inflammatory response to periodontal bacteria.

"Periodontists believe that maintaining healthy gums is absolutely critical to maintaining a healthy body," noted Dr David Cochran, DDS, PhD, who is the President of the American Academy of Periodontology. "That is why it is so important to find simple ways to boost periodontal health, such as regularly drinking green tea – something already known to possess certain health-related benefits."

—D Dye

March 06, 2009

Teens need more vitamin D

2009-04-02T23:01:00.001-07:00

Research reported on March 11, 2009 at the American Heart Association's 49th Annual Conference on Cardiovascular Disease Epidemiology and Prevention, held in Palm Harbor, Florida, revealed an association between reduced levels of vitamin D and a greater risk of hypertension, high blood sugar, and metabolic syndrome in teens. Metabolic syndrome is characterized by increases in waist circumference, blood pressure, serum triglycerides and blood glucose, and/or a decrease in high density lipoprotein cholesterol. Having several of these factors places one at a greater risk of developing heart disease or diabetes later in life.

Johns Hopkins Bloomberg School of Public Health post-doctoral research fellow Jared P. Reis, PhD, and colleagues analyzed data from 3,577 boys and girls aged 12 to 19 who were participants in the National Health and Nutrition Examination Survey (NHANES). The team found that subjects whose blood levels of 25-hydroxyvitamin D were among the lowest 25 percent of participants had a 2.36 times greater adjusted risk of high blood pressure, and a 2.54 times greater risk of elevated blood sugar than those whose levels were in the highest 25 percent. Metabolic syndrome risk was 3.99 times greater in those whose vitamin D levels were low.

The study also found that Mexican American and African American teens had lower levels of vitamin D than Caucasians. While Caucasian teens had average vitamin D levels of 24.8 nanograms per milliliter, levels of the vitamin in Mexican and African Americans averaged 21.5 and 15.5 nanograms per milliliter.

"We showed strong associations between low levels of vitamin D and higher risk of high blood pressure, hyperglycemia and metabolic syndrome among adolescents, confirming the results of studies among adults," Dr Reis concluded. "This is an exciting time; since we are just now beginning to understand the role that vitamin D may play in cardiovascular health."

—D Dye

March 09, 2009

Calcium supplements improve weight loss in deficient women

2009-04-02T23:00:00.000-07:00

In a communication published this month in the British Journal of Nutrition, researchers from the Université Laval in Quebec report that women with a low intake of calcium who received calcium supplements with the mineral experienced greater reductions in weight and fat mass in response to a weight reducing diet compared with those who received a placebo.

For his study, Angelo Tremblay and his associates enrolled 63 overweight or obese women whose daily calcium intake was reported as 800 milligrams or less. The women were assigned to a 15 week reduced calorie diet which was supplemented twice daily with 600 milligrams elemental calcium plus 5 micrograms vitamin D, or a placebo. Weight, fat mass, resting energy expenditure and spontaneous energy intake were assessed before and after the program.

Although there was no difference at the study’s conclusion between participants who received supplements and those who received a placebo, when the analysis was restricted to those whose calcium intake prior to enrollment was 600 milligrams per day or lower, an increase in weight, fat mass, and fat intake was observed in the calcium group. Women in this group lost an average of nearly 6 kilograms, compared to an average loss of 1 kilogram among those who received a placebo.

The study builds on previous research conducted by the team which found that women whose calcium intake was insufficient had increased body fat, waist circumferences, and LDL cholesterol compared with those whose intake was higher.

"Our hypothesis is that the brain can detect the lack of calcium and seeks to compensate by spurring food intake, which obviously works against the goals of any weight loss program," stated Dr Tremblay, who is the holder of the Canada Research Chair in Environment and Energy Balance. "Sufficient calcium intake seems to stifle the desire to eat more.”

—D Dye

March 11, 2009

When Sex Hurts

2009-04-01T07:58:00.000-07:00

Between 25 and 45 percent of postmenopausal women find sex painful, a condition called dyspareunia.

While there are many causes, the most common reason for dyspareunia—painful sex—in women over 50 is vulvovaginal atrophy, a fancy name for a vulva and vagina that no longer have the beneficial effects from estrogen that they did prior to menopause.

As discussed earlier, lower estrogen levels significantly affect your vagina, impacting its ability to secrete lubricant, to expand and contract and to grow new cells. Over time, blood flow diminishes, and the vagina and vulva can atrophy, or shrink as cells die off and aren't replaced.

The result? Soreness, burning after sex, pain during intercourse and, sometimes, post-sex bleeding.

The good news is that vuvlovaginal atrophy is very treatable. One of the best treatments doesn't involve medicine! Turns out that the more often you have sex, the less likely you are to develop atrophy or, at the very least, a serious case of it. That's because sex increases blood flow to the genitals, keeping them healthy.

Other treatments include:

Estrogen. As you might expect, if lack of estrogen is behind vulvovaginal atrophy, then giving back estrogen should help. Both systemic estrogens (oral pills and patches) and local estrogens (creams, rings and tablets applied to the vulva and/or vagina) work. However, most major medical organizations recommend starting with the local approach first because it keeps the estrogen right where it's needed, limiting any effects on the rest of your body.

Studies on the estrogen ring, cream and tablets find extremely high rates of improvement in dyspareunia, with up to 93 percent of women reporting significant improvement and between 57 and 75 percent saying that their sexual comfort was restored, depending on the approach used.

Side effects vary. Most estrogen products applied locally are associated with minimal side effects. However, each woman's response can differ. When using estrogen creams, pills or rings, it is important to talk to your health care provider about any symptoms, such as: headache, stomach upset, bloating, nausea, weight changes, changes in sexual interest, breast tenderness, abdominal pain, back pain, respiratory infection, vaginal itching or vaginal yeast infections. If you have had breast cancer or a family history of breast cancer, be sure to discuss your history with your health care professional, if you're considering using estrogen. Your health care professional likely has covered this topic with you already.

Non-medicated lubricants. If you'd rather not go the estrogen route, consider using some of the over-the-counter products designed to increase sexual comfort. Long-lasting vaginal moisturizers provide relief from vaginal dryness for up to four days.

Other Causes of Sexual Pain
Since many women over 50 do not experience vulvovaginal atrophy, women with sexual pain should be aware that there are other medical conditions that could be responsible for their symptoms. These include:

Vestibulodynia. Vestibulodynia is the most common cause of sexual pain in women under 50, but it can also affect older women. Women with this condition feel severe pain when any type of pressure or penetration is attempted at the entrance to the vagina (an area called the vestibule). It is treated with topical anesthetics, estrogen cream, antidepressants, antiepileptic drugs (often used for nerve-related pain) and physical therapy.

Vulvodynia. This condition involves stinging, burning, irritation, rawness or pain on the vulva, the tissue that surrounds the vagina. The pain and irritation can occur even when nothing touches the area and is likely related to abnormal nerve firing. Vulvodynia is treated similarly to vestibulodynia.

Vaginismus or Pelvic Floor Muscle Dysfunction. In this condition, the vaginal and perineal muscles involuntarily spasm with attempted sexual activity. This can make vaginal entry very difficult or even impossible. Vaginismus can occur after a trauma (such as nonconsensual sex), or it can be related to underlying physical conditions, including musculoskeletal injuries or vestibulodynia. Vaginismus is often treated with dilator therapy (in which women are taught relaxation techniques while using progressive-sized dilators in their vagina) and physical therapy.

Urinary tract conditions, such as cystitis, or fungal infections can also cause pain upon intercourse, as can endometriosis, or a uterus that has "dropped" or prolapsed.

Time to Speak Up
Unfortunately, most women do not talk to their health care providers about sexual pain or problems, nor do their health care providers bring up the topic. In an international survey of 391 women by the Women's Sexual Health Foundation, fewer than 9 percent of women said their health care professionals had ever asked if they had sexual problems. Obviously, if you don't bring up the topic of sex with your health care professional, it won't get addressed. So speak up!

Breast Cancer and Sexuality

2009-04-01T07:56:00.000-07:00

by Sheryl Kraft

Sexuality. It's inevitable that this is a word associated with breasts. Yet it is a challenging subject to write about. Why? First, I've always tended to be rather private when it comes to personal things like my sex life. Second, it's a topic that doctors will rarely bring up with breast cancer patients; perhaps they are uncomfortable or unsure of how to approach this touchy and highly personal subject. Doubtful it's part of their medical school curriculum (and if it is, I'm sure it plays a minor role). And then again, there's that time factor we all fall victim to—inevitably, when we see our doctor, any personal topics will be brought up last...if time allows. The majority of the office visit is spent on purely medical and practical concerns, like physical health and well-being.

There's no denying that for most women, the loss or alteration of a breast touches her sexuality on an extraordinarily deep level.

But it's all so very complicated, I think. Yes, the breasts are an erogenous organ associated with real physiological responses. And there's that psychological aspect of femininity and attractiveness. I was a late bloomer, probably one of the last girls of my age to wear a bra, and even when I finally started wearing one, I really didn't need it. But from a very early age, I was aware of breasts, aware of the effect that they had on boys, whose eyes would linger on the chests of the girls who had something to show, rather than mine. And I clearly remember that the instant I fastened my first bra—with the nonexistent cups—I stood a little taller, felt a little enhanced, like I finally "belonged." I made sure to wear the sheerest white blouse I owned, so that my entrée into womanhood would be evident to everyone, male or female.

In the process of writing this, I came to a realization: I was planning to write about how to maintain—or regain—your sex life, a subject on which I was not an expert. It's all so individual, after all. Then, I thought further and was going to write about the fact that the most crucial thing to regaining your sense of sexuality and femininity is having a supportive partner. But then—sorry for all these reversals!—I realized that when it comes down to it, we are all alone with our own bodies. There's not always that someone by our side to reinforce the fact that we are still beautiful and sexy, is there? And many of us might be single—possibly dating, possibly not.

I'm no authority on relationships or fulfilling sex lives, but I can say something about the relationship we have with our own bodies. After my mastectomy, I had to learn to love mine again.

I could love it because it was still alive and functioning. I could love it because it was healthy, it moved, it was still an expression of who I was, despite the fact that my breast was taken. In a way, I traded my breast for my life. I know this might sound a bit pat and clichéd—but it's true. I had to come to the realization that yes, it was sad to lose a breast, and yes, I'd miss it, but it was a necessary measure to preserve my health.

We are really all on our own. Another person cannot be by our side every hour of the day—like when we are in the shower and glance down at our scars or when we are in a locker room and feel self-conscious about undressing in front of other women; when we undress each night; or when we try on clothing that is suddenly a bit too "clingy" or "revealing" to flatter our changed physiques.

So I think the topic of sexuality has two facets: sexuality in terms of learning to accept your changed body and sexuality in terms of sharing that body with someone you love. The former, in my opinion, must be achieved first. Just like the way I think that we can't love someone until we learn to love ourselves.

I eventually came to accept the fact that breasts were not the only thing that defined my sexuality. If it sounds simplistic, believe me, it wasn't so simple, but I'm here almost 20 years later recounting my story. I can't deny that there were (and still are) times I mourned the loss of my breast; moments where I couldn't bear to look in the mirror. I was envious of the ample cleavages that seemed to surround me. The beautiful sight of a mother nursing her infant could fill me with a deep longing. Suddenly, I'd be transported back to the days when I was too flat-chested to wear a bra and felt somehow inferior.

Here, I'll guide you to some tips I came across while researching sexuality and breast cancer, from one of the best Web sites I've found on the subject, breastcancer.org. (I was truly relieved to find advice on not only how to regain a healthy sex life with your partner, but how to accept yourself.)

Here's the link: http://www.breastcancer.org/tips/intimacy/self_image.jsp

See what you think. It makes sense to me. Nothing happens overnight, so be patient with yourself and give yourself time. If you are in a loving relationship, communicate with your partner. This is vital. I've heard women say that husbands have left their wives after their diagnosis. I say if that's the case, then there were more holes in the relationship than either was willing or able to see. Someone who truly loves you will stand by you and, in all likelihood, not view your body with the close scrutiny you give it.

Yes, there's no denying that this is not an easy thing. But one thing I can say for sure is that in time, you will come to accept that not only has your body changed, but your mind has changed, too, and it is my hope, for all of us, that the two will come together to form a strong bond of love and acceptance. I don't know if positive thinking really does kick your immune system into gear—there have been many conflicting messages about this—but you know what?

It absolutely, without a doubt, cannot hurt.

What is the secret for a great sex life

2009-04-01T07:55:00.000-07:00

Sheryl A. Kingsberg, PhD
A: Well, if I knew that I would be retired on a warm tropical island sipping rum drinks, reading trashy novels and sleeping on ironed sheets!

Seriously, though, there is no secret. And there is no simple, easy answer. Having a great sex life is inextricably tied to the person with whom you want to have such life. In other words, it requires a great relationship.

Now, let me be clear: You can have great sex without having a great relationship; but that's not what you asked me. You asked me about a great sex "life," which to me means maintaining a certain level of desire, having that desire satisfied regularly and being glad that the person who is satisfying that desire is the same person every time.

To have a relationship like that requires work and trust. One "secret" is for couples not to take each other for granted. or

Another "secret" to a great sex life is creativity. If you donÂ’t put some effort into changing things a little, even the most sensational activities become routine and, therefore, a bit stale and boring. It is well worth the minimal effort it takes to come up with and then act on new ways to express sensuality and sexuality with your partner. That might mean bringing some sex toys into the bedroom or having sex in a different environment (the powder room during a party; the study in your home; the backyard on a dark, moonless night). It could mean reading one another poetry while naked; watching an erotic video together; or sharing or role-playing your fantasies.

A male colleague suggested an analogy that he thought many men could understand. "A golfer might play the same course over and over. But every time he plays, it's different. The weather is different. The greens and the rough lie a different way.. Every time there are different challenges and different rewards. Sex should be the same."

Beyond the sex itself, having a great sexual relationship also means talking. Lots of talking. If you have young children, carve out alone time after they're in bed. Older children can make themselves scarce after dinner while you and your partner share your day over a final glass of wine. If you're angry about something, tell your partner; don't let the frustration simmer.

And be honest about what you like and don't like about sex. Do you love to be touched in one spot but cringe when touched in another? Do you want to have sex more often? Less often? Talk about it. Last I heard, there was no such thing as a true mind reader.

—Sheryl A. Kingsberg, PhD
Clinical psychologist and Associate professor
Departments of Reproductive Biology and Psychiatry
Case Western Reserve University School of Medicine
Cleveland, OH.

Let's Talk About Sex

2009-04-01T07:52:00.000-07:00

Do you have questions about sex? "Why don't I want it anymore?" "Why doesn't my partner want me?" "How can I spice up my sex life?" "Why does sex hurt when it never used to?" "How will my sex-life change as I age?" Relax. We're here to provide you with the information you need and the answers you crave so you can have a satisfying and enjoyable sex life at any age.

my OWN lack of interest in sex

2009-04-01T07:51:00.000-07:00

Hmm, where to start..

Well I'm 24 and I've been with my man for 2 years, we are both mature, serious and exclusive. We talk about our future and our lives together very often and we're deeply in love... so I don't think there are any underlying relationship issues going on.

BUT, I don't have a libido. I love him, he's wonderful, I want to be with him all the time... but I just very rarely get frisky. When he initiates I go along with it, but often half-heartedly. It upsets me because I don't want him to think I'm not attracted to him. We have talked about it many times, and he is okay with it, very understanding and he never pushes me.

When we do have sex, I often experience pain or discomfort, especially upon initial entry. We have tried to fix this by using lots of lube (have tried several different brands, water-based, oil-based, natural and synthetic) and that usually helps a bit, but not entirely. This MAY just be because of size, but I would think that after 2 years my body would have adjusted to it. After the initial challenge, I enjoy sex. Sometimes though, I feel like I've had enough sooner than I would have hoped, and I want to stop. Often before either of us have orgasmed. We've also tried watching porn together, haha... but that didn't really go over well, he found it to be a bit awkward.

I have had a couple conversations with my obgyn, and nothing really came of it, and all my PAPs have been normal.

SO... I don't know if my lack of interest in initiating sex is because my body is remembering the pain from last time and "shutting off" my libido so it doesn't have to do all that again... or if it's an emotional thing, or a cycle thing, or an imaginary thing... haha.

Any ideas?

Sexual Health Professional Posting Rules

2009-04-01T07:45:00.000-07:00

Any post that is created in this forum, must be done tastefully and professionally. For example, if you wouldn't feel 100% comfortable with talking in a certain manner, tone of voice, or using certain words with any health care professional, doctor, etc., than it should NOT be used here. This forum will continue to be open ONLY for sexual health related questions/ issues however any post/thread created here must be done PROFESSIONALLY and TASTEFULLY, with the same respect you would give to any other PROFESSIONAL that may feel uncomfortable with certain discussion. The moderators reserve the right to edit/delete any post that they feel may not be professional. Each member will get 3 strikes of this type of posting, on the third they will be banned. If you have any further questions, please feel free to pm a mod.

The Secret Language of Close Couples

2009-04-01T07:44:00.000-07:00

Why cutesy names and code words may be the key to supergluing your bond
Leslie Goldman

Lovey-dovey language—even your own—can be so corny it makes you want to puke. But researchers have found that it might actually serve a purpose: Pet names and code phrases pave the way to a playful, resilient, and satisfying relationship. One study on couples' "insider language" published in the Journal of Social and Personal Relationships reported that the more goofy names, made-up terms, and covert requests for nooky a couple used, the higher their relationship satisfaction tended to be.

The quantity of sweet or silly nothings you utter on any given day may be even more important than the quality, says Jamie Turndorf, Ph.D., a New York City relationship therapist. Studies have found that couples who maintain a five-to-one ratio of positive to negative communications are far more likely to remain happy. "Using nicknames and made-up language is an easy way to inject positive communication into everyday life," Turndorf says. In fact, it's probably the single easiest thing you can do to keep your relationship going strong.

Whether it's baby talk or coded conversation ("It's getting chilly." Translation: "Let's leave now."), the overall message is: The two of you are tight. "You are saying, symbolically, that you care enough about the other person and the relationship to develop your own way of speaking," says Carol Bruess, Ph.D., the director of family studies at the University of St. Thomas in St. Paul, Minnesota, and a co-author of Belly Button Fuzz and Bare-Chested Hugs: What Happy Couples Do. "You've got your own private world, your own mini culture."

The Meaning Behind a Moniker
Pet names also create a boundary, says Pat Love, co-author of How to Improve Your Marriage Without Talking About It. "It's a way to identify the relationship as exclusive," she says. "It's like an auditory marker." When people around you overhear your cutesy conversation, they know you're committed to each other.

The inside banter can also serve as a fast-forward button, says Lillian Glass, Ph.D., a communication and body-language expert based in Los Angeles. Sometimes, after a rough day at work, you just want to come home, flop onto the couch, and pop open a bottle of something smooth and red. How great is it when your partner knows that "the usual" is code for "My imbecile boss just wasted six hours of my life with mindless busy work and I'm really in a mood right now"? Statement, sentiment, and your current mental state all rolled into two words—no need to relive the whole disastrous day blow by blow.

Personalized lingo not only can bond a relationship—it can bail it out, too. University of Western Ontario psychology professor Lorne Campbell, Ph.D., has researched the use of humor during conflicts. In a study published in the journal Personal Relationships, Campbell found that when goofing around is used to help resolve disputes, it ultimately strengthens the relationship. Tossing in an inside joke during a would-be brawl not only relieves the tension, he says, but brings you back to the present.

Cementing Memories
It's no coincidence that new couples give each other nicknames that are sugary and food-related. Cupcake. Honeybun. Peaches. "Sweet is an unequivocally positive descriptor," Glass says. "You're comparing the other person with a treat—something special that you look forward to every time." As a relationship matures and trust builds, you may develop pet names that refer to a feature or personality trait of your partner (like calling your boyfriend Leo when his beard grows shaggy and out of control). That kind of "just between us" language drives home how well you know each other.

Every shared experience, Glass says, opens doors for more nicknames and inside jokes, which become earmarks for your most meaningful memories. Whether he calls you Rodeo, after the horseback-riding trip you took on your first anniversary, or you call him Speed Racer, for the time he drove 90 mph to get you to the airport on time, the names are a way of tracking your romantic history. "You have a word that signifies a time, a date, and a place, and it takes you back to that moment," Glass says.

Of course, for a nickname to work, both parties have to be happy with it. If it annoys you when your man calls you Stinky in memory of your bad bout with Indian food last fall, that's definitely not going to bring you any closer. "You're putting your trust in the other person to treat you in a safe and intimate way," Glass says. "Tread carefully."

The One Must-Say Phrase
What if you and your man would rather cut your tongues out than utter a ridiculous nickname? Don't worry; you're not doomed. Worse, Turndorf says, is a relationship in which "I love you" is hardly ever said. Still, she encourages couples to come up with as many catchphrases as they can stand. They don't have to be gooey and sweet—funny is fine. But one big red flag to watch for is if your partner stops calling you by your pet name, Love says. "It's like calling a naughty kid by his full name. It sends the signal 'I'm not being intimate with you anymore.'" When that happens, it's time to figure out what in your relationship needs fixing.

Bottom line: Having a shared language can only help strengthen the connection you feel with your partner. So swallow your pride and bring on the shmoopy.

Have a Coregasm

2009-04-01T07:42:00.001-07:00

After the urban myths recounting women reaching climax in the gym found their way to the Men’s Health idea dungeon, you could consider the coregasm a closed case. In no time, the MH staff set to work uncovering the mystery of reaching climax during core training--and just how many women were having this “issue.” Here's a breakdown of what they found.

What’s a coregasm?

When Men's Health editor Adam Campbell mentioned the coregasm in his blog, The Fitness Insider, the female feedback was astonishing. Women all over were experiencing this strange (but exhilarating) fitness phenomenon:

"Seems on my third set of 15 reps, if I crank out a few more reps and go to 20, well, yeah, I can have an orgasm!" one wrote. "And no one notices, trust me."

Another said it worked on a leg-lowering drill: "I have to be lying down and usually put a small towel or pillow under my lower back. I get the best “coregasm” when I lower my feet close to the floor."

How the heck...?

Victoria Zdrok, Ph.D., a sex therapist and author of The Anatomy of Pleasure, provided scientific insight.

"A lot of women require a buildup of tension in their legs before they can achieve the release of orgasm," she said. "So, when a woman exercises, the release of endorphins and dopamine, which are necessary for orgasm, combined with the tension in the lower extremities, can cause the clitoral stimulation" that is needed.

Joy Davidson, Ph.D., author of Fearless Sex, offered a fitness angle:

"When that happens, usually it's women who already have very strong pelvic muscles," she said. "And when they’re doing certain exercises that are tapping into the deep core or into the quads and inner thighs, what they wind up doing is almost automatically squeezing pelvic muscles in addition.

Davidson speculated that the tightening of core and leg muscles are "triggering the nerve impulses in the pelvic area. It's a little unusual to get that much response from one squeeze, but if you're doing multiple reps, you're squeezing your pelvic muscles over and over again.

How to have a coregasm (or at least your best bet):

Inspired from these accounts, we put together a list of WH-approved moves that may help you have your very own coregasm. We can't guarantee one--but at the very least you'll get nicer abs. Try these moves separately, or do the the whole coregasm workout.

Hanging straight leg raise

Hanging side crunches

Single leg plank

Arm pullover straight leg crunch

Medicine ball blast

But remember, good form counts! Debby Herbenick, Ph.D., the MH Bedroom Confidential columnist, gives this advice:

“I would emphasize, though, that as fun as [coregasms] are, women should always maintain proper form during physical exercise so that they don’t hurt themselves and so that they get the best physical benefits from exercise. If an orgasm “just happens” to occur while using good form, that may be an added bonus, but I would advise women not to pursue an orgasm at the expense of proper form. After all, they can always enjoy orgasms later on at home or in the shower.”

Go to The WH Coregasm Workout

More tips from coregasm vets

Kristin, a married 26-year old woman in Ontario who has fun with her leg-lowering exercise, says the number of reps she requires for coregasm is different every time.

But she also has an at-home trick: "The thing that sends me to the moon and back is when I use my vibrator at the same time. WOW! It totally vamps up the intensity."

Kali, a woman in Oklahoma, applied her gym training in bed. After discovering the coregasm while doing a hanging hold (like the top position of a chinup), she "held a leg and shoulder lift" during sex.

"It only intensified the pulsing," she reports. In the gym, she starts to reach orgasm after five repetitions of the hanging leg raise. “I’m just glad to know I'm not the only one with this side effect."

Another writer said she had to stop in mid-set during decline weighted crunches with her workout partner because of the intense feeling. "Funny," she adds, "this was before I ever even had sex in my life, so I didn’t know what the heck that feeling was!"

A female trainer told us, "Whenever I either do hanging leg raises or knee ups, I get the best 'coregasm' a girl could dream of. I'm guessing it happens due to activation of the Kegel muscles in conjunction with friction from moving your legs up and down."

Either way, she said, "I don't care why it happens, but just am happy it does."

The added benefit, noted one woman who also finds the exercise orgasmic: "What a great motivator to do hanging leg raises."

Have a coregasm tale of your own? Share it here!

No More Mr. Advice Guy

2009-04-01T07:40:00.000-07:00

He loved to play teacher. It drove her crazy. How one little lesson changed their relationship forever
Andy Raskin

Emily was a week into her first semester of an executive MBA program when she asked me to meet her for dinner at a restaurant near her apartment. She sounded anxious.

"Babe," she said on the phone, "I need you to explain an article in The Economist."

Part of me liked when she called me Babe. But part of me wondered if she really considered me special. We had been dating for only three months. Did she call all her boyfriends Babe, and I just happened to be the current one?

When I got to the restaurant, Emily flashed her green eyes and kissed me. Then she handed me the article her professor had assigned. It was titled "The Miracle of Trade," and was about a simplified world made up of only two countries and two commodities. The author explained how trade would benefit both countries, and Emily had no trouble following most of his argument.

"But there's this one part," she said, "where this guy is, like, speaking another language."

I already had an MBA, so Emily and I read through the article point by point. Emily understood the arbitrary exchange rate, so we moved on to a graph illustrating a consumption-possibility frontier.

"See how this country can trade to any point along this line," I said, "and it's clearly better off?"

Emily's jaw tightened.

"Do you see that?"

She didn't see it. She looked upset.

"What's wrong?"

"Forget it. Let's just talk about something else," she insisted.

We talked about Barack Obama. And I thought, "Oh no. Not again."

In Japan, there's a woman who still wakes up in the middle of the night hearing my voice. In her recurring nightmare, she's snowboarding down a steep mountainside in Hokkaido, the northernmost of Japan's four main islands. I'm about 50 yards in front of her, screaming, "Keep your eyes on the fall line!"

A San Francisco woman has a similar bad dream, except she's doing her best to balance on a Windsurfer. Her body smacks the water just after I say, "Lean back and trust the sail!"

Nearly every time I have tried to teach something to a woman I am dating, it has ended badly. I've inadvertently instigated fights--even breakups--while showing girlfriends how to cook, how to bowl, how to interpret the work of the Japanese writer Haruki Murakami.

Apparently I am not alone. My friend Nancy's divorce began with her on the receiving end of a bad snorkeling lesson. On GolfWRX.com, a user named FlyFish writes, "Teaching your girlfriend to golf is like teaching her to drive--you don't go there if you value your relationship."

Nevertheless, I couldn't resist the chance to help Emily when she asked me to explain the article. And after she rebuffed me, I became obsessed with finding a way to make the article easier for her to understand. I thought about it for days. Then it finally hit me: Substitute dollars for one commodity! I told Emily over the phone about the breakthrough, but she wasn't interested.

"I think I'm going to ask the teaching assistant for help," she said.

She might as well have informed me that she was madly in love with the teaching assistant, that he was better than me in bed, and that she was running away with him to Paris.

My mother called.

"So, how's it going with Emily?"

"Fine."

"What's wrong?"

I told her the story of what had happened and said I had developed a theory: It's impossible to teach anything to someone you're involved with.

"Well, I think Lew taught his wife to play bridge," my mother said.

She was talking about an old family friend, Lew Smoler. (Say his name three times fast. I am not making this up: Lew Smoler is a dentist.)

"Lew also taught his daughter-in-law how to drive a stick," my mother continued. "His son tried to teach her, but it was a complete disaster. Let me talk to Lew and find out his secret."

A daughter-in-law isn't the same as a girlfriend, but it was no use trying to stop my mother when she was on a mission. She e-mailed me the next day.

"Spoke to Lew. Before the lesson, he asked his daughter-in-law what scared her most about driving a stick. You know what it was? That other drivers would get annoyed and honk. So Lew put signs all over the car announcing she was learning. When they got on the road, drivers all around cheered her on."

Emily and I were in bed when I decided to ask her.

"What scares you the most about studying economics?"

She rolled her eyes. "Do we really have to talk about this?"

"Please?"

"OK. What scares me most? You do."

I didn't expect that.

"When I don't understand something, it's like you go into this bizarre teacher mode. Your voice changes. You get all serious. Then I feel like some random student, not your girlfriend."

"Like you're not special?"

"Exactly," she said. "Can we talk about this tomorrow?"

"OK."

"Turn out the light, Babe."

I wasn't sure if I should tell her. But then I did anyway.

"Part of me doesn't like when you call me Babe," I said.

"What?"

"It makes me feel like maybe there's always a Babe, and I'm just the current one," I explained.

"It's a term of affection," she said.

"I know."

"It makes me feel connected to you."

"I know."

Before falling asleep, I realized that I had a fantasy. In my fantasy, I taught Emily about trade theory and she understood it so well that she explained it to her whole class. In my fantasy, she went on to point out to her professor how the Economist article failed to account for switching costs and social externalities. In my fantasy, her professor stared at her in awe, and that's when Emily finally knew that I was special.

Emily called the next night and asked me to drive her to our favorite sushi bar. In the middle of the meal, she reached into her bag and pulled out a textbook titled Microeconomics.

"What are you doing?"

She opened the book to a page she had marked with a Post-it. Then she looked at me with those green eyes.

"I need help with price controls, Andy," she said.

I felt so special that I didn't have to think about what to say next.

"Babe, let's start with the consumer surplus," I offered.

A dimple formed on Emily's right cheek. I could tell that she no longer felt like some random student. The next semester she asked me for help with the interest expense on a 10-year coupon bond, and we fell very much in love.

Andy Raskin's new memoir, The Ramen King and I: How the Inventor of Instant Noodles Fixed My Love Life, is due out in May by Gotham Books.

Should You Shack Up

2009-04-01T07:37:00.000-07:00

Consider the pros and cons before you reserve the moving van
Lisa Ann Smith

If you've never split rent with a beau, chances are good you will: According to the CDC's National Center for Health Statistics, half of all women under 45 have lived in sin at some point in their lives. But research has shown that moving in sans wedding rings can sabotage long-term love. Couples who share an address before they get married have slightly higher odds of getting divorced. So how do you know if the timing is right? Ask yourself these four questions:

Are you willing to wait?
Unless you've already discussed a wedding date, don't assume that moving in together will make picking out china patterns and sending out invites happen any sooner. In fact, according to a report from Rutgers University, only 40 percent of couples were married after living together for five to seven years. So if marriage is on your agenda, talk about it. Uncomfortable bringing it up? Beware. "Intense anxiety about whether he'll pop the question can signal underlying concerns about his commitment to you," says Judith Sills, Ph.D., author of The Comfort Trap. Until that anxiety fades, keep your own pad.

How's his credit rating?
Though it can be one of those prickly chats, the who-pays-for-what conversation needs to happen before you cosign a lease, says Adriane G. Berg, author of Financial Planning for Couples. Disclose your respective salaries and debts, then make a plan for divvying up the bills. Berg suggests using a proportional system (for example, if you earn 30 percent more than your man, you pay 30 percent more of the rent) rather than trying to split everything down the middle.

Are you ready to rumble?
Don't be afraid to end the honeymoon phase by hammering out your differences. It will help you gain a deeper understanding of each other, Berg says, and build a stronger relationship in the process. While some experts recommend keeping a gratitude journal, Berg advises tracking fights. Jot down when you and your man fought, what you fought about, and the outcome. It can help you recognize patterns and identify serious issues. Keep in mind, Berg says, that the entries are learning tools, not ammunition for the next round.

Do you own a blindfold?
You may discover that cohabitating actually results in less quality time. And when you do hit the couch together, there's nothing sexy about it (Babe, are you sitting on the remote?). An easy fix, says WH advisor Yvonne K. Fulbright, Ph.D., is scheduling romance from the get-go. "Decide on a weekly date night before you finish unpacking your boxes," she says. And don't be shy about trying new seduction techniques. Surprise him with breakfast in bed--wearing just an apron.

Crush Control

2009-04-01T07:36:00.000-07:00

He's on your mind at the office, the gym, even in bed--but he's not your boyfriend or husband. What you need is crush control.
Jill Provost

Right after moving in with her boyfriend of three years, Kim, a 31-year-old Web designer In New York City, strolled Into a meeting with a new coworker and felt like she'd been hit by a truck. His intense eyes, his warm voice, his muscular forearms... Kim,* who'd been bored and frustrated at work for months, suddenly felt exhilarated. But right behind that thrill came a wave of guilt: How could she feel this way when she was in love with her significant other? "I hadn't said or done one inappropriate thing," Kim says, "and yet I already felt panicked."

What Kim was experiencing, and what we all go through when a killer crush comes along, is a seismic shift in brain chemistry, says Helen Fisher, Ph.D., a research professor of anthropology at Rutgers University and the author of Why Him? Why Her? Finding Real Love by Understanding Your Personality Type. Ten years ago, Fisher began mapping the brain activity of people overwhelmed by a new and powerful attraction and found that the early stages of romantic love make you feel higher than James Franco in Pineapple Express. The brain unleashes large amounts of dopamine, which can lead to extreme energy, euphoria, and obsessive thinking. "Crushing on a guy you work with or see regularly is like being a chocoholic with a piece of chocolate cake always in front of you," Fisher says.

That's one dangerous slice of cake, says Jackie Black, Ph.D., a Los Angeles relationship coach and the author of Meeting Your Match. "Indulging those feelings--even by fantasizing or flirting casually--is a kind of betrayal," she says. But that doesn't mean it can't be helpful and educational, says Mira Kirshenbaum, Ph.D., clinical director of the Chestnut Hill Institute in Boston and the author of When Good People Have Affairs. Kirshenbaum views crushes not as red flags but as golden opportunities--provided you don't act on them. "They're life's way of telling you that you're missing something you need to feel fully satisfied," she says.

A 2008 study at McGill University backs up Kirshenbaum's theory: Researchers found that when tempted to stray, attached women actually work harder to improve their current relationship. So the next time you find yourself suddenly obsessed with a hot barista or your foxy accountant, don't just bury your feelings and pretend they never existed. Delve into some fascinating self-revelation instead.

Man of the Moment
When crushing on a guy, Kirshenbaum says, the first question to ask yourself is "Why now?" Crushes often pop up when we're bracing ourselves against change. "They're a sign that you need to assess what's going on--real or imagined--in your life, and start sorting things out," Kirshenbaum says.

Although it seemed to Kim as if her crush had materialized out of thin air, it wasn't a coincidence that it happened just after she and her guy had moved in together and while she was feeling dissatisfied with her career. Over the past year, her relationship had gone from thrilling to ho-hum, and sharing an address didn't spice things up the way she had hoped. "I had nothing to look forward to at work or when I came home," Kim says. "Everything kind of sucked at once." She started distancing herself from her man and cozied up to her crush at an after-work happy hour.

Tara,* a 33-year-old massage therapist in Worcester, Massachusetts, was newly hitched when she developed a crush on her charismatic and outrageously flirty trainer. "I was so happy to be married, but also freaking out about it," Tara says. "I thought I'd never be able to flirt again." She was afraid her wife status had robbed her of her mojo, says psychologist Bernard Katz, Ph.D., a co-author of Actually, It Is Your Parents' Fault. It makes perfect sense that she liked a guy who flirted with everyone, Katz says. He exuded sexual confidence, something Tara was afraid of losing.

"Crushes are often a mid-crisis coping mechanism," says couples and family therapist B. Janet Hibbs, Ph.D., co-author of Try to See It My Way: Being Fair in Love and Marriage. "Life isn't easy, and we often believe that if our partner really loved us he'd make everything OK, because in the romantic phase of the relationship he seemed to. But you have to learn to have realistic expectations." Kim and Tara were having mini crises, Hibbs says, and were looking to other men for solutions.

Penis Trauma

2009-04-01T07:35:00.000-07:00

Keep your man's member out of the ER
Naomi Piercey

Hospital drama Grey's Anatomy never disappoints with their very inventive and unusual emergencies. We were just waiting for someone's penis to get broken.

And indeed, as you may have seen on the Jan. 22, 2009 episode, who but promiscuous McSteamy (played by Eric Dane) would find himself in this kind of coitus calamity?

Were you suspicious that this was just a new way for ABC to reel in gullible viewers? Yvonne Fulbright, President & CEO of Sexuality Source, Inc. and author of Pleasuring: The Secrets to Sexual Satisfaction, says that although rare, "breaking a penis" is certainly possible.

"It happens when a penis is erect and thrust against an object that's harder and less flexible," says Fulbright. "This can include plunging deeply into a partner with a great deal of vigor and railing against the pubic bone."

A penis has two chambers of sponge called the corpora cavernosa. The thick membrane that surrounds this erectile tissue can tear when there’s a powerful thrust. The result? A "cracking" sound, an immediate loss of erection, and probably a loud cry of pain coming from the unfortunate owner of the now "fractured" penis. Pain and a great deal of bruising may follow.

"The penis may be 'bent' to one side or the other," says Fulbright. "In major cases, his urethra can be damaged, which affects his ability to urinate."

Who’s at risk? Again, the old mantra holds true: it’s more about the (over-zealous) motion of the ocean than the size of the ship.

"It can happen to any guy since it's been known to happen during masturbation--thrusting against a pillow and ramming himself into whatever is underneath," Fulbright says.

Your best bet is to get to your man to the doctor as soon as he can stop crying long enough to get in the car. A doctor will evaluate the damage and depending on the extent of the fracture, prescribe a course of action for treatment.

Unleash Your Inner Sex Goddess

2009-04-01T06:36:00.000-07:00

We sent one reporter—and closet prude—to get an erotic education. Here, she happily shares her spine-tingling discoveries.
Sarah Miller

Decorated in optimistic tones of pink and yellow, the Seattle branch of the sex-shop chain Babeland brings to mind a stylish girl's kitchen, where she cooks up not food but hot orgasms. I'm here to take the store's "sex educator" employee training, and I'm feeling resistant. The truth is, I've never set foot in a sex shop.

My supervisor for the two-day training is Babeland's sex-education coordinator, Audrey McManus. She's a veritable sunflower of a woman, but facing me, she clouds over.

"You write about sex, and you've never been in a sex shop? Isn't that, like, part of your job?"

"Look, Audrey," I say. "I know where my clitoris is, and with all due respect, I can probably find yours as well."

I indicate a lacquer tray with a couple of boomerang-shaped vibrators designed to stimulate the G-spot. They're pretty and colorful, but I'm almost sure I don't have a G-spot, and I don't care. I pick up a Rabbit. (The Rabbit, in case you missed the famous Sex and the City episode, is a vibrator with a rotating head for penetration and wiggling attachments for clitoral stimulation.) "I mean, if you taught this thing how to operate a cash register, it could work here."

Audrey blinks at me. She doesn't think I'm cute or funny. She picks up a toy large enough to bludgeon a school of hammerhead sharks and, like a dirty schoolmarm, smacks it against her hand. "Now, let's get started with a little anatomy lesson."

I'm corralled into a tiny office with some Georgia O'Keeffe stuff on the walls, some Asian erotic whatnot. "That's a 16th-century Japanese woodblock print depicting female ejaculation," Audrey explains. I'm relieved all I see is a walrus lying in bed brushing his teeth. Audrey pins up a diagram of a vagina. I'm expecting "Here's where you pee out of, here's where you do it," but this has so many lines and zones it looks more like a map of the Chesapeake Bay. I dutifully point out the clitoris and the G-spot. She starts talking about how I said I don't have one. "I think you probably do," she says. She points out the urethra—the tube in front of the vaginal opening where urine exits the body. "This entire passageway is wrapped with erectile tissue," she says. "People make the mistake of looking for only the G-spot—when it's not just a spot but part of a whole sensitive area. And sometimes that area—the lower part of the front wall of the vagina—needs to be stroked before you can even find the G-spot."

Audrey pauses. "Are you blushing?"

"Of course not," I say. "I did not know that."

I get a brief smile, for humility, I guess. "Now we're moving on to lube," Audrey says.

I am about to tell Audrey that I am afraid that even touching lube will bring on early menopause. And that so far, I don't have any, uh, problems, when—splat—I've been slimed. "Rub your fingers together," Audrey says. The entire Babeland staff has gathered around, each eager to show me a favorite brand of lube. Status likes Maximus. "It's nice and thick," he says. Audrey is partial to Sliquid Silk, a water-based lube. "Doesn't that feel like your own natural wetness? Taste it," she says.

The Rise in Newlywed Cheating

2009-04-01T06:35:00.000-07:00

Crazy as it sounds, some men are straying shortly after uttering their wedding vows. We look at what's behind this troubling trend and tell you how you can cheat-proof your love
Jennifer Benjamin

"I thought I'd gotten other women out of my system, but after a year-long engagement, and then a year of marriage, I was cheating again." To hear John, * 28, a pharmaceutical rep from New Jersey, talk about straying so soon after tying the knot, you might assume he's a heartless, hormone-fueled aberration. In reality, he's part of a growing trend: newlyweds who cheat.

"As surprising as it is, infidelity is very common during the first year of marriage," says Bonnie Eaker Weil, Ph.D., author of Adultery: The Forgivable Sin. Last year, researchers at the University of Washington Center for the Study of Health and Risk Behaviors who analyzed data on infidelity taken from the General Social Survey found that roughly 20 percent of men and 15 percent of women under age 35 copped to cheating on their spouses in 2006 (the latest figures available), up from 15 and 12 percent, respectively, 15 years earlier.

What gives? Part of the problem, says David Popenoe, Ph.D., founder and codirector of the National Marriage Project at Rutgers University, is that we've become an anything-goes society, in which the indiscretions of politicians, sports figures, and pop celebrities are practically daily news.

Also, "newlyweds have this sense about cheating that if you're going to do it, do it now," says M. Gary Neuman, an infidelity expert and author of The Truth About Cheating. "Men may feel that if the marriage was a mistake, it's better to figure it out before things get even more entangled with kids and families." And no doubt while their wives are least likely to be suspicious. But there are ways to protect your young marriage. The key is to be proactive—don't assume that uttering "I do" ensures fidelity. Here are the top reasons experts say newlywed men stray, and how you can take action to make sure your guy doesn't.

Reason No. 1
You've played house for years
Time was, being a newlywed meant finally getting to share a roof. Not so today. More couples than ever are shacking up—6.4 million in 2007, compared with fewer than 1 million 30 years ago, according to the Census Bureau. Add the time you've lived together to the average 17-month engagement, and it's a good bet the attraction is less electric by the time you walk down the aisle.

Research shows that infidelity rates are much higher among cohabiting couples than married folks who don't live together first. One possible reason: "Often, a couple that decides to live together isn't as committed," Popenoe says. And if that's the attitude, he adds, it doesn't necessarily change just because you get married. The possible result: In fairly short order, one of you—most likely him—is on the prowl.

How to cheat-proof your love If you do decide to live together, Popenoe says, don't use it as a trial for marriage. That mindset "is almost the opposite of the one you need to have if you want a long-term commitment: Let's see if this works, and if it doesn't we can get out easily." If your guy's got a history of serial monogamy, the risk escalates: "After a whole series of relationships like that, it's very difficult to jump into one where you've got to work everything out and can't run away," Popenoe says. And if a guy feels trapped, an affair can seem like an easy way out.

Reason No. 2
The web makes cheating easy
It's simpler than ever to find an affair online—and the people searching for one are not always those you'd suspect. Of the 3.3 million users of AshleyMadison.com, a dating site that unapologetically caters to married people looking to stray, about 500,000 are newlyweds, according to the site's president, Noel Biderman.

Even if a person doesn't go online specifically to troll for a dalliance, the very nature of the Internet can be the start of a slippery slope toward infidelity. First, there's the easy access to pornography: The University of Washington data found that men under age 35 were two and a quarter times more likely to have cheated if they had seen an X-rated movie. "Consumption of pornography might lead to increases in specific types of sexual behaviors, including anonymous sex," says James Furrow, Ph.D., a co-author of the study and the Freed chair of marital and family therapy at the Fuller Theological Seminary School of Psychology.

Then there are sites like Facebook, where anyone from exes to one-night stands can find you. What starts as innocent e-flirting (which 20 percent of adults who used social-networking sites in 2008 admitted to in a study by the Pew Internet and American Life Project) can quickly get out of hand.

Mark, 28, a financial analyst from Connecticut, began using online dating sites when he was single and hasn't stopped, even though he got married in 2004. At first he just chatted online, but eventually he started arranging dates in cities he traveled to for work. He had his first fling within 16 months of his wedding and has racked up four more since then—none with anyone from his hometown. "The feeling of having e-mails from women across the country in your inbox is exciting," he admits.

How to cheat-proof your love Not every guy with an e-mail account is going to stray, and checking your man's browser history will only show you don't trust him. It's important to remember that most men who use the Internet to have an affair are looking for sex, not intimacy, says Mary Jo Rapini, a psychotherapist at Methodist Hospital in Houston who specializes in sex and intimacy issues. Given that, Rapini advises circumventing the temptation by watching a steamy flick or even some light porn with your hubby. "You're taking away the sneaking-around element and instead enjoying it together," she says. "And that usually ends up turning you both on."