Sexual Concerns

• The use of any substance that alters the sexual response. These include some medications including some anti-depressants, drugs, alcohol and/or smoking. For example, some anti-depressants may lead to impotence or failure to achieve orgasm.

• Surgery. For example, prostate surgery can result in impotence.

• Injuries, such as ones that cause damage to nerves used in the sexual response or that result in scar tissue that interferes with sensations felt during sex.

Treatment

A medical evaluation is the first step. It can determine if physical conditions, medications, etc. are the cause of the problem(s). A physical exam and certain tests can be done. These include:

• Hormonal studies

• Ones that check for neurological problems

• Ones that measure the flow of blood and the conditions of the veins and arteries in the penis

• Blood and urine tests to detect diabetes, urinary tract infections, etc.

• X-rays and/or ultrasound, if needed, which can help detect endometriosis, vaginal scar tissue, ovarian tumors, etc. in women

When a physical condition is found that causes the sexual concern or problem, treating it can get rid of or help with the problem. For example, several treatments exist for impotence. These include:

• Oral medications, such as Viagra, Levitra, and Cialis

• Special vacuum devices

• Self-injections of a prescription medicine and penile implant surgery for men

If no physical condition is found to be at fault, measures to deal with psychological causes can help. These include therapies of many kinds:

• Individual counseling

• Counseling with both partners

• Sex therapy

Questions to Ask

Men Only

Question 1

Does impotence occur with any of the following?

• Prostate surgery

• Medication for: High blood pressure; Allergies (antihistamines); Depression; Anxiety; Muscle relaxation; Any other prescriptions or over-the-counter medicines

• Drugs, such as cocaine. Excessive use of alcohol.

• Cigarette smoking

You should be seen by your doctor for medical advice. Contact your doctor or health care provider to find out how soon you should be seen.

Question 2

Does impotence occur with one or more of these problems?

• An urge to urinate right away or the need to urinate often, especially at night

• Not being able to empty the bladder completely

• A feeling of hesitancy or delay or straining to urinate

• A weak or interrupted urinary stream

You should be seen by your doctor for medical advice. Contact your doctor or health care provider to find out how soon you should be seen.

Question 3

Does impotence occur with diabetes or the following signs of diabetes?

• Constant or frequent urination

• Extreme thirst or unusual hunger. Weight loss or gain.

• Fatigue. Irritability.

• Slow healing of cuts or wounds, especially on the feet

You should be seen by your doctor for medical advice. Contact your doctor or health care provider to find out how soon you should be seen.

Question 4

Are any of these problems present?

• Pain in the penis during intercourse

• Sustained erection that is painful

• Sores and/or painful blisters on the genital area and/or anus

• A discharge of pus from the penis

• Pain and swelling in the scrotum

You should be seen by your doctor for medical advice. Contact your doctor or health care provider to find out how soon you should be seen.

Question 5

Do one or both of the following cause a great deal of distress?

• Not being able to sustain an adequate erection

• Ejaculation that comes too soon

See your mental health counselor, if you have one. If not, call your doctor for a referral. You will get advice on what to do.

Use Self-Help:

You can probably take care of the problem yourself if you answered NO to all the questions. Use the “Self-Help” measures that are listed.

Women Only

Question 1

Is intercourse very painful with or without any of the following?

• Heavy, painful periods. A yellowish-green vaginal discharge.

• Chronic pain in the abdomen or a dull and constant ache on either or both sides of your pelvis

• Abnormal bleeding from the vagina. Itching and burning around the vagina.

• A large, painless ulcer-like sore (chancre) or painful blisters in the genital area, anus or mouth

You should be seen by your doctor for medical advice. Contact your doctor or health care provider to find out how soon you should be seen.

Question 2

Has sex been painful and less pleasurable since having an intrauterine contraceptive device (IUD) inserted?

You should be seen by your doctor for medical advice. Contact your doctor or health care provider to find out how soon you should be seen.

Question 3

Is there a great deal of distress due to an ongoing problem of not being able to allow anything to penetrate the vagina?

You should be seen by your doctor or counselor. Contact your doctor, counselor or health care provider to find out how soon you should be seen.

Use Self-Help:

You can probably take care of the problem yourself if you answered NO to all the questions. Use the “Self-Help” measures that are listed.

Men & Women

Question 1

Does it hurt to have sex and are any of these problems present?

• The urge to go to the bathroom badly or passing urine a lot more often than usual. Burning or stinging feeling when passing urine.

• The feeling that the bladder is still full after voiding

• Bad smelling urine. Bloody or cloudy urine.

• Pain in the abdomen or over the bladder. Stomachaches or feeling like throwing up.

You should be seen by your doctor for medical advice. Contact your doctor or health care provider to find out how soon you should be seen.

Question 2

Do you have symptoms of “Anxiety” and/or “Depression”?

You should be seen by your doctor or counselor. Contact your doctor, counselor or health care provider to find out how soon you should be seen.

Question 3

Do any of the following cause a great deal of distress?

• Little or no desire for sex

• Disgust with having sex or even thinking about it

• Failure to get aroused before sex and/or the inability to stay aroused until the sex act is completed

• Delay or absence of orgasm

See your mental health counselor, if you have one. If not, call your doctor for a referral. You will get advice on what to do.

Use Self-Help:

You can probably take care of the problem yourself if you answered NO to all the questions. Use the “Self-Help” measures that are listed.

Self-Help

• Follow your doctor’s advice for a chronic illness, if you have one, to help prevent possible problems with sexual satisfaction.

• Practice safe sex to prevent sexually transmitted diseases.

• Limit alcohol and other drugs. A little alcohol can act as an aphrodisiac. Too much, however, can lead to unsafe sex, an inability to become aroused, violent behavior, etc.

The following things can help enhance the desire for sex. This is especially important for couples who both work outside the home and also have children. By the time they get into bed each night, sex seems like too much bother.

• Make a point to spend at least 15 minutes of uninterrupted time with your partner each day. If you can’t meet face to face, call each other on the telephone.

• Remember to express your affection for each other every day.

• Plan to spend part of a day alone together at least once a week. Make a date to take a walk in the park, go out for dinner or share other activities you both enjoy.

• Schedule a weekend away together every two months or so.

• Go to bed together at the same time. Tell yourself that what you haven’t accomplished by 11:00 p.m. can wait until the next day.

• Relax by giving each other a massage or taking a shower together.

• Keep the television out of the bedroom. Watching TV can be sexual suicide.

Don’t worry if your sexual encounters occasionally fail. Fatigue and stress are known to cause temporary impotence, a decrease in vaginal lubrication or the inability to have an orgasm. Don’t let yourselves become preoccupied with performance; just take pleasure in being together. Enjoy hugging, kissing and caressing.

For Premature Ejaculation

• The squeeze technique. If a man feels he’s about to ejaculate prematurely, he firmly pinches the penis directly below the head using the thumb and first two fingers of one hand and squeezes for 3 to 4 seconds.

• The start/stop method. The couple should abstain from intercourse for two weeks, but focus on touching. The man concentrates on the sensations in his penis as his partner touches his genitals and brings him to an erection. The man asks his partner to stop just before ejaculation. After a few minutes, his partner continues to arouse him, then stops again. This sequence is repeated two more times with ejaculation occurring the fourth time. Then each time the couple has sex, foreplay is prolonged.

For Lack of Sexual Response in Women

Couples can practice certain techniques to address sexual unresponsiveness in a woman. A few simple methods follow:

• For the first week, limit lovemaking to cuddling, kissing and nuzzling. Don’t touch the genitals or breasts.

• During the second week, the partner should gently touch the female’s vaginal area during lovemaking, but stop before she reaches orgasm to increase vaginal lubrication.

• During the third week, repeat the first two phases, then proceed with intercourse. If the vagina isn’t adequately lubricated, apply a water-soluble lubricant, such as K-Y Jelly to the penis to facilitate penetration. (Penetration may also be easier if the woman is on top.)

If a tight vaginal opening still makes penetration painful or impossible, the following exercise may help:

• The woman should gently place the tip of her partner’s little finger against her vagina and gently push his finger into her vagina. If this feels uncomfortable, she should stop and wait a few minutes.

• The couple should continue this exercise until the partner can insert two fingers in their partner’s vagina without causing pain or discomfort. (It may take several attempts over a period of weeks for this technique to work.)

(Note: The above techniques do not guarantee success. If they do not help improve your sexual concerns, consider professional help from a sex therapist.)

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