ED Usually Has a Physical Explanation

Erectile dysfunction (ED), defined as the persistent inability to achieve and maintain an erection to the point of orgasm, affects an estimated 15 to 30 million men in the U.S. alone. But finding out what's causing your own particular erection problem is a tricky process that needs to involve your doctor.

In the past, doctors believed ED was caused by psychological problems such as depression and performance anxiety, but now as much as 90% of erectile dysfunction is believed to include some physical cause.

When you visit a doctor about ED, he or she should take a detailed medical and sexual history, give you a full physical examination, request a number of blood tests to determine cholesterol, blood sugar, and testosterone levels, and order an EKG if you're over 50.

Here's a list of ED risk factors and causes that should be considered.
• High cholesterol
• High blood pressure (hypertension)
• Diabetes
• Kidney disease
• Multiple sclerosis
• Vascular disease
• Atherosclerosis (hardening of the arteries)
• Neurological disease (i.e. nerve damage and neuropathy)
• Hormonal changes
• Obesity
• Smoking
• Drug use
• Alcoholism
• Prescription medications
• Surgical procedures
• Cancer treatments
• Physical injury (especially pelvic trauma)
• Depression
• Stress or anxiety
• Age
• Conflict with your partner
• Prolonged bicycling

Lead writer: Nick Burns
Last Updated: April 26, 2008

7 Ways to Treat Erectile Dysfunction

Treatment for men unable to have an erection took a great leap forward when the first oral erectile dysfunction (ED) medication, Viagra (sildenafil), was introduced in 1998. But there have been strides recently in a range of other ED treatments too, ranging from over-the-counter pumps to surgical implants and suppositories.

Diagnosing your own ED is not a good idea, however. If you have trouble getting an erection, it's important to see a doctor before pursuing any sort of treatment. There could be a medical explanation for your condition, and your health and sexual history may come into play. Here are seven possible ways to treat ED. View the slideshow: http://slideshows.health.com/slide_shows/10342/slides/10956

Lead writer: Nick Burns
Last Updated: November 10, 2008

After Decades of ED, He Learned to Inject His Penis and Got Back to Dating

Steve Thompson (not his real name), 57, of St. Louis, Mo., has dealt with erectile dysfunction for most of his adult life—he was 24 when he first had trouble achieving and maintaining an erection. "People in those days thought it was psychological," he recalls. "They never considered it was a physical or circulatory problem. They'd say it's your fault, you're too uptight, or you don't know how to have sex properly. I knew something was wrong physically."

ED was an unending frustration that made Thompson gun-shy with women and dating increasingly difficult. After his urologist of 15 years tried him on oral ED medications like Viagra and Cialis and none of them worked, Thompson struck out on his own three years ago to seek advice from a sexual medicine specialist.

The specialist ran blood flow tests and found that the arteries in Thompson's penis had become blocked with scar tissue. In 2007, he recommended that Thompson try injecting a cocktail of three medications, and Thompson was thrilled with the result. For the first time since his 20s, Thompson was able to experience an erection for a full hour. His doctor taught him how to safely self-inject the drugs (which Thompson believes "could turn a eunuch into a porn star") so that he wouldn't have to stop by a doctor's office every time he wanted to have sex.

When we talked to him, Thompson hadn't yet had the chance to self-inject and actually have sex, but he was as eager as an adolescent to give it a shot. "Some people go on a date and bring a toothbrush," he jokes. "I go on a date and bring a bag of swabs, syringes, and a vial."

Lead writer: Nick Burns
Last Updated: April 04, 2008

Erectile Dysfunction (ED) Could Be a Sign of Heart Disease or Diabetes, at Any Age

Erectile dysfunction (ED or impotence) is most common among men over the age of 55, but it can also happen to younger men. For men of any age, it can be an early warning sign for serious diseases, so it's essential for your overall health, not just your sex life, to see a doctor if you experience ED.

If you're 55 or older
"With aging, a number of changes occur within the body and you're more likely to have conditions that can contribute to erectile dysfunction, like high cholesterol and blood pressure, hormonal changes, and hardening of the arteries," says Ridwan Shabsigh, MD, director the division of urology at Maimonides Medical Center and professor of clinical urology at Columbia University in New York City. "Also, people usually take more medications later in life and some have sexual side effects that result in ED."

If you're under 55
"We are starting to understand that these men might have psychological issues and early cardiovascular disease," says Dr. Shabsigh. Diabetes is another possibility. The condition can cause nerve damage and a narrowing of the arteries in the penis. The National Institute of Diabetes and Digestive and Kidney Diseases estimates that 35-50% of men with diabetes experience ED.

Lead writer: Nick Burns
Last Updated: April 29, 2008

2 Tips for Discussing ED With Your Sex Partner

Living with erectile dysfunction (ED) can certainly complicate romance and dating. For many men, it is a humiliating hurdle, and some would rather avoid sex altogether than discuss it with a new partner. But as ED meds become more and more widespread, the stigma of ED has begun to decline and partner discussions have gotten easier.

Steve Thompson (not his real name), 57, from St. Louis, struggled for a long time with the difficulty of discussing his erectile dysfunction with partners. "It's embarrassing and in the single world, you get one shot and that's it," he says. "If you blow it, women will move on."

Here's what he learned.

1. Don't wait till you're naked
Thompson talks about his erectile dysfunction when it's clear that a relationship is about to become sexual; he warns against waiting until you're both naked or letting your partner discover on his or her own. "There's no feeling worse than being thrown out of a woman's house or hotel room because it doesn't work," he says.

2. Tell her you're working on it
What can also help lessen the blow is to explain what you're doing to help correct ED. "Women like the idea that you're doing something to fix the problem," says Thompson.

Lead writer: Louise Sloan
Last Updated: May 13, 2008

It Was Tough Admitting Erectile Dysfunction at 19 Years Old

Jonathan, 25, lives in Winter Park, Fla.

I first realized something was wrong when I was 19 and my girlfriend at the time told me that it wasn't normal to lose your erection in the middle of sex. So I started thinking more about it.

If I can get decently hard, it's gone in about 10 or 15 minutes. I'm 25 now, and I shouldn't have this problem. If I were 55, it would be a different story.

But I didn't get help right away. It took a while to admit that I had any problems at all. I looked up information online and didn't find a lot of answers. By the time I finally worked up the nerve to talk to my doctor, I was married to a very understanding woman. And my problem frustrated us both.

My doctor wasn't much help. I tried Viagra and Levitra, and both of them have helped me to get a fuller erection, but, from what I understand, it's not as full as it should be. And both have the strangest side effects, at least for me. In addition to giving me sinus congestion and headaches, the pills make me feel depressed very quickly. It really kills the mood, and I beat myself up over not being able to satisfy my wife.

I know a lot of doctors say it's often a psychological issue—especially when ED happens in younger guys—but I don't know. I want to say it is, because that means it's something I can eventually fix with therapy. But the fact is that I've had this all my life, and that makes me think there's a physical cause.

Next: After my experiences with the pills

After my experiences with the pills, my doctor recommended that I see a urologist. Unfortunately, the first few urologists I called refused to see me because I'm not a 55-year-old with a heart condition. It was just the doctors' policy. It was so hard to be turned away. I wondered if would be able to find any help at all.

When I finally found a urologist who would see me, sitting in the waiting room was a little uncomfortable. I was the only guy under 40. The doctor gave me a quick five-minute examination and said I might have leaky veins. Basically, the blood flows into my penis at a normal rate but leaves much quicker than it enters. He described a test where they give you an injection to achieve an erection and inject a dye so they can see the blood flow. Ironically, you have to take another medication to get rid of the erection.

But the doctor didn't recommend the test and wouldn't give me a clear reason. The whole experience left me wanting more answers, and I was turned off by how little time he spent talking to and examining me.

I'm planning to get a second opinion. Basically, his idea of a treatment plan was just to deal with it. And at my age, I know that I don't have to accept that.

Jonathan is not his real name.

As told to: Nick Burns
Last Updated: April 13, 2008

Use of ED Drugs With Recreational Drugs Can Be Dangerous

Some men who drink excessively or take recreational drugs such as methamphetamines, cocaine, or ecstasy find it difficult to get and maintain an erection and turn to erectile dysfunction (ED) medications for a temporary solution.

While ED meds (Viagra, Levitra, and Cialis) are considered very safe on their own and there's no solid research on the effects of recreational use, doctors say mixing them with intoxicants could be unsafe—especially in large amounts.

"There could be risks associated, especially since many drugs lower blood pressure and impair judgment," says Ridwan Shabsigh, MD, director of the division of urology at Maimonides Medical Center and professor of clinical urology at Columbia University in New York City.

The ED drugs' side effects—headache, sinus congestion, indigestion, and so-called blue vision—are certainly more common when you take more than the amount prescribed for ED.

(What is known is that nitrates such as amyl nitrite, or "poppers," and prescription nitroglycerin should never be combined with ED drugs, as this can be deadly.)

Also: Don't buy it online
Your email inbox is likely filled with spam advertising cheap ED meds. But purchasing erectile dysfunction medications without a prescription or outside a reputable U.S. pharmacy can be dangerous, not to mention illegal.

You just don't have any guarantee about the quality and authenticity of these products; buyers often receive fake or expired medications, hazardous substitutes, or weak formulations of the pills.
Lead writer: Louise Sloan
Last Updated: May 09, 2008

Premature Ejaculation Is Very Common, But What's Premature?

Premature ejaculation (PE) is probably men's most common sexual dysfunction. It's practically the norm for young men to experience it during their first explorations of sex. But for some, the problem never goes away, while others find it returning later in life. Doctors are not quite sure how to explain either phenomenon.

"Just like urinating or lacking bowel control when we are babies, I think ejaculation is a behavior that we learn to gain control of," says Irwin Goldstein, MD, director of San Diego Sexual Medicine and the editor in chief of The Journal of Sexual Medicine. "Some people cannot learn to gain control (of PE), and the research into the causes is not definitive."

How long should sex last?
But what's a "normal" amount of time to wait for ejaculation? The Journal of Sexual Medicine published a study in 2005 that had 1,587 women time sex with a man from initial penetration to climax and found that the men diagnosed with premature ejaculation climaxed in an average of 1.8 minutes, while the others performed for an average of 7.3 minutes—a difference of just five and a half minutes.

Causes of PE
Some link PE to hyperthyroidism, a condition in which the thyroid gland produces too much of the thyroid hormone thyroxine, which regulates the body's metabolism. A small study in the December 2005 issue of the Journal of Clinical Endocrinology & Metabolism found that 50% of men with hyperthyroidism complained of PE.

Ira Sharlip, MD, spokesman for the American Urological Association and clinical professor of urology at University of California at San Francisco, is not so sure. He blames PE on "subtle abnormalities in serotonin metabolism" and, in some cases, psychological factors. Serotonin is a neurotransmitter that regulates many functions, including mood, appetite, and sensory perception.

Lead writer: Nick Burns
Last Updated: April 30, 2008

4 Ways to Treat Premature Ejaculation

There is no "magic bullet" to instantly remedy premature ejaculation (PE) because its causes are not entirely understood. The problem doesn't have to get in the way of a healthy sex life, however, because there is a range of treatment options to discuss with your doctor or sex therapist.

1. The squeeze
One physical strategy for delaying climax involves squeezing the shaft of the penis right before ejaculation. "It creates a mild discomfort and keeps the event from happening," says Irwin Goldstein, MD, director of San Diego Sexual Medicine and the editor in chief of The Journal of Sexual Medicine.

Not all doctors agree. The squeeze technique is not recommended by Ira Sharlip, MD, spokesman for the American Urological Association and clinical professor of urology at University of California at San Francisco, because he feels it may be difficult to perform properly during sex.

2. Mental distraction
Some people find mental distraction helpful for delaying things. The idea is to think of something completely unrelated to your partner—and distinctly nonsexual. Some guys imagine they are at a football game or do math problems in their heads.

Next: Numbing creams

3. Numbing creams
Topical creams containing lidocaine or a similar numbing agent will reduce sensitivity, although they are not FDA-approved for this function. Or try a lubricant that's formulated with desensitizing ingredients designed to help prolong the sexual experience. Dr. Goldstein has a warning about these, though: "If you are going to use a numbing agent, you should wear a condom or its numbing effects will transfer to your partner." It is recommended, as well, that one wipe off the numbing agent before beginning intercourse.

4. Pills
Some oral medications designed to treat other conditions have also been effective in treating PE because of their (unintentional and otherwise unwanted) sexual side effects. For example, selective serotonin-reuptake inhibitors (SSRIs), widely used as antidepressants, can also be used to delay climax. "SSRIs raise serotonin levels, which is an inhibitor to sexual activity," explains Dr. Goldstein. "One of the side effects is difficulty ejaculating." SSRIs work best for men who take them every day, however; they don't work if you take them immediately before sex. Also, SSRIs typically have another unintended side effect—the loss of libido—so it's important to weigh the pros and cons of this option with your doctor.

The painkiller tramadol can also delay climax. "You can take it right before sex and its effect on the brain ultimately results in prolonged ejaculation," says Dr. Goldstein. Other, less desirable, side effects of tramadol include nausea, vomiting, indigestion, drowsiness, dry mouth, chills, sweating, headaches, and more. Dr. Sharlip also warns it can be addictive.

Lead writer: Nick Burns
Last Updated: May 05, 2008

When Sex Hurts: A Bent or Fractured Penis May Mean Peyronie's Disease

Peyronie's disease is one of the most common causes of sexual pain in men, affecting an estimated 1%. The characteristic sign is a visible curvature or hourglass shape of the penis when erect. Physical damage to the penis causes plaque and scar tissue to build up—usually on the top of the penis, resulting in an upward curve.

"If the penis is bent or twisted, it can tear the fibrous tissue casing that surrounds the erection chambers and cause a laceration in the tissue," says Ira Sharlip, MD, spokesman for the American Urological Association and clinical professor of urology at University of California at San Francisco. "When it heals, scar tissue forms, and eventually it forms plaque."

Another possibility is that your penis was fractured. "If your sex partner is on top and comes down on the penis but misses, the penis will bend," says Irwin Goldstein, MD, director of San Diego Sexual Medicine and editor in chief of The Journal of Sexual Medicine."If there is enough force, it will fracture the envelope. Then inflammatory cells will try to repair the fracture, bringing pain and scar tissue."

he pain from Peyronie's disease can be quite debilitating each time a man experiences an erection. It can even affect his ability to sleep.

Lead writer: Nick Burns
Last Updated: April 21, 2008

4 Ways to Treat Peyronie's Disease

Some cases of Peyronie's disease will improve without treatment, while others require medication or surgery to correct the curvature resulting from damage to the penis. The idea is to reduce the pain associated with the condition while preserving a man's ability to enjoy sex.

1. Arthritis meds
"Peyronie's disease ends up being arthritis of the penis," says Irwin Goldstein, MD, director of San Diego Sexual Medicine and the editor in chief of the Journal of Sexual Medicine. "So there are a number of therapies for arthritis that can be used for Peyronie's, like anti-inflammatories." Anti-inflammatory treatments include Potaba, which the Food and Drug Administration has labeled "possibly effective" for treating Peyronie's disease, as well as colchicine. However, large doses of Potaba are needed for this treatment, and it may cause stomach upset.

2. Injections
Your doctor may choose to try an injection to help reduce the swelling and pain associated with Peyronie's disease. "Injecting drugs such as collagenase, verapamil—a calcium channel blocker—and interferon-alpha-2b is an option," says Dr. Goldstein, "though only interferon has been shown to be effective."

3. Steroids
One of the best ways to stop pain that is resistant to more conservative treatments (such as ibuprofen), says Dr. Goldstein, is through steroids and steroid nerve blocks. He sometimes recommends injecting a steroid such as Kenalog, along with an anesthetic such as lidocaine, into the penis for quick relief of debilitating pain.

4. Surgery
Not all doctors agree on treatment with medications. Ira Sharlip, MD, spokesman for the American Urological Association and clinical professor of urology at University of California at San Francisco, believes there aren't any effective treatments other than corrective surgery.

Surgery may help, but it is generally reserved for more serious, long-term cases. There are three kinds of surgical treatments for Peyronie's disease.
• Nesbit procedure (or Nesbit plication): Tissues in the area of the penis opposite the affected ones are removed or pinched to correct the bend. The procedure can shorten the length of the erect penis, however, so doctors generally reserve this surgery for men with adequate penis length and cases that don't involve an extreme curvature.

• Plaque incision with saphenous vein graft: For someone with a shorter penis, a more severe curve or an hourglass-shaped penis, a doctor might choose to make incisions in the plaque and graft a vein in the area.

• Prosthetic implant: An implant, such as those used for erectile dysfunction, may also help to straighten out the curve from Peyronie's disease and increase the penis's overall hardness.

Lead writer: Nick Burns
Last Updated: May 17, 2008

9 Problems That Can Make Sex Painful for Men

Peyronie's disease is the most common explanation when men have sexual pain, but it is not the only one. See your doctor for an official diagnosis, but here are some other culprits.

• Prostatitis
This is an inflammation or infection of the prostate gland that can cause swelling and pain in the area behind your penis (just below your bladder), pain or burning when urinating, and painful ejaculation.

• Urinary tract infections
You'll want to treat one of these anyway, because they can spread and become very serious.

• Yeast infections
These are sometimes characterized by itching or burning at the tip of the penis.

• Dermatitis
Allergies and sensitivity to chemicals or soaps can cause an inflammation of the skin on the penis, especially for men who are uncircumcised.

• Herpes
If you have genital herpes, a sore on your penis can make for very painful sex; it's better for the healing process to refrain from sex in any case. Also, such sores are extremely infectious.

• Psoriasis
These scaly, red patches may be treated with low-potency steroid creams and are not infectious.

• Phimosis
In this condition, the foreskin is too tight to be completely retracted over the head of the penis.

• Paraphimosis
The foreskin is stuck behind the head of the penis and can't be pulled forward.

Last Updated: May 17, 2008

Men's Orgasm Disorders: Pain, Sneezing, and Other Sexual Surprises

Some men experience pain, headaches, and even sneezing as a result of orgasm. Here are some of men's main complaints.

Migraine headaches
"There's such a tremendous excitation of the nervous system and heavy-duty brain activity during orgasm, so it's no surprise that it could trigger a migraine for some people," says Irwin Goldstein, MD, director of San Diego Sexual Medicine and the editor in chief of The Journal of Sexual Medicine. He suggests working with a neurologist or sexual medicine specialist, who may prescribe a vasodilator (including an erectile dysfunction drug such as Viagra), a migraine medication such as Imitrex, or a neurostabilizing drug such as Neurontin. Ask your doctor if a prescription is right for you.

Abdominal pain
A likely explanation for this sort of pain is the "tremendous muscular contraction in the pelvic floor, or lower abdomen, especially around the prostate and urethra," says Dr. Goldstein, but your doctor should rule out the possibility of a prostate infection that could require antibiotics. If there's no infection, physical therapy of the pelvic floor muscles may help.

Yawning and sneezing
These aren't painful or debilitating reactions to an orgasm, but they can cause your sex partner to feel confused or insulted. One possible explanation is that in the brain, the center for orgasms is close to the centers for yawning and sneezing, says Dr. Goldstein, so one center could activate another. "If your partner yawns during sexual activity, it probably means that he or she is just sexually aroused," he says.
Lead writer: Nick Burns
Last Updated: May 14, 2008

ONLINE RESOURCES 7 Websites to Get You Through Erectile Dysfunction and Other Sexual Problems

Once you've learned the basics about men's sexual dysfunction from us, you may want to see what other reputable websites have to say. Follow the links below for our favorite online tools and resources, including videos, a directory of physicians, and news.



Compiled by: Lisa Freedman
Last Updated: August 28, 2008

Why Some Men Can't Have Orgasms

inability to orgasm, according to Irwin Goldstein, MD, director of San Diego Sexual Medicine and the editor in chief of the Journal of Sexual Medicine. There's a wide range of possible explanations, however, and doctors are generally able to pinpoint your problem through biological and psychological tests.

• Hypothyroidism: The thyroid gland does not produce enough hormone.

• Hypogonadism: Testicles do not produce enough testosterone.

• Psychological causes: These may include depression, anxiety, or a panic disorder of some kind. (Difficulty achieving orgasm can also be a side effect of some antidepressant drugs, such as selective serotonin-reuptake inhibitors, or SSRIs.)

• Neurological problems: Strokes, multiple sclerosis, and diabetic neuropathy can limit your ability to orgasm.

• Physical injuries: Spinal cord injuries and other major wounds can have an effect.

• Prostate problems: These include infections or surgery affecting the prostate or other pelvic organs.
These are some of the conditions that tests may turn up.

See your doctor or a sexual medicine specialist to find out the cause.

Lead writer: Nick Burns
Last Updated: May 22, 2008

FREQUENTLY ASKED QUESTIONS Answers About Women's Sex Problems From Dr. Marjorie Green

Marjorie Green, MD, directs the Mount Auburn Menopause and Female Sexual Medicine Center and is a clinical instructor at Harvard Medical School.

Q: Why does it hurt when I have intercourse?

A: Painful intercourse can have a wide range of physical or psychological causes, from bacterial infection to anxiety to hormonal changes due to menopause. If sex hurts, see your gynecologist and discuss the pain in as much detail as you can. Jot down basics such as:

• When the pain began
• Where you feel it (at the opening of your vagina? deep inside?)
• The nature of the pain (is it sharp? dull?)
• Whether the pain starts and stops with penetration
• If you've noticed any unusual vaginal discharge

Q: I told my physician that sex hurts and she told me that I should just try to relax. Should I get a second opinion?

A: Absolutely! Sex should not hurt. Discuss the pain with a gynecologist as soon as possible, and if he or she can't help you, ask for a referral to a doctor who specializes in sexual pain.

Q: I've been treated repeatedly for the same vaginal infection, but sex still hurts. Could there be another reason for my pain?

A: Ask your gynecologist to examine you more thoroughly to ensure that you're being treated for the right problem. For instance, what may resemble a garden-variety yeast infection could be trichomoniasis, noninfectious vaginitis, or even an allergic reaction to yeast medications, a skin condition, or a reaction to your birth control. If your gynecologist can't find the source of your pain—or insists on the original diagnosis—make an appointment with a sexual pain specialist.

Next: My vagina clenches up during intercourse and it's really painful. What should I do?

Q: My vagina clenches up during intercourse and it's really painful. What should I do?

A: You may have vaginismus, a reflexive tightening of vaginal and pelvic floor muscles. Vaginismus is thought to be the body's way of bracing itself against sexual pain. Women who suffer vaginismus shouldn't force themselves to endure intercourse; further anxiety, stress, and genital pain can cause the body to intensify its protective response. Your gynecologist can investigate the underlying cause of your muscle spasms and, if necessary, refer you to a sex therapist.


Q: My vagina itches, burns, and hurts constantly. What's going on?

A: You may have vulvodynia, a widely unrecognized chronic pain condition that affects an estimated six million American women. The cause of vulvodynia is still a mystery, but what sufferers have in common is periodic or constant burning, stinging, itching, and irritation of the vulva, clitoris, perineum, pubic area, inner thighs, and/or the outer rim of the vagina (the vestibule). Few gynecologists know about vulvodynia, so you may want to see a sex therapist, pelvic floor specialist, or neurologist. For more information, go to the National Vulvodynia Association's website, NVA.org.


Q: How do doctors diagnose and treat vulvodynia?

A: Before a doctor diagnoses you with this chronic pain condition, other causes need to be ruled out—such as vaginal infections, dermatologic diseases, vaginal atrophy, and fibromyalgia. Your gynecologist should ask a battery of questions about your sexual health and history, examine different areas of your vagina, and ask you to rate the pain with each touch. There's no FDA-approved treatment, but your doctor may recommend one among a range of vulvodynia solutions.

Next: It hurts deep in my abdomen when I have intercourse. What could be the problem?

Q: It hurts deep in my abdomen when I have intercourse. What could be the problem?

A: A wide range of health conditions can cause deep abdominal pain during sex. It could be a urinary tract infection, and other causes could destroy fertility if they go unchecked (such as chlamydia, gonorrhea, pelvic inflammatory disease, endometriosis). Deep abdominal pain requires immediate medical attention, especially if accompanied by fever, nausea, and vomiting.


Q: How can birth control pills affect my sex life?

A: Birth control pills can reduce your capacity for lubrication and cause vaginal atrophy, a thinning of the vaginal walls that can make sex painful. The culprits are usually the newer formulations of oral contraceptives that contain low doses of estrogen and testosterone-reducing progestin, which can also decrease your libido.


Q: How can menopause affect my sex life?

A: Dramatic hormonal changes can lead to a decline in sexual desire, an inability to become aroused, and difficulty having orgasms. Menopause can also lead to vaginal atrophy and dryness, which can both lead to pain.


Q: How can chemotherapy affect my sex life?

A: Chemotherapy—a type of treatment that uses drugs to destroy cancer cells—has been associated with changes in menstrual cycle and in ovarian reserve (the number of eggs in your ovaries), which can lead to temporary or permanent menopause symptoms and negative body image. But some women may experience none of those effects.

Next: Could my blood pressure medication affect my ability to have an orgasm?

Q: Could my blood pressure medication affect my ability to have an orgasm?

A: Yes. It can cut the blood flow to your vagina. Talk to your gynecologist about ways to maintain your ability to have an orgasm without sacrificing your cardiovascular health. This may include reducing alcohol consumption, quitting smoking, and getting regular exercise.


Q: I don't have orgasms anymore. What can I do?

A: Orgasms are a complicated mix of physical, emotional, and environmental factors. With the help of your gynecologist or sex therapist, you should examine what has changed about your emotional health, physical condition, and relationship. Keep in mind that many women don't have orgasms without clitoral stimulation. Don't be shy about experimenting with foreplay, oral sex, mutual masturbation, and sex toys.

Last Updated: April 27, 2008

If You Can't Have an Orgasm, Maybe You Just Don't Know What Turns You On

While there may be a medical explanation for your inability to have an orgasm, chances are the cause is in some way cultural or psychological. You may be unable to climax because somewhere along the way you concluded that sex is a shameful topic, or (because you've had a negative sexual experience in the past), you're uncomfortable with your body or you're just not familiar yet with what turns you on.

Who to talk to
Your first stop should probably be a sexual health doctor or sex therapist, who will likely encourage you to explore your own sexual response. "Have you tried a vibrator?" asks sexual medicine specialist Andrew Goldstein, MD, an associate professor at George Washington University. "I tell women they need to masturbate!" says Hilda Hutcherson, MD, an ob-gyn professor at Columbia University.

What to find out about your own sexual response
Do you prefer a light touch or a firmer one? Do you want your clitoris to be stimulated or your vagina to be penetrated, or do you need both at the same time? Despite the impression you may have gotten from romance novels, many women don't have orgasms from vaginal penetration alone. A 2003 German study found that 70% need direct clitoral stimulation in order to achieve orgasm.

Once you figure out what makes you climax, the next step is communicating that to your partner. Working with a certified sex therapist can be helpful, in order to talk through any fears or shame you might have regarding your sexuality.

Medical explanations
While most cases of anorgasmia (the medical term for not being able to have an orgasm) are psychologically or culturally based, there can be medical reasons for the problem, too, so it's important to consult a doctor, especially if you used to have orgasms. Anorgasmia can happen for all the same reasons as low libido: reduced blood flow to the genitals due to disease or medication, hormone imbalances, or the use of medications that dull sexual response.

Lead writer: Louise Sloan
Last Updated: April 09, 2008

Approaching Menopause, She Stopped Wanting Sex

Sue W. Goldstein always enjoyed sex until perimenopause came along. "Around the time I was 50, sex was pretty lousy," says the 58-year-old coauthor of When Sex Isn't Good.

At first, Goldstein thought the problem lay with her husband, but her own dropping hormone levels were muting her desire and her ability to have an orgasm. Blood tests showed "unrecordable androgens"—i.e., zilch testosterone, the hormone that affects sex drive in both men and women. "I wanted it fixed," she says. "I wanted to have an enjoyable sex life."

Hormones did the trick
The treatment Goldstein settled on involved bioidentical hormones, which are hormones manufactured to be chemically identical to the ones in your body (some doctors believe these are safer; others disagree). Bioidentical testosterone gel was prescribed to bring her levels up.

(Note: Testosterone is not an FDA-approved treatment for women.)

The results came quickly: Goldstein's night sweats disappeared, her energy came back, and bone density tests showed good results. A few months later, her libido returned.

When sex problems are medical
Her success inspired the book, which includes the stories of 16 women with sexual dysfunction as well as medical facts and a listing of relevant studies—to educate women that their sexual problems may sometimes be biologically based.

"All the sex therapy in the world isn't going to fix a sex problem if the biology is bad," she says. She also urges women to treat sexual health like any other health issue. "Nobody's embarrassed if you have a broken arm," she points out. "So why should you be embarrassed if you have broken sexual function?"

Lead writer: Louise Sloan
Last Updated: April 02, 2008

3 Questions to Ask if You Have Sex Drive Problems in Your Relationship

If a disparity in libidos is causing strife in your relationship, you may need to take a closer look at each partner's role. This process is best done with professional help, preferably through counseling with a certified sex therapist. But there's some work the couple can do first. Joy Davidson, PhD, a New York City–based psychologist who's on the board of directors of the American Association of Sexuality Educators, Counselors and Therapists, recommends discussing the following questions.

1. What turns on the partner who has a low libido?
Are there certain times when this partner is more motivated to be sexual? What's different about those times? Analyze that and try to replicate those conditions.

2. Are you playful?
"Look at what you're actually doing," Davidson says. "Is your sex life dull and routine? Do you have fantasies that you can share with your partner? Do you read books about sexual alternatives or surf the Web looking at sex toy sites?" A person with a low libido may be uncomfortable with such ideas. "If you freak out at these questions, it is understandable that you seem to have low libido," says Davidson. Perhaps you have been raised to view sex as something dirty or shameful and need to work through those feelings with a professional. "If you have a sex-negative attitude," she says, "your libido will be repressed too."

3. What's going on outside the bedroom?
You or your therapist may look at what Michael Krychman, MD, executive director of the Southern California Center for Sexual Health and Survivorship Medicine in Newport Beach, Calif., calls "environmental sexuality"—basically, what's going on outside the bedroom. For instance, he says, "I've had couples in the same house, texting each other from different rooms," wondering why their sex life has taken a dive.

Lead writer: Louise Sloan
Last Updated: April 15, 2008

3 Reasons You and Your Lover May Have Different Sex Drives

If your relationship is in turmoil because one partner has lost his or her interest in sex, the explanation might be psychological or medical or something else entirely, such as a secret attraction or affair. But there other, simpler explanations as well, rooted in lack of good communication.

Here are three very common reasons behind "sexual disconnect."

1. Gender
If you're a heterosexual couple, the problem could just be that what arouses men is often very different from what arouses women. A man may respond more quickly, whereas a woman's arousal may be more like "warm water that slowly is brought to a boil," says Joy Davidson, PhD, a New York City–based psychologist who's on the board of directors of the American Association of Sexuality Educators, Counselors and Therapists. "You might conclude that his libido is higher than hers," Davidson says. "It's not the case. They are processing stimulation differently and responding to different cues."

2. Priorities
There also may be a difference in priorities, says Davidson: "If one person thinks having a passionate sexual relationship is critical, absolutely central to the marriage, and the other sees it as the icing on the cake, that is not a libido difference, it's a difference in values."

3. Experience
Someone with little prior sexual experience may simply not know yet what will turn him or her on. Your relationship is just the place to experiment with this mystery. Exploring it carefully and sensitively is generally good for both partners.
Lead writer: Louise Sloan
Last Updated: May 09, 2008