COMMON SEXUAL CONCERNS
Robert W. Birch, Ph.D.
Sexologist & Sexuality Educator
On this page, you will find articles addressing several common sexual concerns.
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Go here for everything your want to know about male sexuality!
Go here for an article titled, "Your Introduction to Sex Therapy: What's it all About?"
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Click here to go to the page with these three articles.
- VAGINISMUS AND SEXUAL PAIN
- ERECTILE DYSFUNCTION
- MASTURBATION: COMPULSIVE AND OTHERWISE
LOW SEXUAL DESIRE
WHAT IS SEXUAL DESIRE?
When we talk of "low sexual desire," we are talking of a lack of interest in sex. In street language, the person with low desire does not get "horny," or does so infrequently. Without desire, there is little or no biological motivation to be sexual. Individuals without a sex drive do not understand why they are not interested, and might not even know what it is that's missing. They feel powerless when expected to want sex.
Traditionally, sexual drive was called LIBIDO, and this term is still used by those not trained in the diagnosis and treatment of sexual disorders. Clinically, low sexual desire was initially classified as INHIBITED SEXUAL DESIRE (or ISD), but in recent years has been relabeled HYPOACTIVE SEXUAL DESIRE (or HSD).
Regardless of what it is called, when the level of sexual desire is down, a person's lack of interest can create serious problems within a relationship. However, this is only true if the partner has a higher level of desire. There is no problem if both want sex once every day, and there is no problem if both want sex once a month. However, if one wants it every day and the other only once a month, this discrepancy is likely to cause concern. In other words, it is the discrepancy in levels of desire that is potentially disturbing.
Think of sexual desire as a hunger. If a person is hungry for food, he or she will be motivated to eat, will enjoy eating, and will be satisfied once having eaten his or her fill. The person will reminisce about a good meal, will tell friends about what tastes good, and will look forward to eating again. The sexual drive is also a biological hunger that motivates behavior, influences thoughts, and invades fantasies. Despite the similarities, there are differences, however, between a hunger for food and a hunger for sex. A person is not likely to feel hurt, rejected or unloved if a partner does not want to eat with him or her. Not so when a one is not sexually motivated, for this is often taken much more personally by the partner with the greater appetite.
WHO HAS LOW DESIRE?
The answer the question seems easy. Everyone has low desire... at times. If a person is depressed or temporarily ill, his or her sexual drive is likely to drop. Immediately after being sexually satisfied, desire fades. During a pregnancy, some women lose their sexual appetite. For some women their "horniness" fluctuates in synch with their menstrual cycle, with some women being more interested mid-cycle and some during their periods. We know that certain medications will adversely impact libido. During times of stress and high anxiety, desire will diminish. We have all experienced these low points from time to time. Aging, chronic illness and physical disability can have long term effects on sexual interest.
In real life, questions about desire are not that easy. One must first ask, "How much desire is enough?" The answer is, it all depends! It all depends on the partner's level of desire. Counting the frequency of "horny attacks" is meaningless and once more we must return to the concept of a desire discrepancy. If one partner would like to be sexual twice a week, but the other would like sex four times a week, there might be just as much tension in that relationship as when one partner is totally disinterested and the other feels amorous every third Saturday morning.
The old jokes typically have a woman saying, "Not tonight dear, I have a headache." In reality, however, it seems that in about 45% of the relationships with a desire discrepancy it is the man claiming the migraine. So, put aside that myth that it is only women who have low sexual desire. Levels of desire vary among both males and females. Some men are chronically disinterested as are some women, and the reasons are not always clear.
TRYING TO UNDERSTAND THE DILEMMA
All too often we confuse sexual desire with emotional love. I have heard many people, men and women say to their partners, "I you loved me as much as I love you, you would want me as much." Love and sexual appetite are not the same. Physical attraction, sexual chemistry, physical lust operates on a totally different program than emotional caring and commitment. It is wonderful if there is both love and mutual sexual passion, but by a desire for hot sex is not the same as loving and loving is not the same as wanting. Those who would argue with this must be fortunate to have both, but loving couple with a desire discrepancy understand what I am talking about.
To fully understand the nature of desire, one has to consider that when everything is working, desire precedes sexual excitement, and desire is the motivation to seek that arousal. Arousal precedes orgasm. It is in being arousal that orgasm becomes a very attractive goal. In a sense, then, the sexual response cycle is wanting to get something started so that it can be ended. In the process of doing so, it is nice giving pleasure to a receptive partner, fostering the intimacy of a relationship, and nurturing the shared love... but biologically, the drive is to get started, get hot, and get finished.
Ironically, any one of the three phases (desire, arousal and orgasm) can occur independently, without all the phases happening. That is, there can be desire and arousal, but no orgasm, a concern experienced mostly by women (addressed in other articles). Some older men still have desire, but are unable to become aroused, yet with stimulation of their soft penises, they will ejaculate (orgasm). There can also be arousal and even orgasm without being driven by desire. In another article on this site I talk of "jump-starting," and I'll not repeat that here, other than stating that there are times when a person with no libido can become turned on and experience a wonderfully pleasurable orgasm, but shortly afterward will honestly state, "That was nice, but I don't ever need to do it again." This can be very frustrating to a person who believes that by providing a fantastic orgasm for a disinterested partner, that partner will be "cured" of their low desire. It doesn't happen that way.
Concerns about desire discrepancies make up the most frequently heard complaints in the offices of sex therapists and on the online question and answer boards. Unfortunately, this is the most difficult situation to reverse. It is practically impossible to talk someone into feeling something, and often the attempts to do so either drive the persons further away or cause them to feel guilty.
IS THERE ANY HOPE FOR INCREASING SEXUAL DESIRE?
If one were to ask, "How many sex therapists does it take to change a light bulb?" the answer would be, "Only one!" However, the light bulb must really want to change. A person who has felt desire but then has lost it, is likely to miss the feelings and want to pursue change. On the other hand, a person with chronically low desire does not, in essence, know what it is he or she is missing and is less likely feel motivated. In fact, they often perceive the problem as being their partners' problem. Any feelings of anger, resentment or guilt within the relationship will further dampen an interest in discovering what it is to crave sexual arousal and orgasm with a partner.
If the relationship is good, and emotional issues will not get in the way, sex therapy can help discover ways to stir arousal. However, this often will seem a bit mechanical as, for I have said, it is difficult to build in a biological hunger. There is hope, however, for the many woman who will benefit from testosterone. If a woman's testosterone levels are found to be low, her physician can prescribe hormonal supplements in the form of a pill. If levels are not low, a testosterone cream might be prescribed. A post-menopausal woman on hormone replacement therapy can be give a pill that combines both her estrogen and testosterone. These are all available only by prescription, and require the women to consult her physician.
Experiments with a female form of Viagra have not been promising. Furthermore, there are no known herbs or over the counter pills, creams or ointments that have proven to be effective. The best approach remains couples therapy with a qualified sex therapist, coordinated with medical intervention by a physician knowledgeable in the treatment of sexual dysfunction.
©2001 Robert W. Birch, Ph.D.
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DOES SIZE MATTER?
Men's worry over the size of their penises has lead to exaggerated claims of enlargement pumps, pills and props. Millions of dollars are spent on trying to expand the length and or girth of an average size member, on the assumption that bigger is better. There are even costly surgical procedures claiming to enlarge penis size, with no evidence whatsoever that these operations make any significant or lasting differences. But men worry, and men spend money, and men write all the time asking about what herbs or what exercises will add greatness to their otherwise mundane phallus. The answer, unfortunately, is that there are no reliable guaranteed methods that will make any significant differences in what nature had intended for the owner.
Penises, like noses, come in all sizes... so do clitorises, and ears, and feet. If I said that no woman wants a big penis in her, I would be flooded with e-mail from women stating, "The bigger, the better." Truth is, some women do like the big ones... they are no more likely to orgasm with a large penis than a smaller one, for there is truth in the saying that it is not the size of the tool that matters, but how you use it! But, the fact remains, some women want to feel full. However, it is likely that there are more women who find large penises uncomfortable... even painful, and opt for these of a more reasonable size. Let's face it, some people fit very well together, some don't. One size does not fit all!
Guess what. Vaginas are not of uniform size, although the average, when not aroused, is only about 3.5 inches long. Vaginas lengthen some during arousal and they stretch like crazy, but there is a limit to what they will stretch without triggering pain. For most women, their vaginas will expand as they become aroused, but with higher arousal will close down around the incorporated penis. At that point, unless the penis is either enormous or extremely small, most women will not be aware of the differences in penile size.
So, what can a couple do if they don't quite fit? First of all, let's remember that for the majority of women, the sensitivity of their clitorises far exceeds that of their vaginas. Therefore, couples should work on finding the positions of intercourse that provide to most clitoral stimulation. I always recommend the female superior position for this if the woman is willing to take control and find how best to position and move her body. With good clitoral stimulation, penis size becomes secondary. Another good maneuver is for the man to move up high on his partner's body so that his penis slides down over her clitoris as it enters her. Long stroking with short penis does not work well in this position, but staying in close and using short strokes works quite well.
If a woman wants to feel tighter around her partner's penis, she could begin doing the Kegel exercises that are described in detail in another of my articles on this site. It also adds to the mutual tight feeling if the man enters from the rear ("doggie style"). This is particularly effective if her head and chest are down, as this rotates her pubic bone up and provides a hard surface her partner must slide over. This also works well for a man who has trouble ejaculating during intercourse.
Bottom line on penis size... you've got it, you've got to learn to make the best of it, for no amount of worry, no amount of money, and no amount of magic is going to add anything that would make a perceptible difference to a woman. Experiment with positions of intercourse, perfect oral pleasuring, work magic with your hands and, with mutual agreement, find some fun toys to play with. Good sex is not about size... it's about having fun!
©2001 Robert W. Birch, Ph.D.
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There are other options for male sexual health at RB Health
BIGGER NOT ALWAYS BETTER
Dyspareunia is the clinical term for painful intercourse and there are a lot of physical and psychological causes for sexual pain. One cause is the mismatch of genital size, specifically when the woman is either too small or the man is too big, or both. This is referred to as a "size discrepancy," and it is obvious that a woman would be inclined to avoid anything that hurts.
It is certainly true that some women prefer a big penis, but probably a greater number put a limit on the size. Some penises are just too fat, too long or both. Dr. Birch has written a guide for couples when the woman is experiencing pain because of her partner's penis size. TOO BIG: A Guide to Coping when Pain replace Pleasure offers information, advice and resources for concerned couples.
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CAUTION: THIS ARTICLE INCLUDES GRAPHIC/EXPLICIT LANGUAGE!
GETTING WHAT YOU WANT
Many questions have been received essentially asking, "How can I tell my partner what I want without hurting his (or her) feelings?" Unfortunately, this is a little like asking how to close the barn door after the horses have escaped. Ideally, good sexual communication should begin very early in a sexual relationship, although I realize that in the heat of new passion, just about anything feels good! Often it is only as a relationship settles down that someone wishes they were getting something more or something different.
If your partner is trying, but is off target, too rough, or not rough enough, it might help to guide his or her hand to where you like best to be touched. Then add the words, "I love it when you touch me here." Lift up or press down on the hand to change pressure, saying, for example, I love being stroked gently in this area." Avoid questions such as, "Why don't you every touch my genitals?" Instead, move your partner's hand close to your genitals and say, "It would feel good if you touched me... I would really like that." Of course, the worst thing you could say would be, "All my other lovers knew how to touch me, why don't you?" That would cause major damage!
A problem for some might be a discomfort with sexual language. For some women, it is easy to say, "I love the way you play with my pussy," but other women would be too embarrassed to do so. "Touch my genitals," works, but it is not very specific. Even the term vagina is vague and anatomically incorrect if used to denote the outer genitalia. "Clitoris," although a clinical term, is still difficult for some women (and men) to say out loud. Seems there are those clinical words and there are the "dirty" ones. Penis might be too clinical, cock too raunchy. Vulva might confuse, pussy might offend. Words, words... they can be so playful or so upsetting. Should we talk with partners about what words turn them on and what words turn them off? You bet we should, for there needs to be a common agreed upon language to use when exchanging sexual information.
One way to deal with offensive words and avoid the cold clinical ones is to come up with nicknames for body parts. Some couples come up with creative terms for sexual activities, although less creative folks simply state, "I'd love if you'd touch it and then we can do it. It is such a convenient word... but so sterile. The term making love works for many, but is a misnomer, for we do not really make love with our genitals. We create love in an upright position, foster love without touching, nurture love with our words, feel love in our hearts, and share love when we bond sexually. We made love before having sex, shared love during sex, and continued love after sex... but, the term works for many, and I should not be picky.
Remember never to attempt to give information in a negative way. For example, do not say, "You never touch my (your word) right," for this comes across as a criticism and does not offer any useful information. Better to say something like, "I like it when you touch my (whatever), but boy, it would probably feel even better if you rubbed harder (or softer, or up a little)." Always be sure to recognize and reinforce when something does feel good. "Yes... that spot... I love it when you rub that spot." Does it feel too good to put into words? Then moan!
My view of good sex is that it is noisy, assuming you don't have to worry about waking the children, your neighbors, or your partner's roommate! Add lots of words not only about what you enjoy receiving, but what you enjoy giving. In fact, you might help teach your partner to express more if you tell him or her what you love doing. "I really enjoy giving you pleasure... your wetness (or hardness) turns me on... and this spot right here... mmmm, my favorite. Hope that feels good to you." Moans and groans communicate pleasure, and if you enjoy giving pleasure, when you partner begins to moan because of what you are doing, moan with him or her because of your pleasure in doing it.
Perhaps in response to the question, "How do I tell my partner what I want without hurting his (or her) feelings?" I should simply respond "Very carefully." You do need to be careful not to sound critical or unappreciative. You do need to communicate your needs without damaging your partner's sexual self-esteem... and that all takes some care. But, you will never get what you want if we do not ask for it! Choose your words well, for you must remember... if verbal openness about sexual matters does not come easily for your partner, the reasons go way back into his or her past. He or she will not, therefore, suddenly open up. Sexual communication must begin with his or her willingness to learn comfort, and progress might be slow. Patience and understanding are essential.
©2001 Robert W. Birch, Ph.D.
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