In an era where health information is often overwhelming and contradictory, HT Lifestyle has launched a reader-centric initiative: HT Health Talk. Every week, we invite readers to share their most pressing medical concerns, and put these burning questions directly to the nation’s leading medical experts. Read this also HT Health Talk: You asked, our experts answered how to manage summer migraines
This week, HT readers reached out with a number of concerns regarding sexual health – Many readers expressed concerns regarding premature ejaculation, others shared concerns regarding the physical sensations associated with intercourse.
To provide clarity, comfort and clinically supported solutions, we chose two experts from Bengaluru: Dr. Santosh Raj, consultant in general and laparoscopic surgery, male infertility and sexual health at Motherhood Hospitals, and Dr. Deepti Ashwin, consultant obstetrics and gynecologist at Aster Whitefield Hospital.
1. I have trouble reaching orgasm very quickly. Is premature ejaculation a condition that can be treated or managed medically?
There can be many factors that can cause premature ejaculation including performance anxiety and sensitivity. If he has high sensitivity in the glans penis, it is at the very least a hormonal problem. Factors may also be that it may be a habit, not having a strong pelvic floor and infrequent intercourse; All these can cause premature ejaculation.
It can be treated. Initially, we can make some changes with counseling on how to perform, how to procrastinate, and how to handle anxiety. Another method of treatment is behavioral therapy. Other treatment methods include local applications that may reduce sensitivity and delay climax; The use of condoms, and there are also some medications that can help delay ejaculation. If nothing of the above is working, the problem can be treated surgically through circumcision.
2. I experience significant physical tension and physical discomfort during intercourse or self-stimulation. What underlying medical or psychological factors may be causing this painful, constricting sensation?
Physical causes of such an experience include problems with the pelvic floor muscles, which are either too loose or too tight, or not strengthened well. Other causes may be prostatic/testicular inflammation or tight prepuce skin such as phimosis and paraphimosis. Prostate and testicular inflammation can cause painful ejaculation. If the foreskin is tight or if there is paraphimosis, the foreskin of the penis retracts, and the buttock does not move forward. All these things can cause some kind of physical problem.
Psychological factors include Tension and performance anxiety, where a person will always be very conscious about their performance or will not reach climax soon enough. These experiences may also arise from conflict in relationships or past sexual trauma.
3. What is the recommended hygiene routine to maintain the health and hygiene of the uncircumcised penis?
The recommended hygiene routine to maintain the health and hygiene of the uncircumcised penis includes daily cleaning during bathing when you fully pull out the penis and clean the head with soap and water. It is also advisable not to touch or hold your penis while urinating after washing your hands. This way, any fomites or infection you come in contact with will not enter your body or penis.
4. Is there any clinical evidence to suggest that common hair loss treatments can have a negative impact on male libido or sexual function?
Yes. Typically, we treat male pattern baldness with Minoxidil. Topical application of minoxidil will have little effect on sexual activity or libido. However, we also prescribe another medicine called finasteride. Finasteride is a male hormone-suppressing agent, which can cause impotence with long-term use and at high doses. This may not happen in every person, but is seen in most of the cases. It has been clinically proven to cause impotence or loss of libido.
5. What are the physical effects of masturbation on overall health? Additionally, is there a recommended frequency, and are there benefits or drawbacks to complete abstinence?
Masturbation in itself generally does not have a significant effect on one’s overall health. However, excessive reliance on pornography for sexual arousal may, in some individuals, affect expectations and arousal patterns in real-life intimate relationships. Sometimes, it can also affect emotional or physical intimacy with the partner. Although there is no recommendation on frequency, it is scientifically proven that in the long run, a man who ejaculates less often has a higher risk of prostate cancer than a man who ejaculates regularly. It should be noted that there are no significant drawbacks to moderation.
6. I experience a significant increase in sexual desire, especially at night. Is this hormonal peak considered a normal variation in human libido?
Feeling the desire to engage in sexual activity and increased levels of libido is a completely normal phenomenon and can be linked to a number of physical causes. The evening is usually a time when a person is more relaxed, less stressed, and has more personal space for personal matters; Therefore, the desire may be strong during that time. Hormonal rhythms may also play a role. For example, testosterone levels in men are often higher in the morning, while hormonal function in women can vary depending on the menstrual cycle. Therefore, we cannot attribute this phenomenon to hormones alone. Factors such as privacy, absence of work-related stress, and quiet environments may contribute to increased desire at night.
7. For those experiencing erectile dysfunction, to what extent is the condition reversible or manageable through lifestyle changes and medical intervention?
Erectile dysfunction can be caused by many different factors. It may be physical, hormonal or psychological. Psychological factors usually refer to anxiety and pressure. However, in some cases, erectile dysfunction is somewhat unique when it comes to the psychological aspect, where, apart from the usual examples like anxiety, performance, pressure, marital problems and others, there is another problem. One who is experiencing erectile dysfunction only in the presence of a specific person/partner, while masturbation and sexual intercourse with other persons is normal. Such problems can be easily addressed in a psychological manner.
We will try to deal with this problem through psychological treatments, which include dealing with anxiety, pressure and various methods of stimulation. In case of hormonal issues, we need to consider the role of various hormones in affecting a man’s erection. Correcting this, along with many other aspects, will increase overall testosterone levels, which will also help with ED. Physical measures include treating pelvic floor weakness using exercises modeled after Kegels, along with strengthening of the parapelvic muscles including the glutes, abdominals, quadriceps and hamstrings will also be helpful to some extent. Weight lifting exercises, proper and balanced diet, diet with high protein content, combination of strength training and cardiovascular exercises, weight loss, muscle gain, etc. will all be responsible for increasing male hormones, improving erectile dysfunction.
8. What are the current medical views on the health benefits versus potential risks of circumcision?
A circumcised penis will have more medical benefits than an uncircumcised penis. First of all, the number of infections is less likely to occur when a male is circumcised. Infections are minimized, and even sex becomes good, because when a man experiences premature ejaculation due to increased arousal, circumcision keeps the penis erect for longer. This is a hygienic practice as the formation of smegma under the foreskin is prevented.
9. Can you explain the primary modes of HIV transmission and identify which behaviors pose the highest risk of infection?
The virus is spread mainly through contact with infected blood or through unprotected sex, and from an HIV-positive mother to her child during pregnancy, delivery or breastfeeding. One of the major risk factors for contracting HIV is having unprotected sex with an HIV-infected person. You are more likely to get HIV through anal, vaginal or oral intercourse if there are cuts, tears, bleeding and contact with infected blood fluids.
10. Is it medically safe to use petroleum-based products like Vaseline as a sexual lubricant, or are there specific health risks involved?
Petroleum-based products, such as Vaseline, are not recommended for use as lubricants during sex. Water-based lubricants will be much better than Vaseline. Vaseline causes irritation in the genital areas of the partner’s body. This forms a film coating inside the vagina and causes infection. So, these are all the potential health risks of using Vaseline. Lubricants manufactured by some brands may be more useful for the process of intercourse.
11. What are the real risks of getting or spreading an STI during oral sex, and what preventive measures should be taken?
Oral sex generally has a lower risk of STI transmission than penetrative sex, honestly the chances are generally lower, but it’s not a zero-risk thing. The actual risk is not the same for each infection; Some spread more easily than others, depending on the type of contact and whether symptoms are present. High transmission risk from oral sex: herpes, HPV, gonorrhea, syphilis. Moderate risk: Chlamydia. Low, but still not zero risk: HIV, and this chance increases greatly when there are oral lesions, bleeding gums, or genital ulcers.
Here’s what you can do to reduce the risk in a practical way:
– Use a condom during oral sex when it is being performed on the penis.
– Use a dental dam (or a cut condom) on the vulva or anus during oral sex.
– Get regular STI testing, especially because oral infections can remain silent for a long time.
– Consider HPV vaccination, it is very effective against the strains associated with oral and throat cancer.
– Do not have oral sex when either partner has visible sores, ulcers or active outbreaks.
– Maintain good oral hygiene, and avoid brushing or flossing right before oral sex, as micro-abrasions can subtly increase the risk.
12. From a medical perspective, are there any physical signs that can definitively prove whether a woman has had sexual intercourse or not?
There are no physical markers to prove whether a woman has had sex or not.
13. If a woman misses her hormonal birth control pill dose, what is the immediate medical protocol to ensure continued protection?
Missed pill in less than 24 hours: Take the missed pill immediately, then continue taking the pack as normal. Your safety mostly remains intact. Missed by more than 24 hours (one pill): Take the missed pill as soon as you remember, even if this means two pills in one day. After that, continue as usual. For the next seven days, use backup contraception, such as condoms. If you forget more than two pills, take the latest missed pill immediately, then remove the earlier pills, continue with the pack as if nothing happened, it’s okay. Also, use additional backup contraception for seven days to be safe. Now, if pills are missed in the third week, skip the placebo week completely and start a brand new pack immediately, without any delay.”
Note to readers: This article is for informational purposes only and is not a substitute for professional medical advice. Always seek the advice of your doctor with any questions you may have about a medical condition.
