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 - Treatment for Premature Ejaculation

I am a 45-year-old man. I have been married for 14 years with two kids.I want to know what is the treatment for premature ejaculation? I am suffering from it. Kindly reply.
- Vettikunnel

ASK THE DOCTOR - Treatment for Premature Ejaculation

Premature Ejaculation is not a physical problem, but a ‘learning disability’. There are no medical causes for premature ejaculation. It is essentially of a psycho-behavioural and relational origin. Modern medicine does not offer any drug treatment for this problem. Ejaculating early is a learned reflex response that can be effectively re-conditioned when a man and a woman actively learn ejaculation control together. You need to increase your awareness of the sensations of arousal building so that you can identify the level of your arousal. Secondly, awareness of sensations of arousal and ejaculatory control can be learned by following a step-by-step process. We teach couples the use of the ‘squeeze technique’ or the ‘stop-start technique’. Besides techniques, certain ‘exercises for sphincter control’ and ‘use of condom’ may help in some cases.

ASK THE DOCTOR - Is Watching Porn Normal for a Married Man?

My husband who is a pharmacist has great faith in your words and your knowledge. He watches a lot of porn. I hate it. He says it helps him to stay interested in sex. We argue often over this matter. He calls me abnormal. Kindly answer who is abnormal — him or me?
- H K B

 ASK THE DOCTOR - Is Watching Porn Normal for a Married Man?

It will not be correct to call either of you normal or abnormal. You are simply different from each other. Both of you have a right to choose what you like. Give that freedom to each other.

It is definitely a sign of sexual immaturity when one looks for excitement in pornographic films or literature. For such a person, sex is only skin deep. He is not adequately sensitive to the psychological and emotional components of sex. Counselling could help him to mature sexually and even otherwise.

 Let me add that outside inputs are necessary when there is a lack of love between partners… when sex is merely a physical activity. This lack of love cannot be blamed on only one partner. Love happens between two sensitive human beings. Both of you need to deeply examine your relationship, either on your own individually, or with the help of a good counsellor. Meanwhile, at least stop looking down upon your husband. Change your focus from him to yourself. Ask yourself what you can do to bring more depth into your relationship and make it more than sex — a sharing of intimacy.

ASK THE DOCTOR - Involuntary Ingestion of Fluids

During cunnilingus, there is involuntary ingestion of vaginal fluid. Is it harmful? If so, what preliminary preparations do you suggest before the act?
- Sunita

 ASK THE DOCTOR - Involuntary Ingestion of Fluids

If vaginal fluids are contaminated with infective agents (bacteria, virus, fungus) it can transmit infectious diseases during cunnilingus. Certain fungal, viral infections and parasitic infestations are commonly present on the genitals and may not be visible to the naked eye. A person may be harbouring these infections without manifesting any signs or symptoms, and oral sex could cause transmission of such infections to the partner. HIV/AIDS can also get transmitted through cunnilingus if either of the partners is infected. If the person is truly not infected with any STD, in that case swallowing vaginal fluids involuntarily may not be harmful.

ASK THE DOCTOR - If the Blood Groups of Both Husband and Wife are the Same, can they Both have Children?

If the blood groups of both husband and wife are the same, can they both have children?
- Lakdawalla

 ASK THE DOCTOR -  If the Blood Groups of Both Husband and Wife are the Same, can they Both have Children? 

It is a myth that people with the same blood group cannot conceive. Having the same blood group is perfectly fine. Fertility does not depend on blood groups or matching of blood groups. Blood group matching in a couple is given undue importance by some illinformed people. It carries importance only to the point, that if ‘Rh factors’ of both the partners are not matching, it can be harmful for the second child of the couple. However if such incompatibility is known beforehand, precaution may be taken to avoid any harm to the second child. An injection of “Anti D Immunoglobulin” to the mother immediately after the birth of her first child (or first abortion) is all that is required to prevent any harm to the subsequent pregnancy.

ASK THE DOCTOR - What are the Advantages and Disadvantages of a Vasectomy?

I am a 45-year-old man with two children. My wife and I do not want to have any more children. I am planning to go in for a vasectomy operation soon. I want to know the advantages and disadvantages of a vasectomy.
- J Gonsalves

  ASK THE DOCTOR  - What are the Advantages and Disadvantages of a Vasectomy?

During a vasectomy (male sterilisation surgery), the tube that carries sperms (vas deferens) from each testicle is clamped, cut or sealed. This prevents sperms from mixing with the semen that is ejaculated from the penis. An ovum (egg) cannot be fertilised when there are no sperms in the semen. The testicles continue to produce sperms, but the sperms are re-absorbed by the body. Because the tubes are blocked before the seminal vesicles and prostate, one still ejaculates about the same amount of semen. Sexual desire and erectile function remain unaffected after this surgery.

Advantages: Vasectomy is a ‘permanent’ method of contraception (birth control method). Once your semen does not contain sperms, you need not worry about using any other contraceptive. It is a shorter, safer and cheaper procedure that causes lesser complications than ‘tubal ligation’ surgery in women.

Disadvantages: The procedure MAY cause bleeding or infection under the skin, which may cause swelling or bruising. In extremely rare cases, the vas deferens grows back together (recanalisation), and the man becomes fertile again.

ASK THE DOCTOR - First Time Anxiety

I am frightened of having sex with a man. I fear that I will freeze up and freak out and not perform on my part. When having sex for the first time, does it hurt when the man breaks the hymen?
- Nisha

ASK THE DOCTOR - First Time Anxiety 

Sex is not about performance. Sex is a continuation of the communication you have with your partner. Yes it may hurt the first time, however this is transient. Moreover, it can be greatly minimised by helping each other relax, and if adequate foreplay is done to prepare each other for intercourse. A good foreplay in a relaxed atmosphere produces good amount of lubrication at the vagina, and that minimises the pain. Do choose a partner who you trust, feel comfortable with, and with whom you can communicate. Sex is really more about intimacy. Sex just for the sake of sex is somewhat empty. If you love him it is easier.

ASK THE DOCTOR - My Son’s Masturbation Disgusts Me!

I accidentally saw my 14-year-old son masturbating one day. The whole scene filled me with disgust. Since then, whenever I am with my husband in bed, the sight of my son masturbating comes as a flashback and I get filled with disgust. I cannot get involved in a sex act with my husband due to this. My interest in sex has declined severely since then. My relation with my son is also affected greatly. He is not aware that I saw him that way. What should I do?
- Surinder

ASK THE DOCTOR - My Son’s Masturbation Disgusts Me!

You need to understand two things. Firstly, there is absolutely nothing wrong if your son masturbates. Practically all boys at around this age masturbate. It is an absolutely harmless act. It helps them to organise their sexual urges and patiently wait for a heterosexual encounter while they are still growing towards becoming responsible and mature men. Science has proved that masturbation has no ill effects on one’s bodily or sexual strength. It is only when the child is made to feel either guilty or fearful about the act, that it weakens them psychologically and affects their self image.

Secondly, you seem to have a certain bias about sexual expression, which is filling you with ‘disgust’. There is nothing disgusting about self-pleasuring (through masturbation) in one’s privacy without involving anyone else. At this age, when your son’s secondary sexual characteristics are developing as an inevitable process of nature, he can find no better outlet than masturbation to vent his sexual urges. His behaviour is a manifestation of him growing independent, which is a signal to you that he is no more your ‘baby-boy’ dependant on you for all his needs. You, as a mother, need to ‘let go’. Respect his growing independence and individuality. Love him for being a normal, growing, independent man.

Your intimate relationship with your husband is a completely different aspect of your life. It has nothing to do with your being a mother. See this objectively, and then it will not interfere with your sexual relationship with your husband.

ASK THE DOCTOR - Can Women Experience an Orgasm Through Masturbation?

Male masturbation is often discussed in books and magazine articles, but female masturbation is never spoken or written about. Kindly explain how women masturbate? Do they insert any object in the vagina? Can they experience an orgasm through masturbation?
- R Pinto

ASK THE DOCTOR - Can Women Experience an Orgasm Through Masturbation?

Women and girls masturbate in many different ways. They may either knead their clitoris with their fingers or massage their vulva against something like a pillow or a bolster, soft edges of furniture or stuffed toys. Some women use a water spray, vibrators, dildos or some other sex-toys to stimulate the sensitive areas of their vulva. The vagina plays a minor role in the masturbation practices of women, however vaginal insertion is by no means unusual, uncommon or rare. Just as in men, fantasy commonly plays a key role in a woman’s masturbation activities. The brain is the most important and primary sexual organ and as a result physical stimulation alone is often not adequate to achieve orgasm. If care is taken to maintain hygiene, and if self-stimulation is done gently without causing any injury to the genitalia, and if it is done in privacy, then it is a harmless activity, which helps release the sexual tension in women in the absence of a partner.

ASK THE DOCTOR - Combined Birth Control Pills

What are ‘combined birth control pills’? Are they the same as oral contraceptive pills? or they are something else? How does one take these pills? How effective are they? Can they protect woman from STDs? Can any woman take it? Are there any precautions to keep in mind while taking these pills?
- Kulkarni

ASK THE DOCTOR - Combined Birth Control Pills

‘Combined birth control pills’ contain two synthetic female hormones — estrogen and progesterone. They act by stopping ovulation (release of an egg), thickening the cervical mucus to block sperms at the mouth of the uterus, and by making the lining of the uterus thinner — to prevent implantation of the fertilised ovum (zygote). The pill has to be taken very regularly from the fifth day of the menstrual cycle, one every night for 21 days. The pill does not protect a woman against STDs. The pill may add to your risk of ischaemic heart disease, including hypertension, blood clots, and blockage of the arteries. If you are over the age of 40 and if you smoke, or if you have a previous history of blood clots or breast cancer, you may be advised not to take the contraceptive pill. The pill is 95 to 99 per cent effective in preventing pregnancy if used correctly. If you choose to use a contraceptive pill, you will require a prescription from your doctor and periodic visits to your doctor to ensure you are not having any ill effects of the pill.

ASK THE DOCTOR - What is Molestation?

What is the meaning of molestation? What is the difference between sexual abuse, sexual harassment and rape? What are various behaviours, which come under these? I have undergone a horrendous incident when I was eight. An elderly man touched my private area (genital area) while he was handling his own genitals during a travel. Can you explain this behaviour?
- Subhadra

ASK THE DOCTOR - What is Molestation?

Molestation is touching a woman who is not your wife without her consent. It is punishable as per the section 354 of the Indian Penal Code (1860). As per sections 375 and 376 of IPC, it is rape when intercourse (penetration) is performed on a woman (who is not your wife) against her wish. If the consent for intercourse is taken under threat, or in an intoxicated state or under disguise, still such an intercourse is considered as rape. Intercourse with a woman (who is not your wife) below the age of 16 even with her consent is considered as rape as per the Indian Penal Code. If your wife is below the age of 15, then intercourse even with her consent is legally regarded as rape. Sexual abuse means forced sexual intimacy, with or without penetration, with a person of any age and sex, against her/his wish. Sexual harassment is a phrase used when a woman is psychologically pressurised or tortured, using one’s position, forcing her to give her consent for sexual favours. A man who touched you when you were eight, must have been a sexual pervert suffering from pedophilia.

ASK THE DOCTOR - Is it normal for a Married man to Masturbate?

My husband has confessed to me that he often masturbates fantasising about other women. Is it normal for married men to masturbate in spite of having a willing partner around? According to me, we share a normal sexual relationship. So why does he find the need to behave this way?

- Rani 

ASK THE DOCTOR - Is it normal for a Married man to Masturbate?

Most married men masturbate, irrespective of the status of their sexual relationship. According to the survey conducted by the University of Chicago on ‘Sex in America’, published in 1994, married people are more likely to masturbate than people living alone. Those who have sex the most, masturbate the most. Some other factors also need to be considered. Partners have different degrees of sexual drive. When one partner wants sex more than the other, masturbation is an acceptable and understandable alternative. Some women are upset, even outraged, if they find their partners masturbating. If masturbation is preferred, and used exclusively as a sexual outlet, instead of intercourse, there is a problem in the relationship and it should be addressed together with a counsellor. 

It is definitely a sign of sexual ‘immaturity’ when one looks for excitement in fantasy etc. For such a person, sex is only skin deep. He is not adequately sensitive to the psychological and emotional components of sex. Counselling could help him to mature sexually and even otherwise. Let me add that fantasy is necessary when there is a lack of ‘love’ between partners…when sex is merely a physical activity. This lack of love cannot be blamed on only one partner. Love happens between two sensitive human beings. Both of you need to deeply examine your relationship, either on your own, or with the help of a good counsellor. Change your focus from him to yourself. Ask yourself what you can do to bring more depth into your relationship and make it more than sex — a sharing of intimacy.

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.

DON’T FEEL SHY OF YOUR DOCTOR

Communicating well with your doctor is very important for proper treatment but many people feel shy. Read on and find out what you should keep in mind when you go for a check-up



When it comes to the care and maintenance of your own body many of us either wait too long to seek medical help or become conscious while telling the doctor about the problem. Fear, embarrassment and lack of assertiveness result in communication breakdown that can jeopardise your health even more. But you should not wait too long. Keep these things in mind while going to the doctor.

DON’T WAIT TOO LONG BEFORE YOU DECIDE TO VISIT 

You know your body the best so you can easily make out when you are about to get a cold, have a splitting headache or if you pull a muscle. But what if you experience something you’ve never had before or if a condition seems to persist longer than you remember it did the last time. Then it is clear that you need to visit the doctor as soon as you can.


GET RID OF YOUR SHYNESS 

Many people feel awkward or shy when the doctor examines them, even when they are fully clothed. They feel awkward discussing the irregularities of certain body functions and especially on matters related to sex. What they fail to recognise is that not only have doctors seen a lot of naked people during the course of their practice but they have also treated whatever problem is currently causing such embarrassment. If you are really feeling uncomfortable describing your symptoms to the doctor then write them down before you go, along with the specific questions that are concerning you. Your practitioner will be sensitive to your feelings in this regard and can then proceed to ask you questions that will minimise your having to talk.


BE HONEST 

The purpose of a medical examination is to see how your body is functioning and to diagnose the problem. Some people are so shy that they lie during the test. For example some people visit the eye doctor and tell the doctor they can see clearly even if they are not able to. This should be avoided. It is very important for you to be honest with your doctor because he is the one who will treat your illness. Lying to him or hiding things from him can worsen your problem. If your physician asks you something make sure you are honest because you are giving him critical information that will yield the right cure. And remember that there is nothing you can tell them that they haven’t heard before.

USE SIMPLE LANGUAGE 

Doctors don’t really mean to intimidate us but somehow they always do. In the course of describing your condition and how they plan to treat it, they may use complicated medical terms that you may not follow. If you are confused about something or you have not followed what they are saying then ask them to repeat it in simple terms. Ask the doctor to explain to you the condition in detail so that you are aware of what is wrong with you. The same goes with understanding the particulars of taking a prescription drug. If the dosage instructions aren’t clear or if warnings aren’t heeded they can end up doing more harm rather than good. As far prescriptions go, be sure to read that small print on the label before you ever leave the drug store and ask the pharmacist or doctor to explain anything you don’t understand or that isn’t addressed. You have to be careful about this factor.


TAKE A SECOND OPINION 

If you are not happy with the way your doctor is treating your problem or if it is of sufficient seriousness to warrant a second opinion. Don’t feel shy about asking for a referral. Many patients are hesitant to do this in person out of fear that they will offend their doctor. Your doctor is as concerned as you are about establishing a good relationship with you so if you don’t trust the doctor there is no point going to him. You will tend to resist his/her recommendations and hence not get cured soon. If you want a second opinion, you are entitled to one and should not be hesitant about inquiring about another doctor.

Whatever you do remember one thing – don’t feel shy of your doctor because at the end of the day you are trusting him with your life.

ASK THE DOCTOR - How and When Should we Educate Children about Sex?

How and when should we educate children about sex? How much do we tell children? If we tell them too much too early, will it not cause any harm to their psychology? Will it not encourage them indirectly to experiment and become sexually active? Kindly answer this important question in detail.
- N P

It is extremely important to help children feel comfortable about their sexuality from the very beginning. This will prepare them and make it easier for them to ask any question about sex without inhibitions throughout their lives. As they grow, parents and teachers can give them correct and useful information to help them make healthy and responsible decisions about their sexuality. Invariably parents are concerned that telling children too-muchtoo-soon will harm them in some manner, or will provoke and encourage them to become sexually active early in their life. It is necessary to understand that education and information do not encourage children to be sexually active prematurely. On the contrary, children make better decisions about sex when there are no restrictions on what they can ask and talk about at home and when they have all the necessary information they need.

Furthermore, this makes them better equipped at protecting themselves against sexual abuse, incest, molestation, sexually transmitted infections and unwanted pregnancy. However, there is information that is more apt for children at particular ages. For instance, five-yearold child should know the correct names for his/her body parts, including sex organs, and that his/her genitalia is a ‘private’ part which should never be touched by anyone. Such training at an early age can help to prevent sexual abuse, which is widespread in the society today. Kindly note that it is not necessary to have a major discussion with your children each time they ask a question related to sex. It is necessary to listen to them carefully. They may just need the answer to one question right now; and that is perfectly all right. Be certain that you are answering the question specifically, rather than lecturing or talking in general terms. You can always clarify decently if you are not sure what your child is asking. Make sure that they know that they are most welcome to ask follow-up questions.

ASK THE DOCTOR - What is Meant by ‘Cervical Erosion’?

What is meant by ‘Cervical erosion’? Kindly give reasons and treatment for the same.
- K. Androth

Cervical erosion (also known as Cervicitis) is often caused by infection, but also sometimes by a foreign body (IUD string, Tampon etc) or chemicals. It causes heavy vaginal discharge, sometimes with foul odor. The discharge may range from yellow, gray, brown to even green, occasionally with a tinge of blood. Pain may be experienced during intercourse or when the cervix is touched with a tampon. It is advisable to ascertain the cause of the infection, which could be Bacteria (Gonorroea, Chlamydia etc), Fungus or Trichomonas Vaginalis infestation. The PAP Smear test should also be done to rule out any precancerous condition. Once the cause is identified, specific treatment can be administered. In cases where the condition persists, ‘Electro or Diathermy Cauterization’, laser or cryosurgery may be considered, which destroys the abnormal tissue on the surface and induces healing and growth of new tissue.

ASK THE DOCTOR - Male Sexuality and Female Sexuality?

Can you describe the difference between male sexuality and female sexuality?
- Miranda

Male sexuality is body oriented. Men get sexually attracted to the body of a woman. They need not have any love for her. That is why men go to prostitutes and are interested in seeing the woman’s anatomy displayed in ads, movies, magazines etc. As against this, female sexuality is very heart oriented.

The woman gets sexually attracted to a man only when she loves him. Just a handsome, muscular look may draw her attention but is not enough for her to get sexually aroused or attracted to the man. It is said that ‘man gives love to get sex and woman gives sex to get love’.

However, it may be noted that all men do not have male sexuality in them, they could be having female sexuality i.e. such men would be heart oriented and sensitive. They would need love as a base for a sexual relationship. Likewise, all women do not have

female sexuality within them. Such women would be body oriented and get sexually attracted merely by the physique of the man. (thus the presence of gigolos i.e. male prostitutes and magazines displaying the bare male anatomy)

ASK THE DOCTOR - Fibrous Cavernositis

Kindly explain about the condition ‘Fibrous Cavernositis’ of penis. I have not been able to find any information about this condition anywhere. Kindly give treatment options for the same.
- Dr N Kulkarni

‘Fibrous Cavernositis’ (also known as plastic induration of the penis or Peyronie's disease), is characterized by the formation of a plaque or hardened scar tissue (fibrosis) beneath the skin of the penis that causes pain, curvature, and distortion, usually during erection. The treatment choices for patients with ‘Fibrous Cavernositis’ are very limited. The objective of treatment is mainly to maintain normal sexual function and relieve pain. Invariably, surgery is the only effectual treatment, and as Fibrous Cavernositis may simply resolve by itself, doctors often suggest waiting for one or two years before going for this option. The non-surgical treatment should be implemented within six months of the onset of the symptoms and before the plaque has calcified. Para-aminobenzoate tablets (B- complex substance) and Vitamin E capsules can be taken for few months. A calcium channel blocker such as verapamil, an enzyme (collagenase) that breaks down connective tissue, and steroids such as cortisone can be injected into the plaque or delivered by ‘iontophoresis’. Iontophoresis is a painless method of delivering medication to localised tissue using an electrical current.

ASK THE DOCTOR - ‘Is Loss of Semen Harmful?’

Is it harmful in any way to lose semen is sleep or through masturbation? Does it affect the sexual or physical health of a man? Please answer in detail.
- Javed

Semen is simply a mixture of the products of three glands. Secretions of the seminal vesicles constitute 60 per cent of semen, and the secretions of the prostate gland constitute 30 per cent of the semen. Sperms constitute only 10 per cent of the semen quantity. These glands function throughout your life and continue to be capable of producing their secretions. Some boys worry that if they ejaculate too often, they will reduce the amount of semen in their body. They worry that they may run out of semen and won’t have enough when they need it. This can NEVER happen. A man will make sperms and semen from the start of puberty till his dying day.

ASK THE DOCTOR - Artificial Lubricants

Is it safe to use artificial lubricants with condoms during penetrative sexual intercourse?
- Imran

Condoms are made of latex or polyurethane. Most of the available condoms are pre-lubricated. For additional lubrication, waterbased or siliconebased lubricants are safe to use with condoms; however, oil-based lubricants are not safe as they weaken the latex and can damage the condom making it unsafe. Strictly avoid using petroleum jelly, cooking oil, butter, baby oil or sun tan oil as lubricant with condom during penetrative sexual intercourse.