Shame within a marriage


  • Ask Dr G
  • Sunday, 27 Oct 2013

Q: I am 32 years old and I am facing the problem of premature ejaculation. The interval of intercourse including the foreplay is only one to two minutes. Strangely, I did not have such problem in the past. I feel very demotivated and very ashamed in front of my wife.

Deep

A: I am sorry to hear you have developed sexual dysfunctions recently and this has affected you deeply.

As you are thirty-two years old and previously were not affected by Premature Ejaculation (PE) this seems to be a problem of secondary PE. In reality, we really don’t understand the reason why men experience secondary PE.

Although in some men, this problem is of a transient nature and partner-dependent, in others this can affect them in the long term. Even though we do not really understand the mechanism of onset for secondary PE, researchers still believe that serotonin plays a vital role in this sexual dysfunction.

I often tell my patients that PE can only affect men who care about their partners. It is true! Men gets the libido to have intimacy driven by testosterone, this will enhance erection with arousal and follows by ejaculation. Hence, they serve the purpose as far as sex is concerned, regardless of the interval of intercourse. Even Alfred Kinsey, the famous American aexologist in 1950s, did not consider PE a problem and called it the “Masculine Vigor”. In reality, this sexual dysfunction affects men deeply!

Recent global surveys involving men who suffer from PE revealed a significant compromise in their self-confidence and resulting in interpersonal difficulties. In fact, the issue affects men both inside and outside the bedroom.

I think we have advanced significantly since the 1950s. At least the taboo is much less to have a more open discussion about sexual dysfunctions. This will have an impact in encouraging men to come forward and clinicians more readily to offer treatment.

Since Kinsey’s time, men have been advised by doctors to practice behavioral techniques to overcome PE. Other famous sexologists, Masters and Johnson, recommended the “Start-Stop” and the “Squeeze” technique. As the name suggests, the clinicians simply ask couples to squeeze the penis prior to ejaculation or stop and resume to break the arousal. In practice, these techniques further erode men’s confidence and demotivate men more. Believe it or not, men are still advised to utilize such techniques in the 21st century!

A new medication called Depoxetine is now available to assist men to prolong interval of intercourse. Like the treatment of ED, sufferers are encouraged to take the medication one to two hours prior to intimacy. This has the effect of transiently increasing the serotonin in the brain. It would have the effect of prolonging the intervals by up to four times. In your case, it may increase the interval to eight minutes (which is what non sufferers would achieve)

So, chin up! Go and see your doctors and bring you confidence up again!



Q: My post-menopausal spouse has lost all interests in sex. Can we reignite her?


Disappointed husband



A: You may be aware of the answer I provided last week about the sexual interests in women after menopause. It is a myth that all women will “switch off” after menopause when it comes to sex. In most women, the libido is maintained or even enhanced after menopause.

This is because the women have less worries about contraception and the children, and hence can really enjoy the intimacy with their spouse. In fact, in a more open society, some women would even consider looking for a younger partner after menopause.

Of course, some women do get disinterested with sex after the menses have ceased. This is mainly because loss of estrogen and androgen that can lead to the decrease in sex drive and bodily function. Post-menopausal women may notice that they are not as easily aroused and less sensitive to touch. This may be due to the decrease level of estrogen that reduces the blood supply to the vagina resulting in dryness, discomfort and even increased risk of urinary tract infections. The lack of estrogen may be only one of the factors affecting women’s libido. Others reasons may include agitation, anxiety, sleep disturbance and stress.

There are many ways to re-ignite the dampened passions after menopause. Although estrogen replacement is one of the options, the efficacy of such therapy is not conclusive. In some women, this will get the flame of passion burning again, in others; it simply reduces the dryness in the vagina. Much research is carried out to assess the role of low dose androgen, although the results are still non-conclusive.

I personally do not believe in the role of hormone replacement as the only way to enhance the sexual libido. As the partner, this is the time to be supportive and explore the concerns and problems your spouse is experiencing. The role of sex therapist and counseling may also be important.

These experts will usually educate couples about the anatomy and physiology of bodily functions in response to aging. Methods such as distraction techniques and enhanced stimulation may also be taught to minimize pain and anxiety.

So, Dr. G’s advice to you is be patience and supportive. Explore other areas of intimacy. You never know, the flame of passion might be even more intense than the last round!



Q: I read your article today "Sex at the retiree level", and one of the questions was about phimosis. I got very afraid and am writing in to ask you about it.

 am 26 and not married and have never had sexual intercourse before. I have watched the web pictures and have seen that the foreskin can be fully retracted over the glans penis. I am facing the problem where I cannot retract with or without erection. Do you think i am suffering from Phimosis? Do you think this is caused by masturbation? Need your advice at least via email as I am too shy to meet my doctor to ask this.

Roy


A: Even though it is Halloween this week, my articles are definitely not intended to scare or to shock. I do apologise if the description I offered gave made you feel unease.

The reality is phimosis is a medical condition characterised by tight foreskin that is unable or difficult to retract beyond the glans penis. This may result in the feeling of tightness during erection. This condition is physiological to start off with as it affected all of us as children.

When we grow older with sexual maturity, the foreskin should be easily retractable so that we can clean the smegma (Nasty smelling dead skin trapped within) on a regular basis. The inability to do so may often result in infections such as balanitis. Therefore, the inability to retract the foreskin at an older age may be considered to be pathological as this may adverse affect the health.

When it comes to sexual health, many men may get by with tight foreskin, as intercourse may still be possible. However, such conditions may lead to tears and infection of the skin with repeated injury. This can make the phimosis even worse with time. I understand you have not started sexual intercourse; I can assure you the pain from the tight foreskin may take the pleasure out of the sexual experience.

So, build up your courage, go and see a doctor. You never know, it might be slight tightness that may not cause you any problems in the future. What is the worse case scenario? You might lose the foreskin.It is no big deal, you just join the club of one third of men on earth who have had a circumcision and have a normal sex life. I guess it is not so scary after all, right?

I also don’t believe masturbation will cause blindness nor hairy palm. But you never know…. Happy Halloween!!

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