Managing Prostate Surgery Complications and Atrial Fibrillation: Expert Advice

Dear Dr. Roach: My husband tried two drugs for his enlarged prostate – finasteride and tamsulosin – prior to having prostate surgery in 2016. Since then, his libido has dropped, and his urologist suggested Viagra or a similar medication.

But we were concerned about a heart issue, since he has a stent in the “widowmaker” artery and an aortic aneurysm. He says he isn’t worried, but I’m concerned with his overall health.

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Now he wishes he never did the surgery and wonders whether the other drugs could have been a factor in this.

He will see cardiologist soon, and we can ask if Viagra would cause him harm. I read that men with heart disease should take precautions because Viagra can affect the arteries by widening them, causing blood pressures to drop temporarily by 5-8 mmHg. The article said some cannot use these medicines under any circumstances.

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C.G.

Answer: Sexual problems after prostate surgery are common. A change in libido is less common than a change in erectile function; however, erectile dysfunction (ED) often leads to a lower libido in men.

Medicines like Viagra are effective at treating ED, but do not directly treat low libido. I can’t say whether Viagra would help your husband, but there is a good chance it might.

Side effects of Viagra are generally small, but men with heart disease, whether they have a blockage in the arteries, an aneurysm, or serious heart failure, absolutely need to discuss this medication with their cardiologists.

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Men who take any nitroglycerine medicines cannot safely take Viagratype drugs. The physical activity associated with sex also needs to be considered by the person’s cardiologist.

Fortunately, the drop in blood pressure associated with Viagra is well-tolerated by most men with well-controlled heart disease.

Dear Dr. Roach: I recently underwent minor surgery that involved general anesthesia. Before surgery, my electrocardiogram was normal. After surgery, I developed atrial fibrillation.

My symptoms have included dizziness and fatigue, and I am taking a blood thinner (Eliquis). I also have a monitor placed on my chest, and in the future, I plan to undergo ablation.

I am 77 years old. Before this condition, I walked about four times a week, each time about 4.5 miles. I used to have a normal-to-low blood pressure and pulse rate. I was the picture of good health. What are the prospects for those who have sustained AFib?

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R.T.

Answer: AFib is fast and chaotic electrical activity in the top chambers of the heart that leads to an irregular heart rhythm. Without treatment, AFib commonly causes palpitations, and it may be causing the symptoms of dizziness and fatigue that you have.

But AFib is also worrisome because it predisposes people to strokes. Treatment is indicated to reduce the risk of a stroke and treat symptoms.

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A few people who have AFib that sets in after a specific trigger (such as surgery, pneumonia or excess thyroid hormone) will have it go away spontaneously, but it may come back, even without another trigger.

Ablation is a newer treatment that removes or isolates the area responsible for the abnormal rhythm. It is successful 75% to 90% of the time.

Successful ablation was recently shown to reduce anxiety, depression and psychological distress better than medication. Most people with AFib do well with treatment.

Exercise to prevent and treat Erectile dysfunction (ED)

Exercise at moderate and high intensity has been shown to reduce risk of erectile dysfunction by 37 and 58 per cent respectively. Erectile dysfunction is one of the most common men’s health problems, especially among those...

WHAT IS THE RELATIONSHIP BETWEEN ERECTILE DYSFUNCTION AND HEART DISEASE?

Erectile dysfunction (ED) is the inability to attain or sustain erection of sufficient quality for or during sexual intercourse and performance.

Worldwide, it is estimated that 150 million men have some degree of erectile dysfunction. The figure is likely to double by 2025.

It is one of the most common men’s health problems, especially among those above 40.

In Malaysia, the prevalence of ED is estimated between 26.8-69 per cent in this age group. It means that, in every 10 males aged more than 40, there are about three to seven persons with ED.

Higher prevalence was shown in urban areas, where 70.1 per cent of males in urban areas in Malaysia has ED. ED increases with age. Most (65 per cent) will usually seek traditional medicine for treatment.

ED is associated with other medical conditions like hypertension, diabetes and heart disease. The causes of ED are vascular, neurological, hormonal and psychological.

The most common is vascular problem. ED shares the same risk factor as heart disease. ED is not a life-threatening condition, if it does not occur alongside heart disease.

However, most patients presented with coronary heart disease will usually have ED.

At the same time, patients presented with ED may have heart disease too. A study in Malaysia showed that 90.4 per cent of patients with ischemic heart disease have some degree of ED.

Two-thirds have moderate to severe ED. Lifestyle is the most important modifiable risk factor in ED and heart disease. The lifestyle risk factors are smoking, physical inactivity, obesity, bad diet and alcohol intake. Controlling these factors such as taking up exercise will help reduce the risk of getting ED (and heart disease too).

HOW DOES EXERCISE PREVENT ERECTILE DYSFUNCTION?

Lack of exercise is one of the important lifestyle risk factors of ED after smoking. If you are physically inactive, you have three to four times chance of getting ED than active people.

Exercise at moderate and high intensity has been shown to reduce risk of ED by 37 and 58 per cent respectively. The higher the intensity of exercise, the lower the risk of getting ED. A population study reveals that exercise of more than 18 METs-hour per week will cause better erectile function.

This is equivalent to brisk walking of 3.6 hours per week, or 30 minutes of brisk walking per day. This is similar to the recommendation of exercise by the World Health Organisation, which is more than 30 minutes of exercise per day, five times a week. The more the exercise, the more benefit you will reap.

The most common cause of erectile dysfunction is vascular problem, where there is a problem of artery supplying blood to the region, known as endothelial dysfunction.

In endothelium dysfunction, the artery is not able to produce nitric oxide, which causes occlusion and narrowing of the artery, reducing blood flow and impairing the erection process.

Exercise is able to prevent ED by ensuring availability of nitric oxide through improvement of endothelial function of the artery.

The availability of nitric oxide production by normal endothelium will ensure normal erection process.

CAN EXERCISE TREAT ERECTILE DYSFUNCTION?

Lifestyle modification is the first line of treatment for ED. Exercise is part of lifestyle modification and improvement of ED by exercise has been shown in many studies.

Erectile dysfunction is assessed using International Index of Erectile Function 5 (IIEF-5). Its range of score is between 5 and 25. A score of 22 or more is considered as normal erection function.

There is a systematic review published in Sexual Medicine Journal in 2018. The aim of the study is to provide recommendation of exercise for men with ED.

The review analysed 10 intervention studies, using physical activity to reduce ED.

The study showed that there is improvement of IIEF score between 15 per cent86 per cent in the intervention group (with exercise).

The study concludes that the recommended exercise to decrease ED is 40 minutes of aerobic exercise at moderate to vigorous intensity four times per week.

A total of 160 minutes of exercise per week for six months will decrease erectile problem in men with ED due to physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases

.

Lack of exercise is one of the important lifestyle risk factors of erectile dysfunction after smoking.

I’ve been taking a laxative for two years ...could it harm me?

 I HAVE been taking a laxative for the past two years for chronic constipation. I’m worried now that long-term use might cause me damage, and it feels there’s no end in sight. Can you offer any advice?

CONSTIPATION is a common problem. The aim of laxatives is to help open the bowels with more ease. There are different types available – some, like Movicol, Laxido and lactulose, increase the amount of water in the bowels. This has the effect of softening things, so it’s easier to go. Others, such as Dulcolax (bisacodyl) and senna, stimulate the bowel muscles to get them moving.

There are also bulk-forming laxatives which contain soluble fibre – their aim is to hold on to fluid within the stool, again keeping things soft. Fybogel, which contains a fibrous seed extract called ispaghula husk, is a well-known version.

What will work for an individual depends on personal factors, such as how much water you drink and what is causing the constipation.

New constipation is always a reason to see a doctor as this is considered a change in your bowel habit and can indicate serious disease.

Laxatives are usually not recommended long-term because they can affect the balance of fluid in the body. They can also cause diarrhoea and bowel blockages known as intestinal obstruction.

It is usually recommended to come off laxatives very gradually over months to try to cut down on use. Generally they are continued long-term only for people with a medical condition that causes constipation, or if somebody is taking a medication that causes constipation.

Do not underestimate how useful non-drug measures can be for constipation. Drinking plenty of fluids and eating fruit, as well as taking plenty of exercise, are all known to help the bowels move along.

I HAVE prostate problems, and haven’t had an erection for a long time. I’ve tried Viagra, but it doesn’t work. My partner still wants sex, as she is younger than me, and this is ruining our relationship. What should I do?

SEX is a healthy and important part of a relationship, and it is distressing when it is affected by medical issues. Unfortunately, erectile dysfunction can be a complication of prostate problems – and treatment for them – but there are certainly ways to help. Firstly, do not be embarrassed to speak to a GP, as we regularly see patients about this sort of thing. With a new case of erectile dysfunction, I’d always recommend blood tests to check testosterone levels, and for diabetes. Raised blood sugar, over time, can damage small blood vessels, and a symptom of this can be problems with getting or keeping an erection.

Medications can also cause the problem – for example, some high blood pressure tablets. It is also worth thinking if any lifestyle issues, such as too much alcohol or obesity, are making matters worse.

Sildenafil, known by the brand name Viagra, is one of the commonly prescribed drugs for erectile dysfunction. It can be bought over the counter, but there are other options.

Before saying they don’t work, it is vital to trial different doses and the different drugs.

It is also crucial to understand they don’t spontaneously cause an erection: you still need to engage in normal sex and foreplay to make things work.

They also all have strict timings and some are affected by meals. Each medication should be tried for six to eight weeks before a further consultation and then trying something else.

If nothing is working from the GP, a urologist can help with other treatments such as injections and creams.

I’M asthmatic and have a terrible chesty, rattling cough that won’t go. I spoke to the GP on the phone and he prescribed antibiotics – amoxicillin – and a steroid, prednisolone. But I finished my course two weeks ago, and it’s just as bad as ever. I also feel hot. I would be grateful for any advice.

SYMPTOMS like these make me think Covid – and we are seeing a lot of this at the moment.

Covid tests will only come back positive in the first week or so of infection – so there’s little point in doing one now – but chest symptoms, in particular, do seem to take a while to resolve.

The fact that antibiotics have not helped makes me think it’s even less likely to be a chest infection, and more likely to be the effects of a virus, like Covid.

People with asthma are more at risk of symptoms like these from any infection, whether viral or bacterial, so it is important to speak to the doctor again, if problems persist.

This is especially the case if there is shortness of breath.

The doctor will need to decide whether to try another antibiotic, or if it is in fact viral, meaning antibiotics will be ineffective.

Oxygen levels and breathing need to be checked to see if further steroids are needed: prednisolone dampens inflammation, which is usually given for five days for an acute asthmatic problem.

The GP should consider altering the dose of inhalers the patient is using as well as checking to make sure they are using them properly. In some cases a chest X-ray may be useful.

If it is viral, it may take some weeks or even months to get better, but it usually does.

Erectile Dysfunction Treatment India- Why Saudi Patient Are At Advantage

Overview:

Erectile dysfunction (ED) is the incapacity to get or hold an erection firm sufficient to have sexual intercourse. It’s also every so often called as impotence. Occasional ED isn’t unusual. Many men experience in it times of stress. Frequent ED can be a sign of health troubles that need treatment. It could additionally be a sign of emotional or relationship problems which can need to be addressed through an expert. With erectile disorder, it is tough to get or maintain an erection that is firm enough for intercourse. When ED becomes a routine and bothersome problem, your urologist can help.

Why Saudi Patient choose India to treat ED?

Hundreds of thousands of Saudi Patient are crossing the border into India each year to receive a wide range of ED treatments. Indian healthcare services offers patients from across the globe, which are looking for low cost erectile dysfunction treatment in India.

Saudi Arabia residents are very sensitive to their health issues. Because the clinical arrangements aren’t so evolved in Saudi Arabia, patients prefer to travel overseas for medical management. This has been the scenario in the past, when only the wealthy and the prosperous Saudi Arabia patients could travel to India to get low cost penile implant surgery in India treated with. With the country rising as one of the finest and important medical hub of the world, just like patients from different nations, Patients from Saudi Arabia also can now have afford numerous treatments and have now started out clustering to India for all health associated issues.

1. Top Hospitals for ED Treatment in India

India too has been a historical destination, visited by a constant stream of health travelers seeking penile implant benefits India. During the last decade, India has turned out to be a sought-after spot for low cost penile implant surgery. Many hospitals here enjoy affiliation with major educational institutions; Residents of the Saudi Arabia are entitled to best low cost penile implant surgery India at top hospitals for ED treatment in India

2. World Class Best surgeons in India

World Class Best surgeons in India are recognised as among the best at the international level. Medical technologies, equipments, facilities offered by him are at par with international standards. The wait time for surgery taken by these best surgeons in India are non-existent in comparison to western nations, wherein patients have to wait for weeks or even months for life-saving treatments.

EDTreatment India Medical Value Provider

EDTreatment India is a patient-friendly medical provider and aim at providing quality healthcare services to international patients who are looking out for low cost penile implant surgery in India. The medical services and treatment options, and the facilities and amenities that they provide to patients are pocket-friendly and are at par with the global standards.

Special packages for Saudi Arabia patients

Special packages for Saudi Arabia patient is provided by high quality service and customized care to all international patients and their families. EDTreatment India understands that every international patient has different needs and expectations, and the team is right here to ensure personalized guidance via every aspect the treatment. The devoted staff can help in connecting you with the distinguished physicians, providing and securing cost estimates and coordinating appointments and admissions that meet your travel dates. The team of in-house Interpreters trained in multiple languages that assist you throughout your visit the Hospital.

Services Provided at Lowest Price

The cost of penile implant in India starts from $4000. It cost 4–5 times higher in USA and other countries that’s why patients from these countries come to India for surgery. Surgery cost entirely depends on upon the price of the implant chosen by means of the patients. Erectile dysfunction treatment cost in India makes it easy for international patients coming from all corners of the Saudi Arabia patients.

Making an appointment is now more convenient than ever. Email us: info@edtreatmentindia.com to schedule an appointment online or call +91 9403821740 to speak with a NOW.

Tips for good sex after the menopause

A few generations ago, many women just got old when menopause struck. Currently, many women live for a number of the decades after the menopause, during which they can enjoy good health—and a satisfying sex life. Some problems can occur after the menopause that can impact sex relationships. Tara Allmen, MD is a board certified obstetrician gynecologist and a nationally certified menopause practitioner from The Center of Menopause, Hormonal Disorders and Women’s Health. I consulted with her on the topic.

Dr. Allmen notes that menopause is inevitable—barring an untimely death, every woman will experience menopause. With menopause and post-menopause come natural health challenges or questions that are totally normal and need to be addressed. Talking about these topics is never easy with your friends or partner—or even with your doctor. However, it is important to become educated so you understand your symptoms and how to best manage them. It is also important for postmenopausal women to understand they are not alone.

A common problem impacting menopausal women is vaginal dryness, which is due to a drop in estrogen. The condition can make sexual relations painful and even impossible.For these women, Dr. Allmen recommends the Estring, which is a ring that is inserted into the vagina and releases a small amount of estradiol for three months before it needs to be replaced. When in place, neither the woman nor her partner is aware of its presence. Hormone replacement therapy (HRT) can restore vaginal health; however, some women have health conditions that preclude their use or are reluctant to take HRT because of it has been reported to increase the risk of breast cancer or other illnesses.

Dr. Allmen concurred with me that many gynecologists have busy practices that preclude conversations about an intimate topics. Both she and I agree that a woman should not be afraid to speak up and request time to discuss the situation. Before discussing the situation with a healthcare professional, a woman should educate herself regarding issues of the menopause. She recommends two websites: Urocareindia.com for information regarding the Estring ring and www.edtreatmentindia.com, which is the website of the North American Menopause Society (NAMS). Another good source of information for women is m.edtreatmentindia.com, the website of the American Congress of Urologist, Obstetricians and Gynecologists (ACOG).

Know More About Fibroids

More than two million women worldwide are operated for hysterectomy every year and approximately one third, that is, 6,00,000 are performed because of fibroids. So what are fibroids? Fibroids are noncancerous growth of the muscle wall of the uterus. Fibroids behave differently depending on their size, location, number and associated disorders and hence have a unique behavioural personality. 30 per cent of women have fibroids and a large proportion of these will become symptomatic later on.

Know More About Fibroids 

FIBROIDS THAT CAUSE BLEEDING
PROBLEMS 

Large fibroids in the wall of the uterus, multiple fibroids and fibroids near the inner lining are responsible for heavy bleeding. The normal uterus has two basic ways to stop this bleeding.The first is the blood clotting mechanism that works throughout the body by forming plugs in the blood vessels. The second is unique to the uterus, which has an ability to contract and squeeze the bleeding vessels in the muscular walls. The presence of fibroids possibly does not allow the uterus to squeeze down properly, and so it can’t stop the flow of blood from the vessels and thus it is common for fibroids to cause an increase in the amount of menstrual bleeding.

FIBROIDS THAT CAUSE PAIN 

Fibroids grow because they receive blood flow from the arteries supplying the uterus. They grow at different rates. Some slowly and others quickly. When they grow at a very fast rate, the blood vessels feeding the fibroids may not be able to supply enough blood, resulting in cell death in some parts of the fibroid. This is called degeneration. Due to this degeneration, chemical substances are released that cause pain. This pain can be severe and incapacitating but usually not associated with any other serious problem. An extremely large fibroid can cause pelvic discomfort and a dragging pain continuously. Such fibroids need to be removed. Medicines like anti-inflammatory agents can take away the pain and provide temporary relief.

FIBROIDS THAT CAUSE URINARY PROBLEMS 

The uterus lies directly beneath the urinary bladder and they are partially attached at one point. If a fibroid begins to grow forward, it may push the bladder so that it cannot fill properly, this increases the urge to pass urine frequently. Very large fibroids may obstruct the ureters (which is the tube that carries urine from kidneys to bladder), thereby resulting in back pressure changes in the kidney. Such large fibroids definitely need to be removed.

FIBROIDS AND INFERTILITY 

A small group of fibroids may not allow pregnancy. Fibroids that are located close to the inner endometrial lining and those, which distort the uterine cavity can be responsible for infertility. Also very large fibroids can interfere with pregnancy. These fibroids can be easily treated with hysteroscopy (telescope inserted inside the womb). Larger fibroids are removed laparoscopically.

(telescope inserted inside the womb)

FIBROIDS THAT CAUSE MISCARRIAGE 

Some fibroids, especially the inner lining ones, can interfere with the growth of the developing embryo. These change the internal milieu resulting in a miscarriage. Such fibroids warrant removal hysteroscopically. During pregnancy, fibroids also grow faster.

FIBROIDS AND CANCER 

Fibroids by definition, are benign (non-cancerous) growths. However, very rarely, fibroids can undergo cancerous changes. The incidence is 1:750. Out of all women who have surgery for fibroids one out of approximately 750 would have leiomyosarcoma (fibroid cancer). The treatment in such cases is removal of the uterus and the ovaries if the patient is over 50 years and if her fibroids are growing rapidly.

FIBROIDS THAT RECUR 

Once a fibroid has been removed, it doesn’t come back. However, new ones can grow from other muscle fibres. Clinical recurrence occurs in 15-20 per cent of women within 10 years. The recurrence of fibroids does not depend on the technique with which it was removed the first time, but it is solely dependent on genetic tendencies. Women with only one fibroid in the past have a lower recurrence rate, while those with multiple fibroids have a higher recurrence rate. Fibroids that come back can also be treated laparoscopically.

FIBROIDS THAT CAN BE OBSERVED

If the fibroids are not very large and without bothersome symptoms a patient can wait. She must get an annual pelvic examination and sonography. If the fibroids are growing rapidly and symptoms appear, laparoscopic removal is advised. Fibroids must be dealt with judiciously and if surgical treatment is necessary, endoscopy is the answer.

ASK THE DOCTOR - Helping Relieve Sexual Tension

A friend of mine — a single mother — has a physically challenged son suffering from cerebral palsy. She wants to know if it is OK for her to masturbate her son as he is unable to do so himself. Is it OK for relatives/siblings to help relieve sexual tension by masturbation? If not, what is the correct solution?
- ABC

ASK THE DOCTOR - Helping Relieve Sexual Tension

It is absolutely not advisable for relatives to masturbate the physically challenged person suffering from cerebral palsy. Only he can know his sexual needs, their nature and their intensity, if at all. His ability to understand his sexual needs and the necessity to relive his sexual needs cannot be assessed or guessed by anyone from outside. He may or may not be experiencing any such need physiologically. If an erection is noticed in such an individual, it need not always be a sign of sexual arousal. An erection can happen periodically in men irrespective of sexual urges. You may confuse and even torment the physically challenged person by attempting to masturbate him.

This situation can also be taken advantage of by a ‘sick’ relative who may be carrying a fetish similar to pedophilia and may sexually abuse the child under the garb of relieving the child’s sexual tension. The sexual tension built in a person does get relieved naturally through periodic nocturnal emissions.

ASK THE DOCTOR - Unable to sustain an Erection for Long

I am a 51-year-old married man. My erection does not sustain for long. What can I do?
- Kothari

ASK THE DOCTOR - Unable to sustain an Erection for Long

This is a form of Erectile Dysfunction (ED). There are many organic (physical) as well as psychogenic causes for this problem. It is necessary to find out the cause of this problem first, through history taking, examination and investigations. Once the cause (diagnosis) is found, treatment can be advised. Very effective drugs, Sildenafil citrate and Tadalafil, are now available in India for the complaint of inability to ‘sustain’ the erection. Remember, these drugs cannot bring about erection in a flaccid penis. They only help to ‘sustain’ the existing erection longer.

These drugs are useless in those who have difficulty in getting an erection. It helps only those who get an erection ‘on their own’ but cannot sustain it long enough to perform satisfactory sexual intercourse. You could be benefited with these drugs. However, neither can you get these drugs without a proper prescription by a qualified specialist, nor should you take it on your own. There are risks involved in taking them; and unless you are guided by a qualified expert, kindly avoid selfmedication.

ASK THE DOCTOR - Is Discharge in Adolescent Girls Normal?

Is vaginal discharge in adolescent girls a normal phenomenon? Does it happen due to fungus or infection?
- D M

ASK THE DOCTOR - Is Discharge in Adolescent Girls Normal?

Most adolescent girls get a sticky, white discharge from their vagina. This is a perfectly normal and healthy sign that the pubertal changes have begun in you. Sometimes, this discharge can get on a girl’s underwear. It is good to pay close attention to your normal discharge and how it changes during your monthly cycle so that you can recognise any unusual signs or changes. If you closely pay attention, you will notice that the discharge is not always the same. Sometimes it may be clear while at other times it may be a bit whitish. When you are ovulating, it may become clear and slippery.

A female’s vaginal fluids/discharge also alter when she gets sexually aroused. If the discharge becomes thicker or heavier, changes colour to yellow, green, rusty or brown, or causes burning or itching in the private parts, it is suggestive of an infection. Foulsmelling discharge, and pain or bleeding in the vagina when you are not in your menstrual period, are also signs of infection. If you experience any of these changes, you will need to see a doctor.

ASK THE DOCTOR - Sex During the Menses

Is it true that if a virgin is suffering from severe pain during her menses for a long time and she has sexual intercourse, it cures her problem? Is sex during the menses responsible for developing sexually transmitted infection?
- P.K.

ASK THE DOCTOR - Sex During the Menses

There is absolutely no truth to the rumour that sex cures menstrual pains. In fact, sex during menstruation can increase the risks of getting sexually transmitted diseases (STDs), including HIV. Menstrual blood is a rich medium/environment in which bacteria and viruses can grow very quickly. If a menstruating female has sexual intercourse with a male who has an STD, she is more likely to get infected than during other times of her monthly cycle. In addition, she is likely to get a more ‘serious’ infection when she is menstruating.

This is because the opening of the cervix (mouth of the uterus) is wider than usual so that the menstrual blood can flow out. The STD germs can travel up into the uterus and fallopian tubes and can cause an infection high up in the female reproductive system. This can result in ‘infertility’. For the male, having sex with a menstruating female is also risky. If she is infected with HIV, her menstrual blood will be rich in HIV viruses.

ASK THE DOCTOR - Fantasy of Rape

I am a 25-year-old married woman. Very often I indulge in a fantasy of being raped by someone. I read somewhere that all women carry this fantasy in their mind. Is it normal to have such thoughts?
- R.Shah

ASK THE DOCTOR - Fantasy of Rape

It is true that there are some women (not all) who at some point or the other in their lives carry the fantasy of being taken sexually or being swept off their feet. These fantasies are common but not universal. This idea is played up a lot by some western fiction, pornographic literature and even the mass media. It is important to note that there is a great difference between a self-projected fantasy and an actual rape. Fantasies are our own creation, and thus we have control over it. It can be a great ‘turn on’ for some, but it is not the reality. In reality, rape is a violent act, forced and unwarned, over which a victim has no control at all.

Very often it is seen that a fantasy is necessary when there is a lack of emotional intimacy between partners and sex is merely a physical activity. Therefore, both you and your husband need to deeply examine your relationship, either on your own individually, or with the help of a good counsellor, to determine what can be done to enhance the emotional intimacy so that such fantasies are not required.

ASK THE DOCTOR - Does size Matter?

I am 22 and my fiancé is 27. We will be getting married in November. Recently my fiancé made a confession to me that his penis is small in size; that worries him as to whether he will be able to satisfy me through intercourse. I would like to know whether it is true that satisfaction of a woman depends on the size of the male penis?
- Savita

ASK THE DOCTOR - Does size Matter?

A large number of men carry the complex of small penile size. The size is invariably thought to be the parameter for one’s manliness and one’s ability to satisfy his partner. First of all, the woman’s satisfaction does not depend on the size of the penis. On the contrary, too big a penis can be a problem, as it could hurt the partner. The fact is, that only the outer 1/3rd of the woman’s vagina (approximately 2 inches) is sensitive to sexual stimuli. So, it doesn’t matter to a woman how deep one reaches during the intercourse. If an erect penis is even 2 inches, which is usually the case with most men, it is enough to satisfy his woman. It is not the size, but what you do with what you have, that truly counts.

In men too, only the ‘Glans-penis’ (the front portion) is sensitive to erotic sensations. The shaft behind the glans is incapable of feeling erotic sensations. So the pleasure of the male partner too, does not depend of the entire length of the penis, but depends only on the sensitivity (and not the size) of the glans-penis. A common mistaken belief that a flaccid penis gains in size on erection, in proportion to its flaccid size, causes this fear. The fact is that, though all the penises are different in their flaccid state, they become much more similar in size, when they get erect. Also, one tends to find his penis small as it is always seen from above, as against that of others, which is observed from the side or from the front. The different angles from which the penis is viewed also makes the penis ‘appear’ small or big, as the case may be.

ASK THE DOCTOR - How do I know if my wife is satisfied?

I will be getting married this year. I wish to know wether women experience orgasm and ejaculate during sex? How can I know whether my wife has reached her orgasm and is satisfied?
- Navjyot

Girls/women lubricate at the vagina on arousal. On either sides of the vaginal opening, women have the Bartholin’s glands, in four o’clock and eight o’clock positions. These glands secrete a mucus-like fluid during sexual arousal, providing vaginal lubrication. Women too experience orgasm/climax, however they do not ejaculate like men during orgasm.

The only way to know about her orgasm/satisfaction is to ask her verbally and then believe her answer. What feels good to her is best assessed by her and known only after experimenting and experiencing. Let her be equally active during sex and she will guide you to her satisfaction.