After pregnancy, many times couples report that they don’t experience the pleasure that they used to. Can this be helped?

After normal delivery often-vaginal walls become lax and the penovaginal contact reduces. Thus some people do report less pleasure. This can be helped. While doing the episiotomy, the gynecologist should take one more stitch known as husband’s stitch to ensure adequate apposition that helps in increasing the peno-vaginal contact, thus giving more pleasure.

What are the most common causes of lax vagina? How can it be prevented?

This may occur following childbirth. Proper management of labor with perineal support and an adequate and timely episiotomy can best prevent it.

What is the treatment for a lax vagina?

Kegel’s exercises for contracting the perineal muscles by holding the urine and releasing it, 20 such contractions and relaxations three times a day, may help increase the muscle tone. If this does not work, one may go in for vaginal reconstructive surgery.

What are women’s misunderstandings about men’s sexuality that many lead to sexual dysfunctions?

Often when a man is a premature ejaculator, many women may consider him a poor lover or the woman may make an attempt to reach orgasm early also. At times, this leads to a shortening of periods of intimacy. In cases of retarded ejaculation, where there is a delay in reaching orgasm, the woman starts getting a feeling that her partner does not love her or she is not attractive to him any more which may disturb the intimate relationship. Also most women consider it improper to actively participate in intercourse and prefer to remain completely passive or only minimally responsive leaving the onus on the male who is now under pressure to perform. This may create a situational anxiety that may impair his response and performance. Even if the male is able to perform properly in these circumstances, the minimal or deliberately subdued response of his partner due to traditional misconceptions will leave him with the feeling that the encounter has not been mutually satisfying. If this occurs repeatedly, it instills a sense of inadequacy and frustration in him that may affect his performance and his sex drive may decline.

How should a physician deal with a sexual problem?

Alter an adequate history taking the physician should try to determine exactly where the problem lies misconceptions, unrealistic expectations, disturbed interpersonal relationships, hostility towards a partner. The physician should counsel the couple as a unit, clarify and explain the situation to them, and clear misconceptions. He may offer specific therapy if and when the situation demands.

Are alcohol and smoking safe during pregnancy?

No, both alcohol and smoking are unsafe during pregnancy as they lead to intrauterine growth retardation.

Can stretch marks on the breasts and abdomen following pregnancy be removed by any medicines?

No. Once stretch marks have occurred, they may somewhat decrease in size on their own but cannot be removed by any medicines or creams. They also occur during puberty, obesity, and Gushing’s syndrome besides pregnancy.

When can a women resume sexual intercourse after delivery?

One should not indulge in sexual intercourse:

• If the episiotomy scar (the cut made to ease the birth of the baby) has not healed properly.
• If there is bleeding per vaginum. Usually, after three weeks of delivery a woman can comfortably resume sexual activity.

Is episiotomy necessary during normal delivery?

Yes. It may be advised largely because it facilitates delivery of the fetal head, prevents vaginal and perineal tears, prevents excessive vaginal laxity, and prolapse of the uterus, bladder and rectum.

Can a virgin become pregnant?

Yes. If the sperms are deposited near the vulva, they may pass through the small hole of an intact hymen and may travel up through the full length of the vagina and uterus and meet the ovum resulting in a pregnancy.

Is sex safe during pregnancy?

Usually, a healthy woman can safely indulge in sexual activity during pregnancy. However, coitus should be avoided if there is pain and/or bleeding at any stage. If the woman has aborted in the first three months in the past, coitus during the first trimester should be avoided. In the second trimester coitus is contraindicated if the woman has a history of ‘habitual abortion’ because the cervical Os or the mouth of the uterus is ‘incompetent’ to hold the foetus. In the last trimester i.e. from the seventh month to labour, one may safely indulge in sexual activity till the day of delivery by altering the position so as to ensure that the direct weight does not fall on the foetus.

It must be understood that whenever, because of any reason, intercourse is forbidden during pregnancy, the woman must avoid reaching orgasm by any other means including masturbation. The contractions of the uterus following masturbation are far more intense as compared to normal sexual intercourse.

An obstetrician may be consulted regarding the indulgence in sexual activity during pregnancy, as each case needs to be evaluated individually about any possible contraindication or modification to be made.

What is the G-Spot and how can one stimulate it?

The G-spot or the Grafenberg spot is an area of increased sensitivity with maximum potential for arousal. It is located on the anterior vaginal wall about two inches from the introitus. After sliding the fingers in that position and with forward, backward or side-to-side movement, the female will be able to pin point the spot where she appreciates increased sensitivity. With increased stimulation, the G-spot swells like a nodule, and becomes firm. Simultaneously clitoral stimulation can enhance sexual pleasure.

What is the most common female sexual problem?

As per my observation, painful sexual intercourse leading to vaginismus is the most common sexual problem.

What could be the cause of excessive vaginal lubrication during sexual intercourse?

Physiologically, lubrication occurs in the vaginal walls during sexual arousal. This could increase in certain conditions of heightened sexual excitement and vaginal infection/allergy. The best thing is to find the cause and treat it. At times, a small dose of an anti-histaminic may prove useful.

Do women like breast stimulation?

Most women enjoy stimulation of the breasts as they form an important erogenous zone of the female anatomy. But, enjoyment depends upon the way in which they are stimulated. Also there are times when the breasts are tender and an attempt to stimulate them causes pain. This usually occurs premenstrual and during pregnancy and in women using oral contraceptive pills, when the breasts are engorged due, to hormonal influence. Hence, it is best to ask the partner about whether "to do, or not to do".

Is the breast size important?

No. Large breasts are not more sensitive to stimulation than smaller one's.

Are there any medicines or creams to enlarge the breasts?

No.

Can the breast size be increased?

Certain exercises can help develop the Pectoralis Major muscles that would add a little bulk to the chest (but not the breasts themselves) and this may help to apparently increase the breast size. Plastic surgery may also prove beneficial.

Are there any exercises for sagging breasts?

There are no exercises that can help sagging breasts because there are no muscles in the breasts except the smooth muscles in the nipple. Wearing of a proper brassiere can help minimize sagging.

Does disparity in breast size require treatment?

Disparity in the size of the breasts may be due to various reasons - physiological and pathological. Disparity due to any pathological cause must be thoroughly investigated and treated. For physiological disparity, no treatment other than counseling and reassurance is required. For cosmetic reasons, if the difference is minor, padding the brassiere cup of the smaller breast would suffice. If the difference in size or contour is large then an enhancement! Enlargement mammoplasty of the smaller breast or a reduction mammoplasty of the larger one may be carried out after evaluating each case on individual merit.

What is virginity?

The word ‘virgin’ means one who has not had sexual intercourse, which may be verified by an intact hymen. However, a girl whose hymen is intact may have had intercourse; whereas a girl who has never had intercourse may not have an intact hymen. The idea of chastity and virginity needs to be clarified. There are virgin individuals who are not chaste and chaste individuals who are not physiologically virgin.

Is it a fact that girls who menstruate early also tend to begin intercourse early?

No. The timing of coitus depends upon individual sex drive, situational factors and sociocultural background.

Does pre-menstrual tension affect sexuality?

Yes, it does. Women tend to become irritable with associated symptoms such as nausea, backache and breast tenderness. There is a feeling of discomfort in the pelvic region and, at times, there may be emotional disturbances and varying degrees of depression. In some, however, it is found that the sex drive is enhanced, perhaps resulting from increased pelvic congestion, insufficient to cause discomfort but sufficient to cause intense pelvic ‘awareness’.

Do oral contraceptive pills prevent pre-menstrual tension?

Yes, oral contraceptive pills do prevent premenstrual tension in about 50% and painful periods in over 90% of the women.

What s the difference between a transvestive and a transsexual?

A transvestite is an individual who becomes sexually aroused by donning the apparel of the opposite sex, and a transsexual is one who strongly fools that he or she belongs to the opposite sex.

How can one diagnose transsexualism?

Transsexualism is an overriding feeling of discomfort with one’s anatomic sex and a constant desire to be rid of one’s genitals to become a member of the opposite sex. In other words, a male mind in a female’s body and vice versa. The diagnosis is made only if the disturbance has been continuous for at least two years; if there is no evidence of psychological disorder like schizophrenia; and is not associated with physical intersex or genetic abnormality. The differential diagnosis must be made among true transsexuaiism, transvestism and homosexuality. Physician should be aware that Gender transposition might occur in cases of severe personality disorganization associated with psychosis. A behavioral sex change may emerge even later in life in certain rare cases of temporal lobe epilepsy or as a consequence of senile dementia.

Are eunuchs transsexuals?

No. Eunuchs are not necessarily transsexuals. They are castrated males, who have had their testicles removed prior to puberty so that the secondary sexual characters do not develop. As against this, transsexuals are individuals who have an overwhelming desire to be the opposite sex.

What is paraphilia?

“Para” means ‘beyond’, and “philia” means love. This includes Fetishism, Transvestism, Zoophilia, Podophilia, Exhibitionism, Voyeurism, Sexual Masochism, Sexual Sadism, and others. They are more common in males than among females.

Fetishism: the condition in which a person is dependent on a talisman or fetish object, substance, or part of the body in order to obtain erotic arousal and facilitate or achieve orgasm.

Transvestism: behaviorally, the act of dressing in the clothes of the opposite sex; psychically, the condition of feeling compelled to cross-dress, often in relation to sexual arousal and attainment of orgasm.

Zoophilia: the condition of being responsive to, or depending on, sexual activity with an animal in order to obtain erotic arousal and facilitate orgasm; also known as bestiality. Sexual contact (oral or genital) with an animal may occur sporadically in the course of human development without leading to long-term zoophilia.

Pedophilia: the condition in which an adult is responsive or dependent on the imagery or actuality of erotic/sexual activity with a pre-pubertal or early pubertal boy or girl, in order to obtain erotic arousal and facilitate or achieve orgasm. A pedophiliac may be a male or a female. Pedophilic activity may be replayed in fantasy during masturbation or copulation with an older partner.

Exhibitionism: the condition of being responsive to or dependent on the surprise, debasement, shock, or outcry of stranger (usually female) unexpectedly exposed to the sight of the genitals, in order to obtain one’s erotic arousal and facilitate or achieve orgasm. The actual event may be replayed in a masturbation or coital fantasy.

Voyeurism: It is also called as scoptophilia. The desire to observe the genital of others or to watch sexual intercourse becomes the condition of erotic excitement and gratification. A voyeur is also known as a “peeping Tom.” The actual event may be replayed in masturbation or a coital fantasy.

Masochism: the condition of being responsive to or being dependent on receiving punishment and humiliation in order to obtain erotic arousal and facilitate or achieve orgasm. As the partner of a sadist, a person may impersonate a masochist for commercial gain, within the limits set by the pain threshold.

Sadism: the condition of being responsive to or dependent on punishing or humiliating one’s partner in order to obtain erotic arousal and facilitates orgasm. A person, especially a woman, may impersonate a sadist to oblige masochistic partners for commercial gain.

Frottage: rubbing or pressing against some object, usually the buttocks of a fully clothed woman, in public places, becomes the condition for sexual excitement.

Gorontophilia: the condition in which one prefers to obtain sexual gratification from an elderly person.

Necrophilia: in this condition, gratification is obtained by indulging in sexual activity with a corpse.

Is homosexuality common in India?

Surprisingly, homosexuality in India is far more common than thought of. Male homosexuality, female homosexuality and bisexuality are on the increase in India today.

What is lesbianism?

Mutual sexual attraction, and/or indulgence in sexual activity between two women is termed as lesbianism. It is a specific term for female homosexuality

What is bisexuality?

Attraction towards, and/or indulgence in sexual activity with partners of both biological sexes is termed as bisexuality.

What health hazards does bisexuality pose?

Bisexuals are usually more promiscuous and are prone to health hazards due to multiple sexual partners such as STD’s, AIDS, rectal prolapsed with sphincter incontinence. They are also more prone to paraphilias.

What precautions can one take to avoid AIDS through sexual contact?

As mentioned earlier with a potentially infected partners “prevention is the only cure”. However, precautions that one may take to reduce the risk of transmission are:

1. Avoid sex with individuals who are in a ‘high risk’ group such as - male and female prostitutes, homosexuals, bisexuals, people with multiple partners, individuals who have had sexual contact with an AIDS patient, hemophiliacs, patients on renal dialysis, intravenous drug abusers etc.
2. Avoid sex with multiple partners especially with unknown/casual partners.
3. Avoid sexual activities that lead to exchange of body fluids as, this is risky (the virus has been isolated from the saliva, blood, semen, tears and urine of infected individuals). Therefore avoid oral sex, peno-vaginal sex and peno-rectal sex.
4. Use condoms during sex as they reduce the risk of transmission of the virus.

What are safe sexual practices for uninfected individuals?

Uninfected individuals should avoid all sexual practices that involve exchange of body fluids, when indulging in sexual activity with potentially infected partners. They may safely indulge in non- oral and non-coital sexual practices such as fondling, stimulation of erogenous zones, sensate focus exercises, mutual or self-masturbation, penetration alternatives such as intercourse between the thighs, inter mammary intercourse etc. An orgasm is an orgasm, and is equally satisfying by whatever means it is achieved.

What is an alternative orientation?

Any sexual orientation apart from the popular heterosexual (Attraction towards, and/or indulgence in sexual activity with, partners of only the biologically opposite sex.) orientation may be termed as an alternative orientation. It is not necessarily an aberrant or deviant expression of one’s sexuality. No one knows definitely why some people develop such alternate preferences.

What is homosexuality?

Sexual attraction towards, and/or indulgence in sexual activity with partners of the same biological sex as oneself are called as homosexuality.

Do casual homosexual encounters in early years make an individual a life-long homosexual?

No, they do not. In fact, in a study carried out by Alfred Kinsey, 28 per cent of the females and 50 per cent of the males have had homosexual experiences one time or another in their lives.

What is the ideal thing to prevent AIDS (through sexual transmission)?

In a like India, it would be ideal to use barrier contraceptive devices like the condom, which may offer protection against infection as well as conception.

How can parents help their children in avoid AIDS?

Parents should educate their children about AIDS so that when they become sexually active they know exactly what risks they are taking. Just moralizing does not help to persuade people in changing their behavior. It must be emphasized that there is no cure for AIDS; at the same time one should also emphasize that it is not transmitted via casual contacts, like serving meals, giving hair cuts, shaking hands, using public toilets or swimming pools. Early and accurate information is absolutely essential in the prevention of AIDS, as well as, unnecessary panic and anxiety.

Why is anal sex more risky than vaginal sex?

The rectal mucosa is more prone to abrasions and tears as compared to the vaginal mucosa. Thus, a discontinuity of the lining mucosa creates a direct portal of entry into the blood stream. Thus, AIDS virus from an infected partner will be transmitted more easily during anal sex.

What precautions should a homosexual take?

If possible, avoid. If not, then while indulging in oral sex, avoid taking the partner’s semen in your mouth. While having anal sex insist on the partner wearing a condom.

Can one tell by inspecting a potential partner if he/she is infected?

No. One cannot definitely say whether an individual harbors the virus by mere inspection, as the vast majority of individuals who have been infected are Symptom less carriers’ and show no evidence whatsoever, of the infection. They may themselves be unaware that they are infected. The best method of finding out whether an individual is infected is to undergo a blood test.

Does concentration of semen lead to longevity and ethetic excellence?

If this had been based on physiological facts, then all bachelors would have become athletes and lived longer!

Does reduced consistency of semen indicate sexual inadequacy?

No. Consistency of semen may vary as it depends upon several factors like period of abstinence, intensity of stimulation etc. However, as a man grows older, consistency does thin out, but it has nothing to do with the individual’s sexuality.

Do reduced quantity and change in color of semen indicate a waning virility?

No. As mentioned earlier, the quantity of semen often depends upon the intensity of stimulation, period of abstinence and age. As a man grows older, the color of the semen changes from white to light yellow and the quantity may decrease, but the color and quantity have nothing to do with the sexuality of an individual. Neither does it have any relation to partner satisfaction.

What is AIDS?

It is an Acquired Immune Deficiency Syndrome, a viral disease in which the immune system becomes so weak that the individual becomes susceptible to any infection or disease that an otherwise healthy person would be able to resist easily. AIDS victims can be devastated by the common cold or by a simple attack of diarrhea.

Do you need to worry about AIDS?

Yes. AIDS can spread easily through any infected secretion of an AIDS patient. So far no cure has been discovered for this eventually fatal disease that cripples the immune system making the body increasingly prone to infections. Once contracted the prognosis is usually poor, and the motto one must follow is “Prevention is the only Cure.”

Is AIDS contagious?

Yes. The AIDS virus has been transmitted between male homosexuals, heterosexuals, intravenous drug users sharing contaminated needles, from blood transfusions, contaminated blood products, contaminated secretions like saliva, semen, tears, urine of an infected person, as well as vertical transmission from mother to infant. Tattooing, shaving, dental work, acupuncture, electrolysis needle, can also infect one; surgical procedures etc. if sterile aseptic probations are not used.

How should parents react to their child’s masturbation ?

Parents are usually disturbed when they find out that their child indulges in masturbation. They should understand that this is a normal stage of psychosexual development and a normal expression of childhood sexuality for males and females. It is neither indicative of psychopathology nor of potentially preferential homosexuality in adulthood. They should be very careful not to arouse any fear in the child by scolding or punishing him or making a big issue out of it. In particular the child should not be told any anxiety provoking statements such as, masturbation will damage his sex life or make him insane or lead to genital dysfunction or deformity. Parents should realize that as the child develops it will continue to have strong sexual urges, he/she will be more expressive about his/her sexuality, and will need to find some manner of release. Parents should realize that any anxiety provoking statements at this crucial incipient developmental stage will be detrimental to the child’s psyche. They should provide their constructive support if and when the child solicits it, doing no more; otherwise antagonism and failure are likely. The wisdom of this should be apparent to anyone who reflects upon his personal childhood memories.

Does masturbation lead to curvature of the penis?

No. Just as intercourse does not lead to any curvature of the penis, so also masturbation does not lead to any curvature.

Is semen vital? Does dissipation of semen devitalize a man and promote aging?

Semen is being secreted day in and day out by the genital apparatus. Sperms constitute less than one. percent of seminal fluid, the rest of the fluid is the secretion of the accessory sexual glands, prostate & seminal vesicles. It is being formed for being excreted and cannot be stored even if one wants to do so. Barring conception, semen is not vital. That one drop of semen is equal to hundred drops of blood, which in turn requires a lot of nourishing food, is one of the most rampant sexual myths prevalent.

What s the normal length of the erect penis?

Concern about penile size is as old as the human race. The width, length and erection of the penis vary from male to male, as does the length of the nose, the depth and spacing of the eyes and the width of the forehead. The average sexual length of the vagina is about 15 cm. and only the outer third (5 cm.) has the maximum nerve endings. The inner two-thirds (10 cm.) being virtually insensitive.

If one wants to arouse his partner, he should concentrate on the area where there are maximum nerve endings i.e. the outer lips (Labia Majora) and the outer third i.e. outer 5 cm. of the vagina. Therefore, for female sexual gratification, the size of the erect penis could be anything from 5 cm. plus. However, the size of the penis may be an important factor for women who harbor the myth “a man with a large penis can satisfy his partner better than one with a smaller one”. Penile size is unimportant for partner satisfaction. “An archer is known by his aim and not by his arrows”.

Is he length of the penis in the flaccid state important?

The length in the flaccid state is immaterial, as it is used for urination only. It is the erect penis that is used for performing the sex act and not the flaccid one.

Is the width of the penis important?

No. The vagina is highly elastic. It can expand from the size of the little finger to that of the baby’s head. The vagina distends according to the width and size of the inserted penis.

Can a small penis lead to conceptive inadequacy?

No.

Why do men fee weak after sleep emissions?

Post-emission weakness is totally psychological. Right from childhood the idea has been drilled into our minds that the genitals are special and anything coming out of it is equally special. This misconception about the value of semen generates tremendous anxiety in an individual leading to neurasthenic symptoms. In fact, the calories lost during sleep emission are equivalent to those contained in a glass of lime juice!

What is celibacy?

Celibacy is a state of sexual abstinence.

Is sexual abstinence disadvantageous?

Prolonged sexual abstinence may be detrimental to mental and physical health. There are people who are under the impression that sexual abstinence is conducive to human health and happiness. Because of this misguided belief, they make an attempt to conserve the so-called ‘energy’ by sexual abstinence. The moment they are unable to do this, they get a feeling of guilt and anxiety that they have done something detrimental to their health. When this is repeated several times, the roots of the problem get deeper and deeper. Consistent suppression of the sex drive leads to emotional instability and evokes an abundance of sexual imagery. This usually leads to inability to concentrate, insomnia, irritability and extreme nervousness. The extent of disturbance depends upon the individual’s own mental state and the environment. At times, the consistent suppression and continued inactivity of the sex organs lead to diminished ability to function. Besides, it would be a serious mistake to harbor any misconceptions about celibacy as, ‘celibacy is not hereditary’.

Is there any relation between the sizes of the body end the size of the sex organs?

No.

Is masturbation harmful ?

Is coitus harmful ? Then how can masturbation be harmful, because essentially masturbation mimics coitus. What the penis does in the vagina during intercourse is the same as what the penis in the hand or the finger does in the vagina during masturbation. It is a myth that masturbation causes acne, insanity, impotence, dark circles around the eyes etc. In fact, it trains the individual’s neurological system to respond. It also provides a pleasurable safety valve or outlet for the release of sexual tension, thus reducing the incidence of sexual crimes, unwanted pregnancies and sexually transmitted diseases including AIDS.

Is excessive masturbation harmful ?

Firstly, there is no such thing as excessive masturbation. Besides, just as excess of coitus cannot lead to weakness so also an excess of masturbation cannot lead to weakness. The individual mechanics of masturbation and coitus are the same. In masturbation they occur singly and in coitus they occur conjugally. Further, physiologically, it is disuse which is abuse as it is dis-use and not use which leads to atrophy. Does the tongue become weak in a talkative person and strong if one observes silence ?

I have come across a person who used to masturbate three times a day, regularly for 12 years. When he was examined later, his general condition was good, his blood examination (metabolic profile), and hormonal assays did not reveal any abnormality. His semen analysis was normal, there were no signs suggestive of any disturbance in the genital function and his performance was good.

Is there any treatment for masturbation ?

Masturbation per se is not an illness and hence does not require any treatment whatsoever. It requires treatment, if and only if, it becomes obsessive or compulsive and the individual perceives it to be a problem, and not otherwise. In this case the basic problem is psychological and it is the underlying disorder which merits therapy and not masturbation.

Is it a fact that women must bleed at the first attempt at sexual intercourse?

No. This usually occurs due to the rupture of the hymen in virgins. However, the hymen may be absent from birth or might rupture while playing games, doing exercises or using tampons. Hence, a woman need not necessarily bleed at the first attempt at sexual intercourse to prove her virginity. I have seen plenty of marriages going on the rocks because of this misconception.

Do man have a greater sex drive or women?

Sexual urge depends on the individual’s sexuality and a greater sex drive is not the prerogative of either sex!

For conception and ideal sexual, is simultaneous climax necessary?

No. Simultaneous climax in no way ensures conception. In fact the idea of conception often decreases the intensity of pleasure. As for pleasure, it is the pleasure itself that is important. Whether one got it before, with or after the partner is immaterial.

What is the most dangerous sexual myth?

“A sexologist is always a highly qualified professional”.