By Dr. Josh
Health
As a urologist, I get asked a lot about sex by my patients and friends. Actually, I get more questions about sex than I do about peeing. Some of these questions are simple, while some can be specific and complex. While I wish I could say I have the answer to every question I get, that’s simply not the case. Even as a sexual health specialist, I am constantly learning. I learn from my colleagues and I learn from my patients. I am lucky to have such an avenue to share my knowledge. What follows is a collection of the most frequently asked questions I get about sex. I suspect that some of you may have had similar questions but may not feel comfortable voicing them. Well, I hope you learn something about yourself and what most people out there continue to find confusing about sex.
Is erectile dysfunction inevitable/normal at my age?
Erectile dysfunction (ED) is a common concern among my male patients. Many wonder if developing ED is an inevitable part of aging. The truth is that while age can be a contributing factor due to changes in blood flow and hormone levels, ED is not an inevitable consequence of aging and ED is not normal at any age. It is also important to point out that ED can occur at any age. While it occurs more often in older men, I have many younger patients who struggle with their erections. Unfortunately, all too often younger men seeking help for ED are dismissed or ignored. They are told that it should be “all in your head”, but this is not always the case.
It is important to understand that several factors beyond age contribute to ED. These include underlying conditions such as diabetes, cardiovascular disease and hypertension, unhealthy lifestyle choices such as smoking and excessive alcohol consumption, side effects of medication, conflict between relationships and psychological factors such as stress and anxiety. If you are someone who is having trouble getting or staying hard, seek professional guidance from someone who specializes in sexual health. ED is not inevitable and may be a symptom of a more serious mental or physical health problem that needs attention.
How often should I be tested for sexually transmitted infections?
If you are someone who has sex with more than one person, sexually transmitted infections (STDs) should always be on your mind. Many STDs are on the rise. According to the Centers for Disease Control and Prevention (CDC), in 2021, chlamydia, gonorrhea, and syphilis continued to increase in the United States. While sex should be fun, it’s important to take the necessary steps to protect yourself and get checked for the most common sexually transmitted infections. How often you get tested may vary depending on your risk. While anyone who has sex can get an STD, sexually active gay, bisexual, and other men who have sex with men (MSM) are at greater risk. In addition to higher rates of syphilis, more than half of all new HIV infections occur among MSM. People who have sex with multiple or anonymous partners, those who engage in sex work, and anyone who has sex under the influence of drugs and/or alcohol should be tested regularly.
The CDC recommends that all sexually active adults and adolescents ages 13 to 64 be tested for HIV at least once. They also recommend that all sexually active gay, bisexual, and other MSM be tested at least annually for syphilis, chlamydia, and gonorrhea. Those who engage in higher-risk sexual behaviors should be tested for HIV and other STIs more frequently (approximately every 3-6 months). In recent years, there has been an increased focus on preventing STDs and HIV using drugs. Pre-exposure prophylaxis with drugs such as Truvada and Descovy (both oral drugs) and Apretude (an injectable) reduces the risk of contracting HIV from sex by about 99% when taken as prescribed. Doxy-PEP stands for doxycycline post-exposure prophylaxis, which represents another recent strategy to reduce STD risk. It involves taking a 200 mg doxycycline pill as soon as possible, but no later than three days after unprotected sex. In several studies the use of Doxy-PEP reduced the risk of STDs by up to 75%. Fortunately, we have come a long way in our fight against HIV and STDs. The trick to protecting yourself from them is to be aware of the risk and get tested regularly. If you’re in a high-risk group, consider discussing some of the prevention strategies we discussed with your healthcare provider.
What causes premature ejaculation and can it be treated?
Premature ejaculation (PE) involves ejaculating earlier than desired, often within minutes of starting sexual activity. PE is considered to be one of, if not the most common sexual health problem. Up to 1 in 3 people say they have struggled with PE at some point. PE is also a condition that not only affects the person experiencing it, but also their partner. Premature ejaculation can lead to feelings of inadequacy, depression, anxiety and relationship problems. The exact cause of premature ejaculation is not known. PE was once thought of as a psychological issue, but health care providers now recognize that premature ejaculation involves a complex interplay of psychological and biological factors. Psychological factors may include depression, anxiety, stress, guilt, unrealistic expectations about sex, lack of self-confidence, a history of sexual repression and/or abuse, and relationship problems. Biological factors include age, hormone levels, certain neurotransmitters such as serotonin, and erectile dysfunction. Fortunately, there are effective treatments for PE, ranging from behavioral therapies, exercise, and counseling to medications or topical applications. Determining the cause of PE is crucial to tailoring the most effective treatment plan for each individual, so if you are someone with premature ejaculation, be sure to seek help from a sexual health professional.
Is pain during sex normal?
There’s that “normal” word again. We already know how I feel about this. But I will make an exception in this case and say unequivocally that pain during sex is absolutely not normal. I can’t tell you how many times I’ve been asked this question, mostly by my female patients. Unfortunately, women hear from their peers and even their doctors that sex is sometimes painful and continue to believe that it is normal. If they muster up the courage to discuss the matter with a provider, they are often met with disbelief, dismissed, or simply told to have another glass of wine.
Pain during sex, also known as dyspareunia, is a common problem with a lifetime prevalence of up to 30%. If you are someone who experiences dyspareunia, you are not alone. There is nothing inherently wrong with you. And you don’t just have to have another drink and push it. Dyspareunia can be caused by a number of factors, including inadequate lubrication, hormonal deficiencies, vaginal infections, pelvic floor problems, endometriosis, and/or psychological factors. Every person has the right to have pleasurable sex if they wish. So, if dyspareunia prevents you from doing this, seek help from someone experienced in treating people experiencing sexual pain.
What lifestyle changes can I make to improve my sexual function?
As a general rule, what’s good for your general health is good for your sexual health. With 2024 just around the corner, you may already be making a list of resolutions you plan to keep. Why not make one to improve your sexual health? Exercise is good for the mind, body and soul. Regular physical activity can help improve energy, mood and sleep, reduce stress, improve testosterone levels and build stamina. And guess what: all of this helps improve sexual function. If you’ve been out of the gym for a while, start slow. Walking, swimming and light cardiovascular exercise can help you stay in top shape. Specific pelvic floor exercises such as Kegels can also help strengthen the muscles needed for sexual activity.
Eating a well-balanced, heart-healthy diet can give your sex life the jump it needs. Several studies have found specific sexual health benefits from the Mediterranean diet. In a recent study, participants who consistently followed a Mediterranean diet had better erectile performance, blood flow, exercise capacity, higher testosterone levels, and healthier arteries than those who were less consistent. If you want to up your game in the bedroom, consider following the principles of the Mediterranean cuisine: eat lots of fruits, vegetables and healthy fats, and minimize red meat as much as possible. Sexual health remains an integral part of overall health and wellness. And questions come up for everyone from time to time. While what I’ve shared today represents just a small sample, hopefully you’ll leave here knowing a little more about how I think about sex when I talk to patients and how you can take steps to have a more fulfilling sex life. If you still have questions that need answering, contact your local sexual health professional or follow me on social media. I never tire of discussing all things sexual and I promise you will be entertained and educated at the same time.
