Sexual health can be an uncomfortable or embarrassing topic to discuss for many people, and for patients with cancer, survivors and their partners, it can feel even more awkward. In fact, sex ranks among the top five unmet needs of survivors, and a new digital health startup, Will2Love, has been launched to help fill this void.
Sixty percent of cancer survivors — 9.3 million individuals in the United States alone — end up with long-term sexual problems, but fewer than 20 percent get professional help, according to Leslie R. Schover, PhD, Will2Love’s founder. Among the barriers she cites are overburdened oncology clinics, poor insurance coverage for services related to sexual health and an overall lack of expertise on the part of providers, many of whom don’t know how to talk to patients and survivors about these issues.
Sexual issues can affect every stage of the cancer journey. Schover, who hosted a recent webinar for health care practitioners on the topic, has been a pioneer in developing treatment for cancer-related problems with sexuality or fertility. After decades of research and clinical practice, she has witnessed firsthand how little training is available in the area of sexual health.
“Sex remains a low priority, with very little time devoted to managing sexual problems even in specialty residencies,” she adds.
The problem is twofold: how to encourage oncology teams to do a better job of assessing and managing sexual problems and how to help those impacted by cancer to discuss their sexual concerns.
Schover says that simple, open-ended questions such as: “This treatment will affect your sex life. Tell me a little about your sex life now,” can help to get the conversation started.
Sexual side effects after cancer treatment vary from person to person, and also from treatment to treatment. Common side effects for men and women include difficulty reaching climax, pain during sexual intercourse, lower sexual desire and feelings of being less attractive. Men specifically can experience erectile dysfunction and dry orgasm, while women may have vaginal dryness and/or tightness, as well as loss of erotic sensation such as on their breasts following breast cancer treatment.
Sexual dysfunction after cancer can often lead to depression and poor quality of life for survivors and their partners.
Cancer treatment can impact hormonal cycles, nerves directing blood flow to the genitals, and the pelvic circulatory system itself, explains Schover. In addition, side effects like prolonged nausea, fatigue, and chronic pain also can disrupt a patient’s sex life.
“Simply to give medical solutions rarely resolves the problems because a person or couple needs to make changes in the sexual relationship to accommodate changes in physical function,” Schover stresses. “That kind of treatment is usually best coming from a trained mental health professional, especially if the couple has issues with communication or conflict.”
Schover hopes that Will2Love will bring much-needed attention to the topic by providing easily accessible resources for patients, survivors, their partners and health care providers. (Box)
Currently visitors to the website can subscribe to its e-newsletter and receive a free introductory five-part email course covering topics related to what your doctor may not be telling you about sex, fertility and cancer. After the fifth lesson, users will receive a link to the Will2Love “Sex and the Survivor” video series. “Sexual health is a right,” Schover stresses, and oncology professionals, patients and survivors need to be assertive to get the conversation started.
When pleasuring another dude’s cock, when should I stop riding/sucking/stroking after he’s cum? I know how sensitive my cock gets after cumming, but I also feel like some of the sweetest and most intimate moments can be what I do with his cock as it subsides and softens, not to mention that there can still be intense, intense pleasure in those early post-cum moments.
Go for it, while adapting to his needs!
I agree with you that the sweetest and most intense pleasurable sensations can be had soon after ejaculation. I personally call this post-ejaculatory penile massage post-orgasmic goading (but that’s a personal terminology as I’ve never seen an official terminology for this) because this deliberate teasing is done at a time where we all know the penis to be extremely sensitive.
Post-orgasmic goading is not something we men tend to do instinctively for ourselves, as a consequence of the additive impact of three phenomena happening quickly after ejaculation:
The powerful and overwhelming sensation of fatigue that numbs us after ejaculation
The almost instantaneous disappearance of all interest for sex that follows ejaculation
The excruciating sensitiveness of the penis — of the glans in particular — following ejaculation
Acting synergistically, these phenomena trained us very early into avoiding any stimulation to our penis after ejaculation. In fact, this is something most of us were driven to understand only a few weeks after our first ejaculation. As a result, most men will have little to no experience with (and, for some, even the knowledge of) the powerful sensations that can be squeezed out from the penis after ejaculation.
Does that mean that post-orgasmic goading should be avoided? Not at all: on the contrary, it should be encouraged.
What it means however, is that you have to be mindful when initially introducing a partner to post-orgasmic masturbation.
Begin by announcing your intent. I don’t mean writing down a contract in triplicates, but after the guy has cum and you continue to masturbate him, tell him that you do. Something like “seeing you cum was wonderful, I want to see you squirm and hear you moan longer”. Eventually, you won’t need to ask his permission to go on with the post-orgasmic goading, but at first you’ll need to, so that your partner doesn’t feel apprehensive. Indeed, when unexpected, post-orgasmic goading will bring forth a feeling of loss of control (and it is, to a point). And most men don’t live well with that feeling, as it is not part of the male psyche.
Be clear that you’ll stop if he asks to, and indeed stop when he does asks you to… but with a slight delay. The delay is important as the intensity of the caresses are very likely to make him utter you to stop way too soon. So you should playfully continue a bit longer, yet without going overboard so that he’ll know that you can be trusted. At first, you might not continue for long after ejaculation, but as he learns both that you can be trusted and to let go, you’ll be able to give him long minutes of quasi-orgasmic pleasures…
Finally, be considerate. While you can continue to caress the shaft with a relatively strong grip (yet toned down compared to how you held his cock as you sent him through orgasm), you must handle the glans with extreme care. Using his semen(1) as lube, rub the glans slightly and delicately with your fingertips. You’re better off beginning too delicately than the other way around because if you begin the cockhead’s caresses too harshly, it will hurt and that will be the end of it. To evaluate your accomplishment, watch his abs for sudden contractions, watch his shoulders dance around, watch his head moving back and forth, watch also for his hand(s) that may attempt to grip you (surprisingly) strongly in an attempt to immobilize you. Listen to his moans also. Embolden him to move and moan…
When introducing a man to post-orgasmic goading, one has to be initially very mindful and open to the needs of the other. When done correctly, it opens a new world of sensations and it is totally fun and addictive(2) ! After some time, you’ll be able to make him dance, squirm and whimper for a surprisingly long time. He will even be looking for it.
While semen is a hassle to deal with after ejaculation, we all like to be reminded that we ejaculated and how much we came. Playing with our semen and smearing it all over helps drive the point that we came and helps us registering that we impregnated the world with our DNA. It makes us feel manly. It’s important to fool around with cum, and doing so won’t change the fact that a clean up is needed after orgasm.
This article is written with a partner in mind as this is the question, but the same applies to you too. Every man should use post-orgasmic goading on their own cock. The same careful and delicate approach applies, especially since it is so difficult to persevere at first, as the glans’ exquisite sensitivity tends to make us spineless. Yet, going against the post orgasmic fatigue and the transient disinterest in sex, on one side, and learning to exploit instead of steering clear from the penis’ post orgasmic sensitiveness, on the other side, allows us to milk even more pleasure from our penis. Something no one can be averse to, right? As it goes so much against our instinctual behavior however, it has to be learned and practiced. Practice makes perfect, though. So practice my lad, practice !
Penises can be problematic. They are powerful, untameable beasts, capable of wielding immense pleasure but also able to cause devastating emotional wounds. And that’s just anal sex
by Liam Murphy
As well as the obvious physical harm that can be inflicted – skinny jeans have cursed a generation to suffer cock-caught-in-fly related trauma – the magnificent meat mallet can also bring mental torment when, like an untrained puppy, it just won’t do as it’s told.
THE HARDER THE BETTER?
Some of the best things are hard: hard-boiled eggs, biscuits, those rhubarb and custard sweets, Tom Hardy and, of course, the penis. However, sometimes they can spring up at the most unexpected and inopportune times, and just won’t go away.
“I call my hard-on issue uncontrollable as such,” says 21-year-old Ian, “let’s say ‘eager’ or ‘keen’. It doesn’t take much and it’s ‘up periscope’ time. I’ve been this way as long as I’ve appreciated the male form. I went through a phase of wearing an over the shoulder bag in my late teens so I could cover the odd bus boner (the vibrations cause a right disturbance). Rather that than poke someone in the eye on the way past, I guess!”
However, impromptu erections can also lead to embarrassing retail situations, as Ian explains. “Recent men’s fashion means that I’ve become accustomed to skinny fit jeans, and for whatever reason, I went commando that day – I’m sure you know where I’m going with this – and I guess it must have been particularly sensitive or whatever. Anyway, I ended up with a lob-on in Tesco. My skinny jeans/tight t-shirt combo meant there was no hiding, so I did what any self-respecting bloke would do. I awkwardly leant over the shopping trolley for the next ten minutes. On the upside, I can also get hard on demand! It’s just a combination of a high sex drive and an involuntary physical reaction, I think.”
For Kieran, 25, his perilously perky penis is just part of his day. “I wouldn’t say it’s an issue – more just a fact of life. Some people sweat a lot, some people yawn a lot… I get boners a lot. Not getting them would be an issue, but getting too many, yeah that’s a ‘problem’ I’m OK with – at least I know it’s all working well. It does pop up at any time. When I was due to be giving a talk, someone gave me a wink and boom… up popped my friend downstairs to take his moment centre stage. I stood behind the lectern desperately thinking of Margaret Thatcher and trying to kill it so I could step out and begin my talk properly. The worst though, is when someone you don’t fancy or don’t want to have sex with tries it on and it just feels like he’s betraying you.”
And how does one manage the curse (or blessing, depending on your perspective) of a perpetual hard-on? “Like everyone else I learned the ‘tuck it behind your belt’ trick, or to hide it behind my belt. Granted, occasionally there have been times when I’ve had to miss my tube stop and stay sitting down while I waited for one to subside.”
Will, 38, didn’t notice the problem cropping up until he was in a relationship. “I was never aware of it until I met my boyfriend and it became apparent early on that I would get erect whenever I was around him. It has settled down a bit now but whenever we kissed in public I would get a twinge. And in bed it still sometimes feels like I have an erection all night. I would generally be embarrassed that I was getting these erections. I felt immature. This is what happens to a teenager, not an adult. I was going through a difficult break-up once – lots of tears – we were cuddling and I was hard. I realised then that my hard-ons were not always about sex – to me they were about love too.”
Erectile dysfunction can happen to a lot of people, in varying degrees and for many reasons, medical or otherwise.
“It happens to me every time I put on a condom,” admits Steven, 34. “I have no problem keeping it up before fucking – wanking and getting sucked off have never been a problem – but when I go to fuck someone and I slide the condom on, I lose the hardness. Not totally, but enough that I can’t properly put it in someone’s arse and enough that the sensation goes for me.”
Steven tried mixing up condom brands. “I’ve used thin, ultra-thin, ribbed, tingle… every version of a condom you could imagine and I still get the same flaccid result. I think it must be a psychological thing, because it’s not like I can’t get hard at all. It’s fine when I bareback with long term boyfriends, but with one nighters I tend to have to bottom now.”
Anxiety can often be a cause of not being able to maintain an erection, as 27-year-old James confirms: “Sex in general makes me anxious. I hate getting naked and I get so nervous when it comes to getting down to it in bed. I was dating a guy I really liked, so much that when he touched me I would physically shake, but when it came to sex I just couldn’t get hard. He thought I didn’t like him! And now I dread having sex. I love the dating side of it but I always know that heading to the bedroom is going to be inevitable.”
What can cause you to have trouble getting or staying hard?
Stress and anxiety.
Smoking, recreational drugs and alcohol.
Some prescribed drugs – like Prozac and Seroxat.
Diabetes, high cholesterol and highblood pressure.
Psychological reasons – the more you worry about your erection, the less likely you are to be able to get one.
What can I do to make myself hard?
If you think the reason is psychological – a distraction helps, so encourage your partner to focus on something other than your cock for a while – kissing or nipple play might help to get you back in action.
Cockrings can also be used to help maintain a hard-on – leather or rubber straps are safer to use.
Drugs like Viagra or Cialis – consult your doctor for these.
Matthew Hodson, CEO of GMFA told us: “Rolling a condom onto a rock-hard penis isn’t a problem but if it’s a bit soft and you start to get anxious then it’s easy to spiral with anxiety to the point where a condom is really tricky to use. The more you’re concerned that you won’t be hard enough to use a condom, the more likely it is to happen. If it’s just an occasional problem it’s probably best not to make a big thing of it and just do something else that turns you on while you wait for it to get hard again. If it’s becoming more of a problem, you might want to experiment with cock-rings or talk with your GP about it – there’s no need to be embarrassed, you won’t be the first person who will have approached them with the same problem. Most erection problems can be addressed so there’s no reason why a temporarily soft dick should be a long-term barrier to you enjoying sex safely.”
Everyone should be able to enjoy a penis (which is my campaign slogan if I ever run for Prime Minister), especially their own. Whether it’s too hard or too soft, it doesn’t mean you and your cock have to suffer alone. Confide in your partner/lover/friend/doctor and discuss what you can do to get you and your lifelong pleasure companion talking again.
Step 1: When your cock is hard, take the condom out of the wrapper carefully using your fingers. Using your teeth to tear the packet could damage the condom. Squeeze the air out of the teat on the tip of the condom (if there is one) and put it over the end of your cock. Don’t stretch it and then pull it over your cock as this will make it more likely to break.
Step 2: Roll it down the length of your cock – the further down it goes the less likely it is to slip off. Put some water-based or silicone-based lubricant over your condom-covered cock. Put plenty of lube around his arse too. Don’t put any lube on your cock before you put the condom on, as this can make it slip off.
Step 3: Check the condom occasionally while fucking to ensure it hasn’t come off or split. If you fuck for a long time you will need to keep adding more lube. When you pull out, hold on to the condom and your cock at the base, so that you don’t leave it behind. Pull out before your cock goes soft.
What lube should I use?
When you don’t use enough lube, or use the wrong kind, the likelihood of condom failure is increased, making transmission of HIV and other STIs possible. Water-based lubes (e.g. K-Y, Wet Stuff and ID Glide) and silicone-based lubes (Eros Bodyglide and Liquid Silk) work well with condoms. Oil-based lubricants like cooking oil, moisturisers, sun lotions, baby oil, butter, Crisco, Elbow Grease, etc. can also cause latex condoms to break.
They can however be used with non-latex condoms, like Durex Avanti, Mates Skyn or Pasante Unique. Don’t use spit as it dries up quickly and increases the chance of your condom tearing.
It can be difficult to offer sexuality education to adolescents anywhere—but it’s especially difficult in deeply conservative communities around the world, where sexuality remains a taboo topic. At “Let’s Talk About Sex,” a day-long event organized by GreeneWorks, American Jewish World Service, CARE and International Women’s Health Coalition, participants got an opportunity to explore this challenge through a mix of discussion, movement and performance.
It was a unique way to kick off the 2016 Association for Women’s Rights in Development (AWID) forum, which brought together feminists—1,800 of them, from more than 30 countries—to strategize and connect in Bahia, Brazil this September. Among the participants were representatives from AJWS grantee organizations working to advance gender equality in India.
“As researchers and practitioners, we often operate inside our heads,” said Meg Greene of GreeneWorks. She noted that many people working with international nonprofit organizations tend to resist meaningful discussions of sexuality out of sheer discomfort. “This is a very embodied challenge . . . what can we learn by embodying our experience of it?”
Margot Greenlee of BodyWise Dance began the day by leading the group through a series of warm-up exercises set to samba. Participants drummed on their knees and moved to the music. One woman remarked that the experience was “better than coffee,” and it was followed by a discussion of the reasons why everyone had come.
BodyWise Dance company performs a scene based on the group’s conversations.
One participant said her work with adolescent girls, while deeply meaningful, was sometimes sad and frustrating—in part because the girls were reaching an age when sexuality was becoming part of their lives, and she often felt it impossible to discuss their questions without risking anger from the community. Another woman agreed; she explained that even when her organization tried to educate young people on sexuality, the curricula wound up focusing more on topics related to anatomy and hygiene, like menstruation. She and others wanted to explore new strategies for addressing sexuality more openly.
The rest of the day alternated between performances by the BodyWise company, participatory dance exercises and more cerebral reflections on participants’ respective work. Conversation started off with the social norms and experiences that shape people’s understanding of sexuality and gender roles—and how some people’s beliefs lead to serious barriers that keep girls and young women from exercising their rights.
For example: Alejandra Colom, who works with Population Council, talked about a rural community in Guatemala that’s ruled by drug traffickers. She said many people there view early and child marriage as something that happens simply because, in their view, “it’s the only way to stop bad things that happen to girls.” The community thinks of marriage as a way of increasing the security of girls in a place where sexual violence is commonplace.
Alejandra Colom, left, of the Population Council in Guatemala.
To begin expanding the options and information available to local girls, Population Council hired a young woman who served as a mentor. She met with about 40 girls once a week and spoke to them about topics like sexuality and gender-based violence. Alejandra said the mentor wanted girls to understand their rights—to know that “it’s not normal that if you pass man on road and he fancies you, he thinks he has the right to rape you.”
Once the community heard what she was teaching, Alejandra said, some of the men started proclaiming the education she provided “dangerous.” The real message: women who stand up for their rights will face danger. Young men started harassing the mentor and interrupting her class. One day, a truck followed behind her motorbike, pulling closer and closer. Then the men inside opened fire.
The bullets missed the mentor. But her days with that community were through. She decided not to go to the police. Everyone knew the drug traffickers were ruling the area, not the government. Alejandra said the young woman told her: “The moment they know that I’m doing something about this, they’ll come back and kill every single member of my family.”
This was just one example of the many challenges the group shared. The conversation also unearthed the strategies participants use to continue their work in places that don’t exactly welcome it. Several people at the event spoke about how collectives—organized groups of girls who learn to advocate for their rights together—can be so important for negotiating with communities when tough situations arise. They reminded the group that there’s power in numbers.
On the other hand, participants pointed out, girls need the freedom to make the decisions that are best for their individual situations. In many places, that means choosing between a few very limited options. Archana Dwivedi of Nirantar—an AJWS grantee—spoke about her organization’s research in India, which found that many teenage boys and girls are actually choosing to get married. They often view early marriage as less oppressive than staying at home with their parents, who are incredibly strict.
In order to address the limitations that many girls and young women face, AJWS’s grantees in India are finding ways to increase girls’ mobility and opportunities. Some of them offer computer or English classes because they know this kind of program is accepted by parents; then, the organization discreetly offers sexuality and human rights education to participating girls.
In Archana’s experience, organizations can often withstand community objections to sexuality education by explaining the importance of their work to angry parents and community members, waiting until the tension breaks, and returning to their work in a few months. She noted that organizations who broach topics like sexuality and gender equality with women and girls should expect backlash from conservative communities and prepare accordingly.
“There is always a backlash when you’re working with adolescent girls,” Archana said. “Everyone wants to control them.”
Read more about the connection between early marriage and control of sexuality here.
Many women use terms such as ‘failure’ or ‘freak’ to describe themselves
By Teresa Bergin
Vaginismus is often a problem from the start of a woman’s sexual life but for some it is a secondary problem, developing even though there may have been previous positive sexual experiences
Vaginismus is a very common but rarely discussed problem. Most women I see with this difficulty will not have discussed it with anyone else, not even female members of their own family or girlfriends. The silence that surrounds the issue and the sense of shame experienced sometimes serves to compound the difficulty itself. Many women with whom I have worked will use terms such as “failure” or “freak” to describe themselves, wishing they were “normal” just like every other woman.
Before seeking therapy, they will often have suffered this distress over a long period of time, not feeling able to embark on or enjoy sexual relationships. The thought that they may not be able to conceive through intercourse is frequently a huge anxiety for these women.
What is vaginismus?
Vaginismus occurs when the muscles around the entrance to the vagina involuntarily contract. It is an automatic, reflexive action; the woman is not intending or trying to tighten these muscles, in fact it is the very opposite of what she is hoping for. Often it is a problem right from the start of a woman’s sexual life but for some it is a secondary problem, developing even though there may have been previous positive sexual experiences. In most cases, the woman is unable to use tampons or have a smear test.
What are the symptoms?
The main symptom of vaginismus is difficulty achieving penetration during intercourse and the woman will experience varying degrees of pain or discomfort with attempts. Partners often describe it like “hitting a wall”. This is as a result of spasm within the very strong pelvic floor or pubococcygeus muscle group. Spasm or tightening may also occur in the lower back and thighs.
What are the causes?
Vaginismus is the result of the body and mind developing a conditioned response to the anticipation of pain. This is an unconscious action, akin to the reflexive action of blinking when something is about to hit our eye. This aspect of vaginismus is one of the most distressing for women as they really want their bodies to respond to arousal and yet find it impossible to manage penetrative sex. The more anxious they become, the less aroused they will feel and the entire problem becomes a vicious cycle.
Vaginismus can occur as a result of psychological or physical issues. Often it is a combination of both. Psychological issues centre around fear and anxiety; worries about sex, performance, negativity about sex from overly rigid family or school messages.
Inadequate sex education is often a feature in vaginismus, resulting in fears about the penis being able to fit or the risk of being hurt or torn. There can also be anxiety about the relationship, trust and commitment fears or a difficulty with being vulnerable or losing control.
Occasionally a woman may have experienced sexual assault, rape or sexual abuse and the trauma associated with these experiences may lead to huge fears around penetration. There are physical causes too – the discomfort caused by thrush, fissures, urinary tract infections, lichens sclerosis or eczema and the aftermath of a difficult vaginal delivery can all trigger the spasm in the PC muscles. Menopausal women can sometimes experience vaginismus as a result of hormonal-related vaginal dryness.
Vaginismus is highly treatable. Because every woman is different, the duration of therapy will vary but, with commitment to the therapy process, improvement can be seen quite rapidly. Therapy is a combination of psychosexual education, slow and measured practice with finger insertion and/or vaginal trainers at home and pelvic floor exercises. Women with partners are encouraged to bring them along to sessions so that the therapist can work with them as a couple towards a successful attempt at intercourse.
Vaginismus can place huge stresses on a couple’s relationship as well as their sexual life; therapy can help the couple talk about and navigate these stresses. This is particularly important for a couple wishing to start a family.
What do I do if I think I have vaginismus?
Make an appointment with the GP. It will be helpful to have an examination to out rule any physical problem and have it treated if necessary. The GP is likely to refer you to a sex therapist, a psychotherapist who has specialised in sex and relationships through further training. They have specific expertise in working with this problem on a regular basis. You can also refer yourself to a sex therapist but, because of the very complex and sensitive nature of sex and sexuality, it is important to ensure that they are qualified and accredited. Sex therapists in Ireland may be found on www.cosrt.org.uk
Robert was my first boyfriend. We waited six months to try sex, mostly because I was a virgin and very nervous. My mother had always warned me about not getting pregnant and I think I was too scared to try. When we did try, it didn’t work, it was disastrous. We tried again and again but he could not get in.
Every time we tried, I ended up in tears and over time I started to avoid sex. Robert was really patient but I know that it was very tough for him and I felt guilty. We thought it was a phase and it would improve with time. It didn’t stop us getting engaged because we knew we were right for each other.
Eventually I got the courage up to go to the doctor who diagnosed vaginismus – the relief of having a name to put on it was huge. She referred me to a sex therapist. I was embarrassed even talking about it, but quite honestly it was a relief to finally discuss it all. She explained everything about my problem and started me practising with vaginal trainers. I even got to start using tampons, something I never thought I would be able to do.
Robert also came to the sessions and that was a big help. We were given exercises to do at home together that helped me relax a lot. I made a lot of progress over a couple of months and, finally, last Christmas we got to try intercourse again. Success! Our sexual relationship is completely different now, no more worries and lots more fun.
I feel as if a huge worry has been lifted off my shoulders.