Tuesday, January 15, 2008

Sex: Fact and Fiction

What’s the average penis size? How fast is premature ejaculation? Exactly where is the G-spot? Grab a ruler and a stopwatch as the experts sort sex myths from the facts.
By Rob Baedeker
WebMD Feature
Reviewed by Amal Chakraburtty, MD

If there were a roll call for the founding fathers of sex myths for men, a couple of no-brainers would surely make the list: porn legend John Holmes, whose yule-log-size penis still casts a shadow over anxiety-prone males. Ditto NBA-great Wilt Chamberlain, whose claim of having slept with 20,000 women makes Don Juan look monastic.

And then there’s purveyor-of-sex-myths Walt Disney.

“I think Walt Disney creates a lot of mythology,” says Seth Prosterman, PhD, a clinical sexologist and licensed marriage and family therapist practicing in San Francisco. “In Disney movies, people fall in love and walk into the sunset, and you get this myth that intimacy is a given once you fall in love, and sexuality is natural and follows that.”

In reality, says Prosterman, “Sex is something that we learn throughout a lifetime.”

If sexuality is a continuing education, a lot of us are scrambling to make up course credits. And in a realm that’s clouded by ego, myth and advertising that preys on anxieties, getting the facts about sex can be difficult. What is the average size of the male penis? How long do most men last during intercourse? Can men have multiple orgasms? Does the G-spot exist, and if so, how do I find it?

Penis Size: The Hard Facts

“Drastically enlarge the penis length and width to sizes previously thought impossible!” reads a website for the Penis Enlargement Patch. (One envisions a lab-coated mad scientist pouring chemicals on his own penis, then shouting ”Eureka!” and phoning the Guinness Book.) Almost anyone with an email account has been deluged by spam for such miracle-growth patches and pills, and the endurance of sex myths may explain the pervasiveness of such ads.

“We equate masculinity and power with penis size,” says Ira Sharlip, MD, clinical professor of urology at the University of California at San Francisco and president of the International Society for Sexual Medicine. “Of course, there’s really no relationship.” Still, Sharlip says, “all” of his patients want to increase their penis size.

The idea that bigger is better is “not just total mythology,” says Seth Prosterman, who has counseled couples since 1984 and notes that some of the women he’s worked with do prefer a bigger penis -- aesthetically or “fit-wise.” But, he adds, “For the vast majority of partners, penis size doesn’t matter.”
So what, exactly, constitutes a big penis? Let’s whip out some data:

• The average penis size is between five and six inches. That’s for an erect penis.

• The flaccid male organ averages around three and a half inches.

Sex Fact: We Are Not Our Penises

If you had an anxiety hiccup before you read the “erect” qualifier, consider it a metaphor for the danger of jumping to conclusions about penis size -- or about the primacy of the penis altogether.

“The idea that the penis is the most important part of your body underlies so many of men’s sexual problems,” says Cory Silverberg, a sexual health educator and founding member of Come As You Are, an education-based sex store in Toronto. “One of the biggest sex myths for men is the notion that we are our penises, and that’s all that counts in terms of sex.”

“It’s a myth that using the penis is the main way to pleasure a woman,” says Ian Kerner, PhD, a sex and relationships counselor in New York City whose book She Comes First offers a guide to “female orgasms and producing them through inspired oral techniques.” In his book, Kerner cites a study that reports women reaching orgasm about 25% of the time with intercourse, compared with 81% of the time during oral sex.

OK, OK, Size Isn’t Important. But How Can I Increase My Penis Size?

Despite the facts, the din of penis-enlargement marketing only seems to grow louder. (“Realize total and absolute power and domination in bed with your partner, with your new-found penis size and sexual performance” screams the ad for the Penis Enlargement Patch.) Men keep chasing after the mythical, mammoth-sized member.

Silverberg says male clients at his store, and in his counseling work, constantly ask him about penis pumps, whose powers of elongation, he says, are a “myth,” although he adds that some men who’ve used them report satisfaction, a phenomenon he explains this way: “I think spending more time paying attention to our genitals will probably increase our sexual health.”

Just the Facts on the G-Spot

If sex myths have such power over men’s thinking about their own anatomy, they have even more sway when it comes to female partners’ bodies -- especially the much-debated G-spot.

Named after a German doctor, Ernst Gräfenberg, who first wrote about an erogenous zone in the anterior vaginal wall, the G-spot was popularized by a 1982 book called … The G-spot. This region behind the pubic bone is often credited as the trigger for a vaginal (vs. clitoral) orgasm, and even a catalyst for female ejaculation.

At the same time, the G-spot is commonly derided as perpetuating the myth ensconced by Sigmund Freud -- namely, that the clitoral orgasm is a "lesser" form of climax than the vaginal orgasm, which requires penile penetration. As Ian Kerner summarizes, “In Freud’s view, there were no two ways about it: If a woman couldn’t be satisfied by penetrative sex, something must be wrong with her.”

The G-spot’s existence is still debated, and whether it’s fact or fiction depends on whom you ask.

“The G-spot exists,” says Seth Prosterman. “It’s a source of powerful orgasm for a percentage of women.”

“I don’t think the G-spot exists,” says Ira Sharlip. “As urologists, we operate in that area [where the G-spot should be] and there just isn’t anything there -- there’s no anatomical structure that’s there.”

Prosterman and others point out the importance of thinking of the G-spot in context -- that it may be an extension of the clitoral anatomy, which extends back into the vaginal canal. Kerner writes that the G-spot may be “nothing more than the roots of the clitoris crisscrossing the urethral sponge.”

Helen O’Connell, MD, head of the neurourology and continence unit at the Royal Melbourne Hospital Department of Urology in Australia, says, “The G-spot has a lot in common with Freud's idea of vaginal orgasms. It is a sexual concept, this time anatomical, that results in confusion and has resulted in the misconception that female sexuality is extremely complex.”

In the end, whether this debated locus of pleasure is fact or fiction may not matter that much. O’Connell, who is also co-author of a 2005 Journal of Urology study on the anatomy of the clitoris, says that focusing on the G-spot to the exclusion of the rest of a woman’s body is “a bit like stimulating a guy's testicles without touching the penis and expecting an orgasm to occur just because love is present.” She says focusing on the inside of the vagina to the exclusion of the clitoris is “unlikely to bring about orgasm. It is best to think of the clitoris, urethra, and vagina as one unit because they are intimately related.”

How Long, Part 2: How Premature Is Premature Ejaculation?

The possibilities for exploring a woman’s erogenous zones may be tremendously exciting -- which leads to another source of sex myth and male anxiety: How long can I last? And how long should I be able to last?

Premature ejaculation is “the most common form of sexual dysfunction in younger men” according to Ira Sharlip, and its prevalence is around 20% to 30% in men of all ages.

The medical method of determining premature ejaculation is called “intravaginal ejaculatory latency time” (IELT), a stopwatch-timed duration measured from the beginning of vaginal penetration until ejaculation occurs. However, Sharlip adds, this quantitative measure doesn’t tell the whole story: “There are men who ejaculate within a minute but say that they don’t have premature ejaculation. And then on other end of spectrum, there are patients who are able to last for 20 minutes, and they say they do have premature ejaculation.”

In other words, the definition of "premature" may be largely in the eye (or mind) of the beholder, and depends on a man's sexual satisfaction and his perception of his ability to control when ejaculation occurs.

If you just can’t wait for the numbers, though, a 2005 study in the Journal of Sexual Medicine found “a median IELT of 5.4 minutes.”

Ian Kerner says a common cutoff time used to define premature ejaculation is two minutes, but he adds that many of the men he works with “are not guys who can last a few minutes; they’re having orgasms during foreplay, or immediately upon penetrating. They have a hard time lasting past 30 seconds.”

But a quick trigger is normal, says Kerner. “Men were wired to ejaculate quickly -- and stressful situations make them ejaculate even more quickly. It’s been important to the human race. If guys took an hour to ejaculate, we’d be a much smaller planet.”

Sex therapists and physicians offer a number of techniques that can help men manage their anxiety and prolong their time to ejaculation. Several drugs -- like some antidepressants (used for off-label treatment) and topical sprays -- have been shown to extend time to ejaculation.

And, contrary to the common perception that distraction or decreasing stimulation is the answer (slow down, think about baseball), some say that giving in to sensation can help address the issue as well. “The way to learn [to last longer] is by getting used to intense stimulation,” says Prosterman, “to increase the frequency of intercourse, and feel every sensation of being inside your partner and enjoy it.”

Come Again? The Mythical Multiple Orgasm for Men

While multiple male orgasm is possible anywhere two or more men are gathered and talking, actual male multiple orgasm is another story. Unlike the more established phenomenon of female multiple orgasm, men’s claims of successive climaxes can stray into the realm of sex myth. At the very least, male multiple orgasm is difficult to verify and may depend on the definition of orgasm.

Prosterman says that the book The Multi-Orgasmic Man popularized “an Eastern meditative process that involves wrapping the PC [pubococcygeus] muscle around the prostate. There’s a valve on the prostate that switches on and off before urination and ejaculation. The PC muscle stops this valve from opening, allowing an orgasm without ejaculation. The idea is to keep doing that five or six times in a row.

“Out of hundreds of guys I know who’ve tried this,” says Prosterman, “I know only one who’s been able to do it.”

Is this man Mr. Lucky, or just prone to poetic license?

A 1989 study in the Archives of Sexual Behavior recorded the testimony of 21 other men who claimed to be multi-orgasmic, but Ira Sharlip says “that doesn’t happen,” referring to the phenomenon of “multiple orgasms in succession over a short period of time -- like minutes.” And there’s no such thing as separating ejaculation and orgasm, he says.

Orgasm or Orgasm-esque?

What may be at issue here is the definition of orgasm -- which, according to a 2001 Clinical Psychology Review article, has been strikingly inconsistent. “Many definitions of orgasm “depict orgasm quantitatively as a ‘peak’ state that may not differentiate orgasm adequately from a high state of sexual arousal,” the study’s authors wrote.

In other words, those men who report multiple orgasms may be able to achieve orgasm-esque states before they hit the point of ejaculatory no-return. And many men report that strengthening the PC muscles through Kegel exercises allows them to edge closer to this “point of inevitability” without cresting the mountaintop of ejaculation and descending into the gentle valley of the flaccid and the “refractory” period, where the penis is temporarily unresponsive to sexual stimulation.

Even so, both Prosterman and Sharlip say this refractory period can be short enough that it’s possible for men to orgasm, ejaculate, recover and do it again -- and again -- during the same “session” of sex.

And if that recovery period isn’t super quick, you can still enjoy multiple orgasms -- you may just need to cancel your afternoon appointments.

Sex Fact: It’s Not Always about the Numbers

In the end, there seems to be a recurring theme in moving beyond sex myths: Don’t get too hung up on the numbers.

So often the key to sexual satisfaction is not about penis size, stamina records, or a technical isolation of the G-spot. Rather, it’s about understanding yourself and your partner’s desires and recognizing that, unlike those Disney characters, real people aren’t born with a perfect, divinely granted understanding of sex.

As O’Connell remarks on the perils of over-privileging of the G-spot, “It is best for partners to explore the precise areas that turn someone on and how a partner likes to be given pleasure. That applies to both men and women, and the idea that there is any consistent 'magic spot' in either sex is just tyrannical.”

Monday, January 14, 2008

Older Woman/Younger Man Relationships

Almost one-third of women between ages 40 and 69 are dating younger men (defined as 10 or more years younger).
By Jean Lawrence
WebMD Feature
Reviewed by Louise Chang, MD

He was 27, she was 42. Those were the ages of Ashton Kutcher and Demi Moore when the couple tied the knot last year, making their highly publicized May-December romance official.

But even though their older woman-younger man relationship may be among the world's most visible, it's not that unusual anymore.

Braving "robbing the cradle" jokes, almost one-third of women between ages 40 and 69 are dating younger men (defined as 10 or more years younger). According to a recent AARP poll, one-sixth of women in their 50s, in fact, prefer men in their 40s.

It's not what you think -- the stamina or "re-boot" ability of the younger male. The women like the flexibility and sense of adventure of their more spontaneous, younger companions, Tina B. Tessina, PhD, a licensed family therapist in practice in Long Beach, Calif., and author of The Unofficial Guide to Dating Again, tells WebMD. For their part, the men like the sophistication and life success of their older mates, she explains. The much touted idea that women peak sexually in their 30s and men in their teens does not enter into it -- most of these couples are beyond both those age periods

Other Reasons Behind This Trend

According to Tessina, other reasons underlying this expansion of everyone's dating choices include:

• Older women are looking better every day, thanks to creative medical advances and a gym on every corner.

• Women are more likely to come back on the dating market because of divorce and a longer expected life span.

• Not as many women are looking for the picket fence and two cars. Now companionship, travel, and fun are coming to the forefront.

• Women may also want a man with a less-developed career who could follow her or take care of children, if that is a factor.

• For their part, younger men often find older women more interesting, experimental, fun to talk to, financially settled, and more adept sexually.

But what about the notion that men are "hard-wired" to seek a smooth-faced, curvy receptacle for reproduction and thus are drawn to younger women? "Humans are relatively flexible species," Michael R. Cunningham, PhD, a psychologist in the department of communications at the University of Louisville, tells WebMD. "Factors other than biological can be attractive. You can override a lot of biology in pursuit of other goals."

Interestingly, Cunningham did an unpublished study of 60 women in their 20s, 30s, and 40s, who were shown pictures of men aged to those decades. "The women," he says, "were more interested in men their own age or older."

As for the men, he says: "I guess it could be nice not to hang around a ditz with no knowledge of music or something like that."

Getting Over the "Shoulds"

"We have strong 'shoulds' on ways of partnering up," Kathryn Elliott, PhD, assistant professor of psychology at the University of Louisiana at Lafayette, explains to WebMD. "We are victims of inner-critic constrictedness. We think we should only weigh 120. We should marry people within two years of our age. We pathologize anything that isn't within those shoulds."

The key to making older women/younger man relationships work, Elliott says, is to match what she calls voltages. "Choose someone who is your voltage type -- has the same level of intensity about life. If the voltages are different, one becomes the pursuer and one the distancer. This can create pain."

Voltages are not a factor of age, she says.

"What you don't want," she explains, "is one partner wanting to go out, the other stay in; one willing to talk, the other wanting space (and silence to enjoy it)."

Dealing With the Flak

Susan Winter is co-author, with Felicia Brings, of Older Women, Younger Men: New Options for Love and Romance. She has been in several relationships with men up to 20 years younger than herself.

She works out a lot by her own admission (and judging by her track record in this department) and often meets partners at the gym, not the bars.
Winter tells WebMD that she and her co-author interviewed more than 200 couples for their book. Though hardly a scientific study, the research surfaced three myths such couples hear every time:

• Myth No. 1 -- "He will leave you for a younger woman." Winter says they did not find one younger man who did this, at least for a specific woman and because she was younger. "In some cases, the man wanted children," she says, "and the relationship fell apart because of that."

• Myth No. 2 -- "The woman was the seducer -- Mrs. Robinson." In all 200 cases, Winter says it was the man who initiated the contact.

• Myth No. 3 -- "It will never last." Winter said some of the couples they met had been together 25 year or more. The average length of the relationships was 13 years.

Pretty Promising Material Out There

Winter is upbeat about the younger generations. "The boomers are lost sheep," she says. "All they can do to get a woman is dangle their Porsche keys." As you peel back the decades, though, the men get "cooler," she says. Guys in their 30s get her vote. "They grew up with AIDS, they are considerate. Such men (at least the ones interested in older women) are stable and mature. They don't want to be mothered. They want a woman who knows who she is."

Still, even Winter admits, this may not be for everyone.

Is Masturbation Normal?

Your Guide to Masturbation

Masturbation is the self-stimulation of the genitals to achieve sexual arousal and pleasure, usually to the point of orgasm (sexual climax). It is commonly done by touching, stroking or massaging the penis or clitoris until an orgasm is achieved. Some women also use stimulation of the vagina to masturbate or use "sex toys," such as a vibrator.

Who Masturbates?

Just about everybody. Masturbation is a very common behavior, even among people who have sexual relations with a partner. In one national study, 95% of males and 89% of females reported that they have masturbated. Masturbation is the first sexual act experienced by most males and females. In young children, masturbation is a normal part of the growing child's exploration of his or her body. Most people continue to masturbate in adulthood, and many do so throughout their lives.

Why Do People Masturbate?

In addition to feeling good, masturbation is a good way of relieving the sexual tension that can build up over time, especially for people without partners or whose partners are not willing or available for sex. Masturbation also is a safe sexual alternative for people who wish to avoid pregnancy and the dangers of sexually transmitted diseases. It also is necessary when a man must give a semen sample for infertility testing or for sperm donation. When sexual dysfunction is present in an adult, masturbation may be prescribed by a sex therapist to allow a person to experience an orgasm (often in women) or to delay its arrival (often in men).

Is Masturbation Normal?

While it once was regarded as a perversion and a sign of a mental problem, masturbation now is regarded as a normal, healthy sexual activity that is pleasant, fulfilling, acceptable and safe. It is a good way to experience sexual pleasure and can be done throughout life.

Masturbation is only considered a problem when it inhibits sexual activity with a partner, is done in public, or causes significant distress to the person. It may cause distress if it is done compulsively and/or interferes with daily life and activities.

Is Masturbation Harmful?

In general, the medical community considers masturbation to be a natural and harmless expression of sexuality for both men and women. It does not cause any physical injury or harm to the body, and can be performed in moderation throughout a person's lifetime as a part of normal sexual behavior. Some cultures and religions oppose the use of masturbation or even label it as sinful. This can lead to guilt or shame about the behavior.

Some experts suggest that masturbation can actually improve sexual health and relationships. By exploring your own body through masturbation, you can determine what is erotically pleasing to you and can share this with your partner. Some partners use mutual masturbation to discover techniques for a more satisfying sexual relationship and to add to their mutual intimacy.

Reviewed by the doctors at The Cleveland Clinic Department of Obstetrics and Gynecology.

Sex Drive: How Do Men and Women Compare?

Sex Drive: How Do Men and Women Compare?
Experts discuss the differences between male sex drive and female sex drive.
By Susan Seliger
WebMD Feature
Reviewed by Cynthia Dennison Haines, MD

The simplest way to capture the differences between men’s and women’s sex drives is to consider how you’d answer this test: create a sentence using the words "sex" and "love."

If you’re a woman, odds are your sentence goes something like this: “When two people understand each other, trust each other, and love each other, then the sex is the best.” If you’re a man, chances are your sentence more closely resembles this: “I love sex.”

It’s a stereotype, it’s a clichĂ©, and more often than not, it’s true. “We like to think of men having the higher sex drive -- it’s not always true, but more often, it is,” says Eva Ritvo, MD, vice chairman in the department of psychiatry and behavioral science at the Miller School of Medicine, University of Miami.

“Each person’s sex drive is like an appetite: Some people spend their whole life in the kitchen and think about food all the time; some people can skip lunch,” says Ritvo, who is also chair of the department of psychiatry and behavioral medicine at Mount Sinai Medical Center, Florida.

As a rule, men don’t like to skip lunch. But that’s only the beginning of the story.

What Is Sex Drive?

Sex drive -- the way men and women think about sex and engage in sex -- is a slippery concept. Researchers have a hard time quantifying it: Is it how often we think about sex? How often we want sex? How often we become aroused or actually have sex? Sex drive is all that, and more.

“Sex drive, which scientists now call sexual desire, is one of the most difficult to define,” says Patricia Koch, PhD, associate professor of Biobehavioral Health & Women’s Studies at Pennsylvania State University and adjunct professor of human sexuality at Widener University. Sexual arousal is easily identifiable -- for men it shows up as an erection, in women, lubrication (and enlargement of the clitoris).
“But desire is not just about arousal or frequency -- how often you have sex can depend on so many other circumstances and opportunities: whether you have a partner or not, whether you like your partner,” says Koch.

Some researchers have begun to question how we define sex drive -- insisting that we have only looked at it from a male model, so of course women come up short. The male sex drive model resembles a straight line: It is a “linear model of sexual response, where first they have desire, then arousal, then orgasm,” says Koch. For women, sexual interest follows a more meandering model. “Their drive is for emotional bonding and caring -- once they feel that, then they get aroused and interested,” Koch says. “Women want and enjoy a lot more sex play than men want. It takes them longer to be stimulated through sex play than men,” says Koch. What’s more pleasurable to women may be affectionate physical contact that may or may not end in orgasm, and this indirectness is not a sign of a lack of sex drive.

Here are a few things researchers do know about how men and women’s sex drives compare. Bear in mind, individuals vary from these norms. That’s what makes life -- and sex -- so interesting.

It Is Common for Couples to Experience a Discrepancy in Sex Drives

“The biggest problem I encounter in sex and marital counseling is an imbalance in sexual interest -- one partner wants more, one wants less,” says Richard Driscoll, PhD, a marriage therapist in Knoxville, Tenn. for 34 years, and author of Intimate Masquerades: A Survival Guide for Those Who Know Too Much. “The average American married five years has sex once or twice a week. That’s your average. It’s not a problem if you vary from that average -- you only have a problem when you cannot agree,” says Driscoll.

Many couples cannot agree. Driscoll says half of all marriages experience some discrepancy in desire at some point, and it’s usually men who have a higher sex drive. About one in five women report that their husbands have turned them down for sex, Driscoll says, while half of all men say their wives have turned them down.

Sex and Happiness Are Strongly Linked

“For men, we know one thing: The absence of sex makes them unhappy. For women, it is not as problematic,” says Edward Laumann, a professor of sociology at the University of Chicago and lead author of The Social Organization of Sexuality: Sexual Practices in the United States, the most comprehensive survey of sexual practices since the Kinsey Report.

We also know that in nationwide studies, men report that they are happier and more satisfied with their sex lives than women. “In our study of people aged 40 to 80, there was a 10- to 14-point spread between men and women reporting they were ‘extremely or very satisfied.' Women were lower in satisfaction -- across the world,” says Laumann, citing data from a 2006 international study published in the Archives of Sexual Behavior.

Good Sex and Good Health Go Together

A fulfilling sex life leads to happiness, which in turn seems to make you healthier generally. “All our studies verify this: The more satisfied you are in sexual matters, the happier you are in general,” says Laumann. And the likelier you are to be healthy, too. “We have also found that the happy couple is more likely to be compliant with medication when physical problems come up -- so your health is likely to be better. Married people are healthier than single people,” Laumann says.

Men Think About Sex More Than Women

“When sociologists ask 'How often do you think about sex?' the responses show pretty dramatic differences between men and women,” says Laumann. “The majority of males between 18-to-59 of the U.S. population report that they think about sex at least once a day -- one third think of it several times a day. Only 25% of females report thinking about it every day,” Laumann says.

But maybe some of that difference in sex drive may simply result from the fact that what turns women on is quite different -- and less explicitly sexual -- than what turns men on. “I have had women say ‘What turns me on is when my husband cleans up after dinner and takes out the garbage -- then my interest for sex is piqued,’” says Koch.

Biology Works to Keep Women’s Sex Drive in Check

There are strong biological as well as cultural reasons why women may not be as free to pursue sex as men, even in our post-birth control, post-feminist world. In the simplest terms, women may be hard-wired to be cautious about sex because they are the ones who can get pregnant and wind up taking care of the baby.

“Pregnancy is a threatening condition for women -- it renders them vulnerable; they can’t run from predators,” explains Laumann. As a woman, “If you don’t pick your time felicitously, you get selected out of the gene pool,” Laumann says.

Males, at least young males, seem more avidly interested in sex in nearly every species in the animal kingdom, because they have everything to gain -- disseminating their genetic material -- and not much to lose, according to Richard Driscoll.

“You’ve seen dogs line up for the female in heat and cats go out in storms to tomcat around,” says Driscoll, explaining that because the males of most species invest less in offspring, they’re free to pursue opportunities for sex. The female, who will be required to invest more, does well to “go slowly and choose carefully, because she is going to have to put a lot of resources into each offspring.”

The only exceptions to this rule -- when the female, not the male, becomes the sexual pursuer -- are species such as sea horses and sea snipes (a bird) in which the males are the caretakers of the young, according to Driscoll. “In those two species, the females come on to the males, because the males are investing more” in the offspring, Driscoll says.

Taking Care of Others Can Dampen Sex Drive

“One of the most intriguing obstacles to desire is caretaking,” says Esther Perel, a couples and family therapist in New York City, and author of Mating In Captivity: Reconciling the Erotic and the Domestic. Women today are largely the caretakers -- of the children, the husband, and the home, even if they, too, work outside the home.

Why does this sabotage sex drive? Caretaking makes you think about others, while desire hinges on your being able to think about yourself and your own needs. “Desire is rooted in autonomy, freedom, and selfishness. If you can’t be selfish, you can’t have an orgasm,” Perel says.

Medical Conditions and Medications Can Affect Sex Drive

Any serious illness, from alcoholism to cancer and diabetes can be distracting and dampen ardor. Depression, as well as the SSRIs used to treat it, can inhibit desire. So can tranquilizers and blood pressure medications. Some women find the hormonal changes of menopause cause a drop in sex drive. Cardiovascular disease and hypertension can reduce blood flow to the body, including the genitals, and decrease sexual interest as well. Conditions such as endometriosis, fibroids, thyroid disorders, and tumors of the pituitary gland (which controls most hormone production, including sex hormones), can also have an impact on sexual drive.

Our Culture Encourages Men’s Sex Drive, Not Women’s

Socialization in our culture plays a role, too, in the disparity between men’s and women’s sex drive. “Men are encouraged to pursue sex more than women; they are taught the more you have the better; you’re more of a man if you do,” says Lonnie Barbach, PhD, a psychologist and sex therapist on the clinical faculty of the University of California, San Francisco, and author of For Yourself, For Each Other: Sharing Sexual Intimacy.

The double standard on acceptable sexual behavior for men and women, which still prevails, affects women’s sexual desire, Koch says. “I work with college women, and even though we have Sex and the Cityon TV saying you can be sexual, women still get the message that it is not OK. Men are looked at as studs if they are sexual, but the women are still called sluts,” Koch says.

Men’s and Women’s Sex Drives Work Differently

Men and women travel slightly different paths to arrive at sexual desire. “I hear women say in my office that desire originates much more between the ears than between the legs,” says Perel. “For women there is a need for a plot -- hence the romance novel. It is more about the anticipation, how you get there -- it is the longing that is the fuel for desire,” Perel says.

Men, on the other hand, don’t need to have nearly as much imagination, Perel says, since sex is simpler and more straightforward for them.

That does not mean that men do not seek intimacy, love and connection in a relationship --- they do, just as women do. They just view the role sex plays in that relationship differently. “Women want to talk first, connect first, then have sex,” Perel explains. “For men, sex is the connection. Sex is the language men use to express their tender loving vulnerable side,” Perel says. “It is their language of intimacy.”

Men and Women Approach Casual Sex Differently

Willingness to engage in casual sex “splits totally along gender lines,” says Driscoll. In a University of Hawaii study, researchers had a good-looking guy and good-looking girl approach a student of the opposite sex and talk for five minutes.

After five minutes, each student was asked one of two questions: When asked to go out on a date, male and female responses were identical: 50% of women and 50% of men said yes. But when asked to have sex, the answers couldn’t have been more opposite: 75% of the men said yes and 0% of the women said yes, according to Driscoll.

Orgasms Are Different for Men and Women

While researchers find it tricky to try to quantify issues like the differing quality of male versus female orgasms, they do have data on how long it takes men and women to get there. Men, on average, take four minutes from the point of entry until ejaculation, according to Laumann. (Well, that’s three minutes and 58 seconds longer than the average mosquito.) Women usually take around 10 to 11 minutes to reach orgasm. If they do.

That’s another difference between the sexes -- how often they have an orgasm during sex. Among men who are part of a couple, 75% report that they always have an orgasm, as opposed to 26 % of the women. And not only is there a difference in reality, there’s one in perception, too. While the men’s female partners reported their rate of orgasm accurately, the women’s male partners reported that they believed their female partners had orgasms 45% of the time.

The Number of Sex Partners -- And Affairs -- Varies by Gender, Too

For men, the median number of partners they report is six, according to Laumann’s research. The median number of partners women report is two. Some 23% of men report having 5-to-10 partners; 20% of women report that many.

“Extramarital relations are less prevalent than pop and pseudo-scientific accounts contend,” according to Tom Smith in the 2006 National Opinion Research Center report, American Sexual Behavior: Trends, Socio-Demographic Differences, and Risk Behavior.
“The best estimates are that about 3% to 4% of currently married people have a sexual partner besides their spouse in a given year and about 15%-18% of ever-married people have had a sexual partner other than their spouse while married.” However, Smith writes, married men are twice as likely to have affairs as married women.

What Can Couples Do to Get Their Sex Drives in Sync?

It is only normal for sex drive to ebb and flow, and couples should not be overly alarmed to find that their sex drives do not always match up. However, if differing levels of desire is causing consistent unhappiness for one or both partners, it is important to resolve it. “You both have to be happy with your level of sexual activity,” says Barbach.

1. Talk it over in a calm, neutral setting.

Start talking -- but not right after one person has just been turned down in his or her romantic advances. Wait for a neutral time and do it in a non-charged setting -- outside the bedroom. If opening the conversation feels awkward, get a book about sex and read it together. Look at the pictures, laugh -- break the tension. Let your partner know that you’re open to making things better between you. That’s half the battle.

2. Avoid name-calling.

He is not a “sex fiend” just because he wants more, and she is not a “nymphomaniac” if she wants more, or “frigid” when she wants less. If you are in a committed relationship, and you want it to work, you both have to recognize that it is perfectly normal for sex drives to differ. The important thing is for you both to enjoy the sex you have together -- however and whenever you do.

3. Both parties have to give a little.

Therapists seem divided about who has to try to adapt his or her sex drive to the other’s. “Whoever wants more sex is the one who has to make the most adjustments,” insists Driscoll. Other therapists say the opposite: “The general rule of thumb in sex therapy is that the person with the least desire has to figure out how to enjoy it more -- have more sex, come to a negotiation,” says Pepper Schwartz, PhD, a professor of sociology at the University of Washington and past president of the Society for the Scientific Study of Sexuality. Clearly, the best thing to do is meet in the middle.

4. Allow for physical affection that does not lead to sex.

Go out of your way to touch each other in affectionate, but not explicitly sexual ways. Do not let a day go by when you do not say hello or goodbye with a kiss. Touch each other playfully as you pass in the hall. Cuddle with the clearly-stated agreement that this will not lead to sex so as to take the pressure off the less libidinous partner. Hug until you feel relaxed. These tokens of affection will build the bond between you -- and the electricity as well.

5. Schedule sex dates.

Knowing that on a designated day, you will be having sex, will bring relief to both parties. No one has to face the humiliation of being rejected, or the anguish and guilt of disappointing their partner.
Yes, you have to give up the notion that sex is only hot when it’s spontaneous. But a sure thing can be just as satisfying. And the process of planning can build anticipation. Take pleasure in the details, from the mood music to the lingerie, and make sure there will be no interruptions for at least two hours.

6. Court your partner -- presents help.

“Men have to court women with gifts and good manners to get them in the mood -- every animal in every species does it,” says Driscoll. Among chimpanzees, he says, “the male gives the largest share of the kill to a fertile female” so he can be assured of sex.

Though perhaps found less in nature, men like presents, too. Both partners need to remember how solicitous they were of each other when they first met and always strive for that kind of respect and generosity of spirit.

7. Try whole-body stimulation -- and take it slow.

For men, sexuality tends to be focused disproportionately on the genitals. Slowing lovemaking down and focusing on the other erogenous zones can give a woman the time she needs to become aroused and receptive, and can help ease performance pressures for men. Be pleasure oriented not goal oriented.

8. Surprise fuels sex drive.

Be imaginative and playful. Change rooms, try the couch. Take a look at some of the newer erotic literature and films that include female fantasies as well as male. Share your fantasies with each other -- acting them out only if both of you are comfortable with the scenario. A fantasy doesn’t have to be anything more than imagining what you wish someone would do to give you pleasure. Start small … and build.

9. Reduce Stress in Your Lives

Stress can be the ultimate sex drivesapper. Help each other play more and work less -- go for hikes, take long weekends away. Even if things are going badly at work or with the kids, try to separate those issues from what is going on between you as a couple. “Desire is a healthy form of entitlement -- when you don’t feel deserving, you shut down,” Perel says. And once you’ve helped each other relax a little, remember sex itself can be an excellent stress-reliever.

10. Get outside help

People go to golf and tennis clinics -- so why not sex therapy to improve your game in the bedroom? Also consult a doctor to see if there may be a medical reason behind your dissatisfaction with your sex drive. There may be alternative drugs for depression and other conditions that can have less of an impact on sex drive. And just as poor health inhibits male and female sex drive, good health resulting from increased exercise and improved diet can help restore libido.

Published February 2007.

Great Sex Unzipped

So How’s Your Sex Life? Here Are 6 Tips for Making It Great
By Josh Sens
WebMD Feature
Reviewed by Sheldon Marks, MD

Was it good for you?

If you’re like a lot of men, chances are it wasn’t. At least, the sex wasn’t as good as you think it could have been.

You were addled with anxiety, plagued by concerns over your performance, and worried about the worthiness of your physique during lovemaking. Even if the act achieved the idealized heights of a Hollywood screenplay -- she melted at your touch, you thundered like a stallion, you writhed in unison to volcanic climax -- you still harbor suspicions: You’re pretty much certain you’re not getting it as often as everyone else.

For creatures so famously consumed by thoughts of sex, men remain remarkably confused about what great sex is and how to have it. We’re shadowed by self-doubt, and clouded by myths and misperceptions. It’s not just about our mind-set. We men could also work on our mechanics. Mentally and physically, we’re hampered, hindered. We’re impeded on our path to greater sexual pleasure.

To rephrase a famous question: Can’t we all just have great sex?

Of course we can. But first we should decide what great sex is.

“Great sex is in the eye of the beholder, or the be-hander,” says Patti Britton, a clinical sexologist and author of The Art of Sex Coaching. “For some men, it might be the ability to produce fantabulous multiple orgasms in their partner. For other men, it might mean being able to last three minutes. Being a great lover means becoming a great lover to your particular partner, and that requires doing something very difficult: opening your mouth.”

Great Sex Tip 1: Take Up Pillow Talk

Right. The mouth. Useful for kissing and other orally administered forms of arousal (none of which should be underestimated), it’s also a tool for communication. Try it. Tell her what you want. Ask her what she likes. Shoot for trust and openness.

“If you get to know yourself and your partner, you’ll have a much more erotic and explosive sexual relationship,” says Joy Davidson, a New York-based psychologist and sexologist, and the author of Fearless Sex.

Great Sex Tip 2: Don’t Believe Locker Room Talk

When men do talk, they often puff themselves up to their peers. Less apt than women to discuss their insecurities and more inclined to exaggerate their exploits, men paint distorted pictures of their sex lives for one another.

“A lot of men wind up thinking that their sex life is missing something, that other men are having wilder sex or more frequent sex,” Davidson says. “They have a sense that the pleasure ship has sailed and left them behind.”

According to Michael Castleman, a San Francisco-based sex expert and author of Great Sex: A Man’s Guide to the Secret Principles of Total-Body Sex, the average frequency of sex in committed long-term relationships is roughly once every 10 days.

Great Sex Tip 3: Don’t Compare Your Sex Life With Porn

Not everything men know about sex they learned from pornography. But a lot of it they did. And that can be a problem. Populated as it is by flawlessly formed women and men with etched abs and equine endowments, adult entertainment makes many guys wonder: What am I doing wrong? Or, more to the point: What’s wrong with me?

“One of the most destructive myths of porn is that it convinces so many guys that they’re too small,” Castleman says. “They forget that pornography is self-selecting…These are not average men. They’re the extreme end of the scale.”

Some of the other fictions that porn perpetuates are the idea that women are always primed and ready (“in the real world,” Davidson says, “people do say ‘no’”); that the same moves work on every partner; that satisfying sex always culminates in orgasm.

There are positives to porn -- it can, for example, inspire us to greater sexual exploration. But when Debbie Did Dallas, she also did damage to the way men often think about sex.

“I’m not going to stand in the way of your watching porn, as long as you’re aware that it’s not reality,” Castleman says. “It’s like watching a car chase in an action movie. It’s exciting. It’s entertaining. But everyone knows it’s not the way to drive.”

Great Sex Tip 4: Focus on Pleasurable Sensations

While we’re on driving, let’s talk about commutes. And cubicles. And computers. And the demands and distractions of our daily lives.

Stress is an enemy of great sex. So is anxiety about performance. Minimizing both helps maximize your enjoyment of your partner. “If we can quiet our monkey-minds, put a stop to that ceaseless inner-chatter, we can open ourselves up to better sex,” Britton says.

She recommends that men adopt a mantra: FOPS, or Focus on Pleasurable Sensations.
“There are techniques ranging from eye-gazing to massage and synchronized breathing that help keep you in the moment,” Britton says. “Great sex happens in the present. It doesn’t happen in the future, like worrying about how quickly you’re going to come.”

Great Sex Tip 5: Focus Less on Size and More on Other Matters

“I’m not going to pretend it doesn’t matter,” Davidson says. “There are plenty of women for whom it absolutely does. But I prefer to focus on the idea of the right fit.”

No two people are built the same, and it helps to have compatible body parts. For some women, men of modest size may be a perfect fit. It’s a matter of physiology and personal preference. But perfect-fitting penetration isn’t the only path to satisfying sex. Focus on foreplay. Concentrate on kissing, cooing, caressing -- the full panoply of sexual pleasure giving.

“A lot of women are very responsive to a man’s voice during lovemaking,” Davidson says. “If a man has verbal facility and can entice a woman through his voice, that can become a powerful part of his repertoire.

Great Sex Tip 6: Schedule Sex. Really.

What sounds rote and dreary can actually be dreamy, says Michael Castleman, who recommends the strategy especially to couples in long-term relationships, who’ve passed the can’t-keep-their-hands-off-each-other phase.

“There’s this powerful mythology that says you should fall into each other’s arms spontaneously, with string music playing and the sun setting in the West, and if that doesn’t happen there’s something wrong with you,” Castleman says. “Nonsense. Real life doesn’t work that way.”

Rather than heightening the pressure to perform (“It’s now, or never!”), scheduling can actually make sex more relaxing. You can develop sensual rituals, make romantic gestures in anticipation of your encounter. You can give each other massages or take a shower together.

Castleman says that scheduling sex also eliminates conflict over desire differences.
“People say, ‘What if I’m not in the mood?’ Well, one of the things about relationships is that you sometimes make compromises. But what astonishes people once they start scheduling sex is that they can actually enjoy it.”

Male Enhancement: Is It Worth a Try?

Nonpresciption methods of male enhancement and male enlargement range from the possibly effective to the downright dangerous.
By Richard Sine
WebMD Feature
Reviewed by Louise Chang, MD

Our email inboxes fill up every day with advertisements for pills, ointments, supplements, and contraptions aimed at enhancing penis size, sexual stamina, or libido. It’s a testimony to men’s abiding insecurities about sexual performance. The question is, do any of these “male enhancement” techniques really work?

Richard, a mechanic from upstate New York, is a muscular, athletic guy. He has a loving wife who has always enjoyed their sex life. But ever since he was a young boy, Richard couldn’t get over the feeling that his penis was too small. In public bathrooms, he’d use the handicapped stall. He felt embarrassed in gym locker rooms and when standing naked before his wife. “I didn’t feel manly enough,” he tells WebMD.

Then, in the back of a weightlifting magazine, he saw an ad for the FastSize Extender, a device that claims to make the penis longer and fatter through traction. Richard began wearing the device almost eight hours a day, every day. He was shocked to notice a difference within a few days. After four months of wearing the device, he says his flaccid penis has stretched from 3 inches to over 5 inches; erect, he has gone from less than 6 inches to over 7 inches. The device cost $298, but Richard says the effect on his self-confidence has been priceless: “It made a world of difference to me.”

The FastSize Extender, though not extensively tested, has received some validation from mainstream medical sources. But that makes it a true rarity among the nonprescription methods of male enhancement. Most are a waste of money, and some are downright dangerous, doctors say.

Instead of furtively turning to untested methods, men with persistent concerns should consider opening up about them with their doctors. That’s because performance problems sometimes act as an early warning signal for serious health problems. Your doctor might be able to prescribe something that can really help, or least provide a valuable dose of perspective about what constitutes “normal” sexual performance.

Links Between Sexual and Overall Health

Sexual performance declines naturally as men age, doctors say. But a rapid or severe decrease in performance or libido can be a red flag. Most importantly, erectile dysfunction may be an early predictor of heart disease.

Atherosclerosis, a condition in which fatty deposits build up inside arteries, may restrict blood flow to the penis and cause erection difficulties. “The small blood vessels that go to the penis can become diseased much earlier than the [larger] vessels that go to the heart,” Karen Boyle, MD, a urologist at Johns Hopkins School of Medicine, tells WebMD. “In younger or younger middle-aged men, ED is often the first sign of atherosclerosis.”

For men with ED who are at risk of heart disease, prescribing Viagra or its cousins isn’t enough, Boyle says. These men should be also be controlling their weight and cholesterol level, limiting their alcohol intake, and quitting smoking. Evidence shows that these changes in themselves can have a positive effect on sexual function, Boyle says.

Sometimes men with erection problems or a diminished libido have low levels of testosterone, Boyle says. Testosterone deficiencies can also affect mood and energy levels. Boyle tests for testosterone levels and prescribes it as a topical gel, though she warns it is only safe when prescribed and monitored by a physician. Nonprescription testosterone, such as the kind used by some bodybuilders, is dangerous, she warns.

For men with performance issues who are physically healthy, Boyle often prescribes counseling, such as marriage counseling for men with relationship issues or psychiatric help for men who are preoccupied with a problem in penile appearance. For young men with sexual performance problems and no signs of physical problems, Boyle may prescribe counseling and a low dose of Viagra as they work out issues of insecurity. “They need reassurance from a physician that everything is OK,” she says.

The Quest for a Bigger Penis

The FastSize Extender device promises results, but it’s far from quick and easy. Just ask Bob, a retail manager from New Jersey. He says he’s gained over 2 inches of erect length. All it took was 25 months and over 2,600 hours wearing the device, typically five hours a day, seven days a week. “I was afraid my girlfriend would think I was a freak, but she was supportive because she felt a difference in her satisfaction and I felt more confident in myself,” Bob tells WebMD.

Richard, the mechanic from New York, got results faster than Bob, but still wore the device under his clothes for about eight hours a day. Richard’s wife has also been supportive. “I see a more confident man in front of me from using this product,” she says. She also says the lengthening has enhanced their sex life, though she had no complaints before.

Chicago urologist Laurence A. Levine, MD, director of the male fertility program at Rush University Medical Center, tested the FastSize Extender on 10 men afflicted with Peyronie’s disease, which can cause bending and shrinkage of the penis. At the end of the six-month study, which was funded by the maker of the FastSize Extender, Levine found increased penile length and reduced curvature in every man and increased girth in seven of the men. Calling the results “remarkable,” Levine now prescribes the device to many of his Peyronie’s patients and reports no significant complications.
(Levine has also worked as a paid consultant to FastSize Extender.)

Could FastSize work on men of normal penile length? Levine says it might. “If a woman can have a breast enlargement and it makes them psychologically feel better,” he reasons, “then perhaps we should have the same thing for men.”
Penis-lengthening surgery is also an option for men, but it is a highly controversial procedure. The American Urological Association says a common form of lengthening surgery (involving cutting the suspensory ligament of the penis) has not been shown to be safe or effective. The group also refuses to endorse surgeries that inject fat cells in the penis with the goal of increasing penile girth.

Many doctors question whether the benefits of lengthening surgery outweigh the risks. A 2006 study found that only 35% of men were satisfied with the outcome of surgery, which added only half an inch, on average, to length. Men who are overly preoccupied with penis length tend to have unrealistic expectations of surgery and should seek counseling instead, the authors wrote.

Thousands of years before Viagra, men were consuming everything from horny goat weed to powdered rhino horn in hopes of boosting sexual performance. The remedies persist for men who can’t get their hands on prescription drugs like Viagra or who prefer “natural” cures.

But many doctors are wary of traditional medicines. When Boyle’s patients come to her with bottles of herbal supplements, she tells them she cannot vouch for their safety or effectiveness unless the FDA has reviewed the claims on the label.

No herbal remedy can restore erections like Viagra and its prescription counterparts, says Steven Lamm, MD, an assistant professor of medicine at New York University and author of The Hardness Factor. But Lamm says these remedies may be appropriate for men who have experienced a decline in sexual performance but do not suffer from a diagnosable sexual problem. Lamm has endorsed an herbal remedy, marketed under the Roaring Tiger label, that combines horny goat weed and other herbal extracts with the amino acid L-arginine. (The supplements are made by the same company that makes the FastSize Extender.)

The Way to Happiness in Bed

The Internet is rife with scammers who seek to prey on men’s insecurities, Levine says. “All the pills, topical creams, and gels are worthless. Many men would clearly rather spend $20, $50, $100 on the Internet than go to the doctor and get real information.”

In some cases, men are harming themselves in the pursuit of a bigger penis. Levine cites “jelqing,” a technique involving hours and hours of intense stroking. He says he has patients who have developed Peyronie’s disease due to violent stretching of the penis through jelqing.

It’s ironic that the male preoccupation with enhancement seems to be independent of the needs of women, the supposed benefactors of improved sexual performance. A recent study found that 85% of women are pleased with their partner’s penis proportions, but 45% of men say they want a larger penis. Given that the vast majority of men fall within a certain penis size -- about 5.5 to 6.2 inches long when erect -- most men fall within the normal range.

And there’s plenty of debate on whether size matters at all. The most sensitive nerves in the vagina are found close to the surface, Lamm notes, and the clitoris is found on the vagina’s outside. So there should be plenty of ways to satisfy your partner that have nothing to do with pills, creams, surgery, or devices.

Sex Better Than Money For Happiness

Sex Better Than Money for Happiness
More Money Doesn't Mean More Sex, but More Sex Can Make You Feel Richer
By Sid Kirchheimer

WebMD Feature
Reviewed by Brunilda Nazario, MD

Good news for folks whose bedrooms have more activity than their bank accounts: Research shows that sex is better for your happiness than money.

That's not to say that being financially poor but sexually active is the secret to a happy life. But despite common theory, more money doesn't get you more sex, say "happiness economics" researchers.

After analyzing data on the self-reported levels of sexual activity and happiness of 16,000 people, Dartmouth College economist David Blachflower and Andrew Oswald of the University of Warwick in England report that sex "enters so strongly (and) positively in happiness equations" that they estimate increasing intercourse from once a month to once a week is equivalent to the amount of happiness generated by getting an additional $50,000 in income for the average American.

"The evidence we see is that money brings some amounts of happiness, but not as much as what economists might have thought," says Blanchflower. "We had to look to psychologists and realize that other things really matter."

Rich Man, Poor Man: What's the Difference?

Their paper, "Money, Sex, and Happiness: An Empirical Study," recently published by the National Bureau of Economic Research, essentially puts an estimated dollar amount on the happiness level resulting from sex and its trappings.

Despite popular opinion, they find that having more money doesn't mean you get more sex; there's no difference between the frequency of sex and income level. But they do find sex seems to have a greater effect on happiness levels in highly educated -- and presumingly wealthier -- people than on those with lower educational status.

Overall, the happiest folks are those getting the most sex -- married people, who report 30% more between-the-sheets action than single folks. In fact, the economists calculate that a lasting marriage equates to happiness generated by getting an extra $100,000 each year. Divorce, meanwhile, translates to a happiness depletion of $66,000 annually.

Whether that hefty happiness income boost is the result of marital bliss or more sex is up for debate. But their "econometric" calculations confirm what psychologists have long known: People who consider themselves happy are usually richer in sexual activity.

"Many studies confirm that people who are depressed have less sex," says psychologist and sex therapist Robert Hatfield, PhD, of the University of Cincinnati and a spokesman for the Society for the Scientific Study of Sexuality. "Conversely, if you're not depressed -- 'happy,' as some might say -- you're more likely to have more frequent sex."

Does sex lead to happiness, or are happy people just more likely to lead each other to the bedroom? That's still under investigation, but there is evidence that psyche and sex feed off each other.