Balancing Sexual Passion In A Relationship
relationship can get muddled and off-kilter when a couple allows one
aspect (most often, the physical) to get far ahead of the other aspects! In
any loving relationship, individuals need to maintain rational thinking
and clear mindedness all throughout the dating experience. This means
they must approach the issue of sexuality with utmost caution and
The best relationships involve two people who have worked hard to let
the emotional, intellectual, spiritual, and physical aspects of their
union develop at the same pace. Therefore, it's important to think
through a few principles of physical passion before you find yourself in
a serious relationship.
love always involves strong physical attraction.
If a couple
genuinely loves each other, they will want to hug, kiss, and express
themselves sexually. These desires are a fundamental part of
everyone’s biological and psychological makeup. In fact, if you
don’t feel your partner’s strong physical desire to be close to you,
a crucial element may be missing. A lack of affection or desire for
physical intimacy should raise a red flag in your mind.
is a progression to the way sexuality is expressed.
Think of it as a chain reaction: sexual
behavior moves from the simplest kind of expression (say, touching your
partner's shoulder) to the fullest kind of expression. So the critical
question becomes, how far along the chain can you go and still maintain
full control of your sexual expression?
progression of physical activity establishes a new plateau—and it is
extremely difficult to retreat once it has been reached.
level of sexual experience is so immediately gratifying that it’s
nearly impossible to be satisfied by previous levels. That’s why every
new step of sexual expression must be carefully decided upon by both
people. This may sound too rigid to many because it runs counter to the
popular thinking in our society. But if sexual expression is allowed
complete freedom, and if spontaneity is treated as a primary virtue,
this expression will develop “a mind of its own,” without any
concern for long-term consequences.
involvement must be managed with extreme care.
defined boundaries need to be agreed upon, and there must be
self-discipline to stay within those limits. Otherwise, sexual
expression can take control of the relationship and blind the couple to
reality. When sexual expression is not kept in check, the
emotional, cognitive, and spiritual aspects of the relationship become
slaves to the physical desires. Let us say it again: Physical attraction
is critical, but it needs to develop in a coordinated way with the other
aspects of the relationship.
Issues: 4 Must-Tackle Topics That May Scare You
From your physical connection to the
"exclusivity" status of a relationship, learn how to broach
even the most sensitive subjects with ease! Intimacy. One little word
that can intimidate even the savviest single. And, when it comes to
addressing intimacy issues with a partner that can be even more
fear-inducing. Instead of shying away from the subject, however,
you’re better off tackling the tough topics head-on. What follows are
four common intimacy issues you may be scared to address, as well as
some strategies to help you broach any subject with ease.
let’s define what intimacy actually is. Contrary to popular belief,
intimacy is NOT purely physical. You don’t have to be sexually
involved with someone to be intimate with them. Instead, intimacy is a
connection that builds between two people over time. Emotional
closeness, spiritual trust, and physical connectedness all play a role
in creating intimacy. With that working definition, let’s move on to
the four must-tackle intimacy issues you may be afraid to face.
Issue #1: How to define and pace your physical relationship
intimacy is not solely a sexual issue, physical connection does play a
role. And when you meet and start dating someone new, addressing the
“how much, how soon” topic can be intimidating. While you may be
fearful about expressing your needs to take things physically slow,
it’s essential to your relationship success that you express your
desires up front and keep the lines of communication open. This will cut
down on misunderstandings and unnecessary relationship drama. So how do
you broach the subject? First, find a comfortable and safe environment.
Next, put your potential partner at ease by letting them know how much
you value them. Then, take a deep breath, summon your inner strength,
and communicate your needs. Your partner will most likely thank you for
being up front and honest. In fact, by having this difficult discussion,
you may deepen the level of intimacy between you.
Issue #2: How to communicate your emotional needs
as it’s important to be open and honest about your physical needs,
it’s equally essential in an intimate relationship to communicate your
emotional needs. By consistently expressing your feelings and needs in
healthy ways, you give your potential partner a window into your
emotional well being. If they respond favorably, working to meet your
needs as well as expressing their own, you’re well on your way to
building a solid foundation of intimacy. Or, if they seem unwilling to
meet you half way, uninterested in hearing your needs, or unable to
express their own wants and needs, you’re now armed with the
information you need to decide if you’d like to work on the
relationship or cut your losses and move on.
Issue #3: How to build and maintain trust
key ingredient in any healthy intimate relationship is trust. Again,
this builds over time. Therefore, give yourself and your potential
partner permission to tread softly at first in the trust department.
Reveal yourselves slowly and carefully, paying attention to the other
person’s words and actions. As you reveal yourself, how does it feel?
Safe and comfortable? Excellent! Keep going. If and when red flags
reveal themselves or you begin to feel unsafe or uncomfortable, stop.
Reassess the situation. Proceed with caution until you have a clearer
understanding of whether to continue building trust with this person or
protect your heart and walk away.
Issue #4: How to talk about exclusivity
of the most difficult intimacy issues to discuss in any new relationship
is the subject of exclusivity. Are we or aren’t we? How soon is too
soon? Is it safe to discuss or not? Instead of letting fear keep you
from broaching the subject, summon your inner strength and when the time
is right, talk about it. For example, a first date is most likely too
soon to talk about being exclusive. However, if you’ve been spending a
significant amount of time together, are starting to talk about the
future, and are engaged in a deepening physical relationship, chances
are good that it’s time for a heart to heart about becoming exclusive
with one another. Again, by taking a risk and addressing this important
issue, your partner will most likely appreciate your courage. In return,
your intimacy will deepen.
intimacy is something that builds over time. In any romantic
relationship, it’s important to take things slow, communicate your
needs while working to meet the other person’s needs, and build a
level of trust you’re both comfortable with. When in doubt, refer to
the issues and strategies above. Above all else, trust your gut and
proper way to be friends with benefits
-- There are times in every woman's life where her body wants either
what her heart can't handle or her brain knows better.
know the drill -- you want a man, but not a relationship. Or, more to
the point, you want some loving, but don't want the strings attached.
you're wildly attracted to a dude physically, but find him mentally or
morally lacking -- like a tanning technician or a bounty hunter.
no way you'd ever date him, but why should you deny yourself entirely?
Not a reason in the world.
a long-term, friends-with-benefits type situation can be tricky for us
Dudes are seemingly
born knowing how to detract emotions from physical activity. In fact,
with many of them, I think it's their default setting. They can spend
the night with a woman and then meander off into the sunset without
giving the assignation a second thought.
But women can have a
harder time of it. We worry that we're being "used" (hello?
Pot meet Kettle!) or feel like we're being promiscuous -- talk about a
The trick is to
accept what you've got with this person and avoid trying to make it
something it'll never be. I've certainly been guilty of trying to turn a
completely fine FWB into a BF, and the results were predictably
So here are some
pitfalls to avoid:
Yes, it helps if he speaks a foreign language you don't understand,
but that's not what I'm talking about. Pronouns like us or we are to
be avoided like an open sore and all talk of plans further into the
future than an hour or two away is verboten.
Acceptable FWB dining situations include shared bowls of cocktail
peanuts, late-night grilled cheese sandwiches, and fancy desserts.
Meals to be avoided are breakfast, brunch, dinner, with a special
get-out-of-jail free card for lunch.
Questions any more probing than "what are you wearing?"
and "when can we meet?" can get a little sticky. Your FWB
doesn't want to hear about your crazy mom and you really don't want
him to start yapping about his Ayn Rand fixation. Keep it light,
keep it moving.
He doesn't meet your friends, you don't meet his. That goes double
for family members. The best thing about having a FWB is that he's
your dirty little secret.
I remember being out
with a girlfriend and running into the French-Canadian model I was
spending my nights with at the time. He kissed me hello as my friend's
jaw dropped down three flights of stairs. Blushing, I introduced him to
my buddy who was still having trouble recovering her powers of speech.
As he walked away, she punched me. Hard. "Shut up!" she
yelled. I just smiled.
On second thought, if
he's that hot you might want to bring him around just for a drive-by.
Mayo Foundation for Medical Education and Research (MFMER).
Has your sex life lost some of its spark because your
body feels unresponsive or you're just not interested? You might take
comfort in knowing that as many as 4 in 10 women have the same
problem at some point in their lives.
If you have persistent or recurrent problems with
sexual response — and if these problems are making you distressed or
straining your relationship with your partner — what you're
experiencing is known medically as female sexual dysfunction.
Female sexual dysfunction has many possible symptoms and causes.
Fortunately, they're almost all treatable. Communicating your concerns
and understanding your anatomy and your body's normal response to sexual
activity are important steps toward gaining sexual satisfaction.
can develop female sexual dysfunction at any age, but sexual problems
are most common when your hormones are in flux — for example, when
you've just had a baby or when you're making
the transition into menopause. Sexual concerns may also occur with major
illness, such as cancer.
Your problems might be
classified as female sexual dysfunction if you experience one or more of
the following and you're distressed about it:
desire to have sex is low or absent.
can't maintain arousal during sexual activity, or you don't become
aroused despite a desire to have sex.
cannot experience an orgasm.
have pain during sexual contact.
Several factors may
contribute to sexual dissatisfaction or dysfunction. These factors tend
to be interrelated.
Physical. Physical conditions that may cause or contribute to sexual problems include
arthritis, urinary or bowel difficulties, pelvic surgery, fatigue,
headaches, other pain problems, and neurological disorders such as
multiple sclerosis. Certain medications, including some antidepressants,
blood pressure medications, antihistamines and chemotherapy drugs, can
decrease your sex drive and your body's ability to achieve orgasm.
Hormonal. Lower estrogen levels during the menopausal transition may lead to changes
in your genital tissues and your sexual responsiveness. The folds of
skin that cover your genital region (labia) become thinner, exposing
more of the clitoris. This increased exposure sometimes reduces the
sensitivity of the clitoris, or may cause an unpleasant tingling or
In addition, the vaginal
lining becomes thinner and less elastic, particularly if you're not
sexually active. At the same time, the vagina requires more stimulation
to relax and lubricate before intercourse. These factors can lead to
painful intercourse (dyspareunia), and achieving orgasm may take longer.
Your body's hormone levels also shift
after giving birth and during breast-feeding, which can lead to vaginal
dryness and can affect your
desire to have sex.
Psychological and social. Untreated anxiety or depression can cause or contribute to sexual
dysfunction, as can long-term stress. The worries of pregnancy and
demands of being a new mother may have similar effects. Longstanding
conflicts with your partner — about sex or any other aspect of your
relationship — can diminish your sexual responsiveness as well.
Cultural and religious issues and problems with your own body image also
distress can be both a cause and a result of sexual dysfunction.
Regardless of where the cycle began, you usually need to address
relationship issues for treatment to be effective.
sexual problems are undermining your relationship or disrupting your
peace of mind, make an appointment with your doctor for evaluation.
You might be reluctant to
consult your doctor about sexual concerns, but your sexuality is
integral to your well-being — and it's standard practice during
general medical visits for doctors to ask about sexual health. The more
forthcoming you can be about your sexual history and current problems,
the better your chances of finding an effective approach to treating
You may need a pelvic exam,
during which your doctor will check for any physical changes that may be
diminishing your sexual enjoyment, such as thinning of your genital
tissues, decreased skin elasticity, scarring or pain.
Your doctor may also refer
you to a counselor or therapist specializing in sexual and relationship
Female sexual dysfunction is
generally divided into the following four categories, which are not
Low sexual desire. You have diminished libido, or lack of sex drive.
Sexual arousal disorder. Your desire for sex might be intact, but you have difficulty or are unable
to become aroused or maintain arousal during sexual activity.
Orgasmic disorder. You have persistent or recurrent difficulty in achieving orgasm after
sufficient sexual arousal and ongoing stimulation.
Sexual pain disorder. You have pain associated with sexual stimulation or vaginal contact.
Sexual response is a complex
interaction of many components, including physiology, emotions,
experiences, beliefs, lifestyle and relationships. If any one of these
components is disrupted, sexual drive, arousal or satisfaction may be
Women with sexual concerns
benefit from a combined treatment approach that addresses medical as
well as emotional issues. Occasionally, there's a specific medical
solution — using vaginal estrogen cream, for example, or switching
from one antidepressant medication to another. More often, behavioral
treatments — such as couple's therapy and stress management — are
needed to address the roots of female sexual dysfunction. And sometimes,
a combination approach works best.
for female sexual dysfunction.
You can improve your sexual health by enhancing communication with your
partner and making healthy lifestyle choices.
Talk and listen. Some couples never talk about sex, but open and honest communication with
your partner can make a world of difference in your sexual satisfaction.
Even if you're not used to communicating about your likes and dislikes,
learning to do so and providing feedback in a nonthreatening manner can
set the stage for greater sexual intimacy.
Practice healthy lifestyle
habits. Avoid excessive alcohol. Drinking too much
will blunt your sexual responsiveness. Also, stop smoking and start
exercising. Cigarette smoking restricts blood flow throughout your body,
and less blood reaching your sexual organs means decreased sexual
arousal and orgasmic response. Regular aerobic exercise can increase
your stamina, improve your body image and elevate your mood, helping you
feel more romantic, more often. Finally, don't forget to make time for
leisure and relaxation. Learning to relax amid the stresses of your
daily life can enhance your ability to focus on the sexual experience
and attain better arousal and orgasm.
Strengthen pelvic muscles. Pelvic floor exercises can help with some arousal and orgasm problems.
Doing Kegel exercises strengthens the muscles involved in pleasurable
sexual sensations. To perform these exercises, tighten your pelvic
muscles as if you're stopping your stream of urine. Hold for a count of
five, relax and repeat. Do these exercises several times a day. Your
doctor also may recommend exercising with vaginal weights — a series
of five weights, each increasingly heavier, that you hold in place in
your vagina — to strengthen pelvic floor muscles. You gradually work
up to heavier weights as your muscle tone improves.
Seek counseling. Talk with a counselor or therapist specializing in sexual and relationship
problems. Therapy often includes education about normal sexual response,
ways to enhance intimacy with your partner, and recommendations for
reading materials or couples' exercises. With a therapist's help, you may
gain a better understanding of your sexual identity, beliefs and
attitudes; relationship factors including intimacy and attachment;
communication and coping styles; and your overall emotional health.
Medical treatment for female sexual dysfunction
Effectively treating sexual dysfunction often requires addressing an
underlying medical condition or hormonal change that's affecting your
female sexual dysfunction tied to an underlying medical condition might
Adjusting or changing medications that have
sexual side effects
Treating thyroid problems or other hormonal
Optimizing treatment for depression or anxiety
Strengthening pelvic floor muscles
Trying strategies recommended by your doctor
to help with pelvic pain or other pain problems
Treating female sexual
dysfunction linked to a hormonal cause might include:
Estrogen therapy. Localized estrogen therapy — in the form of a vaginal ring, cream or
tablet — can improve sexual function in a number of ways, including
improving vaginal tone and elasticity, increasing vaginal blood flow,
enhancing lubrication, and having a positive effect on brain function
and mood factors that impact sexual response.
Progestin therapy. In some research studies, women taking progestins experienced a decrease in
sexual desire and vaginal blood flow. However, in other studies, women
experienced improvements in desire and arousal when they took progestin
in addition to estrogen. More studies are under way to see if different
progestin regimens, alone or in combination with estrogen and other
hormonal agents, may benefit sexual function. Progestins generally are
prescribed to balance estrogen's effect on the uterus and not to treat
female sexual dysfunction.
Androgen therapy. Androgens include male hormones, such as testosterone. Testosterone is
important for sexual function in women as well as men, although
testosterone occurs in much lower amounts in a woman. Androgen therapy
for sexual dysfunction is controversial. Some studies show a benefit for
women who have low testosterone levels and develop sexual dysfunction,
other studies show little or no benefit. Testosterone may be given as a
cream or gel patch applied to your skin. Sometimes, testosterone is
given as a pill or injection. Side effects, such as acne, excess body
hair (hirsutism), enlargement of the clitoris, and mood or personality
changes, are possible. Because long-term effects of testosterone therapy
in women aren't known, you should be closely monitored by your doctor.
therapies won't resolve sexual problems that have causes unrelated to
hormones. Because the issues surrounding female sexual dysfunction are
usually complex and multifaceted, even the best medications are unlikely
to work if other emotional or social factors remain unresolved.
Tibolone is a drug currently used in Europe and Australia for treatment
of postmenopausal osteoporosis. In a small study, women taking the drug
experienced an increase in vaginal lubrication, arousal and sexual
desire. But Tibolone hasn't yet received Food and Drug Administration
(FDA) approval for use in the U.S.
each stage of your life, you may experience changes in sexual desire,
arousal and satisfaction. Accepting these changes and exploring new
aspects of your sexuality during times of transition contribute to
positive sexual experiences.
your body and what makes for a healthy sexual response can help, too.
The more you and your partner know about the physical aspects of your
body and how it works, the better able you'll be to find ways to ease
sexual difficulties. Ask your doctor about how things like aging,
illnesses, pregnancy, menopause and medicines might affect your sex
response often has as much to do with your feelings for your partner as
it does with physical sexual stimuli. For women, emotional intimacy
tends to be an essential prelude to sexual intimacy. Show affection and
communicate openly with your partner about your feelings — it can help
you reconnect and discover each other again.
learn more about your body and how to communicate with your partner,
check out these books:
"Hot Monogamy: Essential Steps to More
Passionate, Intimate Lovemaking," by Patricia Love, M.D., and Jo
"Resurrecting Sex: Solving Sexual
Problems & Revolutionizing Your Relationship," by David
"What Your Mother Never Told You About
S-e-x," by Hilda Hutcherson, M.D.
"Sex Over 40," by Saul H. Rosenthal,
Low sex drive in women
Mayo Foundation for Medical Education and Research (MFMER)
A woman's sexual desires naturally fluctuate over the
years. Highs and lows commonly coincide with the beginning or end of a
relationship or with major life changes, such as pregnancy, menopause or
illness. However, if you are bothered by a low sex drive or decreased
sex drive, there are lifestyle changes and sex techniques that may put
you in the mood more often. Some medications offer promise as well.
Even researchers disagree about the best measure of
low sex drive in women. After all, perfectly normal women vary greatly
in their desire for sex and their views about the optimal amount of sex.
Besides, the number of times you have sex each week isn't necessarily a
good measure of your libido; women skip sex for many reasons that have
nothing to do with desire, including fatigue, stress, poor body image or
lack of emotional intimacy.
So, what exactly is low sex drive in women? In medical
terms, you have hypoactive sexual desire disorder if you have a
persistent or recurrent lack of interest in sex that causes you personal
distress. But you don't have to meet this medical definition to seek
help. If you aren't as interested in sex as you'd like to be, talk to
the major symptom of low sex drive in women is a low or absent desire
for sex. According to some studies, more than 40 percent of women
complain of low sexual desire at some point.
The percentage is smaller — 5 percent to 15 percent — if you only
count women with ongoing problems.
researchers acknowledge that it's difficult to measure what's normal and
what's not. If you want to have sex less often than your partner does,
neither one of you is necessarily outside the norm for people at your
stage in life — although your differences may cause distress.
Similarly, even if your sex drive is weaker than it once was, your
relationship may be stronger than ever. Bottom line: There is no magic
number to define low sex drive. It varies from woman to woman.
woman's desire for sex is based on a complex interaction of many
components affecting intimacy, including physical well-being, emotional
well-being, experiences, beliefs, lifestyle and current relationship. If
you're experiencing problems in any of these areas, it can affect your
sexual desire. In other words, there are dozens of reasons you may not
be interested in sex:
A wide range of illnesses, physical changes and medications can cause a
low sex drive, including:
Sexual problems. If you experience pain during sex (dyspareunia) or inability to orgasm (anorgasmia),
it can hamper your desire for sex.
Medical diseases. Numerous nonsexual diseases can also affect desire for sex, including
arthritis, cancer, diabetes, high blood pressure, coronary artery
disease and neurological diseases. Infertility also can contribute to
low sex drive, even after infertility treatments are over.
Medications. Many prescription medications — including antidepressants, blood pressure
medications and chemotherapy drugs — are notorious libido killers.
Antihistamines also can zap your sex drive.
Alcohol and drugs. A glass of wine may make you feel amorous, but too much alcohol can spoil
your sex drive; the same is true of street drugs.
Surgery. Any surgery related to your breasts or your genital tract can affect your
body image, function and desire for sex.
Fatigue. The exhaustion of caring for aging parents or young children can contribute
to low sex drive.
Changes in your hormone levels may change your desire for sex:
Menopause. Estrogen helps maintain the health of your vaginal tissues and your
interest in sex. But estrogen levels drop during the transition to
menopause, which can cause a double whammy — decreased interest in sex
and dryer vaginal tissues, resulting in painful or uncomfortable sex. At
the same time, women may also experience a decrease in the hormone
testosterone, which boosts sex drive in men and women alike. Although
many women continue to have satisfying sex during menopause and beyond,
some women experience a lagging libido during this hormonal change.
breast-feeding. Hormone changes during
pregnancy, just after having a baby and during breast-feeding can put a
damper on sex drive. Of course, hormones aren't the only factor
affecting intimacy during these times. Fatigue, changes in body image
and the pressures of carrying — or caring for — a new baby can all
contribute to changes in your sexual desire.
Your problems don't have to be physical or biological to be real. There
are many psychological causes of low sex drive, including:
Mental health problems, such as anxiety or
Stress, such as financial stress or work
Poor body image
History of physical or sexual abuse
For many women, emotional closeness is an essential prelude to sexual
intimacy. So problems in your relationship can be a major factor in low
sex drive. Decreased interest in sex is often a result of ongoing
issues, such as:
Lack of connection with your partner
Unresolved conflicts or fights
Poor communication of sexual needs and
Infidelity or breach of trust
to your doctor if you are bothered by your level of desire for sex —
whether you're actually having sex just once in a while or several times
care doctors and gynecologists often ask about sex and intimacy as part
of a routine medical visit. Take this opportunity to be candid about
your sexual concerns. If your doctor doesn't broach the subject, bring
it up. You may feel embarrassed to talk about sex with your doctor, but
this topic is perfectly appropriate. In fact, your sexual satisfaction
is a vital part of your overall health and well-being.
you bring up your concerns about low sex drive, your doctor will
probably look for a physical cause of the problem, such as a
prescription or over-the-counter medication you're taking. Undiagnosed
medical conditions such as diabetes or high blood pressure can also
reduce your libido. During a pelvic exam, your doctor can check for
signs of physical changes contributing to low sexual desire, such as
thinning of your genital tissues, vaginal dryness or pain-triggering
spots. He or she may also recommend additional screening tests, thyroid
studies and questionnaires to help pinpoint your level of desire and
find a reason for low desire. In addition, you may be referred to a
specialized counselor or sex therapist to evaluate emotional and
relationship factors that can cause low sex drive.
definition, you may be diagnosed with hypoactive sexual desire disorder
if screening tests reveal a persistent or recurrent lack of sexual
thoughts or receptivity to sexual activity, which causes you personal
distress. Whether you fit this medical diagnosis or not, your doctor can
look for reasons that your sex drive isn't as high as you'd like and
find ways to help.
is no simple pill or potion to increase sex drive in women. In fact,
most women benefit from a multifaceted treatment approach aimed at the
many causes behind this condition. This may include sex education,
counseling, lifestyle changes and sometimes medication.
Lifestyle changes you can make
Healthy lifestyle changes can make a big difference in your desire for
Exercise. Regular aerobic exercise and strength training can increase your stamina,
improve your body image, elevate your mood and enhance your libido.
Stress less. Finding a better way to cope with work stress, financial stress and daily
hassles can enhance your sex drive.
Be happier. A sense of personal well-being and happiness are important to sexual
interest. So find ways to bring a little extra joy to your world.
Strengthen your pelvic
muscles. Pelvic floor exercises (Kegel exercises) can
improve your awareness of the muscles involved in pleasurable sexual
sensations and increase your libido. To perform these exercises, tighten
your pelvic muscles as if you're stopping a stream of urine. Hold for a
count of five, relax and repeat. Do these exercises several times a day.
Relationship changes you and your partner can make
For women, better emotional intimacy often leads to better sexual
Communicate with your
partner. Conflicts and disagreements are a natural
part of any relationship. Couples who learn to fight fair and
communicate in an open, honest way usually maintain a stronger emotional
connection, which can lead to better sex. Communicating about sex also
is important. Talking about your likes and dislikes can set the stage
for greater sexual intimacy.
Seek counseling. Talking with a sex therapist or counselor skilled in addressing sexual
concerns can help with low sex drive. Therapy often includes education
about sexual response and techniques and recommendations for reading
materials or couples' exercises.
Set aside time for intimacy. Scheduling sex into your calendar may seem contrived and boring. But making
intimacy a priority can help put your sex drive back on track.
Add a little spice to your
sex life. Try a different sexual position, a
different time of day or a different location for sex. If you and your
partner are open to experimentation, sex toys and fantasy can help
rekindle your sexual sizzle.
Medical treatments for low
Medications aren't always necessary to treat low sex drive. But they can
Treating underlying causes
of low sex drive. The first medical
intervention for low sex drive is usually addressing an underlying
medical condition or medication that's known to have sexual side
effects. This may include adjusting or changing your current medications
or starting treatment for previously undetected conditions.
Estrogen therapy. Systemic estrogen therapy — by pill, patch or gel — can have a positive
effect on brain function and mood factors that affect sexual response.
Local estrogen therapy — in the form of a vaginal cream or a
slow-releasing suppository or ring that you place in your vagina — can
increase blood flow to the vagina and help improve desire. In some
cases, your doctor may prescribe a combination of estrogen and
Testosterone therapy. Male hormones, such as testosterone, play an important role in female
sexual function, even though testosterone occurs in much lower amounts
in women. However, replacing testosterone in women is controversial and
it's not approved by the Food and Drug Administration (FDA) for sexual
dysfunction in women. Plus, it can cause negative side effects,
including acne, excess body hair (hirsutism), and mood or personality
changes. Testosterone seems most effective for women with low
testosterone levels as a result of surgery to remove the ovaries (oophorectomy).
If you choose to use this therapy, your doctor will closely monitor your
symptoms and blood levels to make sure you're not experiencing negative
sex drive can be very difficult for you and your partner. It's natural
to feel frustrated or sad if you aren't able to be as sexy and romantic
as you want — or you used to be. At the same time, low sex drive can
make your partner feel rejected, which can lead to conflicts and strife.
And this type of relationship turmoil can actually add to your lack of
desire for sex.
may help to remember that fluctuations in your sex drive are a normal
part of every relationship and every stage of life. Try not to focus all
of your attention on sex. Instead, spend some time nurturing yourself
and your relationship. Go for a long walk. Get a little extra sleep.
Kiss your partner goodbye before you head out the door. Make a date
night at your favorite restaurant. Feeling good about yourself and your
partner can actually be the best foreplay.
©1998-2009 Mayo Foundation for Medical
Education and Research (MFMER)
Many men occasionally ejaculate sooner during sexual
intercourse than they or their partner would like. As long as it happens
infrequently, it's probably not cause for concern. However, if you
regularly ejaculate sooner than you and your partner wish — such as
before intercourse begins or shortly afterward — you may have a
condition known as premature ejaculation.
Premature ejaculation is a common sexual disorder.
Estimates vary, but some experts think it affects as many as one out of
three men. Even though it's a common problem that can be treated, many
men feel embarrassed to talk to their doctors about it or seek
Once thought to be purely psychological, experts now
know that biological factors also play an important role in premature
ejaculation. In some men, premature ejaculation is related to erectile
You don't have to live with premature ejaculation —
treatments including medications, psychological counseling and learning
sexual techniques to delay ejaculation can improve sex for you and your
partner. For many men, a combination of treatments works best.
no medical standard for how long it should take a man to ejaculate. The
primary sign of premature ejaculation is ejaculation that occurs before
both partners wish in the majority of sexual encounters, causing
concern or distress. The problem may occur in all sexual situations,
including during masturbation — or it may only occur during sexual
encounters with another person.
often classify premature ejaculation as either primary or secondary:
You have primary premature ejaculation
if you've had the problem for as long as you've been sexually active.
You have secondary premature
ejaculation if you developed the condition after having had
previous, satisfying sexual relationships without ejaculatory problems.
are still trying to determine exactly what causes premature ejaculation.
While it was once thought to be only psychological, we now know
premature ejaculation is more complicated and involves a complex
interaction of both psychological and biological factors.
Some doctors believe that early sexual experiences may establish a
pattern that can be difficult to change later in life such as:
Situations in which you may have hurried to
reach climax in order to avoid being discovered
Guilty feelings that increase your tendency to
rush through sexual encounters
factors that can play a role in causing premature ejaculation include:
Erectile dysfunction. Men who are anxious about obtaining or maintaining their erection during
sexual intercourse may form a pattern of rushing to ejaculate which can
be difficult to change.
Anxiety. Many men with premature ejaculation also have problems with anxiety —
either specifically about sexual performance, or caused by other issues.
Experts believe a number of biological factors may contribute to
premature ejaculation, including:
Abnormal hormone levels
Abnormal levels of brain chemicals called
Abnormal reflex activity of the ejaculatory
Certain thyroid problems
Inflammation and infection of the prostate or
premature ejaculation is caused by:
Nervous system damage resulting from surgery
Withdrawal from narcotics or a drug called
trifluoperazine (Stelazine), used to treat anxiety and other mental
both biological and psychological factors likely play a role in most
cases of premature ejaculation, experts think a primarily biological
cause is more likely if it has been a lifelong problem (primary
factors can increase your risk of premature ejaculation, including:
Impotence. You may be at increased risk of premature ejaculation if you occasionally
or consistently have trouble getting or maintaining an erection. Fear of
losing your erection may cause you to rush through sexual encounters. As
many as one in three men with premature ejaculation also have trouble
maintaining an erection.
Health problems. If you have a medical concern that causes you to feel anxious during sex,
such as a heart problem, you may have an increased likelihood of
hurrying to ejaculate.
Stress. Emotional or mental strain in any area of your life can play a role in
premature ejaculation, often limiting your ability to relax and focus
during sexual encounters.
Certain medications. Rarely, drugs that influence the action of chemical messengers in the brain
(psychotropics) may cause premature ejaculation.
with your doctor if you ejaculate sooner than you and your partner wish
during most sexual encounters. Although you may feel you should be able
to fix the problem on your own, you may need treatment to help you
achieve and sustain a satisfying sex life.
diagnose premature ejaculation based on a detailed interview about your
sexual history. Your doctor may ask a number of very personal questions
and may want to include your partner in the interview. While it may be
uncomfortable for both of you to talk frankly about sex, the details you
provide will help your doctor determine the cause of your problem and
the best course of treatment. A mental health professional may help make
doctor will want to know about your health history, and may perform a
general physical exam. You doctor may ask you questions about:
How often you have premature ejaculation
Whether you have premature ejaculation only
with a specific partner or partners
Whether you have premature ejaculation every
time you have sex
How often you have sex
How you feel premature ejaculation affects
your enjoyment of sex and your quality of life
Whether you also have trouble getting and
maintaining an erection (erectile dysfunction)
Your use of prescription medications and
evaluate whether psychological factors may influence your premature
ejaculation, your doctor or mental health professional may also want to
Your religious upbringing
Your early sexual experiences
Your sexual relationships, past and present
Any conflicts or concerns within your current
you have both premature ejaculation and trouble getting or maintaining
an erection, your doctor may order blood tests to check your male
hormone (testosterone) levels or other tests.
premature ejaculation doesn't increase your risk of serious health
problems, it can cause distress in your personal life, including:
Relationship strains. The most common complication of premature ejaculation is relationship
stress. If premature ejaculation is straining your relationship, ask
your doctor about including couple's therapy in your treatment program.
Fertility problems. Premature ejaculation can occasionally make fertilization difficult or
impossible for couples who are trying to become pregnant. If premature
ejaculation isn't effectively treated, you and your partner may need to
consider infertility treatment.
options for premature ejaculation include sexual therapy, medications
and psychotherapy. For many men, a combination of these treatments works
In some cases, sexual therapy may involve simple steps such as
masturbating an hour or two before intercourse so that you're able to
delay ejaculation during sex. Your doctor may also recommend avoiding
intercourse for a period of time and focusing on other types of sexual
play so that pressure is removed from your sexual encounters.
The squeeze technique
Your doctor may instruct you and your partner in the use of a method
called the squeeze technique. This method works as follows:
Step 1. Begin sexual activity as usual, including stimulation of the penis, until
you feel almost ready to ejaculate.
Step 2. Have your partner squeeze the end of your penis, at the point where the
head (glans) joins the shaft, and maintain the
squeeze for several
seconds, until the urge to ejaculate passes.
Step 3. After the squeeze is released, wait for about 30 seconds, then go back to
foreplay. You may notice that squeezing the
penis causes it to become
less erect, but when sexual stimulation is resumed, it soon regains full
Step 4. If you again feel you're about to ejaculate, have your partner repeat the
repeating this as many times as necessary, you can reach the point of
entering your partner without ejaculating. After a few practice
sessions, the feeling of knowing how to delay ejaculation may become a
habit that no longer requires the squeeze technique.
Certain antidepressants and topical anesthetic creams are used to treat
premature ejaculation. Although none of these drugs are specifically
approved by the Food and Drug Administration to treat premature
ejaculation, some treatment guidelines recommend their use for this
purpose. You may need to try different medications or doses before you
and your doctor find a treatment that works for you.
A side effect of certain antidepressants is delayed orgasm. Doctors
suggest men who have premature ejaculation can take antidepressants to
benefit from this specific side effect.
Your doctor may prescribe one of several
selective serotonin reuptake inhibitors (SSRIs) such as sertraline
(Zoloft), paroxetine (Paxil) or fluoxetine (Prozac) to help delay
If the timing of your ejaculation doesn't
improve, your doctor may prescribe the tricyclic antidepressant
clomipramine (Anafranil), which also has been shown to benefit men with
You may not need to take these medications
every day to prevent premature ejaculation. Taking a low dose several
hours before you plan to have sexual intercourse may be enough to
improve your symptoms.
side effects of these antidepressants can include nausea, dry mouth,
drowsiness and decreased libido.
Topical anesthetic creams
Topical anesthetic creams containing lidocaine or prilocaine dull the
sensation on the penis to help delay ejaculation. Applied a short time
before intercourse, these creams are wiped off when your penis has lost
enough sensation to help you delay ejaculation.
men using topical anesthetic creams report reduced sexual pleasure
because of lessened sensitivity. Although the cream is wiped off before
intercourse, in some studies female partners reported that it also
reduced their genital sensitivity and sexual pleasure. In rare cases
lidocaine or prilocaine can cause an allergic reaction.
This approach, also known as counseling or talk therapy, involves
talking about your relationships and experiences with a mental health
professional. These talk sessions can help you reduce performance
anxiety or find effective ways of coping with stress and solving
problems. For many couples affected by premature ejaculation, talking
with a therapist together may produce the best results.
some cases, premature ejaculation may be caused by poor communication
between partners or a lack of understanding of the differences between
male and female sexual functioning. Women typically require more
prolonged stimulation than men do to reach orgasm, and this difference
can cause sexual resentment between partners and add pressure to sexual
encounters. For many men, feeling pressure during sexual intercourse
increases the risk of premature ejaculation.
communication between sexual partners, as well as a willingness to try a
variety of approaches to help both partners achieve satisfaction, can
help reduce conflict and performance anxiety. If you're not satisfied
with your sexual relationship, talk with your partner about your
concerns. Try to approach the topic in a loving way and to avoid blaming
your partner for your dissatisfaction.
you're not able to resolve sexual problems on your own, talk with your
doctor. He or she may recommend seeing a therapist who can help you and
your partner achieve a fulfilling sexual relationship.
men who experience premature ejaculation feel frustrated and even
ashamed. It may help you to know that this problem is common and often
very treatable. Talk to your doctor if it's causing distress for you or
you explore treatment options, consider taking the pressure off the
sexual side of your relationship. Some doctors recommend avoiding
intercourse entirely for a short time and sharing other forms of
physical pleasure and affection instead. Connecting in this way can help
you re-establish a satisfying physical bond with your partner. Taking
the emphasis off intercourse can remove the worry about ejaculating too
soon — and it can help lay the foundation for a more fulfilling sexual
Mayo Foundation for Medical Education and Research (MFMER)
Erectile dysfunction (ED) is the inability of a man to
maintain a firm erection long enough to have sex. Although erectile
dysfunction is more common in older men, this common problem can occur
at any age. Having trouble maintaining an erection from time to time
isn't necessarily a cause for concern. But if the problem is ongoing, it
can cause stress and relationship problems and affect self-esteem.
Formerly called impotence, erectile dysfunction was
once a taboo subject. It was considered a psychological issue or a
natural consequence of growing older. These attitudes have changed in
recent years. It's now known that erectile dysfunction is more often
caused by physical problems than by psychological ones, and that many
men have normal erections into their 80s.
Although it can be embarrassing to talk with your
doctor about sexual issues, seeking help for erectile dysfunction can be
worth the effort. Erectile dysfunction treatments ranging from
medications to surgery can help restore sexual function for most men.
Sometimes erectile dysfunction is caused by an underlying condition such
as heart disease. So it's important to take erectile trouble seriously
because it can be a sign of a more serious health problem
dysfunction is the inability to maintain an erection sufficient for
sexual intercourse at least 25 percent of the time.
occasional inability to maintain an erection happens to most men and is
normal. But ongoing erection problems are a sign of erectile dysfunction
and should be evaluated. In some cases, erectile dysfunction is the
first sign of another underlying health condition that needs treatment.
sexual arousal is a complex process involving the brain, hormones,
emotions, nerves, muscles and blood vessels. If something affects any of
these systems — or the delicate balance among them — erectile
dysfunction can result.
Anatomy of an erection
The penis contains two cylindrical, sponge-like structures (corpus
cavernosum) that run along its length, parallel to the tube that carries
semen and urine (urethra).
a man becomes sexually aroused, nerve impulses cause the blood flow to
the cylinders to increase several times the normal amount. This sudden
influx of blood expands the sponge-like structures and produces an
erection by straightening and stiffening the penis.
sexual arousal maintains the higher rate of blood flow into the penis
and limits the blood flow out of the penis, keeping the penis firm.
After ejaculation or when the sexual excitement passes, the excess blood
drains out of the spongy tissue, and the penis returns to its nonerect
size and shape.
Physical causes of erectile dysfunction
At one time, doctors thought erectile dysfunction was primarily caused
by psychological issues. But this isn't true. While thoughts and
emotions always play a role in getting an erection, erectile dysfunction
is usually caused by something physical, such as a chronic health
problem or the side effects of a medication. Sometimes a combination of
things causes erectile dysfunction.
Common causes of erectile dysfunction include:
Clogged blood vessels (atherosclerosis)
High blood pressure
causes of erectile dysfunction include:
Certain prescription medications
Alcoholism and other forms of drug abuse
Treatments for prostate cancer
Hormonal disorders such as low testosterone (hypogonadism)
Surgeries or injuries that affect the pelvic
area or spinal cord
some cases, erectile dysfunction is one of the first signs of an
underlying medical problem.
Psychological causes of erectile dysfunction
The brain plays a key role in triggering the series of physical events
that cause an erection, beginning with feelings of sexual excitement. A
number of things can interfere with sexual feelings and lead to — or
worsen — erectile dysfunction. These can include:
Poor communication or conflict with your
physical and psychological causes of erectile dysfunction interact. For
instance, a minor physical problem that slows sexual response may cause
anxiety about maintaining an erection. The resulting anxiety can worsen
variety of risk factors can contribute to erectile dysfunction. They
Getting older. As many as 80 percent of men 75 and older have erectile dysfunction. Many
men begin to notice changes in sexual function as they get older.
Erections may take longer to develop, may not be as rigid or may take
more direct touch to the penis to occur. But erectile dysfunction isn't
an inevitable consequence of normal aging. Erectile dysfunction often
occurs in older men mainly because they're more likely to have
underlying health conditions or take medications that interfere with
Having a chronic health
condition. Diseases of the lungs, liver, kidneys,
heart, nerves, arteries or veins can lead to erectile dysfunction. So
can endocrine system disorders, particularly diabetes. The accumulation
of deposits (plaques) in your arteries (atherosclerosis) also can
prevent adequate blood from entering your penis. And in some men,
erectile dysfunction may be caused by low levels of testosterone (male
Taking certain medications. A wide range of drugs — including antidepressants, antihistamines and
medications to treat high blood pressure, pain and prostate cancer —
can cause erectile dysfunction by interfering with nerve impulses or
blood flow to the penis. Tranquilizers and sleeping aids also can pose a
Certain surgeries or
injuries. Damage to the nerves that control
erections can cause erectile dysfunction. This damage can occur if you
injure your pelvic area or spinal cord. Surgery to treat bladder, rectal
or prostate cancer can increase your risk of erectile dysfunction.
Substance abuse. Chronic use of alcohol, marijuana or other drugs
often causes erectile dysfunction and decreased sexual drive.
Stress, anxiety or
depression. Other psychological conditions also
contribute to some cases of erectile dysfunction.
Smoking. Smoking can cause erectile dysfunction because it restricts blood flow to
veins and arteries. Men who smoke cigarettes are much more likely to
develop erectile dysfunction.
Obesity. Men who are obese are much more likely to have erectile dysfunction than
are men at a normal weight.
Metabolic syndrome. This syndrome is characterized by belly fat, unhealthy cholesterol and
triglyceride levels, high blood pressure, and insulin resistance.
Prolonged bicycling. Over an extended period, pressure from a bicycle seat has been shown to
compress nerves and blood flow to the penis, leading to temporary
erectile dysfunction and penile numbness.
erectile dysfunction is more than a temporary, short-term problem, see
your doctor. Your own doctor, or a doctor specializing in erectile
dysfunction, can help you determine the underlying cause or causes of
erectile dysfunction and then help you find the right type of treatment.
might view erectile dysfunction as a personal or embarrassing problem,
it's important to seek treatment. In most cases, erectile dysfunction
can be successfully treated. Also, see your doctor if the therapy or
medication prescribed to treat erectile dysfunction isn't working for
you. Don't try to combine medications or therapies on your own or make
changes from prescribed doses.
doctor will ask questions about how and when your symptoms developed,
what medications you take and any other physical conditions you might
have. Your doctor will also want to discuss recent physical or emotional
your doctor suspects that physical causes are involved, he or she will
likely want to take blood tests to check your level of male hormones and
for other potential medical problems, such as diabetes. Your doctor may
also want to try eliminating or replacing certain prescription drugs
you're taking one at a time to see whether any are responsible for
specialized tests may include:
Ultrasound. This test can check blood flow to your penis. It involves using a wand-like
device (transducer) held over the blood vessels that supply the penis.
The transducer emits sound waves that pass through body tissues and
reflect back, producing an image to let your doctor see if your blood
flow is impaired. The test often is done before and after injection of
medication into the side of the penis to see if there's an improvement
in blood flow.
Neurological evaluation. Your doctor usually assesses possible nerve damage by conducting a physical
examination to test for normal touch sensation in your genital area.
cavernosometry and cavernosography (DICC).
This procedure involves injecting a dye into penile blood vessels to
permit your doctor to view any possible abnormalities in blood pressure
and flow into and out of your penis. It's generally done with local
anesthesia by a urologist who specializes in erectile dysfunction.
Nocturnal tumescence test. If your doctor suspects that mainly nonphysical causes are to blame, he or
she may ask whether you obtain erections during masturbation, with a
partner or while you sleep. Most men experience many erections, without
remembering them, during sleep. A simple test that involves wrapping a
special perforated tape around your penis before going to sleep can
confirm whether you have erections while you're sleeping. If the tape is
separated in the morning, your penis was erect at some time during the
night. Tests of this type confirm that there is not a physical
abnormality causing erectile dysfunction, and that the cause is likely
variety of options exist for treating erectile dysfunction. They range
from medications and simple mechanical devices to surgery and
psychological counseling. The cause and severity of your condition are
important factors in determining the best treatment or combination of
treatments for you.
You and your partner may want to talk with your doctor about how much
money you're willing to spend and your preferences. Treatment for
erectile dysfunction can be costly and insurance coverage varies.
Because erectile dysfunction can by a sign of a number of underlying
health conditions, initial evaluation of the problem is covered by most
insurance policies. Medications or other treatments for erectile
dysfunction may or may not be covered by your policy — check with your
insurance provider to find out. Many policies have a limit on how many
pills or injections are covered per month. Standard Medicare
prescription drug coverage doesn't cover medications for erectile
Oral medications available to treat ED include:
three medications work in much the same way. Chemically known as
phosphodiesterase inhibitors, these drugs enhance the effects of nitric
oxide, a chemical that relaxes muscles in the penis. This increases the
amount of blood flow and allows a natural sequence to occur — an
erection in response to sexual stimulation.
medications don't automatically produce an erection. Instead they allow
an erection to occur after physical and psychological stimulation. Many
men experience improvement in erectile function after taking these
medications regardless of the cause of their impotence.
medications share many similarities, but they have differences as well.
They vary in dosage, duration of effectiveness and possible side
effects. Other distinctions — for example, which drug is best for
certain types of men — aren't yet known. No study has directly
compared these three medications.
Not all men benefit
Although these medications can help many people, not all men can or
should take them to treat erectile dysfunction. You should not take
these medications if:
You take nitrate drugs for angina, such as
nitroglycerin (Nitro-Bid, others), isosorbide mononitrate (Imdur) and
isosorbide dinitrate (Isordil)
You take a blood-thinning (anticoagulant)
You take certain types of alpha blockers for
enlarged prostate (benign prostatic hyperplasia) or high blood pressure
Levitra or Cialis may not be a good choice for you if:
You have severe heart disease or heart failure
You've had a stroke
You have very low blood pressure (hypotension)
You have uncontrolled high blood pressure
You have uncontrolled diabetes
expect these medications to fix your erectile dysfunction immediately.
with your doctor to find the right treatment and dose for you. Dosages
may need adjusting. Or you may need to alter when you take the
taking any medication — including Viagra, Levitra or Cialis — make
sure to discuss with your doctor:
Potential benefits and side effects of the
medication you are considering
Any illnesses or serious health problems you
have now or have had in the past
Any prescription or over-the-counter
medications you take (including herbal remedies)
Prostaglandin E (alprostadil)
Two treatments involve using a drug called alprostadil. Alprostadil is a
synthetic version of the hormone prostaglandin E. The hormone helps
relax muscle tissue in the penis, which enhances the blood flow needed
for an erection. There are two ways to use alprostadil:
- Needle-injection therapy.
With this method, you use a fine needle to inject alprostadil (Caverject,
Edex) into the base or side of your penis. This generally produces
an erection in five to 20 minutes that lasts about an hour. Because
the injection goes directly into the spongy cylinders that fill with
blood, alprostadil is an effective treatment for many men. And
because the needle used is so fine, pain from the injection site is
usually minor. Other side effects may include bleeding from the
injection, prolonged erection and formation of fibrous tissue at the
injection site. The cost per injection can be expensive. Injecting a
mixture of alprostadil and other prescribed drugs may be a less
expensive and more effective option. These other drugs may include
papaverine and phentolamine.
- Self-administered intraurethral
therapy (Muse). This treatment involves using a
disposable applicator to insert a tiny alprostadil suppository,
about half the size of a grain of rice, into the tip of your penis.
The suppository, placed about two inches into your urethra, is
absorbed by erectile tissue in your penis, increasing the blood flow
that causes an erection. Although needles aren't involved, you may
still find this method painful or uncomfortable. Side effects may
include pain, minor bleeding in the urethra, dizziness and formation
of fibrous tissue.
Hormone replacement therapy
For the small number of men who have testosterone deficiency,
testosterone replacement therapy may be an option.
This treatment involves the use of a hollow tube with a hand-powered or
battery-powered pump. The tube is placed over the penis, and then the
pump is used to suck out the air. This creates a vacuum that pulls blood
into the penis. Once you achieve an adequate erection, you slip a
tension ring around the base of your penis to maintain the erection. You
then remove the vacuum device. The erection typically lasts long enough
for a couple to have sex. You remove the tension ring after intercourse.
This treatment is usually reserved for men whose blood flow has been
blocked by an injury to the penis or pelvic area. Surgery may also be
used to correct erectile dysfunction caused by vascular blockages. The
goal of this treatment is to correct a blockage of blood flow to the
penis so that erections can occur naturally. But the long-term success
of this surgery is unclear.
This treatment involves surgically placing a device into the two sides
of the penis, allowing erection to occur as often and for as long as
desired. The inflatable device allows you to control when and how long
you have an erection, the semirigid rods keep the penis in a rigid state
all the time. These implants consist of either an inflatable device or
semirigid rods made from silicone or polyurethane. This treatment is
often expensive and is usually not recommended until other methods have
been considered or tried first. As with any surgery, there is a small
risk of complications such as infection.
Psychological counseling and sex therapy
If stress, anxiety or depression is the cause of your erectile
dysfunction, your doctor may suggest that you, or you and your partner,
visit a psychologist or counselor with experience in treating sexual
problems (sex therapist). Even if it is caused by something physical,
erectile dysfunction can create stress and relationship tension.
Counseling can help, especially when your partner participates.
most men experience episodes of erectile dysfunction from time to time,
you can take these steps to decrease the likelihood of occurrences:
Work with your doctor to manage conditions
that can lead to erectile dysfunction, such as diabetes and heart
Limit or avoid the use of alcohol.
Avoid illegal drugs such as marijuana.
Get enough sleep.
Get help for anxiety or depression.
See your doctor for regular checkups and
medical screening tests.
the cause is physical factors or psychological factors or a combination
of both, erectile dysfunction can become a source of mental and
emotional stress for a man — and his partner. If you experience
erectile dysfunction only on occasion, try not to assume that you have a
permanent problem or to expect it to happen again during your next
sexual encounter. Don't view one episode of erectile dysfunction as a
lasting comment on your health, virility or masculinity.
addition, if you experience occasional or persistent erectile
dysfunction, remember your sexual partner. Your partner may see your
inability to have an erection as a sign of diminished sexual desire.
Your reassurance that this is not the case can help.
to communicate openly and honestly about your condition. Treatment is
often more successful if couples work together as a team. You may even
want to see a counselor with your partner. This can help you address
concerns you both have about erectile dysfunction and can be an
alternative treatments are being investigated for potential to alleviate
erectile dysfunction, but their safety and effectiveness are not proved.
DHEA, a hormone that's a building block for
mainstream medications and treatments, these alternative approaches also
have risks and side effects — especially for men who have chronic
health problems or take other medications.
alternative products that claim to work for erectile dysfunction can be
dangerous. The Food and Drug Administration (FDA) has issued warnings
about several "herbal Viagras" including True Man, Energy Max,
Rhino Max, Rhino VMax and Libidus. These contain potentially harmful
drugs that aren't listed on the label. These drugs can interact with
prescription drugs and cause dangerously low blood pressure. These
products are especially dangerous for men who take prescription drugs
that contain nitrates.
Mayo Foundation for Medical Education and Research (MFMER)
Painful intercourse can be difficult to talk about. If
you're experiencing painful intercourse, you may wonder if the pain is
all in your head or the result of something you're doing wrong in bed.
After all, sex is supposed to be pleasurable, right?
The truth is that sex isn't pleasurable or pain-free
for all women all the time. In fact, many women experience painful
intercourse at some point in their lives, for a variety of very normal
reasons. The medical term for painful intercourse is dyspareunia —
which is defined as persistent or recurrent genital pain that occurs
just before, during or after intercourse and that causes you personal
distress. And painful intercourse is worth talking about, because there
are treatments that can help eliminate or reduce this common problem.
estimate that up to 60 percent of women experience episodes of genital
pain that occurs just before, during or after intercourse. But the
location of pain and frequency of pain varies greatly. If you experience
painful intercourse, you may feel:
with every penetration, even while putting in a tampon
Pain with certain partners or just under
New pain after previously pain-free
Superficial (entry) pain
Deep pain during thrusting, which is often
described as "something being bumped"
Burning pain or aching pain
women with dyspareunia complain of superficial pain, which occurs upon
of painful intercourse vary by the location of the pain.
Causes of entry pain
Pain during penetration may be associated with a range of factors,
Inadequate lubrication. This is often the result of not enough foreplay. Inadequate lubrication is
also commonly caused by a drop in estrogen levels after menopause, after
childbirth or during breast-feeding. In addition, certain medications
are known to inhibit desire or arousal, which can decrease lubrication
and make sex painful. These include antidepressants, high blood pressure
medications, sedatives, antihistamines and certain birth control pills.
Injury, trauma or
irritation. This includes injury or irritation from
an accident, pelvic surgery, female circumcision, episiotomy or a
Inflammation, infection or
skin disorder. An infection in your genital area or
urinary tract can cause painful intercourse. Eczema or other skin
problems in your genital area also can be the problem.
Reactions to birth control
products. It's possible to have an allergic
reaction to foams, jellies or latex. Pain may also be caused by an
improperly fitted diaphragm or cervical cap.
Vaginusmus. Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make
attempts at penetration very painful.
Vestibulitis. Painful penetration also occurs in a condition called vestibulitis, which
is characterized by unexplained stinging or burning around the opening
of your vagina.
Causes of deep pain
Deep pain usually occurs with deep penetration and may be more
pronounced with certain positions. Causes include:
Certain illnesses and
conditions. The list includes endometriosis, pelvic
inflammatory disease, uterine prolapse, retroverted uterus, uterine
fibroids, cystitis, irritable bowel syndrome, hemorrhoids and ovarian
Infections. An infection of your cervix, uterus or fallopian tubes can cause deep pain.
Surgeries or medical
treatments. Scarring from surgeries that involve
your pelvic area, including hysterectomy, can sometimes cause painful
intercourse. In addition, medical treatments for cancer, such as
radiation and chemotherapy, can cause changes that make sex painful.
Emotions are deeply intertwined with sexual activity and may play a role
in any type of sexual pain. Emotional factors include:
Psychological problems. If you experience anxiety, depression, concerns about your physical
appearance, fear of intimacy or relationship problems, it can contribute
to painful intercourse.
Stress. Your pelvic floor muscles are very sensitive to stress. So stress can lead
to painful intercourse.
History of sexual abuse. Most women with dyspareunia don't have a history of sexual abuse, but if
you have been abused, it may play a role.
it can be difficult to tell whether psychological factors are a cause or
result of dyspareunia. Initial pain can lead to fear of recurring pain,
making it difficult to relax, which can lead to more pain.
women with persistent sexual pain never seek medical attention. Don't be
one of them. If you are experiencing painful intercourse, talk to your
doctor. Treating the problem can do wonders for your sex life, your
emotional intimacy and your self-image.
you have recurrent pain during sex, talking to your doctor is the first
step in resolving it. Primary care doctors and gynecologists often ask
about sex and intimacy as part of a routine medical visit, and you can
take this opportunity to discuss your concerns. Your regular doctor may
diagnose and treat the problem or refer you to a specialist who can.
medical evaluation for dyspareunia usually consists of:
A thorough medical history. Your doctor may ask when your pain began, exactly where it hurts, how it
feels, and if it happens with every sexual partner and every sexual
position. Your doctor may also inquire about your sexual history,
surgical history and previous childbirth experiences. Don't let
embarrassment stop you from giving candid answers. These questions
provide clues to the cause of your pain.
A pelvic examination. During a pelvic exam, your doctor can check for signs of skin irritation,
infection or anatomical problems. He or she may also try to identify the
location of your pain through gentle touch of the genital area and
pelvic muscles, and a speculum examination of the vagina. Some women who
experience painful intercourse are also uncomfortable during a pelvic
exam, no matter how gentle the doctor is. You can ask to stop the exam
at any time if it's too painful.
Additional tests. If your doctor suspects certain causes of painful intercourse, he or she
might also recommend a pelvic ultrasound or laparoscopy — a minor
surgical procedure in which a slender viewing instrument (laparoscope)
is used to view your pelvic organs.
intercourse used to be viewed primarily as a psychological problem that
required psychological treatment. Fortunately, that view is outdated.
Researchers and doctors now understand the many causes of dyspareunia
and recommend an integrated, multifaceted treatment approach. Your
particular treatment depends on the underlying cause of your pain, but
treatment may include:
Avoid scented bath products, such as body washes and shower gels.
These products can irritate your genital area and zap your natural
lubrication, particularly if you overuse them. Skip douching as
techniques and counseling
You and your partner may be able to minimize pain with a few changes
to your sexual routine:
- Switch positions.
If you experience sharp pain during thrusting, the penis may be
striking your cervix or stressing the pelvic floor muscles, causing
aching or cramping pain. Changing positions may help. You can try
being on top of your partner during sex. Women usually have more
control in this position, so you may be able to regulate penetration
to a depth that feels good to you.
Talk about what feels good and what doesn't. If you need your
partner to go slow, say so.
- Don't rush to the main event.
Longer foreplay can help stimulate your natural lubrication. And you
may reduce pain by delaying penetration until you feel fully
- Use lubricants.
A water-based lubricant, such as K-Y jelly or Astroglide, can make
sex more comfortable. If contraceptive creams cause irritation or
dryness, try a different preparation or ask your doctor about
switching to another type of birth control.
Medications and therapies
In some cases, medications or therapy are necessary to treat painful
conditions. If an infection or medical condition is
contributing to your pain, treating the underlying cause may resolve
your problem. Changing medications known to cause lubrication problems
also may eliminate your symptoms.
Estrogen therapy. For most postmenopausal women, dyspareunia is caused by inadequate
lubrication resulting from low estrogen levels. Often, this can be
treated with a prescription cream, tablet or flexible vaginal ring.
Other medications. In some cases, your doctor may suggest an oral prescription pain medication
or injections of pain medications into the site of the pain.
Desensitization therapy. During this therapy, you learn vaginal relaxation exercises that can
decrease pain. Your therapist may recommend pelvic floor exercises (Kegel
exercises) or other techniques to decrease pain with intercourse.
Counseling or sex therapy. If sex has been painful for a long time, you may experience a negative
emotional response to sexual stimulation even after treatment. If you
and your partner have avoided intimacy because of painful intercourse,
you may also need help improving communication with your partner and
restoring sexual intimacy. Talking to a counselor or sex therapist can
help resolve these issues.
vaginal penetration becomes less painful and bothersome, try broadening
your bedroom repertoire. You and your partner might find other options
to be more comfortable, more fulfilling and more fun than the same-old
routine. Sensual massage, kissing and mutual masturbation can all be
good alternatives to intercourse. Besides, trying different things can
do more for your sexual relationship than clinging to a narrow view of
what does or doesn't constitute good sex.
Discharge: What’s Abnormal?
discharge may not be a popular topic of conversation. But you might like
to know that it actually serves an important housekeeping function in
the female reproductive system. Fluid made by glands inside the vagina
and cervix carries away dead cells and bacteria. This keeps the vagina
clean and helps prevent infection.
Most of the time vaginal discharge is
perfectly normal. The amount can vary from woman to woman, and the
normal color can range from clear to a milky whitish, depending on the
time in your menstrual cycle. You may also notice slight changes in the
amount and odor of the discharge. For example, there will be more
discharge if you are ovulating, breastfeeding, or sexually aroused. The
smell may be different if you are pregnant or you haven’t been
diligent about your personal hygiene.
None of those changes is cause for alarm.
However, if the color, smell, or consistency seems significantly
unusual, especially if there is itching or burning in the vagina, you
could be noticing a sign of an infection or other condition.
causes abnormal discharge?
Any change in the balance of normal bacteria
in the vagina can affect the smell, color, or texture of the discharge.
These are a few of the things that can upset that balance:
- antibiotic or steroid use
- bacterial vaginosis, which is a bacterial infection
more common in pregnant women or women who have multiple sexual
- birth control pills
- cervical cancer
- chlamydia or gonorrhea, which are sexually
- douches, scented soaps or lotions, bubble bath
- pelvic infection after surgery
- pelvic inflammatory disease (PID)
- trichomoniasis, which is a parasitic infection
typically caused by having unprotected sex
- vaginal atrophy, which is thinning and drying out of
the vaginal walls during menopause
- vaginitis, which is irritation in or around the
- yeast infections
See the chart below to learn more about what a
particular type of discharge might mean.
Types of Abnormal
Discharge and Their Possible Causes
It Might Mean
menstrual cycles, or less often, cervical or endometrial cancer
vaginal bleeding, pelvic pain
between periods, painful urination
yellow or greenish with a bad smell
and itching while urinating
of the uterine lining after childbirth (lochia)
and pain around the vulva, itching, painful sexual intercourse
gray, or yellow with fishy odor
or burning, redness and swelling of the vagina or vulva
does the doctor diagnose abnormal discharge?
The doctor will start by taking a
health history and asking about your symptoms. Questions the doctor may
did the abnormal discharge begin?
color is the discharge?
there any smell?
you have any itching, pain, or burning in or around the vagina?
you have more than one sexual partner?
The doctor may take a sample of the
discharge or do a Pap test to collect cells from your cervix for further
is abnormal discharge treated?
Call your doctor for an appointment
if you notice any unusual discharge. How you are treated will depend on
the condition that’s causing the problem. For example, yeast
infections are usually treated with antifungal medications inserted into
the vagina in cream or gel form. Bacterial vaginosis is treated with
antibiotic pills or creams. Trichomoniasis is usually treated with the
drug metronidazole (Flagyl) or tinidazole (Tindamax).
Here are some tips for preventing
vaginal infections that can lead to abnormal discharge:
the vagina clean by washing regularly with a gentle soap and warm
use scented soaps or douche. Also avoid feminine sprays and bubble
going to the bathroom, always wipe from front to back to prevent
bacteria from getting into the vagina and causing an infection.
100% cotton underpants, and avoid overly tight clothing.