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 - Painful Intercourse

I am an 17-year-old girl. I have tried for the first time to have sexual intercourse with my boyfriend but just as he tries to insert his penis in my vagina, I get an extremely severe pain — so I ask him to stop. Please tell me, is it normal to have so much pain during penetration? Is it safe to let him continue the act anyway, irrespective of my pain?
- Kajal K

ASK THE DOCTOR - Painful Intercourse

Many girls unconsciously carry an apprehension about penetrative sexual intercourse and therefore are unable to comfortably respond during the first few experiences of intercourse. This may also happen because her emotional involvement in this relationship is not yet ‘ripe’. If there is unbearable pain, do not force yourself into the act. You may cause harm/injury to yourself. A tight hymen also can cause this problem. For this, you require an examination by a gynecologist.

Also remember that there is always the possibility of an unwanted pregnancy and STD once you go all the way, even if you are using contraception.

You are just 17. Don’t rush things. Grow and relax in this relationship. Know each other better. Sex will be more comfortable and pleasurable as you and your relationship matures.

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 - What is the HIV Window Period?

How important it is to get an HIV test done before marriage? What is window period?
- Anindita

ASK THE DOCTOR - What is the HIV Window Period?

People are fast becoming aware of HIV testing before marriage. However, the majority still does not know about the ‘window period’. If a person is infected with HIV, then the blood test (Elisa test for HIV antibodies) comes positive only after around three months. The initial period of three months, when the test is negative is known as the ‘Window Period’. This is a dangerous period, as it gives the false impression that a person is HIV negative, and the infected person can give the infection to others through unprotected sex. I strongly recommend two HIV tests with a gap of three months before marriage.

Besides HIV, it is also necessary to test for one more fatal disease that is transmitted sexually — Hepatitis-B. A carrier of Hepatitis-B appears healthy outwardly but could transmit the deadly disease to the partner through sexual contact. Syphilis, though fully treatable, is a dangerous sexually transmitted disease if undetected. It is particularly notorious as it plays hide-n-seek with the patient giving him/her false signals of self-recovery, while it is progressing in the body. Thus a ‘VDRL test’ or ‘TPHA test’ for syphilis is a must in all the check-ups before marriage.

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.