Sexual Health
Sexual problems can be so complicated. Say, for example, you can only climax from oral sex. Is the problem physical (you need to try new positions during intercourse), psychological (you saw your parents making love when you were 5 and never recovered), or emotional (maybe you've never found a man who could make you feel comfortable enough to climax during intercourse)? Or maybe you're just normal, and most women can't climax from intercourse alone.
Q I sometimes have an while sleeping. orgasm while I'm sleeping. How can I possibly be climaxing without physical stimulation?
Psychological advice: "Everybody needs a certain amount of sexual activity, and if you're not getting it through interaction with other people or through masturbation, your bodies will `discharge' naturally. Once our conscious mind, with all its baggage--distractions, guilt, whatever--is disengaged, our fantasies (i.e., our dreams) take over."
--Dr. Drew
Medical advice: "You're probably responding to sexual fantasies in your dreams, just as you might respond to fantasies alone in waking life. Our sexuality, after all, isn't only about physical touch. In fact, the physiologic buildup of excitation that's ultimately released in orgasm can be triggered even by merely thinking of sex."
--Dr. Reichman
Q I haven't become sexually aroused in more than four years, and intercourse feels like I'm being speared. The total lack of desire is frustrating because I think about sex a lot. What should I do?
Medical advice: "You should make sure the problem isn't merely a matter of insufficient lubrication, which may be solved with more foreplay or by using an over-the-counter lubricant. Also, if you are taking an antidepressant--Prozac or Paxil, for example--it can make you feel dead from the waist down. If neither lubrication nor medication is to blame, see your gynecologist to make sure there's not something wrong in the pelvis that:s causing the pain--whether its endometriosis (a fairly common condition in which the uterine lining grows outside of the uterus), adhesions (an overgrowth of scar tissue following surgery), or rarely, perhaps a tumor."
--Dr. Reichman
Psychological advice: "People who experience ambivalence about their sexuality to the point where sex is overwhelmingly painful--those for whom the notion of sex is okay but the act is something unpleasant--often are survivors' of some kind of childhood sexual abuse. If you suspect or know that you are indeed a survivor, you can expect to continue having difficulty with intimacy for your entire life--unless you recieve professional treatment in the form of long-term psychotherapy. Of course, lesser childhood trauma (brought on by parents who have withheld love, for example) could cause a spectrum of difficulties with intimacy but probably not the total shutdown you describe, indicative of someone who was abused. The same can be said for a relationship gone sour: It can cause a women to have difficulty functioning sexually, but again, the dysfunction would probably not be so severe."
--Dr. Drew
Q My fiance's penis curves upward. How can we "straighten out" the problem so that we can experiment different positions without hurting him?
Psychological advice: "Penises turn and twist in all directions. In your fiance's case, you both have to accept that his penis happens to curve upward and that certain positions will be more comfortable than others. But the penis is flexible, as are your bodies. So all positions are possible if you adjust a little or raise here and there."
--Dr. Judy
Medical advice: "There is, however, a rare condition called Peyronie's disease, in which a curved penis--accompanied by pain on erection--is a symptom, but it afflicts only 1 percent of males and can be corrected surgically. So if your fiance is experiencing pain as well as curving, he should see a urologist. Otherwise, don't worry."
--Dr. Drew
Q I can achieve orgasm only by way of a man's hands or mouth. Anything can do about this?
Medical & psychological advice: "If it's any comfort, most women (the estimate is put at more than 50 percent) share your experience. One reason is that the finger and the tongue can stimulate the clitoris or G spot or other sensitive place more effectively than the penis can during penetration. But there are a number of bridge techniques that may increase your chances of climaxing during intercourse. While he's inside you, either one of you could use a finger for clitoral stimulation. Or you could get close to climaxing through foreplay and then, when he enters you, you could continue to stimulate your clitoris with your fingers while he does so peripherally by thrusting. That should do the trick. But remember: While it's often psychologically more satisfying to have an orgasm during penetration, sex is not only form of intercourse. Sometimes oral sex can be even more intimate."
--Dr. Judy
Q Is it true that my gynecologist will be able to tell that I masturbate?
Medical advice: "Not unless you're doing something really extreme that physically injures you."
--Dr. Cherry
Psychological advice: "No. Besides, who cares? Every gynecologist I know feels that masturbation is merely a part of normal sexuality."
--Dr. Reichman
Q I was shocked to find out that my boyfriend had contracted crabs. His doctor said he probably got them from me, but I've never had them. Should I trust him when he says he hasn't slept with anyone else?
Medical advice: "Crabs are lice that inhabit the pubic region, and though they are often transmitted by body contact, they can also be picked up from things like bedsheets or towels. So your boyfriend doesn't necessarily have. have slept with someone else to have gotten the lice."
--Dr. Cherry
Psychological advice: "And now that you know this is one of those sexually transmitted conditions that you are able to catch in other ways, trust shouldn't be an issue. I strongly suggest you stop obsessing about it."
--Dr. Judy
Q I've never had an orgasm--not even when I masturbate. Could the problem be physical?
Medical advice: "When women are not orgasmic, it's usually a psychological phenomenon. One exception is if the woman is using drugs--recreational or prescription, even alcohol--which can diminish the ability to have a sexual response. But ruling out drugs, and in the absence of a debilitating disease, chronic illness, or fatigue --any of which cut the ability to function on every level--I can think of no anatomical, physical, or organic condition that would prevent you from being orgasmic."
--Dr. Cherry
Psychological advice: "First, realize it isn't unusual that you haven't had an orgasm, because an estimated one-third of all women haven't! Second, recognize that sometimes women have to learn to have an orgasm, so continue to practice by yourself on yourself, and don't hesitate to use a vibrator. If you're inhibited for any reason, there's a greater chance you'll be able to climax with a lover after you've become comfortable coming on your own. Mentally, many women stop themselves from going over the edge, over the top, when they're with a man. They reach a certain point where they get to the intensity of the feeling, and then they're frightened--fearful of getting too attached to the man or of losing control. Should you get to the point where you feel that fear, press on. Ask yourself, `If I have an orgasm, what:s really the worst thing that's going to happen here? Will I lose the guy? Will he think I'm a loose woman?' Gradually, you'll rationally eliminate your fears, and when you reach the critical point of teetering on the edge, you'll realize you have only something to gain here--nothing to lose. Meanwhile, allow yourself to feel the smaller sensations and to value them so that they build."
--Dr. Judy
Q I've recently married, and I'm not interested in sex. I just started a new job, and I'm always tired and stressed. What should I do?
Medical & psychological advice: "This is a complaint I hear from most career women. When you're under stress, all systems go down. You don't function the way you normally would. Stress can also affect your hormones, which can impede the arousal process. But the fact is, you must take time out to enjoy sex with your husband. Maybe you shouldn't try to do it during the week but decide that weekends are the time for lovemaking. It's a matter of figuring out priorities and schedules. What you need is a prescribed vacation."
--Dr. Reichman
Q My problem is the opposite of vaginal dryness during intercourse. Is there any way to reduce extreme vaginal lubrication?
Medical advice: "The first thing to do is make sure you don't have an infection that might be producing an abnormal vaginal discharge. If that's not the case and the secretions are solely due to sexual stimulation, there's nothing you can do about it. And rather than considering it an abnormality, my advice is simply to enjoy it."
--Dr. Cherry
Psychological advice: "You should welcome the lubrication and never ever do anything that would reduce your excitement level. Think of it with pride--the way a man does when his penis gets harder and bigger."
--Dr. Judy
Q Every time I make love, I jump in the shower right afterward to wash off all that drippy semen. Isn't it unhealthy to have it sticking to my body? Or am I just being weird?
Medical & psychological advice: "All that drippy semen is not going to harm your health. I wouldn't say you're weird, but I am concerned that your behavior might imply you find lovemaking dirty and therefore jump into the shower to purge yourself, or that you might have some intimacy issues. I would recommend that you try spending 10 or 15 minutes after sex just cuddling with your partner and examining your feelings to see what comes up. If you can't tolerate the closeness--if you feel you just have to jump up and run to the shower--then something else is going on and you should consult with a therapist."
--Dr. Drew
Q Ever since my boyfriend bought me a vibrator, I find I can't climax without it, and I've completely lost interest in him. Is this normal?
Medical advice: "A vibrator is very good for clitoral stimulation In fact, many women have told me that it's better than the real thing, because you can set the speed and place it exactly where you want, and you don't have to tell it what to do--which many women have trouble doing. The truth is, no man can effectively mimic an electrical vibrating appliance, but why not double your pleasure by using it with him."
--Dr. Reichman
Psychological advice: "Maybe the loss of interest in your boyfriend is symptomatic of a distancing in your relationship; you're looking for an explanation and the vibrator seems like the most obvious one. So I suggest you examine the relationship. Maybe the guy was always only a source of mechanical pleasure. If that's true, consider the wisdom of continuing this relationship. Maybe you should end it now."
--Dr. Drew
Q I'm constantly badgered by my boyfriend to shave my pubic hair. He says that a bald pubic area sexually arouses him. Could this be a fetish? And isn't it unhygienic to shave "down there"?
Psychological advice: "Unless he requires that you shave in order for him to become sexually aroused or sexually functional at all, I don't think that what you describe would qualify as a fetish. It seems to me to be more an issue of personal taste and style."
--Dr. Drew
Medical advice: "Pubic hair protects the somewhat fragile lips of the vagina, and even the clitoris, from friction caused by our clothing. So you're losing that protection if you shave, but I don't feel it's a major health concern so much as a matter of personal comfort. I have several patients who shave, and aside from the occasional infected hair follicle or ingrown hair or rash from razor burn, it doesn't seem to hurt them at all."
--Dr. Reichman
Q My fiance and I have been engaged for three years. For most of that time, we had great sex, but now, during intercourse, my vagina feels like it's ripping apart. What could be wrong?
Medical advice: "If you're on the Pill, you may have developed a thinning of the vaginal mucosa. So first, I'd suggest you either try a pill higher in estrogen--low levels of which can exacerbate the problem--or switch to another means of birth control. Meanwhile, I'd give you an estrogen cream to use I locally and a male hormone cream called testosterone propionate to apply to the labia to thicken the skin anti protect it from tearing. I'd suggest avoiding Jacuzzis and hot tubs, because they drain the vaginal tissue of' its moisture, which can lead to further irritation. Also, stay away from deodorant soaps, and shower rather than tub-bathe for a while. Finally, abstain from intercourse until the hormonal creams have had a chance to take effect--usually at least two weeks."
--Dr. Reichman
Medical advice 2: "Also, get your gynecologist to do a culture to see if you have a strep infection of the vagina, which comes from the same bacteria that causes strep throat and can be passed to you by your partner through oral sex. It's common enough and very easy to cure with penicillin."
--Dr. Cherry
Psychological advice: "If there's no medical reason for your symptoms, then you have to think there might be some emotional reason for the problem that could show up as painful intercourse--which is commonly caused by vaginismus, a spasm of the pelvic-floor musculature. Anger, depression, ambivalence, previous trauma--all these things can predispose you to it. If you're frustrated by the inertia of your relationship--three years of engagement warrants looking into--it may he brought out as vaginismus It may be time to he honest with your fiance about how you're feeling, or you may need couples therapy. Or, it may he time to move on."
--Dr. Drew
Q I had an abortion six months ago. Since then, my live-in boyfriend initiates sex only when he thinks I'm asleep. Is there a connection?
Psychological advice: "Yes. Men--women too--who initiate sex only when their partner is sleeping do it as a way not to confront the relationship. I'm sure this is related to the trauma of your pregnancy and subsequent abortion. Your boyfriend is withdrawing, and I think you need to get him to talk about what he's feeling. You must truly mourn together; otherwise, you'll never get back to having a natural, open sexual relationship "
--Dr. Judy
Psychological advice 2: "I agree that you and your boyfriend have to discuss the impact the abortion has had on both of you. He may literally be gun-shy--frightened of impregnating you again or traumatized and not able to overcome his anxiety. And you may have changed more than you realize. I've yet to meet a woman who didn't experience remorse, didn't feel the biological sense of loss and the depression that accompanies the hormonal changes of having gone from pregnant to not pregnant, let alone the psychological trauma brought on by what she's actually done. You may be reacting to all this by pushing your boyfriend away without even realizing it. You need to talk to him about these issues, and of course, he has to share his angst with you."
--Dr. Drew
Q I have been diagnosed with venereal warts. Are they serious? Can I pass them along to my boyfriend? If we have oral sex, can I transmit the warts to his mouth?
Medical advice: "Venereal warts are caused by any of 23 strains of the human papilloma virus (HPV) that can inhabit the genital/urinary tract. The more virulent strains (they number eight or so) are associated with cervical and vaginal cancer. Although there is no test for detecting the virus, these high-risk strains can be identified in women by a virapap test or HPV-DNA testing, either of which will he ordered by your gynecologist if a Pap smear indicates anything abnormal. Like so many viruses, HPV is silent, meaning it can stay in your body for years and years without ever manifesting itself In approximately 1 percent of the people who harbor the virus, however, it starts to multiply for Unknown reasons and forms little growths varying in size from pinpoint to the dimensions of a pinkie fingernail and in color from flesh-toned to reel to black In women, these often occur in the cells of the cervix and cause the precancerous changes that turn up in an abnormal Pap (which is reason in itself to have a Pap smear at least once a year)--in which case the affected cervical tissue is lasered or cut away. Or the genital warts can appear on the labia or rim of the vagina, and in men on the penis (often invisibly SO, especially if hidden by the foreskin). They can he removed with chemicals or laser or by freezing or cutting them out But though the warts are then gone, you will still have the virus;l it's in the body as part of' your vaginal flora (the bacteria and viruses that normally inhabit the vagina) There's no medication you can take to get rid of HPV, and you can pass it along to your sexual partner--and he to you--even in its silent state (although a hit more easily if the warts are present) unless he wears a condom. In fact, a recent report from the Department of Public Health identified HPV as the fastest growing sexually transmitted disease in the United States--to the tune of 1 million new cases diagnosed every year What's more, it's estimated that 50 percent to 70 percent of sexually active people will eventually be infected with one form or another of HPV--one shot of unprotected sex is all it takes It doesn't happen often, but the virus can also be transmitted by oral sex from the genitals of a man or a woman to a partner's mouth, where the warts, if they do develop, usually appear back toward the throat. And the virus--even after the warts are removed--could conceivably he retransmitted to a partner's genitals' again by oral sex."
--Dr. Reichman
Psychological advice: "Even so, you can still enjoy oral sex safely by using a dental dam, which is basically a sheet of' latex that you lay across your genitals to form a barrier against the virus."
--Dr. Drew
Q My boyfriend is just in his 20s, but once the first lovemaking session is over, it takes him a couple of hours to recoup for round two. What's wrong with him?
Medical advice: "Men have a much longer refractory period--the time before they can climax again--the do women, hut there's tremendous variation from individual to individual. There are men who can get an erection 30 minutes later and ejaculate again, and men who can ejaculate four times a day, and men who can ejaculate only once a day. So you really can't say anything is wrong if it takes your boyfriend two hours--no matter what his age."
--Dr. Cherry
Psychological advice: "Why not just relax and let him set his own pace? Trying to make him feel pressured about getting hard and coming again is exactly what will sabotage him."
--Dr. Judy
Q I recently lost my virginity. Occasionally, I hurt to the point where my boyfriend can't enter me--especially during a particularly long "session." Other times, it just hurts but penetration is possible. And sometimes I bleed as well. What's wrong with me?
Medical advice: "There is nothing wrong with you. Some women simply have more of a hymen than others--the hymen being the soft tissue encircling the opening of the vagina that is usually broken when you first have intercourse--so there may be more sporadic bleeding and pain than usual. Also, some women have a low-grade vaginitis--similar to a yeast infection--and when the vagina is irritated by intercourse, the condition flares up, so that what's being perceived as painful intercourse is really a flare-up of vaginitis and should be checked out by a gynecologist. Then, too, some women go dry and the vagina becomes traumatized. But using an artificial lubricant like K-Y Jelly, or a new one called Astroglide, will usually alleviate that problem."
--Dr. Cherry
Psychological advice: "You may have what is called selective dyspareunia --pain during intercourse at certain times and not others--and it could come from selective vaginismus brought on by your vagina's tightening up when you're not relaxed. One way to counter this problem is to use the mantra of "I am relaxed, I am relaxed," repeating it over and over to yourself while breathing deeply until you open up. You might also examine whether there are certain times when you're just not in the mood and your vagina is telling you so. Or perhaps it's tightening in response to your fears of getting pregnant or of not having an orgasm. There could be endless hidden reasons for your pain, so if relaxation techniques fail to work, I suggest you see a therapist for a short time to sort the problem out."
--Dr. Judy
Q It seems every time I have sex, I get a yeast infection. Could this be psychosomatic and in some crazy way associated with guilt?
Medical advice: "Yeast doesn't grow because you're guilty. When you become sexually aroused, vaginal secretions increase, which can change the pH--the acidity--of your vagina, making it more alkaline. This creates an environment conducive to the growth of yeast, which causes infection by destroying the `good bacteria'--the lactobacilli--normally present in the vagina. Some of my patients ask if douching with yogurt or taking acidophilus helps retard the multiplication of yeast. Contrary to popular belief, the answer is no--first, because the lactobacilli in yogurt are totally different from the lactobacilli in the vagina, and second, because acidophilus is easily absorbed by the vagina and therefore doesn't hang around long enough to have a local effect. All you can do is treat the problem--usually with over-the-counter antiyeast creams or suppositories--whenever an infection occurs. Even more effective is the relatively new pill called Diflucan, which is available in pharmacies by prescription and taken by mouth."
--Dr. Reichman
Medical advice 2: "It could also be that you've never really gotten rid of the yeast infection between flare-ups. Maybe you applied medication only until the symptoms went away but not the underlying infection--and then, once some irritant was introduced, it flared up again. That's a good reason for taking Diflucan--one pill, and the infection's gone in only three or four days."
--Dr. Cherry
Medical advice 3: "You should also be examined by a physician to make sure you don't have some illness that predisposes you to yeast infections--like diabetes or HIV."
--Dr. Drew
Q My boyfriend and I are both virgins and not yet ready for intercourse, but we've recently started having anal sex. Are there any particular health risks we should be aware of?
Medical advice: "You can get HIV from anal intercourse, obviously. In fact, it's a more common way to transmit the disease than through vaginal intercourse, which is why the incidence is so high in the homosexual male population, where anal intercourse is the norm. Intercourse is more traumatic to the anus than to the vagina because the anus is a smaller opening that doesn't self-lubricate and is easily torn. And it's these tears that allow the AIDS virus secreted by the penis direct access into the bloodstream. Being the receptive partner in anal intercourse makes you vulnerable to all other sexually transmitted diseases as well, so it's essential that your boyfriend use a condom which will also help protect him against the risk of getting a urinary-tract infection from the bacteria present in your rectum."
--Dr. Cherry
Psychological advice: "Why, I wonder, would you indulge in anal sex but not vaginal sex? Both qualify equally as sex. So it seems that you're holding to a very technical definition of virginity: not breaking the hymen. But in my opinion, whether anal or vaginal or oral, sex is sex, period!"
--Dr. Judy
By Robyn Brown, Allison Fabian, Caryn Kanare, and Erica Werner, Cosmopolitan
Q I sometimes have an while sleeping. orgasm while I'm sleeping. How can I possibly be climaxing without physical stimulation?
Psychological advice: "Everybody needs a certain amount of sexual activity, and if you're not getting it through interaction with other people or through masturbation, your bodies will `discharge' naturally. Once our conscious mind, with all its baggage--distractions, guilt, whatever--is disengaged, our fantasies (i.e., our dreams) take over."
--Dr. Drew
Medical advice: "You're probably responding to sexual fantasies in your dreams, just as you might respond to fantasies alone in waking life. Our sexuality, after all, isn't only about physical touch. In fact, the physiologic buildup of excitation that's ultimately released in orgasm can be triggered even by merely thinking of sex."
--Dr. Reichman
Q I haven't become sexually aroused in more than four years, and intercourse feels like I'm being speared. The total lack of desire is frustrating because I think about sex a lot. What should I do?
Medical advice: "You should make sure the problem isn't merely a matter of insufficient lubrication, which may be solved with more foreplay or by using an over-the-counter lubricant. Also, if you are taking an antidepressant--Prozac or Paxil, for example--it can make you feel dead from the waist down. If neither lubrication nor medication is to blame, see your gynecologist to make sure there's not something wrong in the pelvis that:s causing the pain--whether its endometriosis (a fairly common condition in which the uterine lining grows outside of the uterus), adhesions (an overgrowth of scar tissue following surgery), or rarely, perhaps a tumor."
--Dr. Reichman
Psychological advice: "People who experience ambivalence about their sexuality to the point where sex is overwhelmingly painful--those for whom the notion of sex is okay but the act is something unpleasant--often are survivors' of some kind of childhood sexual abuse. If you suspect or know that you are indeed a survivor, you can expect to continue having difficulty with intimacy for your entire life--unless you recieve professional treatment in the form of long-term psychotherapy. Of course, lesser childhood trauma (brought on by parents who have withheld love, for example) could cause a spectrum of difficulties with intimacy but probably not the total shutdown you describe, indicative of someone who was abused. The same can be said for a relationship gone sour: It can cause a women to have difficulty functioning sexually, but again, the dysfunction would probably not be so severe."
--Dr. Drew
Q My fiance's penis curves upward. How can we "straighten out" the problem so that we can experiment different positions without hurting him?
Psychological advice: "Penises turn and twist in all directions. In your fiance's case, you both have to accept that his penis happens to curve upward and that certain positions will be more comfortable than others. But the penis is flexible, as are your bodies. So all positions are possible if you adjust a little or raise here and there."
--Dr. Judy
Medical advice: "There is, however, a rare condition called Peyronie's disease, in which a curved penis--accompanied by pain on erection--is a symptom, but it afflicts only 1 percent of males and can be corrected surgically. So if your fiance is experiencing pain as well as curving, he should see a urologist. Otherwise, don't worry."
--Dr. Drew
Q I can achieve orgasm only by way of a man's hands or mouth. Anything can do about this?
Medical & psychological advice: "If it's any comfort, most women (the estimate is put at more than 50 percent) share your experience. One reason is that the finger and the tongue can stimulate the clitoris or G spot or other sensitive place more effectively than the penis can during penetration. But there are a number of bridge techniques that may increase your chances of climaxing during intercourse. While he's inside you, either one of you could use a finger for clitoral stimulation. Or you could get close to climaxing through foreplay and then, when he enters you, you could continue to stimulate your clitoris with your fingers while he does so peripherally by thrusting. That should do the trick. But remember: While it's often psychologically more satisfying to have an orgasm during penetration, sex is not only form of intercourse. Sometimes oral sex can be even more intimate."
--Dr. Judy
Q Is it true that my gynecologist will be able to tell that I masturbate?
Medical advice: "Not unless you're doing something really extreme that physically injures you."
--Dr. Cherry
Psychological advice: "No. Besides, who cares? Every gynecologist I know feels that masturbation is merely a part of normal sexuality."
--Dr. Reichman
Q I was shocked to find out that my boyfriend had contracted crabs. His doctor said he probably got them from me, but I've never had them. Should I trust him when he says he hasn't slept with anyone else?
Medical advice: "Crabs are lice that inhabit the pubic region, and though they are often transmitted by body contact, they can also be picked up from things like bedsheets or towels. So your boyfriend doesn't necessarily have. have slept with someone else to have gotten the lice."
--Dr. Cherry
Psychological advice: "And now that you know this is one of those sexually transmitted conditions that you are able to catch in other ways, trust shouldn't be an issue. I strongly suggest you stop obsessing about it."
--Dr. Judy
Q I've never had an orgasm--not even when I masturbate. Could the problem be physical?
Medical advice: "When women are not orgasmic, it's usually a psychological phenomenon. One exception is if the woman is using drugs--recreational or prescription, even alcohol--which can diminish the ability to have a sexual response. But ruling out drugs, and in the absence of a debilitating disease, chronic illness, or fatigue --any of which cut the ability to function on every level--I can think of no anatomical, physical, or organic condition that would prevent you from being orgasmic."
--Dr. Cherry
Psychological advice: "First, realize it isn't unusual that you haven't had an orgasm, because an estimated one-third of all women haven't! Second, recognize that sometimes women have to learn to have an orgasm, so continue to practice by yourself on yourself, and don't hesitate to use a vibrator. If you're inhibited for any reason, there's a greater chance you'll be able to climax with a lover after you've become comfortable coming on your own. Mentally, many women stop themselves from going over the edge, over the top, when they're with a man. They reach a certain point where they get to the intensity of the feeling, and then they're frightened--fearful of getting too attached to the man or of losing control. Should you get to the point where you feel that fear, press on. Ask yourself, `If I have an orgasm, what:s really the worst thing that's going to happen here? Will I lose the guy? Will he think I'm a loose woman?' Gradually, you'll rationally eliminate your fears, and when you reach the critical point of teetering on the edge, you'll realize you have only something to gain here--nothing to lose. Meanwhile, allow yourself to feel the smaller sensations and to value them so that they build."
--Dr. Judy
Q I've recently married, and I'm not interested in sex. I just started a new job, and I'm always tired and stressed. What should I do?
Medical & psychological advice: "This is a complaint I hear from most career women. When you're under stress, all systems go down. You don't function the way you normally would. Stress can also affect your hormones, which can impede the arousal process. But the fact is, you must take time out to enjoy sex with your husband. Maybe you shouldn't try to do it during the week but decide that weekends are the time for lovemaking. It's a matter of figuring out priorities and schedules. What you need is a prescribed vacation."
--Dr. Reichman
Q My problem is the opposite of vaginal dryness during intercourse. Is there any way to reduce extreme vaginal lubrication?
Medical advice: "The first thing to do is make sure you don't have an infection that might be producing an abnormal vaginal discharge. If that's not the case and the secretions are solely due to sexual stimulation, there's nothing you can do about it. And rather than considering it an abnormality, my advice is simply to enjoy it."
--Dr. Cherry
Psychological advice: "You should welcome the lubrication and never ever do anything that would reduce your excitement level. Think of it with pride--the way a man does when his penis gets harder and bigger."
--Dr. Judy
Q Every time I make love, I jump in the shower right afterward to wash off all that drippy semen. Isn't it unhealthy to have it sticking to my body? Or am I just being weird?
Medical & psychological advice: "All that drippy semen is not going to harm your health. I wouldn't say you're weird, but I am concerned that your behavior might imply you find lovemaking dirty and therefore jump into the shower to purge yourself, or that you might have some intimacy issues. I would recommend that you try spending 10 or 15 minutes after sex just cuddling with your partner and examining your feelings to see what comes up. If you can't tolerate the closeness--if you feel you just have to jump up and run to the shower--then something else is going on and you should consult with a therapist."
--Dr. Drew
Q Ever since my boyfriend bought me a vibrator, I find I can't climax without it, and I've completely lost interest in him. Is this normal?
Medical advice: "A vibrator is very good for clitoral stimulation In fact, many women have told me that it's better than the real thing, because you can set the speed and place it exactly where you want, and you don't have to tell it what to do--which many women have trouble doing. The truth is, no man can effectively mimic an electrical vibrating appliance, but why not double your pleasure by using it with him."
--Dr. Reichman
Psychological advice: "Maybe the loss of interest in your boyfriend is symptomatic of a distancing in your relationship; you're looking for an explanation and the vibrator seems like the most obvious one. So I suggest you examine the relationship. Maybe the guy was always only a source of mechanical pleasure. If that's true, consider the wisdom of continuing this relationship. Maybe you should end it now."
--Dr. Drew
Q I'm constantly badgered by my boyfriend to shave my pubic hair. He says that a bald pubic area sexually arouses him. Could this be a fetish? And isn't it unhygienic to shave "down there"?
Psychological advice: "Unless he requires that you shave in order for him to become sexually aroused or sexually functional at all, I don't think that what you describe would qualify as a fetish. It seems to me to be more an issue of personal taste and style."
--Dr. Drew
Medical advice: "Pubic hair protects the somewhat fragile lips of the vagina, and even the clitoris, from friction caused by our clothing. So you're losing that protection if you shave, but I don't feel it's a major health concern so much as a matter of personal comfort. I have several patients who shave, and aside from the occasional infected hair follicle or ingrown hair or rash from razor burn, it doesn't seem to hurt them at all."
--Dr. Reichman
Q My fiance and I have been engaged for three years. For most of that time, we had great sex, but now, during intercourse, my vagina feels like it's ripping apart. What could be wrong?
Medical advice: "If you're on the Pill, you may have developed a thinning of the vaginal mucosa. So first, I'd suggest you either try a pill higher in estrogen--low levels of which can exacerbate the problem--or switch to another means of birth control. Meanwhile, I'd give you an estrogen cream to use I locally and a male hormone cream called testosterone propionate to apply to the labia to thicken the skin anti protect it from tearing. I'd suggest avoiding Jacuzzis and hot tubs, because they drain the vaginal tissue of' its moisture, which can lead to further irritation. Also, stay away from deodorant soaps, and shower rather than tub-bathe for a while. Finally, abstain from intercourse until the hormonal creams have had a chance to take effect--usually at least two weeks."
--Dr. Reichman
Medical advice 2: "Also, get your gynecologist to do a culture to see if you have a strep infection of the vagina, which comes from the same bacteria that causes strep throat and can be passed to you by your partner through oral sex. It's common enough and very easy to cure with penicillin."
--Dr. Cherry
Psychological advice: "If there's no medical reason for your symptoms, then you have to think there might be some emotional reason for the problem that could show up as painful intercourse--which is commonly caused by vaginismus, a spasm of the pelvic-floor musculature. Anger, depression, ambivalence, previous trauma--all these things can predispose you to it. If you're frustrated by the inertia of your relationship--three years of engagement warrants looking into--it may he brought out as vaginismus It may be time to he honest with your fiance about how you're feeling, or you may need couples therapy. Or, it may he time to move on."
--Dr. Drew
Q I had an abortion six months ago. Since then, my live-in boyfriend initiates sex only when he thinks I'm asleep. Is there a connection?
Psychological advice: "Yes. Men--women too--who initiate sex only when their partner is sleeping do it as a way not to confront the relationship. I'm sure this is related to the trauma of your pregnancy and subsequent abortion. Your boyfriend is withdrawing, and I think you need to get him to talk about what he's feeling. You must truly mourn together; otherwise, you'll never get back to having a natural, open sexual relationship "
--Dr. Judy
Psychological advice 2: "I agree that you and your boyfriend have to discuss the impact the abortion has had on both of you. He may literally be gun-shy--frightened of impregnating you again or traumatized and not able to overcome his anxiety. And you may have changed more than you realize. I've yet to meet a woman who didn't experience remorse, didn't feel the biological sense of loss and the depression that accompanies the hormonal changes of having gone from pregnant to not pregnant, let alone the psychological trauma brought on by what she's actually done. You may be reacting to all this by pushing your boyfriend away without even realizing it. You need to talk to him about these issues, and of course, he has to share his angst with you."
--Dr. Drew
Q I have been diagnosed with venereal warts. Are they serious? Can I pass them along to my boyfriend? If we have oral sex, can I transmit the warts to his mouth?
Medical advice: "Venereal warts are caused by any of 23 strains of the human papilloma virus (HPV) that can inhabit the genital/urinary tract. The more virulent strains (they number eight or so) are associated with cervical and vaginal cancer. Although there is no test for detecting the virus, these high-risk strains can be identified in women by a virapap test or HPV-DNA testing, either of which will he ordered by your gynecologist if a Pap smear indicates anything abnormal. Like so many viruses, HPV is silent, meaning it can stay in your body for years and years without ever manifesting itself In approximately 1 percent of the people who harbor the virus, however, it starts to multiply for Unknown reasons and forms little growths varying in size from pinpoint to the dimensions of a pinkie fingernail and in color from flesh-toned to reel to black In women, these often occur in the cells of the cervix and cause the precancerous changes that turn up in an abnormal Pap (which is reason in itself to have a Pap smear at least once a year)--in which case the affected cervical tissue is lasered or cut away. Or the genital warts can appear on the labia or rim of the vagina, and in men on the penis (often invisibly SO, especially if hidden by the foreskin). They can he removed with chemicals or laser or by freezing or cutting them out But though the warts are then gone, you will still have the virus;l it's in the body as part of' your vaginal flora (the bacteria and viruses that normally inhabit the vagina) There's no medication you can take to get rid of HPV, and you can pass it along to your sexual partner--and he to you--even in its silent state (although a hit more easily if the warts are present) unless he wears a condom. In fact, a recent report from the Department of Public Health identified HPV as the fastest growing sexually transmitted disease in the United States--to the tune of 1 million new cases diagnosed every year What's more, it's estimated that 50 percent to 70 percent of sexually active people will eventually be infected with one form or another of HPV--one shot of unprotected sex is all it takes It doesn't happen often, but the virus can also be transmitted by oral sex from the genitals of a man or a woman to a partner's mouth, where the warts, if they do develop, usually appear back toward the throat. And the virus--even after the warts are removed--could conceivably he retransmitted to a partner's genitals' again by oral sex."
--Dr. Reichman
Psychological advice: "Even so, you can still enjoy oral sex safely by using a dental dam, which is basically a sheet of' latex that you lay across your genitals to form a barrier against the virus."
--Dr. Drew
Q My boyfriend is just in his 20s, but once the first lovemaking session is over, it takes him a couple of hours to recoup for round two. What's wrong with him?
Medical advice: "Men have a much longer refractory period--the time before they can climax again--the do women, hut there's tremendous variation from individual to individual. There are men who can get an erection 30 minutes later and ejaculate again, and men who can ejaculate four times a day, and men who can ejaculate only once a day. So you really can't say anything is wrong if it takes your boyfriend two hours--no matter what his age."
--Dr. Cherry
Psychological advice: "Why not just relax and let him set his own pace? Trying to make him feel pressured about getting hard and coming again is exactly what will sabotage him."
--Dr. Judy
Q I recently lost my virginity. Occasionally, I hurt to the point where my boyfriend can't enter me--especially during a particularly long "session." Other times, it just hurts but penetration is possible. And sometimes I bleed as well. What's wrong with me?
Medical advice: "There is nothing wrong with you. Some women simply have more of a hymen than others--the hymen being the soft tissue encircling the opening of the vagina that is usually broken when you first have intercourse--so there may be more sporadic bleeding and pain than usual. Also, some women have a low-grade vaginitis--similar to a yeast infection--and when the vagina is irritated by intercourse, the condition flares up, so that what's being perceived as painful intercourse is really a flare-up of vaginitis and should be checked out by a gynecologist. Then, too, some women go dry and the vagina becomes traumatized. But using an artificial lubricant like K-Y Jelly, or a new one called Astroglide, will usually alleviate that problem."
--Dr. Cherry
Psychological advice: "You may have what is called selective dyspareunia --pain during intercourse at certain times and not others--and it could come from selective vaginismus brought on by your vagina's tightening up when you're not relaxed. One way to counter this problem is to use the mantra of "I am relaxed, I am relaxed," repeating it over and over to yourself while breathing deeply until you open up. You might also examine whether there are certain times when you're just not in the mood and your vagina is telling you so. Or perhaps it's tightening in response to your fears of getting pregnant or of not having an orgasm. There could be endless hidden reasons for your pain, so if relaxation techniques fail to work, I suggest you see a therapist for a short time to sort the problem out."
--Dr. Judy
Q It seems every time I have sex, I get a yeast infection. Could this be psychosomatic and in some crazy way associated with guilt?
Medical advice: "Yeast doesn't grow because you're guilty. When you become sexually aroused, vaginal secretions increase, which can change the pH--the acidity--of your vagina, making it more alkaline. This creates an environment conducive to the growth of yeast, which causes infection by destroying the `good bacteria'--the lactobacilli--normally present in the vagina. Some of my patients ask if douching with yogurt or taking acidophilus helps retard the multiplication of yeast. Contrary to popular belief, the answer is no--first, because the lactobacilli in yogurt are totally different from the lactobacilli in the vagina, and second, because acidophilus is easily absorbed by the vagina and therefore doesn't hang around long enough to have a local effect. All you can do is treat the problem--usually with over-the-counter antiyeast creams or suppositories--whenever an infection occurs. Even more effective is the relatively new pill called Diflucan, which is available in pharmacies by prescription and taken by mouth."
--Dr. Reichman
Medical advice 2: "It could also be that you've never really gotten rid of the yeast infection between flare-ups. Maybe you applied medication only until the symptoms went away but not the underlying infection--and then, once some irritant was introduced, it flared up again. That's a good reason for taking Diflucan--one pill, and the infection's gone in only three or four days."
--Dr. Cherry
Medical advice 3: "You should also be examined by a physician to make sure you don't have some illness that predisposes you to yeast infections--like diabetes or HIV."
--Dr. Drew
Q My boyfriend and I are both virgins and not yet ready for intercourse, but we've recently started having anal sex. Are there any particular health risks we should be aware of?
Medical advice: "You can get HIV from anal intercourse, obviously. In fact, it's a more common way to transmit the disease than through vaginal intercourse, which is why the incidence is so high in the homosexual male population, where anal intercourse is the norm. Intercourse is more traumatic to the anus than to the vagina because the anus is a smaller opening that doesn't self-lubricate and is easily torn. And it's these tears that allow the AIDS virus secreted by the penis direct access into the bloodstream. Being the receptive partner in anal intercourse makes you vulnerable to all other sexually transmitted diseases as well, so it's essential that your boyfriend use a condom which will also help protect him against the risk of getting a urinary-tract infection from the bacteria present in your rectum."
--Dr. Cherry
Psychological advice: "Why, I wonder, would you indulge in anal sex but not vaginal sex? Both qualify equally as sex. So it seems that you're holding to a very technical definition of virginity: not breaking the hymen. But in my opinion, whether anal or vaginal or oral, sex is sex, period!"
--Dr. Judy
By Robyn Brown, Allison Fabian, Caryn Kanare, and Erica Werner, Cosmopolitan
posted by James at 3:25 PM
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