Men's Sexual Health

Testicular cancer...
While most men don't think about it, being aware of testicular cancer can save your life. Regular testicular self-examinations can help detect abnormalities. If you have any abnormal sensations in the testicles or have detected a small lump on the testicles, seek an evaluation by a health care professional.

Sex - Some Things You May Not Know

Some people assume that men know everything there is to know about sex. However, this assumption is very likely not true. Men, like women, have questions about different issues with sex and their bodies. These issues are rarely talked about - particularly if it is related to a sexual problem. This page will address some of the topics that you may be really concerned about - like premature ejaculation, erectile difficulties, feeling like you have to do it when you don't want to, and others.

Premature Ejaculation

Premature ejaculation is uncontrolled ejaculation either before or shortly after sexual penetration, with minimal sexual stimulation before the person wishes. It may result in an unsatisfactory sexual experience for both partners. This can increase anxiety that could potentially worsen the problem. Premature ejaculation is one of the most common forms of male sexual dysfunction and has probably affected every man at some point in his life.

What Causes Premature Ejaculation?
Most cases of premature ejaculation do not have a clear cause. With sexual experience and age, men often learn to delay orgasm. Premature ejaculation may occur with a new partner, only in certain sexual situations, or if it has been a long time since the last ejaculation. Physiological factors such as guilt, anxiety or depression can cause premature ejaculation. Since alcohol may delay orgasm, stopping the regular use of alcohol before sex may play a role in this problem.

Some Suggestions...

Know Yourself
To learn to control, you must be aware of your sexual response and recognize when you are approaching the "point of no return." Before you get there, lessen the stimulation by slowing down or stopping. Once the feeling subsides, you can resume until you reach the threshold again, then slow or stop, over and over. Practice this three or four times a week, and in a few months there should be some improvement. This is known as the stop-start method.

Pressure to have sex...
There is a misperception that men are sex machines, ready to go all the time, but you know this simply is not true. There are times when you may not want to be physical, but your partner wants to and you feel like you should because men should always be ready. Both men and women have the right to say no. You should never feel pressured to do anything you do not want to do. And if your partner pressures you about it, then they are just buying into myths about male sexuality. Just like women, sometimes men don't want sex - because they're tired, because they are stressed, or because they are just not in the mood.
Do what's right for you, and it's alright if that means not having sex.

Whether with a partner or by yourself, another technique similar to stop-start is the "squeeze method." For this method, the penis is squeezed by a man or his partner before the sensation of inevitable ejaculation to delay ejaculation and, in time, teaches better control.

Use a Condom
Some men find the sensation of sex without a condom too intense, causing them to lose control quickly. Using a condom can diminish sensation just enough to make the experience last longer and be more enjoyable (never use more than one condom at the same time).

Masturbate
After any period of abstinence, it may be difficult to delay orgasm. Masturbation may help prevent premature ejaculation. Masturbating before a sexual encounter may take away pressure to perform and give better control over an orgasm.

Other Suggestions
While alcohol may delay and prevent orgasm, it may be a cause of premature ejaculation when alcohol is not consumed. Additionally, it lessens awareness making it more difficult to know your body.

Prescription drugs should only be used if recommended by a physician. Some doctors prescribe drugs such as Prozac to delay ejaculation, but this should only be done under the care of a physician. Like alcohol, many topical creams only dull sensation.

Erectile Difficulties

Erectile problems, sometimes called impotence, refers to a man's consistent inability to get or maintain an erection sufficient to have satisfactory sex. It does not mean a lack of sexual interest or desire. It also is not an occasional difficulty achieving or maintaining an erection (which effects all men at some point in their life).

Normally, an erection occurs when your imagination or one or more senses are stimulated and you become aroused. Your central nervous system sends nerve impulses that increase blood flow to your penis.

You may be able to avoid erectile problems related to anxiety and stress by trying to take a more relaxed approach to having sex. Talk to your partner about problems and concerns. Other things you can do to decrease your chance of developing problems include:

• Quit smoking
• Avoid using excessive alcohol or drugs
• Exercise regularly
• Keep your cholesterol in check

Tobacco use can constrict blood vessels, including those in the penis that produce and maintain erections. Recent studies show that the toxins in smoking can damage blood vessels and reduce blood flow in your arteries. An erection is simply a large surge of blood to the penis, and if the blood vessels are blocked, then it will be difficult for the blood to enter.

Alcohol is a little more complex. It physically diminishes spinal reflexes which decrease sensitivity and erectile ability (both having and maintaining erections). Initially alcohol seems to give men more sexual prowess by regulating the area of the brain that controls fear and anxiety, promoting, not decreasing, aggressiveness. However, even a few drinks lower testosterone levels, and low testosterone is often coupled with diminished sexual desire. More drinks could lead to the point where erection is impossible.

In addition to physical causes, psychological reasons, such as stress, fear of an STI, concern about pregnancy, feeling guilty for having sex, or just performance anxiety can also impact erectile functioning. When trying to distinguish the cause of the problem, considering the context is important. If an individual can have an erection for masturbation, then the problem is not likely a physical cause (unless it's excessive alcohol use). It may be necessary to contact a professional to discuss these issues.

The Truth About Condoms

Where to find condoms...
• Free condoms are available in the Health Promotion Department at the University Health Center (2nd floor)
• University Health Center pharmacy sells condoms at a reduced price
• Condoms are available for purchase at any drug, grocery or convenience store
• Condoms are available for discreet purchase online and can be mailed directly to you.

There is a popular belief that men don't like condoms and shouldn't like them for any number of reasons. The truth is many men prefer a certain type of condom to no condom at all. It can help reduce the fear of STIs and pregnancy and sometimes can help you maintain your erection longer. Not having to worry about these things can make the experience more pleasurable. If there is concern about loss of sensation, one way to increase the sensation is to add a small drop of water-based lubricant to the inside tip of a condom before putting it on. If the feel of a condom is too strange to make a sexual encounter pleasurable, practice masturbation with a condom in order to get accustomed to the feeling.

Some Brief Condom Tips:

• One of the most common reasons condoms break is because there is not enough lubrication. The amount on a "lubricated" condom may not be enough; adding extra water-based lubricant may be important.
• Check to make sure the condom is not "inside out" before putting it on. If you put it on incorrectly, don't turn it right side out and put it on again. Pre-ejaculatory fluid can cause pregnancy and transmission of STIs.
• If you're concerned that putting on a condom ruins the experience, try not to stop to put it on. Putting on a condom takes less than 30 seconds, so it shouldn't slow you down too much. Having your partner put on the condom can also make it an enjoyable part of the sexual experience.

Remember

Sexual problems are normal for both men and women at any age. Sometimes it's hard to talk about them with friends, partners or health care professionals, but it's important to your well-being to get the information or treatment you need. There are many resources on these issues. Contact the University Health Center's Health Promotion Department at 706-542-8690 for more information. To make an appointment with a health care provider, contact the Medical Clinic at the University Health Center by calling 706-542-8666.

References:
www.webmd.com, 2006
Total Health For Men, 1995
The Guide to Getting It On, 2nd ed., 1999