KateC Says...

Permanent Birth Control

Hi Kate!

My partner and I have been considering getting some type of permanent birth control as tubal ligation or vasectomy for a while. We had discussed it plenty of times but never had the determination to do it until now. I had an abortion last month and it revived the discussion. First, I want to make clear that this decision is based on our lack of desire to have children. It's not a result of us freaking out due to the abortion. No. We've talked about it in depth and we're sure it's the right choice for us.

Now there's the decision. Tubal ligation or vasectomy? We've reading about both of them and it seems that him getting a vasectomy would be easier. While I'm thin and don't suffer from any disease that could make it not recommended for me, I'm still young (24) and I've never had a baby. I've heard/read a lot about young women being refused a tubal ligation due to these reasons. Truth is I've never asked my gyno about it and I suppose it would depend on the doctor.

We've made the decision but there's no rush. He has an appointment next month and I shall talk to my gyno soon. But being the impatient and avid for information person I am, your input would be much appreciated.

Thanks for writing in and following up!  I infer that everything went well after your last question, and I'm so glad that you and your partner are on the same page about your future together.  That makes life much easier!

I, too, have heard that doctors are reluctant to grant sterilization procedures to young people who do not have children.  It's likely based upon the relatively common instance of changing life goals, colloquially known as "the ticking biological clock."  I'm sure that many a person who, at 24, thought she never wanted a baby, comes to want one later in life.  I'm also sure that many a person who knows, at 24, that she never wants a child, continues never to want a child and leads a full and wonderful life without ever procreating.  I support whatever decision you make at this point and I hope that your doctor does too.  The more you can think on this, and the more thoroughly you know yourself (and your partner, himself), the better this decision is likely to be, so take your time and do your soul-searching, and then look for a doctor who supports your right to control your fertility -- absolutely.

The short answer to your question: I hear that vasectomy is a much easier, safer, cheaper, and less invasive procedure than tubal ligation with fewer instances of serious side effects.  Do your research.  Ask your OB/GYN, and have your partner talk to a urologist.  Read up on vasectomies and tubal ligation, but everything I've heard points to vasectomies being the easier procedure.

The long answer: you should talk with your boyfriend about what happens if one of you dies.  Seriously.  I know it's morbid, but consider the possibility that you may not always have each other.  What if tragedy strikes?  What if you are forced to move on?  What if the next person you fall for wants kids?  How will that affect the way you feel about procreating?

If one of you feels that, with another partner, you just might want to be able to reproduce, than the other person should get the surgery.  Sure, vasectomies and tubal ligations are sometimes reversible, but not always.  The person who is most sure about not wanting biological children -- under any circumstance -- is the one who should have the procedure.

Also consider both of your health in this decision.  Anything that might put you or your partner at risk for complications (obesity, diabetes, severe allergies, etc.) should be considered before elective surgery. 

Any reluctance at all from either one of you should be cause to shift the procedure to the other or postpone it to some later date when things seem more certain and the choice is easier.

Whatever you and your partner decide, good luck with it!  If you go with tubal ligation, opt for laproscopic surgery.  In fact, any time you're considering abdominal surgery, get laproscopy if you can!  The healing time is much quicker and there are fewer scar-tissue-related complications.  Local anesthesia is always easier to recover from than general, and the smaller the incision into your abdomen, the better for you in the long run!

Follow whatever directions the surgeon gives you, abstaining from sex, heavy lifting, blood-thinning pain meds, and rigorous activity for as long as you are asked.  Rest well and heal thoroughly.

If you can't find anyone to give you sterilization, consider using a long-term effective method of birth control like an IUD in the interim.  No, it's not quite as effective as surgical sterilization, but it's not easy to forget like a pill, it delivers extremely low dose of hormones or nothing at all, and it lasts for years.  It's general policy not to give an IUD to a childless woman, but I know many young women who use one with the support of their doctors.

Best wishes for the surgery, whoever decides to get it!  Congratulations on being responsible in your sexual activity.

Rhythm Method

Do you think rhythm or calendar-method birth control methods are ever
worth considering for someone who does NOT want to get pregnant? I
know the mainstream word on the issue is that these methods are
generally ineffective, but their legitimacy and popularity seems to be
growing in more alternative circles in the last few years. Is this
something that the world of conventional medicine has rejected out of
a fear of the unknown, or should cycle-based methods absolutely be
avoided if you’re not willing to chance pregnancy? Do any other
effective non-hormonal birth control methods exist?

[I have edited out a couple of paragraphs of personal information on the poster.  The pertinent details: she is in a monogamous, committed relationship and is using condoms but has had some trouble with their reliability.  She used the depot shot in the past with no bad side effects, but would prefer not to be on hormones.  She is allergic to nickel.]

I apologize for the long wait on this response!  As luck would have it, I actually happened upon an expert opinion on the matter today!  The nurse and lactation consultant I see at my mothers' group used to coach people in natural family planning.  Just by chance, she brought it up today so I got to pick her brain about it.

There are different ways to use natural family planning.  You use the term Rhythm, and this is technically just the calendar method of birth control where you chart your periods, count out the days from your last period to estimate your ovulation date, and remain celibate around this time of your cycle to prevent pregnancy.  There are various ways of counting and various tools for reminding you what day you're on.  You have to be celibate for up to 14 days out of your cycle, which is a long time, and perfect use gives annual failure of about 5-10% (according to Wikipedia and that oft' quoted table that is printed on all birth control pill pamphlets).  This method relies on a cycle like clockwork and   Regular use gives up to 25% failure rates (according to the same table and the Mayo website).  That isn't great -- worse than condoms and much worse than hormonal methods of birth control.  It's even worse than the pull-out method.  It is decidedly better than nothing (85% of women using no birth control get pregnant in a year), however I think it is not a suitable method of birth control to be used if you really want to protect yourself well from pregnancy.

There are ways to improve your results without introducing synthetic hormones, IUDs, or condoms.  The Sympto-Thermal method of birth control is more accurate, less reliant on a regular cycle, allows for more days of sex, and gives much better results than the calendar method alone.  This is very similar to the calendar method of BC, but instead of just counting days and poking your finger at a likely ovulation date, you develop a very acute awareness of your body, reading it for clues about your exact day of ovulation and abstaining from sex (or using a condom ) on these days. 

Clues include:

• Basal Body Temperature:  Buy a basal thermometer (it has an extra decimal, measuring to the hundredths) and take your temperature every morning, very first thing, before you even get out of bed.  Chart your temperature on graph paper, and when you see it jump about 0.4F (~0.2C) then you know that you ovulated.  Tough luck if you've had sex in the last three days!  Sperm can live that long inside of you.  Temperature alone does not warn you of impending ovulation, but it can help you get to know your cycle better, and that is a good deal more helpful than counting days on the calendar. 

• Cervical Mucous: Inspect your vaginal discharge every day.  Keep an eye out for the changes.  When it seems to get slippery or mucousy, stop having sex or use a condom.  When it appears like egg whites, forming goey strands between your finger and thumb as you stretch it apart, then that's your ovulation.  Abstain for a few more days.  This will likely add up to about a week of condoms or abstention. 

If you choose to practice this method of birth control, I HIGHLY recommend that you get a coach or attend a class to help you learn how to do it well.  When done correctly, this method is about as effective at preventing pregnancy as condoms, but without help, you might end up staring at your discharge every day not quite knowing what to make of it and getting pregnant for lack of support.  There are educational seminars on this method almost anywhere there is a Catholic church.  Seek one out and drop in, no matter what your religion. The church certainly has its dogmatic motives to push this method of birth control.  They have funded most of the research that has gone into it and they run most of the education that there is about it.  My gut reaction to that fact was suspicion of the results, but then I thought about it further and realized that lots of stats on the pill are presented by drug companies, and stats on condoms are presented by durex, so the church probably isn't that different.  If this is a method you want to use, then I recommend using their resources.

Now, none of this is as effective at preventing pregnancy as hormonal methods or IUDs.  Condoms and sympto-thermal method have ~3% failure rate per year (perfect use).  The pill and IUDs have ~0.1% failure rate per year (perfect use).  If you really, really want to cover your bases, you want to prevent ovulation or implantation, and that means hormones and IUDs.  Being allergic to nickel, I agree that metal is out as a method of BC.  You'd have to go for an IUD that is made of plastic, and these contain very low levels of hormones.  Consider that you were once on the shot, which is the biggest wallop of hormone on the market.  It's a huge dose, delivered in one go every few months.  It is a method of birth control that has many side effects for many people because of this dose and drug delivery method.  If you didn't get side effects from that, you would very likely be absolutely fine on a low-dose pill (less hormone) or on a hormonal IUD (minuscule amounts of hormone).  These would be the best at preventing pregnancy, but if you don't want the hormone, then you don't want the hormone.

Hormonal contraceptives are a very effective method of birth control.  IUDs are also very effective and are dummy-proof.  Condoms are a good method of birth control and the only one that protects against STI transmission.  Sympto-thermal is also, in my opinion, a good method of birth control, but one that takes a lot more planning and self-control than simply taking a pill every day or keeping the cupboard stocked with condoms.  Calendar method?  It's definitely better than nothing, but I wouldn't rely on it.

I believe that the sympto-thermal method of birth control is a really, really good thing to practice for any ovulating woman, but that it's even better if you're not using it exclusively.  More knowledge about your cycle can only help you.  So go ahead and learn about it!  Track that temperature.  Inspect that cervical mucous.  Learn as much as you can about your fertility.  On top of it all, I recommend to keep using those condoms.  Two methods are better than one!  And if your condom fails you?  At least you'll have a good idea of your risks and will know whether or not to run out for the Plan B.

Good luck with it!  I hope that it works out well for you.

Additional Reading:

I talked to three women today who used the sympto-thermal method of birth control, two to avoid pregnancy, and all three to get pregnant when they felt ready.  The all recommend a book: Taking Charge of Your Fertility. 

General Clinic Note

I received a question yesterday from a poster who asked me not to quote her for privacy reasons.

The question asked about the specifics of financing a visit to a clinic like planned parenthood for sexual health concerns without insurance and without a steady income.

I can't answer this question for every clinic or for every situation, but I will give this general advice: if you want to know how much it will cost to visit a clinic, you should call the clinic and ask.  It's something you can do privately and conveniently from your own home, and if the clinic you choose does not offer you services that you can afford, you can just keep calling through that section of the phone book until you find someone better suited to help you. 

Call the specific location that you hope to visit, as laws and policies might actually change from state to state.  Know that there are clinics in the US that help people who can not pay for their care, but that the rules of sliding scale cost might vary from place to place, so it never hurts to ask in advance.

If you want to start with planned parenthood, enter your location information in the column at the right and contact the center nearest you to ask about the sliding scale cost of care:

http://www.plannedparenthood.org/

Good luck getting the attention that you need!  Don't be afraid to advocate for yourself in this!

Erectile Dysfunction

Hi Kate.

My husband doesn't want sex from me at all anymore, and I'm really at my wits end. I think I'm a pretty attractive woman - I'm not overweight, I try to stay fit and eat right, I have a busy life and interests outside of our relationship, etc. At the beginning of our marriage, we had sex every other day or so, and it eventually dwindled down to once a week. That was fine for me because we both have very busy careers and it just wasn't practical to have sex during the week. But now, every time I try to initiate anything with him, he can't maintain an erection. It's a big blow to my ego because you never really hear about men who can't get turned on. It's so embarrassing to be putting all your effort and sex appeal into trying to excite someone and getting no response.

I don't think there's anyone else because I don't see how he would have the time, and there are no females in his office. I'm pretty sure he's not gay, either, just to rule that out. I asked him if he's looking at porn or masturbating on his own (which I wouldn't mind, I just want to know the truth), and he says he's not. He gets very angry when he can't get stimulated and refuses to talk about it. I've pleaded, begged, tried to ask him if there's something I'm doing wrong or if there's a fantasy he'd like to try, and he just shakes his head and tells me no. He says he doesn't know what's wrong - he mentally wants me, but his body just isn't responding.

Unfortunately, this is really tearing apart our marriage. I feel unwanted and starved for affection, and I can't help but think that there are women out there who have husbands that touch them, caress them, make them feel beautiful. I haven't had any of that in a very long time. Please help.

Poster, it is incredibly important that you realize that this issue is not about you.  Your husband is suffering from erectile dysfunction, the inability to get and/or maintain his erection.  There might be any number of reasons for this, from mental (stress, depression, etc.) to physical, but fixing the problem is not about you getting sexier, it's about getting your husband to an appropriate doctor.

You're right: we don't hear about men with erectile dysfunction very much.  If it makes you feel inadequate, just stop for a minute and try to imagine how it's making your husband feel.  He is expected to be this creature who gets turned on at the drop of a hat.  His masculinity is all wrapped up in that unrealistic expectation, and yet he has this physical problem that prevents him from maintaining his erections.  No wonder he doesn't like to talk about it and gets angry!  Pile on top of his own feelings of inadequacy the knowledge that he is letting down his wife, and it's pretty clear why the issue has driven a wedge between you two.

Your first step has to be to take a big step back and extricate yourself from this matter emotionally.  Realize that there is a problem here, and it does need attention, but it is not about you, and it doesn't mean you're not sexy, and it doesn't mean your husband doesn't love you.  I know it's hard, but you have to forgive yourself all of those fears.  Allow yourself to feel loved and wanted as a separate matter from this sexual issue, because you ARE loved and you ARE wanted.  His is a physical problem.  A medical problem.  A problem that is far more common than either of you probably realize.  Don't beat yourself up about it.  It doesn't help.

In order to help your husband, you must be patient and understanding.  You must take the sexual pressure off and help him to separate the issue of sexual prowess from the issue of his erectile dysfunction.  If he is to get better, he must seek some professional support and treatment, and part of that process means opening up about a matter that is probably deeply embarrassing to him.  By being a source of unconditional support, you can help him to get there and help speed his recovery.

You may be interested to read up a little bit on Erectile Dysfunction first.  It may make you feel better and help you to approach the issue in a less injured way.

A quick search of "impotence" or "erectile dysfunction" will give you some information:

http://www.kidney.niddk.nih.gov/kudiseases/pubs/impotence/

http://www.medicinenet.com/impotence_ed/article.htm

You may also be able to find online support groups and forums for both you (wives of men with ED) and your husband (sufferers of ED).  It might help you both to be able to talk about this issue with other couples like yourself and realize that you are not alone.

The most important step is that your husband has to see a urologist.  He can start at your family doctor, but get the referral to a urologist to investigate the source of his problem.  He may be able to work on it with something simple and non-invasive like pelvic floor exercises (like kegels for men), or he may be suffering from some sort of nerve damage that requires surgery to fix, or perhaps he would benefit from a drug treatment like viagra or cialis.  Whatever the problem, a urologist should be able to sensitively and compassionately help him to regain control of his sex life.

I know that it's hard to step back from something like this and approach it confidently and helpfully, but I strongly feel that this is your very best chance at helping your husband.  The better you can help him, the sooner he can recover and the better you can both reopen the lines of communication that allow you to feel loved and gratified, even if the actual recovery of your sex life takes a little more time.

Whatever you do, be sensitive.  Read on the issue so that you are better informed, so that you do hear the stories that so often go unspoken.  Realize that this is not a reflection on your sexiness or on your marriage.  When you talk to him about it, help him to see that a medical problem with his penis is not the same thing as a personal problem with his manhood.  Take the sexual pressure off while you help him to seek the treatment that can, with time, get him back on track.  This isn't something that any man ever wishes for.  It's plum bad luck -- but it's not the kind of bad luck that he (or you) must live with forever.  There is help for erectile dysfunction.  Help him to find it.

Meeting The Foreskin

Hi Kate!

Why don’t we talk about penises? Let’s see. The guy I’m currently seeing is uncircumcised. We haven’t had sex yet but the topic came out in a conversation and he told me about it. Big deal? I don’t think so. All penises are pretty weird looking to me so a bit of foreskin won’t make much of a difference. But I remember talking about it with my friends a long time ago. All of them who had had a first-hand experience said it was weird and gross and had no desire the repeat the experience. It sounds a little silly and immature to me. Just because circumcision is pretty common around here it doesn’t mean that it is everywhere. Where my boyfriend is from, circumcision is not practiced at least there is a medical reason to do so.

So I guess my question is: does it make a difference at all? Do you need to “adapt your performance” when playing with an uncut penis?

Your friends' reactions sound silly and immature to me too! I'm firmly with you in the philosophy: all penises look a little weird anyway.  But they're really not for looking at all day, are they?

The biggest rule for dealing with any new penis is to learn how to treat it from its owner.  This goes for penises that are circumcised, uncircumcised, short, long, bent, straight, black, white, and anything else.  Your boyfriend himself will have far more experience with his genitals than anyone else, and I'm sure he will be happy to guide you in your exploration.  Don't be afraid to ask for his lead.

In general, there definitely are differences between circumcised and uncircumcised penises.  Circumcised penises have had the foreskin removed, usually at infancy.  The glans (head of the penis) is left without its protective sheath, and the membrane on it toughens and becomes thicker, more like skin than the moist membrane of an uncircumcised glans.  This toughening process is called keratinization.  It protects the glans from friction, and it can reduce sensitivity.  Many people assume that a less sensitive penis is less fun, but it really depends on the person.  Sensitivity can mean great pleasure in some cases, but it can also mean quick discomfort!  It is much, much easier to accidentally hurt an uncircumcised penis than a circumcised one, so be aware of that!

When your boyfriend gets an erection, his foreskin will probably cover the glans until he or you pull it back.  (This is not true for everyone.  Some men's foreskin naturally pulls back with erection.)  Don't yank the foreskin back all at once to expose the glans and then treat it like a circumcised penis.  It may look the same, but it won't feel the same.  Such treatment will probably hurt your boyfriend.  The quick pull-back is likely to catch and tug his glans uncomfortably, and direct friction with the glans is likely to feel more like rug burn than like pleasure.  Instead, start by keeping the foreskin over the glans.  You can roll it up and down and work it back and forth gradually.  If your boyfriend experiences any pinching or pulling, don't be afraid to introduce some lube to help things go smoothly. 

When it comes to direct contact with the glans, keep it slippery.  Use lube.  Use saliva.  Use your own natural lubrication.  Whatever keeps things wet.  You can directly stimulate his glans, but unless he likes it rough, he won't want you to do so dry! If you're into fellatio, work the foreskin back first, and don't be afraid to slobber.  If you're using a condom for sex, you can lube the inside tip of the condom before you put it on him.  (The foreskin is generally pulled back before the condom is put on.)  If you're using your hands, either keep the foreskin between your hands and the glans, or use more lube for direct contact.

The only other big difference for uncircumcised partners is with hygiene.  With the foreskin in place, sebum, a natural moisturizer, can build up under the foreskin.  This tends to build up, mix with urine, grow bacterial cultures, and turn into smegma -- smelly, white, waxy buildup.  It's not nice stuff.  He should retract his foreskin in the shower every day and clean well with warm water to prevent accumulation of smegma under his foreskin.  He probably already does this.  He's probably been good about cleaning himself since childhood, but if he isn't, then tell him early, before it gets too hard.  He needs to know.  (Sidenote: similar sebum buildup can happen in the folds of labia, so we women are not immune to this phenomenon.  We, too, should clean well with warm water daily!)

If he keeps the smegma at bay, but has a strong urine smell, then he can fix that with a quick rinse before you get it on, or you can use lube/saliva/water on your palm to dilute it and wipe it away before you get up close and personal. 

That about covers it!  Plenty of straight women have a preference for circumcised or uncircumcised, but I feel pretty strongly that the best penis is whichever one is attached to the man I choose as my mate.  It sounds as though you feel the same way!  This uncircumcised penis will be somewhat different than those you've seen before, but it won't be hugely different.  Use it as a good excuse to really pay attention to your boyfriends preferences, to really learn his body well.  That's a good way to get to know any partner, no matter what the state of his penis!

Have fun!  I'm sure you will.

Assorted Orgasm Advice

This is a really long question, so I'm going to break it up paragraph by paragraph.  I'm including the whole question because so many girls and women have trouble reaching orgasm in the early years of their sexuality, that I think it may benefit some readers to see one woman's entire breakdown of her situation.

Hi Kate,

Well, here's yet another orgasm situation. I really wanted a knowledgeable, outside perspective on this, and figured you'd be the perfect person to talk about this with. I'm in a loving relationship with a man who puts no pressure on me sexually and always makes me feel good, which I deeply appreciate. We are very open about sex, and he's said he's willing to try anything (that won't potentially damage the relationship) to get me to experience an orgasm. And I want to experience it so badly! However, I can't help but feel a little frustrated when I look for tips, and all I see is "touch the clit!", or "rub the g-spot!", or "masturbate!" etc. My clitoris is very small -- not that I would know by comparison, it just seems... really small. Too small to get any pleasure from. And I don't really get much pleasure from it, except when he's giving me oral, but even though it feels good, it's not intense enough to bring me to orgasm.

I'm glad you have such an open and caring relationship!  This bodes really well for the kind of work that you'll have to do to get your orgasms.  As for the clitoris, size doesn't matter.  I have a really tiny clitoris too (apologies for the TMI, readers), and it works just fine.  It's more a matter of figuring out what kind of stimulation works best for it.  Do you like direct contact?  If so, you may have to pull back on the clitoral hood to expose the clitoris.  Is that just way too sensitive?  If so, playing around the clitoral hood is better.  If you like oral, you may be enjoying a sucking sensation which is hard to reproduce with any other implement.  If it feels great, though, then your clitoris is working.  You're not broken. 

Oh, and yes, it is lame when people just say "find your g-spot!" as though that is a good enough answer for the female orgasm.  It may be enough for some, but for most, it's a whole lot more complicated than that!

As for the g-spot, there have been times when he's been going down and fingering me, which feels GREAT. There might have even been a few times when, if he went on for a while longer, I might have been able to come. But usually I end up initiating intercourse, either because I'm ready for that "full" feeling of him inside of me, or I begin losing sensation.

If you're getting these times when it feels great, then I think you are capable of orgasm.  You just have to learn how to manage these feelings more productively.  Sometimes that may mean deprivation -- not having sex even though you really want that full feeling.  Sometimes it may mean getting creative -- using a dildo instead of a finger while he continues to go down on you so that you can have it all.  When you start losing sensation, it's probably time to take a break, because pushing on through that won't get you your orgasm.  Next time around, see if he can tease you much longer and see if you can manage your mental state of arousal so that, once he actually starts to stimulate you in earnest, you are already farther progressed towards a climax than usual.  This may be all it takes, management of arousal and timing.

And that brings us to... masturbation. I don't care for it. I don't get anything from it; not only does it feel like a complete waste of time while I'm doing it, it doesn't feel all that great. I've tried vibrators and fingers, but it all does nothing. And I can never seem to get turned on by thinking kinky thoughts. I used to read a lot of erotic fiction, and for some reason I no longer derive any pleasure from it. Porn? It's interesting, occasionally fascinating, but it does nothing for me. I don't even get turned on. So masturbation's out.

In general, I think that masturbation is, hands-down, one of the best ways to work towards an orgasm.  If you know that it doesn't work for you, then I can't argue with that.  You know your body and your sexuality better than I do.  Sometimes these things come and go in cycles, though.  If you used to like erotic literature, it may titillate you again someday, and if it does, then take advantage of it and try to find the pleasure in the different sensations of masturbation.  If not, then that's fine, it just means that you'll have to put in all the practice with your boyfriend, and that might take a little longer.  No worries, though.  I'm still confident that you'll get there eventually.

Another possible factor -- my boyfriend and I are in a long distance relationship, and he is my first in terms of intercourse. We've discussed this recently, and we think that this may be one reason I have trouble reaching orgasm. We only see each other once a month, and although we've been together for over two years, maybe I haven't had enough sex to learn what I really like. I'm also on Yasmin, by the way.

Distance is definitely a factor here.  You can't practice regularly the way you could if you loved masturbation or if you lived with your boyfriend.  Again, this may mean it takes longer for you to figure out the orgasms reliably, but it will come eventually.

The yasmin may or may not be a factor.  Some women experience sex drive suppression on hormonal contraceptive -- not orgasm suppression, but decreased libido.  This could be contributing to your disinterest in solo-sexuality.  If you want to test this out, you may consider asking your doctor to switch to a lower dose hormonal contraceptive for a while and see if things change.  If you're happy on your BC, though, if it's working for you, then don't sweat it. 

Also (and I'm sorry this is turning into such a long-winded email!), is it unusual to have been molested but not have any real emotions from it, only "phantom" effects that manifest in subtle ways? Because I was molested when I was 12 by my abusive stepfather, but since then I haven't had any negative reaction to it. The act ended up with my mom divorcing him, which was what I'd been dreaming about for years. So in a way, my intense elation at my mother's and my freedom from that man eclipsed any distress I should have experienced from the molestation. My boyfriend and I are wondering if maybe my orgasm difficulties are actually a subconscious block left over from the molestation. If that's the case, I won't know what to do, because as far as I'm concerned, I've moved past it and am very happy. Talking to a therapist about it (again; the first time was neutral because I didn't really need it) would do nothing but make me feel like the event is still plaguing me, like a victim, when it's obviously not.

You know, I'm not a psychologist, and if you worry that there may be something deeper hidden in your psyche, you should probably seek out a therapist to help you tease it out.  I'm with you, though.  Different people respond to things differently.  It is tragic and awful that your stepfather abused you in this way, but if you have been able to grow and move on from that without harboring any major scars or pain, then wonderful!  I take that at face value.  It is entirely possible to live a normal live with a normal sexuality even after these kinds of events.  Does everyone?  Of course not.  But if you do, then you do, and that's great.  So many women have trouble reaching orgasm without any such past experiences, that I think your orgasm difficulties are probably pretty straightforward.  As always, though, if you want a professional opinion on this then you should definitely seek one out.

I really do think it's a good combination of the long distance/lack of experience and perhaps the birth control.

I don't really know what I'm looking for in terms of advice, but any insights you have on my little orgasmic issue would be much appreciated!

I hope that this answer helped!  I think that it's an issue of figuring out how to manage timing, titillation, and sensation.  Without being able to practice every day, this process is going to take a bit longer for you, but you've got a willing and able boyfriend, and a really good awareness of your body and sexuality.  I think it's just a matter of time and practice.  Don't make it a chore.  Don't put any more pressure on yourself than you need to.  Just enjoy exploring touch and pleasure and timing without too great a sense of urgency.  You'll get your orgasms eventually!

Pain During Sex II

Hello Kate!

Pain and sex is not something I appreciate. Lately I've been feeling some discomfort during sex. It's not really that painful, but after a couple of minutes of penetration we have to stop. I don't know what's the problem here. My last appt with my gyno was three weeks ago and everything was perfect. It's not a problem of wetness, it's not a problem of lack of foreplay and it's not about lack of communication. This has been going on for the last 4 weeks and it happens every time. Sometimes it gets a little better with time and a lot of pauses but most of them it ends with a "ok, let's forget about this and do other stuff" feeling.

Any ideas? It's quite frustrating and I don't know if I should go back to the doctor to have it checked again.

Thanks!

Pain during sex is no fun at all, but unfortunately it is a problem that many, many women deal with at some point or another. I wrote a long post about some causes of pain during sex, you might want to read through it:

Pain During Sex

It is worth calling your doctor about this.  Start with a phone conversation with the nurse or doctor on duty.  You will likely leave a message and be called back later in the day.  They may be able to give you some suggestions over the phone, or may ask to have you come in for another pelvic exam.  The most worrying cause of pain during sex would be an STI.  If you looked great just a few weeks ago, then it is unlikely that you were displaying any obvious symptoms of an infection at that time, but you could be expressing symptoms now that they want to look for.  Something like a low-grade yeast infection might not have been showing irritation a few weeks ago, but it might now.  They likely tested for chlamydia as a matter of course, but perhaps want to screen for additional STIs just to be safe.  You can get more information over the phone and head in if it seems prudent.

Before you call, try to put into words what kind of pain this is.  Is it a stabbing pain?  A dull pain?  Does it feel like frictional irritation like a rug burn?  Do you feel as though your vagina is tensing up?  Does your boyfriend feel as though your vagina takes on a vice-grip when you are in pain?  These details can be clues to help hone in on what your problem is.

Good for you for ruling out lubrication and for keeping very open communication with your partner.  Good for both of you for not just pushing through the pain when you are in serious discomfort.  Some pain you can relax through and it eases and dissipates, but you should never push through pain that is escalating.  It sounds as though you have a very good sexual relationship and a good head on your shoulders about this.

Based on what you've told me, I think that you could be experiencing vaginismus, an involuntary clenching of the vaginal muscles, and that it might be escalating as you have sex.  If this is your problem, do not despair!  You can practice relaxation exercises to help re-train your body to stay loose and relaxed during sex. It takes some practice and adjustment, but it is possible. 

I also think that you could be experiencing an allergic reaction.  Allergies can come on over time.  I was not allergic to latex as a child, but I am allergic to latex now.  If you use condoms and have developed a latex allergy, then sex might feel okay for the first few minutes, but get progressively worse as your exposure time wears on.  An easy way to test this is to switch to latex-free condoms.  Trojan and Durex (the two biggest brands around here) both make latex-free condoms that are effective against both pregnancy and HIV.  Don't be fooled by decade-old advertising that claims latex is the only condom that protects against HIV.  That was true when the only latex-alternative was a biological membrane called "sheep skin," but it is not true now that they make condoms out of other synthetic polymers.  You could also be sensitive to spermicide, which is incredibly hard on the vagina.  Avoid spermicide at all cost.  Using other reliable methods of birth control should render it unnecessary anyway.  

Those are my two best ideas for now, but I think that you should call your doctor to get a professional opinion.  Pain during sex stinks.  I hope that yours is resolved soon so that you can get back to full enjoyment of your sex life.

Sexual Timing

Kate,

I'm having a sex issue. My boyfriend and I have been sexually active for over a year. At first it took him forever to come and there were several occasions that he never did. I made it my mission to get him to come as often as possible. Over the last few months it's become much more regular, almost an every time occurrence. I figured it was a combination of things, him being more comfortable, me working harder, and lots of foreplay on my side to warm him up.

It's been great, however, the last two times we've had sex he's been coming abruptly. I hate to look a gift horse in the mouth because I'm almost more excited when he comes than when I do, and I would have gladly traded my orgasm for his on those early nights. But I NEED my orgasm, especially after our foreplay sessions.

Should I scale back the sexy, the foreplay? The first time this happened was after a very long blow job, I kind of expected it. The last time I was just wearing a slip nightgown and we watched a movie together before going at it.

Maybe I'm just over thinking it, maybe it's just an off couple of weeks. My starving libido is clouding my judgment. Sex with myself just doesn't measure up.

So I guess my question is: Since he's coming more should I work a little less?

for the delay in my response!  It's been a crazy week.

So he used to take forever to come, but now he's coming too soon?  Looks as though you need to work towards some kind of compromise.

I'm not sure that I'd say that you should work less, but you probably should modify your foreplay so that it is more conducive to both of your sexual pleasure.  If he is ejaculating prematurely, then he might not need as much physical touch before sex as you had been giving him before, when he took a long time to orgasm.  If he is ejaculating prematurely before you even touch him, then he might want to work on orgasm control on his own time.  I can outline a few things for you to try when with your boyfriend, and a few things for him to try on his own, too.

When you're with him, if you find that he is more sensitive or responsive to touch than he was before, try backing off of the most intense forms of stimulation during foreplay.  Instead of giving him a blowjob or handjob before sex, tease him with your mouth or fingertips.  Avoid touching the glans (the most sensitive part of the penis).  Make foreplay a way to get him excited and eager for sex rather than progress towards his orgasm. 

More importantly, if you are now having a hard time getting off within the shortened time limit, you should encourage more attention on yourself during foreplay.  Oral sex for you, manual stimulation, whatever helps work you towards your orgasm would be a great investment of foreplay time.  That way, you'll be closer to your own orgasm by the time you actually start having sex, and his shorter timing won't be as much of a problem.

There are times when it sounds as though his orgasm comes before you even start to have sex.  Modifying his timing isn't something that you can do entirely for him, it's something that he has to practice on his own.  The good news is that it is quite possible for him to develop better control over the timing of his orgasm through a few simple methods.

First, if he orgasms at the drop of a hat, he might want to try masturbating more often.  Many men find that their first orgasm of the day comes more quickly than subsequent ones, so if he keeps up a healthy schedule of masturbation, then when he sees you, his early-trigger response may be suppressed.

When he practices this masturbation, he should also try to work towards restraining his orgasm so that he can develop the ability to hold back when he is having sex with you.  One way to do this is to slow down or let up on stimulation when he nears his orgasm, back off the sensation, then work back up again slowly.  He should also experiment with different kinds of tension in his body as he nears orgasm.  Does relaxing his body help him back off and last longer?  Does tensing certain muscles help?  Another thing he may want to play with is whether or not he can, through clenching his pelvic floor muscles, retain his erection even after an orgasm.  Some men can do this, others can not.  It isn't any shame for him if he can't just keep his erection after his orgasm, but it might be something for him to play with to see if he can develop that particular trick.  If he can, then it would matter less when he orgasms because he could continue to penetrate you until you come too.  Masturbation needn't just be a means to a quick and dirty end for your boyfriend, he can use it as a tool to help hone his sexual control and improve your shared sex life.

I do not have a penis, so my words on male orgasm control are pieced together from things I have read and stories shared by some of my male friends over the years.  I invite the male response to give more specific and helpful input on this matter than I can give.  Please call me out if what I say is ridiculous, and please offer your own words of experience in turn!

My only final suggestion is that, while you two practice finding your cadence and coordinating your timing, you may consider other ways to help you reach your orgasm even if your boyfriend does come first.  If you really like internal stimulation, perhaps he could switch to fingering you after he comes.  If you're more of a clitoral girl, then there are any number of things that he could do to switch to stimulation of your clitoris and finish you off.  If you need that fullness of having a penis, and a finger or clitoral stimulation just won't cut it, consider introducing some sort of toy into your shared sex life so that he can quickly switch from penis to toy when you need more time.  Some men will be very sensitive on this issue, so introduce the idea in a way that makes him feel helpful and sexy -- the means to your orgasmic end -- rather than like an inadequate minute man, and don't choose a penetrative toy that dwarfs his penis.  Unless he is totally on board and enthusiastic, that would definitely be bad sexual etiquette!  

I have faith that you two will, with practice, work out better timing.  The suggestions I have given will hopefully speed this process, but I think that you would figure it out on your own through trial and error eventually.  After all, you and he solved your initial problem!  You can solve this one too.  Good luck to you both!

Stress, The Mood Killer

Hi Kate!

Lately my very sexual self has turned into an "I'm not in the mood" person due to the stress my job is causing me. The 7-9 times a week are gone. Now it's once a week (if that) and when we do it, I'm not really into it. It's not that I feel obligated to do it, which I don't, I wanna do it but I'm not capable of forgetting all my worries and enjoying it. This means I don't orgasm. I don't worry too much about it. My sexual life has been very satisfying since I'm with him and I'd never had trouble reaching orgasm. I know my libido will be back to normal once I'm done with this damn project in a couple of weeks and lack of orgasming will no longer be a problem.

So why am I here then? My boyfriend thinks it's a big deal. He believes it's about him, that he may be doing something wrong. Of course he's not! I try to reassure him and let him know how attracted I feel to him, but stress is taking a toll on me and he may have to satisfy his needs on his own. I don't think I convinced him though. I can see he feels insecure and I hate that I don't have more time to spend with him.

What can I do to convince him that it's not about him?

You are off to a good start.  This is a problem of communication.  Your sex drive has changed in a way that you understand well, with a source that is short-term and will solve itself in a matter of weeks.  In the meantime your boyfriend is left feeling as though he is doing something wrong.  You know that he is not doing anything wrong, but that your body won't let you enjoy sex as much when you're so stressed out.  Telling him this point blank was the right thing to do, but it appears that it is not enough to set him at ease.

Stress can take a toll on men too.  You might try to relate to him on this level of personal experience.  Ask him if he has ever been so stressed out that he just wasn't able to let go and enjoy the things that usually bring him pleasure.  Explain that this is how you feel right now, and that sex is one aspect that has taken a hit.  The effect should be quite temporary, but for now, your stress levels make it very hard for you to stop your brain for long enough to just enjoy sensations of touch.  The female orgasm is wrapped up in the psyche.  If your mind is in overdrive on your project, it might just not be possible to enjoy sex, let alone reach orgasm.  That is clearly no fault of your boyfriend's.  His physical technique might be masterful, but it won't make any difference if you can't let go of your stress to enjoy it.  Make this much clear.

Your boyfriend might be one of those people who is not satisfied to just have a problem explained to him.  I sense that he wishes to find a solution.  There is your plan to wait out the situation, knowing that the stress will dissipate.  I agree that this is a perfectly suitable solution, it will almost certainly work, but it isn't one that allows your boyfriend to help in the progress.  We should come up with some ways in which your boyfriend can help you to relax and confront the source of the sexual disinterest: the stress itself.  I doubt that this will immediately get you back to 7-9 orgasmic sexings a week, but it might make him feel as though he is doing something right and it might introduce the opportunity for a few genuinely positive sexual experiences even during this stressful time.

Suggest some ways in which he might help to alleviate your stress.  Some people relax very well with massage.  Ask him to put on some relaxing music and massage you one night to help get work off your mind. 

I always relax better if I see sources of worry knocked off my list.  For instance, coming home to find that my husband has prepared dinner or vacuumed the house would be a huge relief to me in a stressful time.  It would be even better if he sent me off to do a few yoga poses while he did the dishes.  To me, that would be better than a full-body massage, just knowing that I was being looked after and that I could stop thinking about some of my usual chores.  It might open up the opportunity for me to let go of my day and really enjoy his company, even if things were terrible at work.

I don't know how that would sound to your boyfriend... "Wait, you mean no sex AND I have to cook dinner?" but if he is looking for ways to help, present him with options.  Let him help you, and make a concerted effort to use your extra time to let go of your busy day and put yourself in your at-home head space.  After that, cuddle it up and see what feels good.  Even if you're not up for sex, just the show of affection might be enough to set him a bit at ease if he is worrying about your feelings for him.

In the end, I believe that you are right.  This, too, shall pass.  Over the next few weeks, though, while things remain hectic, let your boyfriend help you with your daily grind in any way that he can.  When you get home, leave work at the office and try to enjoy your boyfriend's company.  Don't push the sex, but do make an effort to show your affection and appreciation for your boyfriend.  Instead of trying to have sex every day, just try to relax and enjoy his company every day.  Let sex happens when it comes naturally again.  Hopefully you can at least foster closeness with your boyfriend and manage your stress a little bit better even during this difficult time. 

Good luck!  I hope that your project goes smoothly and I hope that your boyfriend realizes that he is valued even if your libido is temporarily stifled.

Where to Find a Fantasy

Hello Kate! Whenever I masturbate I can not think of something to fantasize about. Can you give any tips on what to do?

I don't generally get questions that make me blush, but the idea of sharing my own sexual fantasies on the internet has me beet red.  I will be keeping my own thoughts to myself.

I can, however, help point you in the direction of many other people's sexy thoughts.  You can always sift through these and figure out what works for you and your imagination.

Different people find different scenarios titillating.  What is a huge turn on for one might be a disgusting or disturbing fantasy for another.  The beautiful part of fantasy, though, is that it is safe and private and very much your own.  You can customize your thoughts to whatever you like and banish the thoughts that turn you off.

So where to start?  You could start from square one, just allowing yourself to imagine sexual scenarios, and embellishing when you think of something that turns you on.

If this seems like too much independence too soon, if you are looking for some direction, you could start at the main story page for literotica, and just scroll down to the categories.  These categories represent some common themes that people fantasize about.  If any of them sounds enticing to you, you could just use that key word or phrase and let your imagination take it from there.  If you're at a loss for what to picture or how to fantasize, just click the link and choose a story.  On an erotic story website, hundreds of other people have already done the fantasizing for you, and you can read pages upon pages of what they came up with.

There are plenty of other sources of inspiration out there.  A great many people use porn to fuel their fantasies.  A quick websearch should give you a lifetime's supply -- but most of it will be mainstream porn, which turns plenty of people off.  I, myself, find mainstream porn to be fake and creepy looking and therefore not arousing.  If you want to look at sexual imagery but don't like mainstream porn, you could search for antique or vintage porn (images from before the age of cosmetic surgery and the porn star), or you could try amateur porn (sex acts taped by normal people or couples or groups outside of the sex industry), or you could look for erotic art forms like erotic comics.

If you prefer the written word, there are many databases of stories online, but there are also books that are collections of stories.  You can search "erotic stories" on Amazon or just spend some time in the erotic literature corner of your local bookstore.  Some people prefer to be swept up in the story of romance novels, which can get pretty heated on certain pages.  You can generally identify these books by the dramatic, bodice-ripping soft covers and the tattered pages of the steamiest chapters. 

In short, there are troves upon troves of fodder for sexual fantasy to be found and enjoyed, and they may help give you some scenarios to play with and expand upon in your own imagination.  The only rule is this: you have to allow yourself to feel good while thinking about these things.  If you get too caught up in guilt or complex emotion, you won't likely benefit from the experience of sexual fantasy.  Remember: fantasy is safe.  It is private.  Nobody ever has to know what you're thinking about and you have nothing to be ashamed of.  Your mind is an erogenous zone, and it is healthy and normal to use it as such, even if that means feeling turned on by thoughts that are more adventurous, dangerous, naughty, or embarrassing than you would ever want to actually do in real life.  That's just the nature of human sexuality!

Good luck, and enjoy your imagination.  This is about the safest sex you could possibly be having!