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Why Men Wake up With Erections

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Have you ever wondered why men often wake up with an erection?

The morning penile erection, or as it is medically known, “nocturnal penile tumescence”, is not only an interesting physiological phenomenon, it can also tell us a lot about a patient’s sexual function.

Morning penile erections affect all males, even males in the womb and male children. It also has a female counterpart in the less frequently discussed nocturnal clitoral erection.

What causes erections?

Penile erections occur in response to complex effects of the nervous system and endocrine system (the glands that secrete hormones into our system) on the blood vessels of the penis.

When sexually aroused, a message starts in the brain, sending chemical messages to the nerves that supply the blood vessels of the penis, allowing blood to flow into the penis. The blood is trapped in the muscles of the penis, which makes the penis expand, resulting in an erection.

Several hormones are involved in influencing the brain’s response, such as testosterone (the main male hormone).

This same mechanism can occur without the involvement of the brain, in an uncontrolled reflex action that is in the spinal cord. This explains why people with spinal cord damage can still get erections and why you can get erections when not sexually aroused.

What about erections while we sleep?

Nocturnal penile erections occur during Rapid Eye Movement (REM) sleep (the phase during which we dream). They occur when certain areas of the brain are activated. This includes areas in the brain responsible for stimulating the parasympathetic nerves (“rest and digest” nerves), suppressing the sympathetic nerves (“flight and fight” nerves) and dampening areas producing serotonin (the mood hormone).

Sleep is made up of several cycles of REM and non-REM (deep) sleep. During REM sleep, there is a shift in the dominant system that’s activated. We move from sympathetic (fight and flight) stimulation to parasympathetic (rest and digest) stimulation. This is not found during other parts of the sleep cycle.

This shift in balance drives the parasympathetic nerve response that results in the erection. This is spontaneous and does not require being awake. Some men may experience nocturnal penile tumescence during non-REM sleep as well, particularly older men. The reason for this is unclear.

The reason men wake up with an erection may be related to the fact we often wake up coming out of REM sleep.

Testosterone, which is at its highest level in the morning, has also been shown to enhance the frequency of nocturnal erections. Interestingly, testosterone has not been found to greatly impact visual erotic stimuli or fantasy-induced erections. These are predominantly driven by the “reward system” of the brain which secretes dopamine.

Men don’t wake up with erections because they’ve been having sexy dreams.

Since there are several sleep cycles per night, men can have as many as five erections per night and these can last up to 20 or 30 minutes. But this is very dependent on sleep quality and so they may not occur daily. The number and quality of erections declines gradually with age but they are often present well beyond “retirement age” – attesting to the sexual well-being of older men.

It’s also important to highlight the counterpart phenomenon in women, which is much less researched. Pulses of blood flow in the vagina during REM sleep. The clitoris engorges and vaginal sensitivity increases along with vaginal fluidity.

What’s its purpose?

It has been suggested “pitching a tent” may be a mechanism for alerting men of their full overnight bladder, as it often disappears after emptying the bladder in the morning.

It’s more likely the reason for the morning erection is that the unconscious sensation of the full bladder stimulates nerves that go to the spine and these respond directly by generating an erection (a spinal reflex). This may explain why the erection goes away after emptying one’s bladder.

Scientific studies are undecided as to whether morning erections contribute to penile health. Increased oxygen in the penis at night may be beneficial for the health of the muscle tissues that make up the penis.

What does it mean if you don’t get one?

Loss of nocturnal erection can be a useful marker of common diseases affecting erectile function. One example is in diabetics where the lack of morning erections may be associated with erectile dysfunction due to poor nerve or blood supply to the penis. In this case, there’s a poor response to the messages sent from the brain during sleep which generate nocturnal erections.

It is thought nocturnal erections can be used as a marker of an anatomical ability to get an erection (a sign that the essential body bits are working), as it was thought to be independent of psychological factors that affect erections while awake. Studies have suggested, however, that mental health disorders such as severe depression can affect nocturnal erections. Thus its absence is not necessarily a marker of disease or low testosterone levels.

The frequency of morning erections and erection quality has also been shown to increase slightly in men taking medications for erectile dysfunction such as Viagra.

So is all this morning action good news?

While some men will put their nocturnal erections to good use, many men are not aroused when they have them and tummy sleepers might find them a nuisance.

Since good heart health is associated with an ability to have erections, the presence of nocturnal erections is generally accepted to be good news. Maintaining a healthy lifestyle is important in avoiding and even reversing erectile dysfunction, so it’s important to remember to eat healthily, maintain a healthy weight, exercise and avoid smoking and alcohol.

Complete Article HERE!

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The Real Reason Men Lose Their Erection When Using A Condom

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by Raffaello Manacorda

Men Lose Their Erection When Using A Condom

That Awkward Moment When…

If you’re a man, you’ve probably experienced this. Everything is perfect, the foreplay is going great, and the stage is set for a throbbing, mind-blowing, heart-shattering lovemaking. Your erection is strong and powerful, and feeling it turns you on even more.

And then, that moment comes. Your lover looks at you sweetly but squarely in the eyes, and with a soft but firm voice says, “We need to use a condom.”

This makes perfect sense. The risk of STIs and/or pregnancy is real. So you’ve got to wear that condom.

But our genitals don’t understand logic. And, sometimes, it only takes a few seconds of this pause for your penis to soften. Her being sweet and comprehensive only makes things worse: something inside you tells you that you won’t be able to do it if you wear a condom.

I’ve gone through the same process. I used to consistently lose my erection whenever a woman asked me to wear a condom. It wasn’t pretty. I hate to admit it, but a couple of times I even lied to a partner, telling her that there were no condoms in the house, while I actually had plenty. I just was too scared of sexual failure. Boy, am I grateful that no one got an STI or got pregnant because of that dirty little lie of mine.

So why on Earth does this happen? Why do we men lose our erection because of condoms?

The Real Reason Condoms Turn Men Off…

You might try to fool yourself and others with explanations such as:

  • That you don’t feel enough pleasure with a condom.
  • That a condom squeezes your penis too much.
  • That the pause “takes the romance away”…

But deep in your heart, you know that those are not the real reasons.

As for sensitivity and comfort, you know well that your penis is not all that sensitive. In fact, the harder it is, the less sensitive it is. And as for the non-romanticism of the 2-minutes pause, you have fantasized or have been in way less romantic situations, where your erection stood strong and implacable.

So WHAT is the real reason why you lose your erection? And what can you do about it?

To answer this question, the first thing you need to understand is that your main sexual organ sits in between your ears or, if you prefer, inside your chest. It is your head and your heart that turn you on (or off).

So, the reason why we men lose our erection when a woman asks us to wear a condom is that some deeply uncomfortable thought and/or emotion arises in us in response to that request. And what might that thought or feeling be?

Although every man is different, that uncomfortable thought is virtually always a variation on the same theme: she asking you to wear a condom carries the message that she does not accept you inside her body. And this can be truly devastating for a man.

Some Truths About Male Sexuality

Men love to feel invited, welcomed, by a trusting lover that opens up to their force and thrust. When the body of a woman is welcoming, wet, inviting, this is a huge turn-on for a man. When the body and soul of a woman tense, close up, tighten – this is a turn-off.

Men deeply crave to feel accepted, welcomed, and trusted.

The request to wear a condom challenges that. It can seem to convey the following messages:

  • If you don’t wear it, I won’t let you inside me (you’re unwelcome)
  • I don’t trust you to be healthy, or to control your ejaculation (you’re not trusted)

This is the subterranean thought that runs into most men’s mind, and makes them lose their erection.

Understanding it is the first step towards liberating your sexuality from this blockage.

As a man, you need to realize that, even if you wear a condom, you are welcome and accepted. That she wants you just as badly. In fact, she wants you so badly that she wants to be fully trusting and surrendered. And in order for that to happen, she needs to feel safe. This conviction will take some time to build, but once it’s there, it will never leave you. Condoms won’t be an issue anymore.

In order to get there, the best thing to do is start practicing, both by yourself and with a partner.

Practicing By Yourself

Get familiar and friendly with condoms. Buy a pack of condoms and start experimenting. Wear a condom and play with yourself.

Now, I know that the condom instructions say that you should wear it only when you are fully erect. The reason they say this is that if your penis is not fully erect, then a condom can potentially slip away, which is not cool. But for now, you can forget about this. You are alone, and you can wear a condom even if your penis is completely flaccid. In fact, you should practice this skill. Wear a condom on your soft penis, and then stimulate your penis so that it becomes hard.

Familiarize yourself with the condom, and lose your aversion to it. This will be really useful once you practice with a partner.

Practicing With a Partner

This is potentially going to be scary, so you’ll need to set a firm intention: you won’t back off. You will wear a condom no matter what, whether you end up having intercourse or not.

Next time you have the opportunity, do not wait for your partner to propose using a condom. Once you have enjoyed your foreplay long enough, go ahead and say the magic phrase: “I’ll put on a condom now, just in case.”

That means that, whether you are going to penetrate your partner or not, you can wear a condom anyway and then continue with whatever you were doing. At some point you may even forget that you have a condom on.

Your partner also has a role in this. You can ask her to support you in a very simple way: by doing with your penis exactly what she would do with it if there were no condoms. Touching it, sucking it, teasing it—just as if that condom did not exist.

And now, if the moment is ripe for both of you, still wearing your condom, penetrate her. Don’t worry if your erection isn’t that strong. In that case, just make sure to hold the bottom of your condom with your fingers to make sure it doesn’t slip away. But do get yourself to the point where you can penetrate her while still wearing a condom.

This moment is a threshold, and after that, the rest will be much easier. The more you feel that things are going well, the more natural it will become to continue making love with a condom. You will notice that it isn’t all that different from not using it, and that wearing a condom will give both of you more confidence and a feeling of safety. Since you are practicing here, refrain from ejaculating inside your partner, even if you are wearing a condom. The purpose now is to gain confidence with condoms—not necessarily to have the hottest lovemaking of your life.

Every man on this planet should be able to make love with a condom, if necessary. We owe it to ourselves, and we owe it to our partners, men or women. Asking a partner not to use condoms just to protect our sexual pride is not an option. If two lovers decide to not use condoms, let that be a conscious decision, rather than a slippery workaround of a sexual blockage.

Have fun!

Complete Article HERE!

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The Guybrator Cometh!

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Dr Dick Sex Toy Reviews Is BACK!

Hey sex fans!

I got some fantastic news for you.

After a hiatus of nearly three years, I am reviving Dr Dick Sex Toy Reviews.

There have been lots of changes in the adult product marketplace over the intervening years and there have been lots of changes here at Dr Dick Sex Advice too.

When our last review appeared in December 2014 the Dr Dick Review Crew and I were plum tuckered out after more than seven years of grueling product testing. We all decided that it was high time to throw in the towel. Despite having the opportunity to sample some of the world’s best adult products we needed a break. Frankly, I thought for sure that when we ended our review run it was the end of it…for good. Well, like they always say, never say never.

Over the years, I’d hear from my loyal readership; they’d tell me that they missed our fun, informative, snarky, and sometimes irreverent reviews. My readers would ask about members of the Dr Dick Review Crew. “What ever happened to Jack & Karen, Glenn & Hank, Joy and Dixie and the others? And when are they gong to return?” I would answer the best I could, but I would always say, “It’s not likely that we’ll revive our product reviews, but I’m delighted to know that our thoughts and comments were meaningful and helped folks make wise buying decisions.”

The intervening years also brought several new potential reviewers. “Hey Dr Dick, If ever you revive your sex toy reviews, I want to volunteer to be on your crew.”

New and innovative products were coming to the marketplace and manufacturers would often reach out to me with offers to send me samples. Again, would thank them for their interest, but declined their offers.

The long and short of it is, I kinda missed the hurly-burley of it all too. There’s nothing like getting a new product delivered to your door, a product that holds out the promise of fun and pleasure.

So, we’re officially back!

We have some new Review Crew members, a hot load of very interesting products, and an eagerness to share it all with you.

Our inaugural product is something very special and here to tell you all about it is a new Dr Dick Review Crew Member, Trevor. I’ll let him introduce himself and what he has in his hot little hands.

Pulse III Duo —— $149.00

Trevor
Hey all! I’m Trevor. I’m 32 years old. I’m originally from the UK, Manchester to be precise, but have been in the US since I was 13. I live with my da. My mom passed away three years ago. I am involved with this great gal. Shelia is her name. We’ve been together for just over a year.

I absolutely LOVE sex! I’ve been interested in sex for as long as I can remember. Get this, my da caught me wankin’ away like the little pervert I was when I was just eleven. Embarrassing, huh? Actually it was OK. I think he was as embarrassed as me. Anyhow, after that we’ve been able to talk about sex, which, I think, has been good for both of us. Especially now since my mom’s gone. But I’m getting ahead of myself.

Right now, I want to introduce you to the Pulse III Duo. It’s the world’s first Guybrator. It says so right on the classy super-shiny outer box. And this lovely comes from the good people at Hot Octopuss out of London…the one in England. GO Great Britain!!

Inside the box you’ll find a drawstring storage pouch, which has the Hot Octopuss logo on it, a magnetic/USB charging lead and an instruction manual. Then there’s a formed cardboard insert that holds the Pulse III Duo and a round remote control. All the packaging is recyclable. That’s the first item on the Dr Dick Review Crew’ checklist for a GREEN product.

Now let’s take a quick look at the Pulse III Duo itself. It’s basically a palm-sized hammock for your dick. It has these two flexible wings that surround your cock and you can use it with either a limp dick or a stiffy. It’s covered in this beautiful 100% silicone skin and it’s also 100% waterproof. By the way, the Pulse III Duo is the second generation Pulse. There’s also a Pulse II and a Pulse III Solo.

There are buttons on either side of the Pulse III Duo, one for power and vibrating patterns on the left side, and two (+/-) buttons to control intensity on the right side. The Pulse III Duo’s remote activates and controls the independent external vibrator for clitoral stimulation when you use it as a couple. So it’s actually two vibrators in one.

After giving the Pulse III Duo a charge for four hours using the magnetic USB charger, it was ready to go. I used it alone first. I started with my limp dick. I placed it in the hammock with my frenulum, the underside of my cockhead, on the sweet spot of the guybrator, and switched it on. The pulsing piston-like osculation action got me rock hard in moments. This thing is fantastic! I cycled through the 6 stimulation modes and adjusted the intensity with each mode. I couldn’t believe the sensations. I nearly blew my wad in the first few minutes.

Just when I thought I had experienced the full range of sensations I happened upon the “Turbo” button. You just press and hold the (+) button for a moment and it will take your vibrations straight to warp speed. DAMN!! This took me over the top in a matter of a couple minutes. Now, just so you know, I wasn’t actually stroking myself; I was just holding the Pulse III Duo on my dick.

The next time out I decided to add some lube. As with all silicone toys, use only water based lube. A silicone based lube would mar the beautiful finish of the toy. This time I gripped the Pulse III Duo around my dick, folding the wings slightly to embrace my cock. It felt so good I almost forgot to add the vibration. I edged my self for about 20 minutes this way. No mean task, because the pleasure was so intense I had to release my cock several times just to avoid cumming too soon.

The third solo use was in the shower. I love to wank in the shower. And because the Pulse III Duo is waterproof it’s the ideal shower or bath buddy.

I can see where the Pulse III Duo would make a great tool for some guy trying to gain control over his ejaculation response. If you cum too quickly and you want to lean how to last longer, this toy could help train you to do that.

After nearly exhausting myself with solo play I decided to put the Pulse III Duo away till I had the opportunity to show it to and play with it with my gal, Shelia. Luckily, Shelia loves sex toys, particularly the ones that vibrate. In fact, she is the one that originally turned me on to sex toys.

One evening we got a little buzz on with some killer Chardonnay. I whipped out the Pulse III Duo and handed it to her. I didn’t tell her anything about it; I wanted to see if she could figure it out. She handled it a bit and said, “this is a guy’s toy, right?” “Well, it sure can be.” I responded. I told her about my solo play and how I nearly knocked myself out with the powerful orgasms I had with it.

She thought that was all fine and good, but said, “I thought you said this was a toy for couples.” “It IS!!” I responded. That’s when I handed her the remote and showed her how she could adjust the completely independent vibrations on the bottom of Pulse III Duo to stimulate herself while my cock was being stimulated in the hammock.

In no time we were out of our clothes and messin’ around. I put the Pulse III Duo around my dick and positioned the base of the thing on Shelia’s pussy. We were kissing passionately, she was using the remote to cycle through the vibrations, and, within minutes, we both came. Breathless, Sheila simply said, “Wow!”

This is the most fun we’ve had without actually fucking.

One thing to note; the Pulse III Duo is kinda loud, at least comparatively speaking. Shelia and I didn’t care, but you might.

If, for some reason you and your partner, guy or gal, don’t feel up to the old in and out of penetrative sex, this is the toy for you.

As I already mentioned, the Pulse III Duo is covered in velvety, latex-free, nonporous, phthalate-free, and hypoallergenic silicone. And because it is waterproof and made of silicone it’s a breeze to clean. Toss it into the skink with mild soap and warm water, scrub it down a bit, and let it air dry. Or you can just wipe it down with a lint-free towel moistened with peroxide, rubbing alcohol or a 10% bleach solution to sanitize for sharing.”

I mentioned my da at the beginning of this review, right? He’s in his mid 60’s and has been having some problems with blood pressure. He confided in me some months ago that his blood pressure meds are robbing him of his erections. I felt so bad for him because I can get a boner at the drop of a hat. Once I saw what the Pulse III Duo could do with my flaccid dick I offered to share it with him.

I said, “Look what I got.” “What the hell is that?” He responded. I explained how the thing worked the best I could then showed him the Hot Octopuss website and some of the Pulse III Duo videos on YouTube. I said, “Ya know, you don’t even have to be hard to get enough pleasure to cum.”

I said, “I’m gonna just leave this here. Take it for a spin if ya like.”

He did and absolutely loved it. He went out the very next day and bought one for himself.

Speaking of which, you can purchase the Pulse III Duo through the Hot Octopuss website, or just about any high-end adult products store online will carry it too.

Full Review HERE!

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How many times do women need to explain that penetration isn’t everything before everyone gets it?

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This week, sex therapist Dr Janet Hall advised MamaMia of a catchy new term for sex that doesn’t just involve placing a penis inside a vagina and wriggling it about.

‘Introducing outercourse’, said MamaMia, explaining that ‘outercourse’ counts ‘kissing, massaging, using vibrators, touching erogenous zones, clitoral stimulation, oral sex or toe-sucking. Basically, everything else that might come with sex, but isn’t penetration.’

They go on to note that outercourse shouldn’t be thought of as foreplay, as it’s not an add-on to sex, but something that’s absolutely essential to female pleasure.

Which is all true, and incredibly important to point out.

The issue is that ‘outercourse’ has been picked up and spread around the internet as a catchy new sex trend, as if it’s an easy ‘trick’ to get women off.

Which is a bit irritating really, because women have been saying over and over that we need more than just a poke with a penis to enjoy sex.

So why is the world still not getting it? Why is the revelation that the penis isn’t a magic orgasm stick still being treated as truly shocking news?

The ‘penetration is everything’ idea has been f***ing over women who have sex with men for ages. Women are being left unsatisfied or putting up with painful sex, because we’re taught that foreplay is just build-up to the main event – and the main event is all about the man getting off.

There’s an orgasm gender gap as a result (straight women have been shown to have the fewest orgasms out of everyone else having sex), and an oral sex gender gap, proving that the importance of non-penetrative sex is huge.

There’s a load of reasons men and women expect that five minutes of foreplay is enough before popping a penis into a vagina.

Think of sex scenes in films, which go from ripping each others’ clothes off to the woman gasping as she’s penetrated in a matter of seconds.

Think of sex education, which mentions that the penis becomes erect before penetrating vagina, but rarely makes any reference to the process the vagina needs to go through before being penetration-ready – because our sex education focuses more on sex for the purposes of reproduction (for which a female orgasm isn’t essential) rather than sexual pleasure.

Think of porn, which will more often show bow jobs than a man going down on a woman, which shows fingering as sharp-nailed fingers sliding in and out as the woman writhes around in ecstasy, which shows women reaching orgasm within seconds of a dildo or dick entering her.

We’re taught about foreplay as an afterthought, as a ‘nice to have’ instead of a ‘need to have’.

And it’s women who are missing out as a result.

A recent study from OMGyes found that just 18% of women can orgasm from penetration alone (again, this isn’t surprising or new. Countless other studies have found similar results), and that 36% of women need clitoral stimulation to have a chance of climaxing.

Rushing through the non-intercourse bits of sex is leaving women unsatisfied and pressured into faking orgasms – because they’ve been taught that they’re supposed to be able to come from a few quick pumps of a penis, and feel like they’re failing, or there’s something wrong with them, if they don’t.

None of this should be news. We’ve known for decades that the clitoris is hugely important, and women have reported for decades that they feel more pleasure through oral or manual stimulation than penetrative sex.

And yet, penetration is still held up as the be all and end all. We still place value on the idea of losing ones virginity as having penetrative sex, ignoring that for many women who have sex with women, this definition would make them virgins after multiple sexual partners.

Sex is not just penis in vagina. Foreplay is not an optional add-on. Sex is oral, and touching, and sucking, and all the other stuff that gives us pleasure.

If you’re bothered about women’s pleasure, sex needs to involve things other than penetration for much, much longer than a half-hearted five minutes. Foreplay shouldn’t just be a chunk before the good stuff – for many women, it is the good stuff, the bit where they’re actually likely to have an orgasm.

Touching the clitoris orally or with your fingers, kissing, caressing. It’s incredibly difficult for a woman to even get wet without that stuff, let alone have any chance of achieving orgasm.

We need to stop viewing an erection as the start of sex and ejaculation as the end. If a woman is not aroused, if she’s not experienced genuine pleasure, sex isn’t done – and the only way to get that done is the stuff that isn’t penetration, because your penis, shockingly enough, is not uniquely gifted to give orgasms.

Basically, if you’re not doing the stuff that isn’t penetration, you’re not doing sex.

Listen to women. Value our pleasure. Stop viewing our bodies as mysterious, otherworldly things that can’t be understood when we keep shouting exactly what we want (decent oral, clitoral stimulation, more of the stuff that isn’t penetration).

If you’re confused, ask women what they want. Then give it to them for an adequate chunk of time – not as a starter for sex, but as an essential part of the entire experience.

Complete Article HERE!

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How To Talk To Your Doctor About Sex When You Have Cancer

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More people are surviving cancer than ever before, but at least 60 percent of them experience long-term sexual problems post-treatment.

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So you’ve survived cancer. You’ve endured brutal treatments that caused hair loss, weight gain, nausea, or so much pain you could barely move. Perhaps your body looks different, too—maybe you had a double mastectomy with reconstruction, or an orchiectomy to remove one of your testicles. Now you’re turning your attention back to everyday life, whether that’s work, family, dating, school, or some combination of all of those. But you probably aren’t prepared for the horrifying side-effects those life-saving measures will likely have on sex and intimacy, from infertility and impotence, to penile and vaginal shrinkage, to body shame and silent suffering.

More than 15.5 million Americans are alive today with a history of cancer, and at least 60 percent of them experience long-term sexual problems post-treatment. What’s worse, only one-fifth of cancer survivors end up seeing a health care professional to get help with sex and intimacy issues stemming from their ordeal.

Part of the challenge is that the vast majority of cancer patients don’t talk to their oncologists about these problems, simply because they’re embarrassed or they think their low sex drive or severe vaginal dryness will eventually go away on their own. Others try to talk, but end up with versions of the same story: When I went back to my doctor and told him I was having problems with sex, he replied, ‘Well, I saved your life, didn’t I?’ And many oncologists aren’t prepared to answer questions about sex.

“Sex is the hot potato of patient professional communications. Everyone knows it’s important but no one wants to handle it,” says Leslie Schover, a clinical psychologist who’s one of the pioneers in helping cancer survivors navigate sexual health and fertility. “ When you ask psychologists, oncologists and nurses, ‘Do you think it’s important to talk to patients about sex?’ they say yes. And then you say, ‘Do you do it routinely?’ They say no. When you ask why, they say it’s someone else’s job.”

Schover spent 13 years as a staff psychologist at the Cleveland Clinic Foundation and nearly two decades at the University of Texas MD Anderson Cancer Center. After retiring last year, she founded Will2Love, a digital health company that offers evidence-based online help for cancer-related sex and fertility problems. Will2Love recently launched a national campaign called Bring It Up! that offers three-step plans for patients and health care providers, so they can talk more openly about how cancer treatments affect sex and intimacy. This fall, the company is collaborating with the American Cancer Society on a free clinical trial—participants will receive up to six months of free self-help programming in return for answering brief questionnaires—to track the success of the programs.

Schover spoke to Newsweek about the challenges cancer patients face when it comes to sex and intimacy, how they can better communicate with their doctors, and what resources can help them regain a satisfying sex life, even if it looks different than it did before.

NEWSWEEK: How do cancer treatments affect sex and intimacy?
LESLIE SCHOVER: A lot of cancer treatments damage some of the systems you need to have a healthy sex life. Some damage hormone levels, and surgery in the pelvic area removes parts of the reproductive system or damages nerves and blood vessels involved in sexual response. Radiation to the pelvic region reduces blood flow to the genital area for men and women, so it affects erections and women’s ability to get lubrication and have their vagina expand when they’re sexually excited.

What happens, for example, to a 35-year-old woman with breast cancer?
Even if it’s localized, they’ll probably want her to have chemotherapy, which tends to put a woman into permanent menopause. Doctors won’t want her to take any form of estrogen, so she’ll have hot flashes, severe vaginal dryness and loss of vaginal size, so sex becomes really painful. She’ll also face osteoporosis at a younger age. If she’s single and hasn’t had children, she’s facing infertility and a fast decision about freezing her eggs before chemo.

What about a 60-year-old man with prostate cancer?
A lot of men by that age are already starting to experience more difficulty getting or keeping erections, and after a prostatectomy, chances are, he won’t be able to recover full erections. Only a quarter of men recover erections anything like they had before surgery. There are a variety of treatments, like Viagra and other pills, but after prostate cancer surgery, most men don’t get a lot of benefit. They might be faced with choices like injecting a needle in the side of the penis to create a firm erection, or getting a penile prosthesis put in to give a man erections when he wants one. If he has that surgery, no semen will come out. He’ll have a dry orgasm, and although it will be quite pleasurable, a lot of men feel like it’s less intense than it was before. These men can also drip urine when they get sexually excited.

Why are so many people unprepared for these side-effects?
If you ask oncologists, ‘Do you tell patients what will happen?’ a higher percentage—like in some studies up to 80 percent—say they have talked to their patients about the sexual side-effects. When you survey patients, it’s rare that 50 percent remember a talk. But most of these talks are informed consent, like what will happen to you after surgery, radiation or chemotherapy. And during that talk, people are bombarded by so many facts and horrible side-effects that could happen, they just shut down. It’s easy for sex to get lost in the midst of this information. By the time people are really ready to hear more about sex, they’re in their recovery period.

Why is it so hard to talk about sex with your oncology team?
It takes courage to say, ‘Hey, I want to ask you about my sex life.’ When patients get their courage together and ask the question, they often get a dismissive answer like, ‘We’re controlling your cancer here, why are you worrying about your sex life?’ Or, ‘I’m your oncologist, why don’t you ask your gynecologist about that?’ Patients have to be assertive enough to bring up the question, but to deal with it if they don’t get a good answer. Sexual health is an important part of your overall quality of life and there’s nothing wrong with wanting to solve or prevent a problem.

What’s the best way for people to prepare for those conversations?
First, because clinics are so busy, ask for a longer appointment time and explain that you have a special question that needs to be addressed. At the start of the appointment, say, ‘I just want to remind you that I have one special question that I want to address today, so please give me time for that.’ Bring it up before the appointment is over.

Second, writing out a question on a piece of paper is a great idea. If you feel anxious or you’re stumbling over your words, you can take it out and read it.

Also, some people bring their spouse or partner to an appointment. They can offer moral support and help them remember all the things the doctor or nurse told them in answering the question.

So you’ve asked your question. Now what?
Don’t leave without a plan. It’s easy to ask the question, get dismissed, and say, I tried. Have a follow-up question prepared. For example, ‘If you aren’t sure how to help me, who can you send me to that might have some expertise?’ Or, ‘Does this particular hospital have a clinic that treats sexual problems?’ Or, ‘Do you know a gynecologist or urologist who’s good with these kinds of problems?’ If you want counseling, ask for that.

What happens if you still get no answers?
I created Will2Love for that problem! It came out of my long career working in cancer centers and seeing the suffering of patients who didn’t get accurate, timely information. When the internet became a place to get health info, it struck me as the perfect place for cancer, sexuality and fertility. Sex is the top search term on the Internet, so people are comfortable looking for information about sex online, including older people or those with lower incomes.

Also, experts tend to cluster in New York and California or major cancer centers. I only know of six or seven major cancer centers with a sex clinic in the U.S. and there are something like 43 comprehensive cancer centers!

We offer free content for the cancer community, including blogs and forums and resource links to finding a sex therapist of gynecologist. We also charge for specialized services with modest fees. Six months is still less than one session with a psychologist in a big city! We’re adding telehealth services that will be more expensive, but you’re talking to someone with expert training.

What can doctors do better in this area?
For health care professionals, their biggest concern is, ‘I have 40 patients to see in my clinic today and if I take 15 extra minutes with four of them, how will I take good care of everybody?’ They can ask to train someone in their clinic, like a nurse or physician’s assistant, who can take more time with each patient, so the oncologist isn’t the one providing sexual counseling, and also have a referral network set up with gynecologists, urologists and mental health professionals.

 

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