#SexUncovered: Let's Talk About It!

#SexUncovered: Let's Talk About It!

Question:  What's the most common reason couples attend sex therapy?

Dr Margaret Redelman:  The most common reason why couples come to me together is a discrepancy in sexual desire, that is, different libido levels. There are stereotypes in the community that men want to do it all the time and women are feigning headaches, but in approximately one third of the couples I see clinically, it is the woman who has the higher libido.

Question: How often does a -regular' couple have sex?

Dr Margaret Redelman:   Almost everyone wants a figure, or -target', when they come to see me. For younger couples, averaging 2-3 times a week is probably a good amount, while for older couples it might more realistically be 1-2 times a week or fortnight. However, the critical factors are probably the longevity of the relationship and the happiness quotient of the couple.

 

Question: How long should the sex last? What's the -normal' length of time before a man/women climaxes?

Dr Ginni MansbergThere is no such thing as -normal', but there are some averages. A lot depends on what's happening in people's lives and their relationship, the motivation for their love making at that time and their physical surroundings.

 

We do know that the average time to a man's climaxing is 5.4 minutes from penetration. If a man's consistently lasting less than two minutes then we're probably looking at a problem for men. They should think about seeking help from a doctor if they and their partner are not being satisfied.

 

Both Dr Mansberg and Dr Redelman explained that women's climaxes can be very complex, and not all women climax from penis to vagina sex alone.

Dr Margaret Redelman: Women need on average 20 minutes of foreplay before penetration. But remember, not all women want this all the time. A quickie without orgasm can sometimes be as much fun as a long session with orgasm.

 

Question:  How common is it for men -not to come' and what causes this during sex?

Dr Margaret Redelman:  Some men have a high threshold for orgasm. There can also be emotional and physiological challenges for some men in ejaculating with age, disease and medication. Some medical conditions can impact ability to climax, for example, diabetes can effect nerve supply that impacts stimulus, while some medications inhibit ejaculation. There will be some men who are inhibited because of psychological makeup, family of origin issues, past sexual experiences and current relationship issues such as anger and pregnancy fears.

 

As men get older some men can have trouble if their partner has vaginal laxity and the penis is not getting enough stimulation. As men age, however, some find they don't need to ejaculate every time they make love. They can find lovemaking to be emotionally satisfying without having to ejaculate.

 

Question:   How can couples keep things fresh in the bedroom after being together for a while? What should you say if you want something different?

Dr Margaret Redelman: If your partner's not meeting your sexual needs, say something sooner rather than later. The longer you take to say something the harder it will be to change, and the more hurt your partner could be. Say something with empathy and warmth, but say it!

The most important thing is not to accuse, or say they're a bad lover. Talk about yourself and your needs and working together to be great in bed together. In a new relationship people are often shy to say things, but if you let it stay for a long time there will be repercussions for the long term sexual relationship.

 

Dr Ginni Mansberg: Good communication. Good communication. Good communication. Make it positive. If your partner hears -I want to spice things up' they can read it wrong and turn off if it seems like an accusation. If it's wanting to return to the rockstar sex of the past, and saying -I love you, let's do it together, what about trying something different together' you can have a great time.

Make sure your partner feels attractive. If it's said in a positive way it can be very exciting, but otherwise it can sound negative or accusatory. Sometimes it can be a very simple change. If a woman can't orgasm through penis-vagina sex, what if she said -maybe you could rub my clitoris while having sex?'

When suggesting something new, make sure your partner hears: -I love you. I want you'."

 

Question:   How do you speak with your partner if they're experiencing sexual dysfunction?

Dr Ginni Mansberg: Definitely don't ignore it. Don't point the finger or blame, approach these types of problems as a team. Speak as -we' and about what -we can do.'

Studies have shown that premature ejaculation (PE) is the most common form of male sexual dysfunction.

Having treatments that really work has changed the landscape completely. It is now a mainstream, medical situation where there is safe help available. We can now sort this out. Whether the man comes to a doctor's appointment together with his partner, or alone, the main issue is ensuring that men feel supported and there is open communication.

Men, go to the doctor!

 

Dr Margaret Redelman:   If you aren't sure what is -normal', or are confused about what's happening, get some background education for yourself, raise it with your doctor or go online. One resource, including an online self-assessment for PE is controlPE.com.au, which has been created by Menarini.

You should definitely address any problems with your partner – and sooner rather than later – with a three step process:
1) Say something nice. Most people, in their anxiety, rush to say what they want and forget this step. Validating or acknowledging the partner's feelings will open them up to hearing the dialogue better. Remember, you're talking to someone you love! Let them know it.

2) Offer neutral observation and what is happening to/for you. Don't judge or accuse them. Give them information about your experience of the situation using the words 'I".

3) Tell them what you want or your ideas on next steps which you think may help you. Ask them if they're open to exploring -what we can do together…' Ask them for their input or suggestions.

Question:  How -soft' does a penis need to be to call it erectile dysfunction?

Dr Margaret Redelman: I use a scale of 1-10 for erections in speaking with people. Realistically you want the penis to be firm enough that it doesn't need hand support to enter the vagina. Some women's vaginas can be more difficult to penetrate if there is tightness of the pelvic floor muscles.

Firmness can be age related. If a 30 year old man needs to hold his penis to penetrate it's more of an issue than a man in his late 60s.

Question: How big is the average penis? What's normal?

Dr Margaret Redelman:  There is quite a range of sizes. There is an average, which is around 4.5 – 7.5 inches [11.25 – 18.75 cm].

The more relevant question is -when is a penis too small or too large to enjoy love making?'

When it's smaller you need to be more careful with the positions and the range of movement is reduced. The best position when it's smaller is to have the woman on top.

Larger penises are more of a problem for women as penetration can be painful if the woman is not relaxed enough and well lubricated. Use of a small circular cushion at the base of the penis so the depth of penetration is limited can be helpful. These are available in sex shops. Sudden jerky full thrust motions should not be used. If the penis is particularly wide/thick, ensure the woman is very lubricated and relaxed. Digital preparation of the vaginal opening prior to penetration may be helpful. The woman on top position, where she's in control, can also be helpful.

 

Dr Ginni Mansberg: Australians are slightly a bit above average. When you're looking at size, people should remember there are -showers' and -growers'.

When a man's a -shower', the flaccid size is very similar to the erect size, so he may look very impressive when flaccid. For -growers,' men may look small when flaccid, but their penis can actually end up as one of the bigger sizes when erect.

Penises come in all shapes and sizes, just as women's genitals do. Some say it is about -pegs and holes' – the direction of her cervix, length, width etc will all impact on sex between that couple too.

 

Question:  Does the -g-spot' actually exist and does every woman have one?

Dr Ginni Mansberg: No, it's actually a bit of a fantasy. There has been some research to suggest that there is a section of the vagina – around two thirds of the way up on the front wall - that if touched can result in intense sexual pleasure, but it's inconsistent.

 

Dr Margaret Redelman: I don't think the -g-spot' exists. There is a -g-spot' area where there is a small plexis of nerves with increased sensitivity. In the same way as the fact that no two clitorises are the same, some women seem to have this area and some women don't.

 

 

Question:  Are pelvic floor exercises the best thing to improve the sexual experience for a woman?

Dr Margaret Redelman: Pelvic floor exercises are critical for women and also important for men to do. They can improve the sexual experience for both men and women.

For women, the stronger your pelvic floor the better your orgasms will be. If she's below a certain strength she won't be able to have an orgasm and if it's above a certain strength there's potential to be multi-orgasmic.

Walking upright puts tremendous pressure on our pelvic floor muscles, so as we age and after kids we have reduced pelvic floor strength. So to maintain orgasmic potential over time it is very important to exercise your pelvic floor.

 

 

Question: Why do some men seem to want/prefer anal sex over vaginal sex? Why is it considered more pleasurable for them and are there any medical reasons not to do it?

Dr Ginni Mansberg: There are a number of reasons men might like anal sex. The muscles around the anus are often quite tight, and tighter than the vagina, making the entry tighter, which some men may enjoy.

 

One thing to remember, however, is once you're passed the opening, the rectum can be quite loose – not like a vagina – so that tightness to begin with is not the same when a man's inside.
It is also seen as something a bit -naughty' and to some this can be very appealing. People are becoming more open to experimentation, particularly younger generations. There has been some connection to pornography, and what stimuli we're exposed to, changing trends in what we want to try. You'll find what works for you if you experiment slowly.

As long as it's something you are both comfortable with trying, it can be safe.

The reason not to perform anal sex would be if someone has wart virus infection or someone found it unattractive or off-putting. If you find it uncomfortable or painful or you don't like the idea you shouldn't do it. People should definitely not feel pressured.

 

Dr Margaret Redelman: The anal area has similar pelvic nerve supply as the vagina. It does have erotic sensation to it. However, the vagina is purpose built and the anus is not. If you're going to try anal sex you must use lubrication, go slow and allow time to stretch.

It is very important to follow a hygiene procedure. It is critical for the woman's vaginal health never to go from anus to vagina due to bacteria found in the anus which is not safe for the vagina.

 

Question:  When do women have the highest libido?

Dr Margaret Redelman: Overall, women generally have higher testosterone during what we often call the -honeymoon period' of a new relationship which gives women a higher libido during this period of time.

 

Usually this lasts for 6 – 24 months, encompassing a lot of -firsts' – meeting, holidays, moving in together.

 

Following on from this time, having a good sex life requires the inclusion of intellectual elements such as planning, scheduling, motivation and generosity.

It's also worth noting that not all women have a reduced libido after children and for some women it can actually increase. This may have a lot to do with how she's feeling about herself and her partnership with the father.

 

Question:  Does the contraceptive pill lower libido?

Dr Ginni Mansberg: It certainly can, particularly pills that reduce testosterone. If you have low testosterone already, some pills can definitely send libido into hibernation.

Libido is impacted by a lot of things, and sometimes women do miss-attribute their changes to different things.

If your libido takes a dive, look at what's happening in your relationship or the stress in your life. Stress shuts down your ovulation, which in some ways can be your body protecting you.