Sex Matters 6/5/02: Louanne Cole Weston, PhD

Last Editorial Review: 10/23/2003

Everything you've ever wanted to know about sex but were afraid to type. WebMD's Sex Matters? expert, Louanne Cole Weston, PhD, joined us for this live event to discuss our members' intimate questions and concerns. The following discussion took place on June 5th, 2002.

By Louanne Cole Weston
WebMD Live Events Transcript

The opinions expressed in this transcript are those of the health professional and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician.

Moderator: Hello, Louanne. Welcome back to WebMD Live. We have several questions from our members. Let's get started.

Member: I am a 51-year-old woman who had a hysterectomy in October (one ovary was left). Ever since surgery and healing, I could have sex all day long. Is this hormonal, psychological, or what? I am not complaining about this heightened libido, just wondering.

Weston: Sometimes, people have a history of painful menstrual periods or chronic pain in the pelvis throughout the month. These types of symptoms are not very conducive to having enjoyable sex. So when a hysterectomy takes those problems away it is not uncommon for a woman to have a sexual rejuvenation and her desire can really increase. So if by any chance you were having pain associated with having a uterus prior to your hysterectomy, then probably my explanation would make sense.

Member: My wife is 50 and postmenopausal. I am 54. While my need and desire for sex is not at all what it was even 10 years ago, my wife has seemed to just "turn off" completely. She shows absolutely no interest at all, period! She doesn't tell me, "no," she just doesn't participate, which makes me feel like I'm taking something from her, almost as if I'm raping her. It is a horrible feeling. She will do everything she can to avoid having sex. She was not this way before menopause. Please educate me; she will not talk about it.

Weston: It would be important to encourage your wife to have her hormone levels checked by her doctor. She may be operating with a deficiency of estrogen and/or testosterone. Menopause often does cause a decrease in estrogen levels and without it, many women don't feel very womanly or sexually interested. I can understand your discomfort in experiencing sex with her the way you have described, no one who respects his or herself would want to have sex in this manner.

After your wife has a blood test to check her hormones, the next step would be finding a sex therapist with whom both of you feel comfortable talking and see if together some shared understanding could be created between you and your wife. I know that she does not want to talk about it, but I would recommend that she, out of love for you, agree to attend three sessions and give up having sex with you in the manner you have described where she doesn't seem to really be there. It would not be a bad trade-off in my mind. Let your wife know that you care for her and you are interested in her happiness. Ask her if she is willing to spend a little time being interested in a portion of your happiness. Attending a few therapy sessions would be a sign of that.

Member: I know that there are extremes on both ends with a question like this, but in your experience, what have you found the average amount of sex a married couple would have in a week? I am 23 and we have sex three or four nights a week. Just wondering what you thought.

Weston: Questionnaires that ask about frequency of sexual contact per week cannot always be relied upon, because people sometimes increase or decrease their answer for a number of reasons. Sometimes they hope to impress the researcher, sometimes they fear shocking the researcher, sometimes they have read other statistics and they want to be like all the others and sometimes they just plain forget. I've often found in my therapy practice that I've asked the question how often do you have sex, per week or per month, and two people will give me rather different answers sitting there together in the same room. So I don't rely heavily on studies that ask that question. My tendency is to say does the frequency you have feel good to you and your partner? Are you two happy with each other? So giving you some kind of number right now wouldn't be very useful, sorry to disappoint.

Member: I recently had a blood test to check my testosterone level. The result was 430. My doctor said it was OK, but he didn't seem sure. Do you know?

Weston: Four hundred thirty probably was a test for total testosterone and while it is meaningful, it is not the complete story. What may be more meaningful would be measuring your free testosterone. That is because the free testosterone is what provides you, as a man, with your sexual drive. You might have a high number of total testosterone, but a bunch of it could be bound with other molecules and therefore not free to give you sexual drive. So knowing the 430 is a good start and it is a good number, but if you are feeling low sexual drive, a return trip to measure your free testosterone would be the next step.

Member: Can you tell me a little about penis enlargement? Is there really such a thing? I've been receiving a lot of spam email lately offering all kinds of stuff about that and I must confess that for years I have this complex about size. My wife says she is satisfied and she doesn't care, but I can't believe that. It's me that is not satisfied. That doesn't seem to be an issue in our sexual life but it does bother me sometimes.

Weston: About four years ago there were quite a few surgeons performing penis enlargement surgery. Most have stopped doing the surgery because the results were not always that good. It involved cutting a suspensory ligament that allowed the penis to dangle longer and lower from the body when not erect. But when erection occurred, most men who had this surgery found that their erections pointed more toward the floor than the ceiling. In many cases it needed to be lifted by hand to be inserted. Some men had cases of pubic hair growing out of the shaft of the penis and felt uncomfortable with that result.

Widening procedures involve injecting fat under the skin. Although some came out well, others came out lumpy and uneven looking. In a few cases it turned into necrosis where some of this tissue actually died. So I would be the last one to recommend penis widening or lengthening surgeries.

There are men who are doing a technique now called Jelquing, which involves daily tugging on the penis and there are some men who firmly believe this has worked to lengthen their penis. There is one person on the Sex Matters message board who is a big fan and his name is Steven62; he has posted descriptions in detail of how to do this technique. There are others who say, "nope I've been tugging for a while and nothing is happening." To be honest I have some skepticism. The time when your penis is likely to look the biggest is when you've just stepped out of a hot shower. The warmth in your body permits your scrotum to hang lower and fuller and your penis to be as full of blood as it could be without being erect. So, for times when you would like to see yourself at your biggest, try a hot shower.

Personally, I'd rely on what your wife says, and realize that the vagina is most sensitive at the outer three inches. Any man with three inches or more has that territory covered. Just to prove that point, gynecologists can do minor surgery in women's vaginas past that three inches without anesthesia. Hopefully that will make a believer out of you. Most of what you receive in your spam is just attempting to take advantage of people's doubts, particularly things that come in pill or cream form.

Member: I've been married to my wife for five years, and we both have never been engaged in sex before or after marriage with anybody else. My question is, can I have anal sex with my wife without using condom? Is there any risk of getting an STD? Since we both never had sex outside the marriage should we still use the condom for anal sex?

Weston: Since you have not had sex with any other partners, you would not have any STDs. So, you would not convey anything to one another by having sex in her anus. There could be danger if part of your anal sexuality included what's called rimming. That is where the mouth of one person contacts the anus of the other person. There could be bacteria -- not sexually transmitted -- in the feces of the partner that could, taken into the mouth of the other, be problematic. But you could not catch anything such as HIV from anal intercourse with your wife. For simplicity sake you might want to continue using the condom so that there isn't any concern about accidentally transferring anal bacteria to places you don't want it, such as one's mouth or vagina. If you use a condom you can simply peel it off and not have to think about anything else. Anal bacteria can cause a vaginal infection if it gets in there.

Member: How does one solve the problem of premature ejaculation through self help?

Weston: An important technique that you can do on your own involves stimulating yourself up near to the point of ejaculating but stopping just short of it. You would want to approach and stop two times in one masturbation session before allowing yourself to reach orgasm on that third approach. This helps you recognize your point of no return and get familiar with it. That way when you are with a partner, you can start to recognize when you are close and slow down or back off from the stimulation before ejaculating.

When you are masturbating, be sure of focus on your sexual feelings. It is not the time to think of baseball scores and taking out the garbage.

Many men with rapid ejaculation try not to pay attention to their body and their sexual sensations. I recommend doing just the opposite. Pay lots of attention to what you are feeling and what is going on throughout your body. That is a technique that you should practice frequently, perhaps several times per week, to get your body used to a new way of responding. You can also look at both the FAQs featured at the top of the front page of the Sex Matters message board because I have more details about that there. And there is at least one article in the Sex Matters archives located at the top of that same page. So you could read up on it there, as well.

Member: I am an attractive, sexually-active 60-year-old who really enjoys sex. My last relationship was with a man 18 years younger and very active and good in bed (we made love four to five days a week, for several hours each time). I am being courted by an old flame who is 70-years-old, has always been a very high-energy, active person, and is in great physical shape. He has been an athlete for most of his life and exercises a minimum of three hours a day since he was 14. He has just undergone a triple bypass and will soon undergo back surgery. If I take this relationship further, what are the chances that he will satisfy me sexually and for how many years is it reasonable to expect a man 70 to be sexually active? I really would appreciate your response, as it is an important question. I can't keep on going out with 30- and 35-year-olds to take care of this issue.

Weston: Well, my crystal ball is a bit hazy. There are a few things I can say to help you with your interest in predicting the future. If your 70-year-old athlete has been able to resume his workout schedule since his surgeries, there is a pretty good chance that he would have the stamina to keep up with you. Of course, one can't guarantee this, but this person might be worth exploring. There are some athletic men who do not have a strong sexual appetite so one can never know for sure what kind of sexual desire would be available to you. You could engage in some flirtatious conversation and see what kind of flirtatious conversation you get back before you actually test the waters.

Member: I'm 22 years old. I am not married and cannot have sex with a girl outside of marriage because it's against my religion. I'm masturbating at least two times per week. And every time I see beautiful women I must masturbate. I'm afraid that masturbating so much will affect my ability to have sex when I get married. Will it? Also I want to stop masturbating and I do not know how.

Weston: The body does not know what causes its orgasm. The hand of a wife, or the hand of the body's owner, meaning you. So there is no harm that self-stimulation can cause that is any different from what a wife could cause. Some people do make the mistake of masturbating in a manner that is completely different from the stimulation that they might get from a partner. This can lead to the possibility of it being difficult to reach orgasm with a partner or, for heterosexuals, through penis-in-vagina intercourse. So, as long as you masturbate in a way that somewhat simulates intercourse, you are not likely to cause any problems for yourself in the future. I would recommend continuing your masturbation for a couple of reasons. There is some data that suggests that regular ejaculations, no matter how they are caused, are good for the health of the prostate. And while this may not apply to you at all, recent data has shown that as the availability of sexual pictures on the internet has increased, the incidents of sexual assault has decreased. So if you can, relax about your masturbation and keep looking for that woman you would like to marry.

Member: Is it true that premature ejaculation comes from masturbation at early ages?

Weston: There is no data to support the idea that early masturbation is linked to or causes rapid ejaculation.

Member: I have recently started bleeding after and during intercourse. I have been sexually active for 10 years now, and I am not performing rough sex. This has never happened to me before. I have also been diagnosed with HPV and have been treated with cryosurgery. But the last time I was treated was in 1998. I don't know what is wrong, or if perhaps I have contracted an STD. What are some possible things that could be the reason for the bleeding?

Weston: It is impossible to diagnose you over the Internet and I would strongly recommend your seeing your gynecologist as soon as you can. Consider having intercourse just prior to the appointment so the doctor can see the source of the trauma and/or bleeding. Don't wait for it to get worse.

Member: I have trouble having an orgasm with my husband. It's hard for me to relax and receive pleasure from him without feeling like I should be pleasuring him. I'm wondering how I can feel more at ease? I'm pretty shy and have a hard time giving directions

Weston: The situation you have described is a little bit complicated to answer in the time that we have remaining. I would recommend two things. First consider taking a look at a book called For Each Other, by Lonnie Barbach. After you read the book, consider seeing a sex therapist for a few sessions with your husband. You would probably benefit from the back and forth interaction that you could have with a therapist. That person could help you work your way through the subtleties of why you feel uncomfortable receiving pleasure. Third, take a look at the FAQs in the Sex Matters message board. There are three batches of articles about women having orgasms that might be of help to you.

Moderator: We are out of time. Our thanks to Louanne Cole Weston, PhD, and thank you, members, for joining us today. You can visit Louanne on the WebMD Sex Matters message board. For more information, please check out our news stories, features, and archived interviews with experts -- visit our Healthy Sexuality Center.

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