Fructose Test

If there are no sperm in the semen analysis it may mean that none are being produced by the testes, or that they are being produced but the tubes are blocked and they cannot get through to be ejaculated. Where no sperm are present, a test for fructose is done. Fructose is a sugar normally found in semen. The absence of fructose in the semen can mean that the seminal vesicles are blocked, stopping both sperm and fructose from getting through. It may be possible to surgically correct such a blockage. Alternatively, the absence of fructose could mean that the man does not have any seminal vesicles. If fructose is present but the man does not have any sperm in the sample, further investigations need to be done. These can reveal whether there is a blockage nearer to the testes or whether the testes are not in fact producing sperm.

Anti-sperm Antibody Test

This test attempts to determine whether the man is producing substances which are causing the sperm to clump together, lose motility or prevent fertilisation. These antibodies would make the man’s immune system ‘see’ his own sperm as foreign bodies and try to destroy them.

The most common test for antibodies is the MAR (mixed antiglobulin reaction) test which is now often done as part of the normal semen analysis. If antibodies are present, the sperm will be clumped together instead of moving freely.

Sperm antibodies can be produced in response to an infection. Antibodies can also be produced in about 70 per cent of men after a vasectomy. During the procedure some sperm may leak out and, because previously they had been contained within the reproductive system, the body views them as a foreign substance and produces antibodies to them.

Treatments for anti-sperm antibodies may include steroids which carry their own side-effects, such as weight gain, stomach bleeding and depression. IVF may be a possibility if the sperm can still penetrate the egg, otherwise ICSI will be suggested.

It is also possible for the woman to be producing antibodies to her partner’s sperm and this can be checked by a blood test.

Post-coital Test

The post-coital test has been used since the 1860s to assess the cervical mucus and the sperm’s ability to swim through it. You go to the clinic around the time of ovulation after having intercourse about four to ten hours before. A cervical mucus sample is taken and examined under a microscope. The clinic is looking to see whether there are any sperm in the mucus, whether they are dead, or whether they are just shaking rather than moving forward. If a man has active, healthy sperm when he gives a sperm sample, and yet in the post-coital test the sperm are dead, then something is obviously happening once the sperm are inside the vagina. The test needs to be performed precisely at the right time of the cycle and it is possible to get a number of false results. This means that it has to be repeated, if it looks as if the woman is killing off her partner’s sperm.

There are not many clinics who still do this test and it is interesting that a study published in the British Medical Journal in 1998 came to the conclusion that ‘Routine use of the post-coital test in infertility investigations leads to more tests and treatments but has no significant effect on the pregnancy rate’. The researchers took couples who were attending an infertility clinic and then split them randomly into two groups. One group had all the usual fertility investigations plus the post-coital test and the other group just the fertility investigations without the post-coital. At the end of the study there was no difference in the number of pregnancies between the two groups, and yet the group having the post-coital test was given more fertility treatments on the basis of their post-coital results.

*3/73/5*

It is always wise to obtain a complete and detailed sexual and background history. At the Masters and Johnson Institute, two histories are taken from each member of the couple: one each by both of the therapists, first, male-male, female-female; then male-female, female-male, with an opportunity for the therapists to discuss the first history with each other before the second one is taken. This gives an opportunity for obtaining additional information by exploring any lead which may have been developed in the first history session.

The next day the therapists meet with the couple to go over the histories and to clarify any misunderstandings which may have occurred. This is described as the “round table.” Should any material in the individual history reveal something that the patient does not want the partner to know, then this is red-lined and not disclosed. However, if it seems essential to the therapeutic process for this to be discussed with the other partner, then this is explained to the person concerned, but even then is not disclosed if the individual insists on it even after its importance is explained.

It is believed at the Masters and Johnson Institute that no sexually dysfunctional relationship can exist with an uninvolved partner, even though the presenting complaint is primarily by one partner, such as impotence in the male or a non-orgasmic female. As Masters and Johnson have written, “There is no such thing as an uninvolved partner in any marriage in which there is some form of sexual inadequacy”.

Both primary and secondary orgasmic dysfunction, vaginismus in the female, and impotence, premature ejaculation, and ejaculatory incompetence in the male are usually successfully treated by the method developed by Masters and Johnson. The basic approach is that of the history and round-table routine. Each type of dysfunction requires some variation in approach. At the round table after clarification of the history, the couple is instructed to carry out what Masters and Johnson describe as the “sensate focus.” In effect, each partner is instructed in ways of caressing the other in order to give the greatest degree of pleasure without involving the breasts or genitals. This is done first by one, then the other partner. The following day these areas may be included in the caressing, but without any attempt to perform sexually, thus obviating performance anxiety. It is emphasized that this should be a sensual, not a sexual activity. Although no time limit is given, it is suggested that the exercise should last for twenty to thirty minutes. The reaction of the couple to this experience is discussed with them, since it is usual in most instances that this type of activity would lead to sexual performance. It does, however, lead to a significant degree of sexual stimulation without performance anxiety, which is an important factor in causing sexual dysfunction. The fear of inability to perform may be a very important factor in causing whatever type of dysfunction exists. The sensate-focus activity is, of course, undertaken with both partners in the nude and in comfortable and pleasant surroundings.

Following the basic approach described above, attention in therapy is directed to the type of dysfunction involved. Thus, the treatment of impotence requires a different approach from that of premature ejaculation, even though such symptoms are quite likely to be closely inter-related. Different procedures are also used in the treatment of the non-orgasmic female or the female with vaginismus. In treating premature ejaculation it is generally conceded that the squeeze technique is the best approach.

This was first described by Semans and more specifically developed by Masters and Johnson. In this approach the female stimulates the male to erection and when the male is aware that ejaculation is about to occur, she is instructed to squeeze the phallus with the first two fingers, one above and one below the corona on the anterior surface of the penis, with the thumb on the frenulum. Considerable pressure can be applied without causing pain when the penis is erect, and if the squeeze is undertaken soon enough it invariably prevents ejaculation. This can be repeated a number of times at each session and after satisfactory reaction has been developed, it should be kept in mind that this procedure should be repeated occasionally. Dr. Kaplan and others recommend this even after the premature ejaculation is under control.

*242/187/5*

Diagnosis

As in the case of homosexuality, bisexuality per se is a condition or way of behaving erotically, not a syndrome. Therefore, in the strict sense, there is no diagnosis. The condition is identified by the history either of sexual practice or imagery, or both. In its most covert form, bisexuality may not be identifiable as such, being manifest only as a failure of complete heterosexual abandon. Physical signs are noncontributory.

Differential Diagnosis

The issues are the same as in the differential diagnosis of homosexuality.

Therapy

Of and by itself alone, bisexualism is not a disease and does not require therapy. The vast majority of individuals with a bisexual history never see a therapist. If bisexualism is associated with a lack of well-being, however or if it is experienced as a source of distress to the person or partner, then either or both will benefit from some form of psychological counseling or therapy. The goal of treatment most often is to restore a sense of bisexual well-being. Less often and in selected instances, the goal may be one of predominant heterosexual eroticism.

Prognosis

Bisexuality as an optional life style, equally acceptable to consenting partners; is like a vocational life style in not requiring a diagnosis. If a prognosis is required, it is for the sequelae of the life style. For some, overt bisexuality represents a solution to problems of erotic relationships. Then the prognosis is positive. For others, it represents a compounding of problems, with a prognosis that is guarded, but not necessarily negative.

With less social stigmatization, bisexualism could become therapeutically accepted as a variant of human sexuality. For some individuals who otherwise might be victimized by social pressures into becoming patients, bisexuality enlarges the range of their behavioral options in eroticism and love so that they need not become patients.

*205/187/5*

If a woman chooses a nonconventional career, she then has to acquire a position enabling her to pursue it. She “applies” for a job. It is at this point that the most obvious and concrete examples of access discrimination can occur. The fact of discriminatory treatment in selection decisions has been documented widely. Before presenting these data, however, it is important to consider why such processes are so prevalent.

Because of the lack of competing information, when an individual first seeks to enter an organization, sex stereotypes are apt to be a predominant element in decision making. One of the functions of such stereotypes is a cognitive one—to make the world less complex and less ambiguous and thus more manageable. By treating an individual woman as merely one member of a large and well defined subgroup, “women,” and ascribing attributes to her that presumably are characteristics of that group, a great deal of information about that individual is generalized. Whether true or not, assumptions about any one woman and what she is like are likely to be made on the basis of her subgroup identity when little other information is available.

Without exception, the attributes ascribed to females are not those believed essential to work success. As we already have seen, achievement-oriented traits are sorely lacking in the stereotypical profile of women’s attributes. Consequently, work success, especially in occupations not traditionally feminine, is associated only with males.

Schein empirically demonstrated this by asking male management personnel in insurance companies to describe either women, men, or successful middle-level managers. She found that “men” and “successful middle manager” were described in very similar terms but “women” were described quite differently. Apparently, those attributes characterizing a successful manager are not at all those typically ascribed to women. Success at managerial work is indeed considered to be a “male” phenomenon.

The pervasiveness of this point of view was documented in a study conducted by Feldman-Sumners and Kiesler. In the course of designing the procedure for their experiment, these researchers administered a pretest survey to approximately eighty-five male and female undergraduates at the University of Kansas. Each was shown descriptions of people and was asked to indicate how successful he or she believed them to be. The following professionals were described: pediatrician, writer, child psychologist, surgeon, dancer, diagnostician, clinical psychologist, and biographer of famous women. For each subject, half of these were presented as male and the other half as female. The results were dramatic. In no instance was a woman expected to be more successful than a man! The authors also report that in later work with additional professions and work categories they were unable to find even a single occupation in which women rather than men are expected to be more successful. This was found even when the traditionally female occupations were used, such as nursing and elementary school teaching. This is indeed very compelling evidence that success at work is generally associated with men more than women.

Sex-stereotypic norms also are likely to have a detrimental effect on women’s access to jobs. The demands of traditionally masculine jobs, such as managerial ones, are incongruent with the behavior thought to be appropriate to women. Dealing with subordinates, competing for resources, and making hard-nosed decisions are not activities consistent with the view of women as the gentle sex. Women interested in positions with these job descriptions are apt to be seen as “out-of-line” and to be penalized for their violation of sex-related expectations no matter what their background or qualifications. The result: steering the woman applicant to less challenging positions or not considering her for employment at all.

A related point is that concerning the persistent notion that women are unreliable workers, lacking commitment to their work. Starting from the view that a certain type of lifestyle is appropriate to a woman, many personnel decision makers are likely to assume that a woman would be pursuing a nontraditional career only because she either has nothing better to do (has not as yet any family obligations or has a bad marriage) or she is doing so out of economic necessity. Each of these can neatly explain her unconventional behavior. They foster the belief that if the woman in question should “find a man and settle down,” “divorce and remarry” or “get her hands on some money” she no longer would be interested in working. Taking this point of view, it is easy to understand the argument that the company should not make an investment in such an individual.

Some women are, of course, exempt from these allegations. Generally they are the “masculine” women who fit into “old maid” or “asexual” categories. Because they seem to have clearly rejected their femininity they are less suspect. Their motives for working appear to be clear, their role conflicts minimal, and the risk in hiring them less grave than in hiring a more feminine woman.

*168/187/5*

One of the most striking aspects of the anthropological literature on sexuality is the near-universal concern that men have about pollution or contamination resulting from contact with women. The Kaluli men of Papua New Guinea repeatedly warned anthropologist Schieffelin against sleeping with his wife and pointed to Schieffelin’s clumsiness on the trail as a result of such indiscretion (Schieffelin). The Kaluli men share the same concern as the men of the Central Highlands of New Guinea, as reported by Read: “In their view of the world, too close and constant an association with the opposite sex, even with one’s own wife, could impair a man’s vigor or retard his growth during the critical years of adolescence”. Mead generalizes that for all of Polynesia, “all women, and especially menstruating women, are considered contaminating and dangerous”. Suggs found this to be the case in the Marquesas; men would refuse sex during menstruation for a variety of reasons. Impotence might result, and they also voiced complaints against the practice on aesthetic grounds (Suggs). Tahitian males consider menstrual blood dangerous (Levy). The Fulani of Upper Volta designate menstruation with a phrase which, literally translated, means “to see dirt” (Riesman). Fulani women cannot pray during their menstrual periods. Menstruation and its associations seem to stand as the basis for the Fulani’s radical separation of male and female spheres, women being naturally weaker. Navajo women of the American Southwest cannot conduct a chant while menstruating (Bailey). The Navajo have an interesting paradox: although it is dangerous to have intercourse with a menstruating woman, to do so increases the likelihood of pregnancy (Bailey). In native South America, we find Mehinaku men who see menstrual blood as especially dangerous, capable of causing sickness and cramps in men.

Schieffelin observes from Kaluli:

Those women are weaker and less dynamic than men, that they are slow and clumsy and know less, is part of the same general condition of debility they manifest in menstruation. And this condition is dangerous to men because it is capable of destroying their manhood. The man who spends too much time in the woman’s section . . . who touches his wife too often or who eats food a woman has stepped over is likely to become emaciated, develop a cough, or lose his endurance on the trail.

The implication here is that menstrual blood or menstruation is not dangerous per se; it is symbolic of the weakness or danger that men more generally attribute to women. That Schieffelin’s clumsiness on the trail could be attributed by the Kaluli to his sharing a bed with his wife indicates a more general cultural separation between strength and weakness and agility and clumsiness that ascribes success to men but places blame on women. After all, a man should be able to negotiate a trail smoothly by nature; should a man falter, he is suspected of female contamination. Schieffelin, who knows he is clumsy by nature, sees the irony and sexism in the Kaluli men’s comments, and states: “It struck me as poignant irony that the person on whom a man most depends in his domestic household and whom he usually holds in his affections is also the one most dangerous to his vitality”.

Because the pattern is so pervasive and consistent in male/female antagonism, one might conclude that there are important, cross-societal universals about men and women. Although such a claim can be substantiated, to do so would be to miss the point about context. Many of these societies seem to be built on a “we/ they” male opposition; the “we” is generally the male domain, and the “they” consists of women, who some of the time are incorporated into “we” but usually are treated as a weaker, more dangerous “they.”

*131/187/5*

Marriage is the only human relationship within which sexual intercourse is universally sanctioned. We have seen, however, how variable are individuals within groups. Among some people, marital intercourse is proscribed at certain times, as during menstruation and pregnancy. Among others, provision is made routinely for extramarital liaisons, as among the Turu, and in Western countries which have institutionalized the mistress-lover relationship. Within groups data also testify to individual variation in needs, tastes, and behavior. Even within an individual’s historical repertoire, changes over time may be observed as a life style evolves and new behaviors emerge.

Generalizations about sex in marriage seem possible only for carefully defined samples, the results qualified by attention to the sources of variation and their effects. Currently in our society, we can describe the scene of marital sexuality only as pluralistic, providing many models, each with adaptations and variants. From one couple’s brief, once-a-week encounter, never deviating from the male superior position, to another’s daily, highly sensual, experimenting adventure, to yet another’s exploration of swinging and group sex, and many others closer to and farther from the norm, we gain a sense of the plasticity of human sexual experience as it occurs in the old institution of marriage.

*95/187/5*

The first of the modern semirigid prostheses was the Small-Carrion, named for the two doctors who developed it. It’s been around since 1973 and is still being used by some physicians.

Now, other variations on the same theme have been introduced. The newer models—the Flexirod, invented by Dr. Roy Finney, the Jonas Silicone-Silver prosthesis, named for its developer Dr. Udo Jonas, and the AMS 600—were designed to make the implant more concealable and bendable when not in the erect position.

The Small-Carrion prosthesis is bendable and allows the penis to be moved up, down or to the side. It has no portion specifically designed to bend, however. It is uniformly stiff throughout.

Unlike the Small-Carrion implant, the Flexirod was specifically designed to bend at the base of the penis to be more easily concealed. And the Flexirod is slightly stiffer along the shaft.

Yet another variation of the semirigid implant has a kind of memory: When you bend it, it will stay where you put it, and not snap back. Both the Jonas and the AMS 600 prostheses have this characteristic, made possible by their twisted wire core covered by silicone rubber. The advantage of these models is that once the penis is bent down, it will stay that way, so the penis won’t always look erect. The one drawback to this type is that rarely, a wire may break, and although the wire is still covered by the silicone rubber, the penis then becomes more floppy at the base.

*151\184\8*

Blood tests are a crucial part of a workup for erection problems. Here’s what your blood is being tested for, and why:

• Testosterone and prolactin. Testosterone is necessary for sexual desire, and, apparently, also for erection. Prolactin is a hormone from the pituitary gland which, in excess, can sneakily sabotage erections. If your body makes too much prolactin, low sexual desire, decreased testosterone and impotence may result.

• Fasting blood sugar and glucose tolerance. To see if diabetes may be contributing to your problem.

• Thyroid function. Too much or too little thyroid hormone may be connected with potency problems. (Ifs an easily treated condition.)

• Liver function. Because liver disease can affect potency.

• Kidney function. Kidney function can also affect potency.

Not all of these tests may be required in each case. In the absence of any suspicious evidence of disease, the last three tests may be omitted. Discuss this with your doctor.

*120\184\8*

Gary manages a furniture store and he met Cynthia, his second wife, when she began working at a nearby business. Gary and Cynthia dated for almost a year before they married.

Cynthia was burdened by a painful history when she married Gary. She had previously been married to a man who constantly criticized her and belittled her appearance and her sexuality. For a long time, she believed that she was incapable of enjoying sex or of pleasing a man sexually. But being with Gary changed all that. “It opened up a whole world to me, it was wonderful,” says this petite, shy woman. Then, after a couple of years of marriage, Gary developed erection problems. “It came on gradually. There was absolutely no problem when we first married,” says Cynthia.

Gary and Cynthia didn’t talk about the change in their sex life and their painful silence continued for three long years. “I kept thinking it was an isolated problem. But it was driving me up the wall and the last year I finally had to accept the fact it just was not working, and I tried to talk to Gary about it,” says Cynthia. She prepared herself for this discussion by reading a book on sexual responsiveness. But just mentioning the topic upset Gary tremendously. Concerned that she had caused him such pain, Cynthia dropped the matter. “We went for two weeks without talking about it—at all. Then he said, ‘Okay we really should do something.’ So we tried to follow some of the recommendations in the book—sort of doing sex therapy at home. And it helped some. But I got impatient. I short-circuited the whole thing.”

Gary finally sought medical help several months later, but he didn’t tell his wife until after he went to the doctor. She was greatly relieved when she learned that he had finally taken the first step. “I didn’t want to bring up the subject again because felt guilty. I mean, on some level, when a failure occurs, when he can’t get an erection, I feel he must hate me. It feels like rejection.

Gary went through several tests, and much to the surprise o his physician, was found to have extremely low levels of testosterone. In addition to causing Gary’s erection problems, the abnormality could even have contributed to his lack of motivation to correct the situation, since low testosterone can reduce desire. Gary was placed on shots of the hormone, and severe weeks later reported that his erections were normal. And he and Cynthia were able to make love again.

“If s been reasonably successful,” says Cynthia of the treatment. “But Gary still doesn’t talk about the cause. We don’t tall about it.” Tears well up in her eyes. Although her husband has c demonstrable physical cause for his potency problem, she still feels rejected. And his silence hasn’t helped her.

*91\184\8*

Sexual expectations are not always conscious, nor are they regularly communicated to another person. As a result, partners are often at cross-purposes when their pleasure-seeking goals are on the line. That was the situation of Gina and Paul, both in their mid-thirties, who had been married for four years. Their mutual attraction bad been based on their shared work—both were dedicated medical researchers—but now they seemed to be going in opposite directions.

“Ever since Paul began lo experience his ED. something has changed,” Gina began. “I don’t mean just the physical side; I mean the emotional one as well. He’s pulled away from me. Anytime I start to talk about how I feel about our situation he walks out of the room. He’s taken up a hobby—coin collecting—which he works on alone, in the middle of the night.”

His face reddening, Paul replied, “That’s because the last thing I want to do is discuss my erections with her. I feel strongly that it’s my problem. I realize she’s affected by it but I don’t see how having a sensitivity session about it is going to make it any better.”

“It’s not going to make it worse,” she pointed out.

“I disagree. The truth is—I never felt that we had such a great sex life to begin with. Now I have the opportunity to change it—”

“And you’d rather explore that brave new world with someone else,” she finished the sentence for him.

As he nodded his head in assent, Gina excused herself and walked out of my office.

“I’m sorry about this,” Paul told me. “It’s not that I don’t have feelings for Gina. It’s just that we were each other’s first real lover, and then we got married and spent so much time working that we—I— never had the time or inclination to explore what I really wanted from sex. I didn’t even want to, until my ED occurred. Now I have another opportunity—and I want to take it.”

Not surprisingly, Gina and Paul split up a short time later. The basis for their marriage—shared work—was not enough to keep them together. Sadly, their breakdown in communication prevented them from trying to find another bond to keep them together. Today, Paul’s ED is under control and he is excited at the prospect of exploring his own sexuality more fully.

The emotional issues in their situation included:

• dissatisfaction of one partner with their sex lives

• a change in feelings toward a partner

• unwillingness to discuss the problem

Think about your own feelings concerning:

• how satisfied you are with your sex life

• how content you are with your present partner or partners

• how pleased your partner is with your sexual relationship

• the frequency of your sexual encounters

• what the core of your relationship is, and whether it is based on sex, friendship, or family

• your comfort level in discussing your sexual attitudes

• the reaction of your partner

• the likes and dislikes in the sexual history with your partner

• things you would like your partner to do

• things you wish your partner wouldn’t do

• any changes you would like to make

Remember that a satisfying sex life is a major component of a healthy life. When the physical aspects of a relationship are on track, you and your partner are in sync. Anticipating each other’s needs and wants, you create an experience that is greater than the two of you. Boosting vitality, vigor, and optimism, a mutually gratifying sex life adds to overall mental and physical contentment.

*63\183\8*

A healthy young man in his teens and early 20′s should have no trouble getting erections. In fact, he may embarrass himself with erections in awkward situations.

Paul can remember what that feels like. Now 39 and married for more than a decade, Paul recalls his adolescent potency with a mixture of fondness and humor: “I’d be sitting in class with an erection—I’d sometimes have an erection all day long. And it could be embarrassing—you’d have to lose it before you could stand up. I was actually looking for the day when that didn’t happen.” His tanned face breaks out in a big grin. Maturity hasn’t diminished his sense of humor. “Now, Lord knows, I can sit for hours.”

A man who’s in late adolescence or early adulthood can have intercourse two or three times within a fairly short period of time. (One man recounted with great pride a memorable afternoon in which he had intercourse four times in four hours.) At this age, a man’s sexual appetite is strong, and so is his ability to get an erection. Consequently, on a purely physical level, foreplay may not be tremendously important. In fact, for some men this age, foreplay doesn’t exist.

*18\184\8*

Take the case of Robert and Jane. Their six-year marriage had hit serious snags and they were working—seemingly to no avail—with a psychiatrist to iron things out. Robert had trouble getting an erection, and seven months of very expensive therapy was fueling his anger, making his ED a burden that grew heavier day after day.

The primary conflict in their marriage was Jane’s career. While Koberi was proud of her accomplishments—she was a successful and highly visible banker—he chafed at her absences from home. And although he certainly admired her financial acumen and respected her choice to keep her personal finances and investments separate from his, the fact that she was more savvy at it than he was bothering him.

Jane, on her part, craved intimacy with her husband. She knew that her extended absences were a strain on their marriage and she felt that closeness was even more important those times when she was home. But when she was there, she was tired and sex wasn’t necessarily what she needed or wanted.

Robert, on the other hand, began to feel that Jane’s frequent absences were growing proof that she didn’t really love him. And when they did have time for sex, he found, to his growing dismay, that he was often unable to achieve an erection. His anxiety increased, leading to more erectile failure, which, in turn, led to even more worry about his performance in bed. Eventually, he avoided any kind of physical closeness altogether.

Jane took his behavior as a clear sign that he was no longer interested in her. One night, they finally had the confrontation that had been building for months. When Robert, after two glasses of Scotch, told Jane that her career left no room for him and made him feel worthless, she was stunned. The ultimate accusation was even worse: his ED, he said, was her fault.

Stung by his words, Jane knew they were at a turning point in their marriage. Fortunately, she had heard about the clinical trials of the new oral ED medications from a colleague. Feeling there was nothing to lose, she mentioned them and offered to accompany Robert to my office.

Now they began to make headway in their work with the psychiatrist, and they were willing and able to address the issues that concerned them. Defining what intimacy and sex meant to each of them, as well as dealing with the problems brought about by careers and finances, brought them closer. And as their communication skills improved, their relationship flourished. Over time, Robert’s’ erectile difficulties began to vanish. Soon, he found that he didn’t always need a pill to achieve an erection.

But the best part of this story is this: the effect of psychotherapy is jump-started by the medication, and the time an ED patient will spend in a therapist’s office is, therefore, vastly reduced. Had Robert come to me for the medication as soon as his problem began, I might have been able to shorten his time on the psychiatrist’s couch by half.

Mark, Jim, and Robert are just three of my many patients who have had their sex lives fully restored using the new medications. Whether the syndrome is provoked by changes in circumstances, which cause a temporary and easily rectified problem, or by ongoing worries about endurance, past performance, or other conditions, this medication regimen can help. Its effect is so profound that it is capable of aiding those men who suffer from ED as the result of certain diseases. 11 can even produce startling results for men who have suffered with ED for a decade or more.

*4\183\8*

An amazing number of people find it extremely difficult to talk directly and honestly with their partners about their sexual desires, fears and problems. Many people have been trained to perceive discussions about sex as being so private, so embarrassing and so revealing, that they hesitate to talk about their own feelings and wishes even with the person they’ve been married to for years.

In this context it is absolutely essential for partners to talk to each other about sex, so that their bodies can adjust mutually and their pleasures increase. Despite this, in my experience, most couples never talk to each other about what they do in bed, whether it is good or bad, or whether it gives them any satisfaction. I, for one, find it hard to believe that during the most intense moments of a couple’s relationship, neither partner knows what the other is thinking; their minds remain separate whereas their bodies are striving to get as close as two bodies can.

Many women talk freely to their friends about unfulfilled desires, disappointments and frustrations, but men generally keep their sex lives secret. I’m convinced that there would be far fewer misunderstandings, arguments and conflicts if both partners would talk openly about their physical and emotional expectations. I believe that nothing but good would come of sharing these innermost desires, however strange and fantastic they might appear to be.

*103\79\2*

Many women think of masturbation as unnatural and disgusting and a complete waste of time, and don’t understand why anybody does it and are unsympathetic to the view that people might continue to do it even though they have sexual partners. The majority of men, though they may keep their feelings to themselves, don’t agree.

For most people, once it is faced, masturbation in front of, or with a partner, and particularly if it is mutual, can be an extremely enjoyable and exciting way of making love, especially if it comes at the end of an extended period of foreplay. Differences in attitudes can be ironed out only if you are candid with your partner and voice your feelings about masturbation. You may get a shock; you may find that you are both mutually attracted to the idea.

There are many myths about masturbation, but it is important to realize that masturbation cannot cause any trouble for anyone unless it is against one’s own moral sanctions. View it as an excellent opportunity for self-education. You should be open and comfortable with it; it should never end up leaving impressions of hurriedness, guilt or secretiveness about sex. More importantly, masturbation can lead to intense orgasms, and it is the one way to develop sexual comfort, security and self-esteem.

Above all, masturbation is not something that means sex with your partner is not as good as it should be, or even that your partner cannot stimulate your genital organs in the way that you like. Many partners have their best sexual experiences when masturbation or mutual masturbation is engaged in prior to or during sexual intercourse.

*77\79\2*

Many people find it worthwhile to take a good, hard look at themselves as a way of getting in touch with and appreciating their bodies. Most of us are far too hard on ourselves. It will buck up your feelings quite a lot if you concentrate on your good points rather than emphasizing the bad.

Doing the following should help to lessen self-consciousness and make you more comfortable with yourself and with your body as a source of sexual pleasure. It is best to do these “exercises” in private, when you have plenty of time and feel as relaxed as possible.

The Sexual Repertoire-The activities described here are practised by most people. There are more bizarre practices, but these aren’t included since they occur rarely and may not be embraced whole-heartedly by both partners. Your sexual experience may include some if the former, you might like to try out the new ones. Remember that for truly satisfying experiences, partners must learn how to receive as well as give.

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Sexual tension in the initial stage increases more slowly in women than men, frequently taking 20 or 25 minutes but, on average, 15 minutes. The more varied and stimulating the foreplay, the more rapidly a woman passes through this initial arousal phase. Her pleasure then rises in a parallel and step-wise fashion with the thrusting of the penis within her vagina. If direct stimulation of the clitoris is maintained simultaneously throughout this period, a woman can proceed quickly to the point of orgasm. After orgasm there is a slow and gradual return to normality often extending up to half an hour. During this resolution phase, the breasts return to their normal size and the swelling of the labia diminishes.

Woman’s experience-With penetration and the man’s thrusting movements, her pleasure increases in step-wise fashion and she proceeds to orgasm.

The woman becomes fully aroused more slowly than the man during foreplay. Tension increases until the plateau phase, when she longs to be penetrated.

After the climax, a woman’s return to normality is slow and gradual, unlike a man’s. Sometimes she can delay this phase and remain at least at plateau stage, experiencing multiple orgasms if further stimulated.

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The changes that mark a boy’s physical development into a mature man begin in the pre-teen and early teen years and are completed when he is between 14 and 18. These changes — when boys become taller and more muscular, with wider shoulders, more developed genital organs and with hair appearing on their genitals, underarms, faces, chests, arms and legs – are caused mainly by the male hormone, testosterone. As well as having the characteristics set out below, the adult male has experienced his voice “breaking”, caused by the larynx enlarging and the vocal cords becoming longer and thicker so that the pitch of the voice drops, and an increase in sweat and sebaceous gland activity.

After testicular activity is established at puberty it normally continues for the rest of life with only slight impairment in later years. In old age there is a slight reduction in the production of sperm and androgen. This is associated with some degenerative changes in the testes, but there is no abrupt testicular decline comparable to the female climacteric.

The “average” man is approximately 173 centimetres (5 feet 9 inches) tall and weighs 74 kilos (162 pounds); his chest, waist and hip measurements are 98, 80, 93 centimetres (39, 32, 37 inches).

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