Balancing Sexual Passion In A Relationship

By: eHarmony Staff

A 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 clarity.
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.  

·        Passionate 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.

·        There 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?

·        Every progression of physical activity establishes a new plateau—and it is extremely difficult to retreat once it has been reached.

Every 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.

·        Physical involvement must be managed with extreme care.

 Strongly 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.

Intimacy Issues: 4 Must-Tackle Topics That May Scare You

From by eHarmony Staff

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.

Defining Intimacy

First, 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.

Intimacy Issue #1: How to define and pace your physical relationship

While 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.

Intimacy Issue #2: How to communicate your emotional needs

Just 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.

Intimacy Issue #3: How to build and maintain trust

A 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.

Intimacy Issue #4: How to talk about exclusivity

One 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.

Ultimately, 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 respond accordingly.

The proper way to be friends with benefits

By Judy McGuire

(The Frisky) -- There are times in every woman's life where her body wants either what her heart can't handle or her brain knows better.

You 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.

Maybe you're wildly attracted to a dude physically, but find him mentally or morally lacking -- like a tanning technician or a bounty hunter.

There's no way you'd ever date him, but why should you deny yourself entirely?

Answer: Not a reason in the world.

Negotiating a long-term, friends-with-benefits type situation can be tricky for us ladies.

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 double standard!

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 disastrous.

So here are some pitfalls to avoid:

• Language: 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.
• Meals: 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.
• Conversation: 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.
• Socializing: 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.

Female sexual dysfunction

©1998-2009 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.

You 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:

• Your desire to have sex is low or absent.
• You can't maintain arousal during sexual activity, or you don't become aroused despite a desire to have sex.
• You cannot experience an orgasm.
• You 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 prickling sensation.

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 may contribute.    

Emotional 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.

If 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 them.

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 problems.

Female sexual dysfunction is generally divided into the following four categories, which are not mutually exclusive:

·         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 affected.

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.  

Nonmedical treatment 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 sexuality.

Treating female sexual dysfunction tied to an underlying medical condition might include:

·         Adjusting or changing medications that have sexual side effects

·         Treating thyroid problems or other hormonal conditions

·         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.

Hormonal 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.

Emerging treatments
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.

At 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.

Understanding 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 life.

Sexual 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.

To 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 Robinson

·                              "Resurrecting Sex: Solving Sexual Problems & Revolutionizing Your Relationship," by David Schnarch, Ph.D.

·                              "What Your Mother Never Told You About S-e-x," by Hilda Hutcherson, M.D.

·                              "Sex Over 40," by Saul H. Rosenthal, M.D.

Low sex drive in women

©1998-2009 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 your doctor.

Obviously, 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.

Still, 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.

A 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:

Physical causes
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.

·         Hormone changes
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.

·         Pregnancy and 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.

Psychological causes
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 depression

·         Stress, such as financial stress or work stress

·         Poor body image

·         Low self-esteem

·         History of physical or sexual abuse

Relationship issues
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 preferences

·         Infidelity or breach of trust

Talk 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 a week.

Primary 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.

Once 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.

By 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.

There 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 sex:

·         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 intimacy:

·         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 sex drive
Medications aren't always necessary to treat low sex drive. But they can help.

·         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 progesterone.

·         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 side effects.

Low 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.

It 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.

Premature ejaculation

 ©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 treatment.

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 dysfunction.

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.

There's 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.

Doctors 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.

Experts 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.

Psychological causes
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

Other 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.

Biological causes
Experts believe a number of biological factors may contribute to premature ejaculation, including:

·         Abnormal hormone levels

·         Abnormal levels of brain chemicals called neurotransmitters

·         Abnormal reflex activity of the ejaculatory system

·         Certain thyroid problems

·         Inflammation and infection of the prostate or urethra

·         Inherited traits

Rarely, premature ejaculation is caused by:

·         Nervous system damage resulting from surgery or trauma

·         Withdrawal from narcotics or a drug called trifluoperazine (Stelazine), used to treat anxiety and other mental health problems

Although 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 premature ejaculation).

Various 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.

Talk 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.

Doctors 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 the diagnosis.

Your 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 recreational drugs

To evaluate whether psychological factors may influence your premature ejaculation, your doctor or mental health professional may also want to know about:

·         Your religious upbringing

·         Your early sexual experiences

·         Your sexual relationships, past and present

·         Any conflicts or concerns within your current relationship

If 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.

While 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.

Treatment options for premature ejaculation include sexual therapy, medications and psychotherapy. For many men, a combination of these treatments works best.

Sexual therapy
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 erection.

·                              Step 4. If you again feel you're about to ejaculate, have your partner repeat the squeeze process.

By 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.

Medications
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.

Antidepressants
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 ejaculation.

·         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 this disorder.

·         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.

Other 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.

Some 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.

Psychotherapy
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.

In 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.

Open 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.

If 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.

Many 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 your partner.

While 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 relationship.

Erectile dysfunction

©1998-2009 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

Erectile dysfunction is the inability to maintain an erection sufficient for sexual intercourse at least 25 percent of the time.

An 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.

Male 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).

When 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.

Continued 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:

·         Heart disease

·         Clogged blood vessels (atherosclerosis)

·         High blood pressure

·         Diabetes

·         Obesity

·         Metabolic syndrome

Other causes of erectile dysfunction include:

·         Certain prescription medications

·         Tobacco use

·         Alcoholism and other forms of drug abuse

·         Treatments for prostate cancer

·         Parkinson's disease

·         Multiple sclerosis

·         Hormonal disorders such as low testosterone (hypogonadism)

·         Peyronie's disease

·         Surgeries or injuries that affect the pelvic area or spinal cord

In 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:

·         Depression

·         Anxiety

·         Stress

·         Fatigue

·         Poor communication or conflict with your partner

The 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 erectile dysfunction.

A variety of risk factors can contribute to erectile dysfunction. They include:

·         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 erectile function.

·         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 hypogonadism).

·         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 problem.

·         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.

If 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.

You 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.

Your 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 changes.

If 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 erectile dysfunction.

More 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.

·         Dynamic infusion 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 psychological.

A 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.

Cost
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 dysfunction.

Oral medications
Oral medications available to treat ED include:

·                              Sildenafil (Viagra)

·                              Tadalafil (Cialis)

·                              Vardenafil (Levitra)

All 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.

These 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.

These 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) medication

·         You take certain types of alpha blockers for enlarged prostate (benign prostatic hyperplasia) or high blood pressure

Viagra, 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 (hypertension)

·         You have uncontrolled diabetes

Don't expect these medications to fix your erectile dysfunction immediately.

Work 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 medication.

Before 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.

Penis pumps
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.

Vascular surgery
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.

Penile implants
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.

Although 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 disease.

·         Limit or avoid the use of alcohol.

·         Avoid illegal drugs such as marijuana.

·         Stop smoking.

·         Exercise regularly.

·         Reduce stress.

·         Get enough sleep.

·         Get help for anxiety or depression.

·         See your doctor for regular checkups and medical screening tests.

Whether 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.

In 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.

Try 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 effective treatment.

Several alternative treatments are being investigated for potential to alleviate erectile dysfunction, but their safety and effectiveness are not proved. They include:

·         Acupuncture

·         DHEA, a hormone that's a building block for testosterone

·         Ginkgo

·         L-arginine

Like 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.

Some 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.

Painful intercourse (dyspareunia)

©1998-2009 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.

Researchers 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:

·         Pain with every penetration, even while putting in a tampon

·         Pain with certain partners or just under certain circumstances

·         New pain after previously pain-free intercourse

·         Superficial (entry) pain

·         Deep pain during thrusting, which is often described as "something being bumped"

·         Burning pain or aching pain

Most women with dyspareunia complain of superficial pain, which occurs upon penetration.

Causes 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, including:

·         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 congenital abnormality.

·         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 cysts.

·         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.

Emotional factors
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.

Sometimes, 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.

Many 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.

If 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.

A 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.

Painful 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:

• Hygiene habits
  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 well.
• Sexual 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.
• Communicate. 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 aroused.
• 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 intercourse.

·         Treating underlying 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.

Until 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.

Vaginal Discharge: What’s Abnormal?

From: WebMD

Vaginal 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.

What 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 partners
• birth control pills
• cervical cancer
• chlamydia or gonorrhea, which are sexually transmitted infections
• diabetes
• 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 vagina
• 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        

How does the doctor diagnose abnormal discharge?

The doctor will start by taking a health history and asking about your symptoms. Questions the doctor may ask include:

• When did the abnormal discharge begin?
• What color is the discharge?
• Is there any smell?
• Do you have any itching, pain, or burning in or around the vagina?
• Do you have more than one sexual partner?
• Do you douche?

The doctor may take a sample of the discharge or do a Pap test to collect cells from your cervix for further examination.

How 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:

• Keep the vagina clean by washing regularly with a gentle soap and warm water.
• Never use scented soaps or douche. Also avoid feminine sprays and bubble baths.
• After going to the bathroom, always wipe from front to back to prevent bacteria from getting into the vagina and causing an infection.
• Wear 100% cotton underpants, and avoid overly tight clothing.