Ask the Experts: Sexual Health

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Below are some of the questions people have sent us about sexual health. Click the + to see answers from our experts.

 



I have a small penis. How can I enlarge it?



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Almost all men have a normal size penis – although many young men are concerned that their penis is too short or too small. Sometimes they believe this because they have compared themselves with friends or classmates in a common shower or locker room, or maybe someone teased them or made a hurtful comment. Or they might have seen pornographic pictures or movies and compared themselves with the porno “stars” (many of whom have unusually large genitalia).

The penis reaches adult size over a number of years during puberty (the years during adolescence when boys and girls grow and change to become adult men and women). A boy who matures more slowly than his friends will not get an adult-size penis until late in adolescence – and this may cause anxiety or make him feel as though he has an abnormally small penis.

It is also worth noting that a man’s penis may change size considerably depending on time of day, temperature, and factors other than sexual stimulation or excitement. During sexual stimulation or excitement, the penis becomes engorged with blood and stands erect – but there is a wide variation in normal size and shape and angle for an erect penis also. In some men, the erect penis is almost the same size as the flaccid (soft or non-erect) penis, while in other men the erect penis is much longer and wider than the flaccid penis. You cannot tell by looking at a man’s flaccid penis what size it will be when erect.

As a general rule, the size of the penis does not determine a sexual partner’s satisfaction with a sexual experience. That usually depends much more on the relationship between the two people and on both partners trying to make each sexual experience mutually pleasurable and satisfying for both of them.

Because many young men are concerned about the size of their penis and would like it larger, there are many unethical people or businesses that offer lotions or pills or other types of non-medical treatment to enlarge or lengthen the penis. None of these methods have been fully tested in clinical trials and approved for medical use – and none of them are recommended by reputable physicians. They are taking advantage of a man’s concerns about his penis size (despite the fact that most men have a normal size penis) and seeking to get his money for treatments that are worthless at best. Some can be dangerous or may even damage the penis. None of these methods or products can be recommended or should be used.

Finally, there are a few uncommon medical conditions of the penis that a man should talk about with his doctor (especially a urologist). The first is an extremely small penis, a condition called micropenis in which the penis does not develop to a normal size. Occasionally a boy will also have a penis that does not develop normally even before birth; usually these conditions are recognized shortly after the baby boy is born and given the necessary medical attention. Another medical condition occurring most commonly in middle-aged men is Peyronie’s Disease. In this problem the penis develops scar tissue that may cause it to be smaller or curve abnormally – but this is not a cause of concern about a small or short penis in young men.

Online References:
Wikipedia article on human penis size
Study: Men May Overestimate Normal Penis Size
WebMD: Penis Enlargement, Does it Work?

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I read the study that suggests boys who masturbate are also more likely to use condoms. Why would there be such a connection? And really, doesn’t everyone masturbate?

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The exact reason isn’t known for an association between young men’s condom use and masturbation. One simple possibility is that masturbation allows young men to become more familiar with their own penis when it is erect. Using condoms is pretty easy, but knowing what to expect, and some practice, can make it really easy.

Another possibility is that young men who masturbate may be more comfortable with their sexuality. We’ve begun to learn in the past few years that young people who are comfortable with their sexuality are often more careful in protecting themselves and others. It may be that masturbation and condom use are both ways by which people express their sexual health.

A final important point about the study you read is that it shows that people still masturbate even after they’ve started having sex with others. In fact, we know that many men and women continue to masturbate even into their 60’s and 70’s. Even if masturbation isn’t for everyone (isn’t it nice to be able to choose?), it certainly seems that masturbation is a part of people’s expression of their sexuality, no matter how old.

--J. Dennis Fortenberry, MD, MS



Currently I am 27 years old and I still experience wet dreams.
Is this normal?

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Different experts define “wet dreams” (or “nocturnal emissions”) slightly differently, so I will start with the broadest possible definition of wet dreams: episodes of lubrication, ejaculation, and/or orgasm during sleep, which may or may not be associated with sexual sensations or dreams. In males, wet dreams are one way the body rids itself of a buildup of seminal fluid and sperm in the testes, prostate and seminal vesicles. In both males and females wet dreams may be sparked by changes in hormones, the physical sensations of one’s genitals rubbing against the sheets, dreams with sexual content, or a full-bladder.

During an average night’s sleep, most males will have several erections, no matter what their age. Not having night-time erections, in fact, is a sign of erectile dysfunction among men past puberty. Similarly, most females will lubricate several times each night. So a more practical definition of a “wet dream” is any experience of lubrication, ejaculation or orgasm which a person happens to notice, either because s/he wakes up during a sexual dream, or because s/he wakes up to a noticeable wet spot on his/her sheets or underwear.

Though the incidence of wet dreams does tend to decrease as people age and/or become sexually active, having wet dreams at age 27 is not uncommon. It is possible that as you get older the frequency of your wet dreams will decrease over time, though some sexually healthy men and women continue having (and even enjoying) them for their entire lives.

If your night time experiences are distressing for you, you might try masturbating more often or before bed in order to see if that affects your rate of nocturnal emissions. Many people report that when they increase the amount of sex which they have during the day—either partnered or solo—they have fewer noticeable wet dreams at night, though others notice no difference in frequency. Since frequent orgasm is correlated with increased lifespan, strong immune system, and a decreased risk of heart disease and some kinds of cancer, making masturbation part of your daily routine is likely to have a positive effect on your health, whether or not it affects the frequency of your wet dreams.

Some men experience wet dreams as one symptom of what is sometimes termed “premature ejaculation,” which simply means that they ejaculate during sex more quickly than they and/or their partners would hope. If this is the case for you, read the Q&A about premature ejaculation on this page.

--Amy Stapleford, M.Ed.



I am an 18 year old male. Every time I lay with my girlfriend and hold her I get an erection and prematurely ejaculate. I don’t get an orgasm from it, all I feel is the wetness in my pants. I’m so ashamed of it that I won’t have sex because I don’t want her to know. I lost my last girlfriend because of this. Is there anything I can do to prevent this? Is there something wrong with me? Will I grow out of this? Any advice would be greatly appreciated as I can’t bring myself to talk to anyone about this issue.

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A: The short answer to your question is that there are no negative effects of masturbation. That means in terms of mental health, physical health, sexual health.

The first question to ask is whether or not you are actually ejaculating. It may possible that the wetness in your pants is a generous amount of pre-ejaculate or "pre-cum," the natural, clear lubrication secreted into the urethra and out through the tip when a man is aroused. Some men produce very little pre-ejaculate, while others can produce around a teaspoon, certainly enough to make your underwear feel wet. You cannot control the amount of pre-cum, but you take comfort in the fact that all men secrete pre-ejaculate and that your body is doing its job well.

If you are ejaculating prematurely—before you want to—you should know that this is quite common as well. Is there anything wrong with you? Probably not, though I certainly recommend talking with your healthcare provider. Certain anti-depressants can inhibit sexual arousal, and your healthcare provider will know whether this option might be appropriate for you. Will you grow out of it? Probably so. Most estimates suggest that about a third of men have some challenges with ejaculatory control, and that most of those men grow out of the difficulty as they age.

The ability to control ejaculation is not a skill anyone is born with; it is one every man has to learn. When you were a young child you learned to control urination. You have probably also learned how to control sneezing, or at least to moderate how loudly you sneeze when you are in a quiet environment. Ejaculation, like urination and sneezing, is a physical reflex, and learning to control it takes practice, experimentation and experience, along with a willingness to make mistakes along the way.

The fact that you recognize the difference between orgasm and ejaculation means you already have a high level of body-awareness. The techniques that are most often suggested for increasing ejaculatory control simply build on this strength you already possess: awareness of your physical reactions.

I caution you against trying to think about a non-sexual topic in order to avoid feeling sexual. Distracting yourself during physical contact with someone you care about is a hard habit to break and ultimately tends to create more problems than it fixes. If your goal is to be able to focus on your girlfriend and your own physical pleasures while also controlling ejaculation, then distracting your mind takes you further away from that goal rather than toward it.

I suggest that first you practice controlling ejaculation on your own while masturbating, using the "squeeze" technique or the "stop/start" technique, both which will give you practice in recognizing signals from your body, allowing you to enjoy sexual sensations and get close to ejaculation without going past the "point of no return," when ejaculation becomes inevitable. Resources to help you learn about these techniques are listed below.

In addition, masturbate to orgasm and ejaculation (once or more) before your dates with your girlfriend. Having already experienced sexual release may slow down your responses once the two of you are together.

I also suggest you talk to your girlfriend about what’s happening for you if you feel you can trust that she will keep this information in confidence. It may be flattering for her to learn that she turns you on so much, and simply sharing this information might help you decrease your anxiety and embarrassment. Anxiety about ejaculatory control may actually make it more difficult to moderate ejaculation. Once your difficulty is out in the open, you can work together modify the techniques you’ve been practicing on your own. The DVD and most descriptions of the practice techniques assume couples are having intercourse, but you can modify the same principles to fit your relationship.

For example, the two of you might experiment this way: See how close you can sit to each other before you get an erection. Slowly practice moving closer to each other and touching each other—first holding hands, then wrapping an arm around her, then allowing her to put her head on your chest. How long and in what ways can you touch before you feel like you are close to ejaculating? At that point, before you reach the "point of no return," move further apart or stop touching until you are ready to try again. With practice, you will likely be able to hold her more closely for longer periods of time.

If you ejaculate before you are ready, don’t worry. Just laugh, go change your underwear (keep several pairs on hand for such occasions), and return to snuggling, knowing that controlling ejaculation will most likely get easier over time as you practice with patience and self-acceptance.

Resources:

--Amy Stapleford, M.Ed.



I have been masturbating for several years. What effect could it have on my physical and sexual health?



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A: The short answer to your question is that there are no negative effects of masturbation. That means in terms of mental health, physical health, sexual health.

In fact, masturbation is such an important part of our sexuality that it appears to be universal. It is practiced by younger as well as older people, and often by people having other sorts of sex as well. Examples of masturbation can be found in sculptures and art from ancient times, and we know that animals masturbate. Masturbation is not just common in humans, but appears to be innate to us. Innate behaviors often have positive health benefits, which allows them to be passed along in time and shared among species. For example, studies from non-human primates (who also masturbate) show that masturbation helps maintain healthy sperm counts. So, I think it is something that is innate to us as human beings, as part of the gift of our sexuality.

Probably the most negative effect of masturbation is worry or guilt about it. I think a lot of people wonder about masturbation because of things heard from others or because of jokes people tell. Sometime people get the idea that only certain kinds of sex are “normal.” However, it is completely accurate to say that masturbation is one of many normal ways by which people explore and express their sexuality.

--J. Dennis Fortenberry, MD, MS



I'm the parent of a pre-teen. I want to know how to broach the subject of sex and STIs with my child. How do I start? What are the main topics I should cover?

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Talking to your children about sex is something that almost every parent thinks about. Especially when their child (or their child's friends) start showing signs of puberty.

Here are some points to consider in getting yourself ready.

1. It's not just one "talk."
You want your teen to understand that sex isn't simple so you shouldn't expect to cover everything in one "talk." Relationships, love, the mechanics of sex, the feelings of sex, the good parts of sex, the dangerous parts of sex...these are all things that require attention, probably more than once.

There are two other important things to remember. First, the fact that you are talking at all is the most important part of helping your child grow up. Exactly what is said, and when, may be less important than talking itself.

Second, listening to your child may be as important as talking. Paying attention to what your child is talking about in other conversations, or watching on television, may give you useful opportunities to engage the issues around sex. As you do this, don't mistake apparent lack of attention for lack of interest.

2. Prepare yourself
It's probably a good idea to prepare yourself to talk to your child about sex. You have your own values and experiences that have shaped you: it may be useful to review those before talking to your child. That process may also be helpful in clarifying your hopes and expectations for your child as a sexual person.

It may help to think about the type of language you want to use. Very few people use formal anatomic language in discussions about sex with others. On the other hand, much of our informal language about sex is considered vulgar. Thinking through the words you can be comfortable with helps express your comfort with the topic to your child.

Finally, do some homework. There are lots of inexpensive resources for parents. For example, Beyond the Big Talk: Every Parent's Guide to Raising Sexually Healthy Teens--From Middle School to High School and Beyond by Debra W. Haffner.

The National Campaign to Prevent Teen Pregnancy has guides in both English and Spanish for parents wanting to help their teen delay sex and be sexually healthy.

3. Look for opportunities to talk
Parents are sometimes so uncomfortable in talking about sex that they attempt to "schedule" a talk. There are lots of circumstances--watching television, listening to news, reviewing homework, riding to practices--when some talk about sex would be appropriate to the context.

--J. Dennis Fortenberry, MD, MS



What is foreplay?


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"Foreplay" is generally defined as any sexual or romantic activity that prepares someone for intercourse. Kissing, hugging, petting, oral sex, manual stimulation (such as fingering), bondage/discipline/S&M (such as spanking), a romantic dinner, dating, sexual teasing, watching or reading porn/erotica, and talking all can be “foreplay” if partners become aroused (“turned on”).

For intercourse to be comfortable, a man’s penis needs to be engorged with blood (“hard”), and a woman’s vagina needs to be self-lubricated (“wet”). Often people get aroused at different rates, so you should have enough foreplay before intercourse to make sure everyone’s ready. If a woman tries to have intercourse when her vagina is not lubricated, for example, it can be uncomfortable or even painful for her.

If you have anal intercourse, foreplay should involve both getting turned on and relaxing the muscles of the anus of the person(s) who will be receptive. Because the anus does not self-lubricate, you’ll need to use lubricant any time that you have anal intercourse (or insert fingers).

Sometimes men or women do not become erect or lubricated, even when they feel good and are enjoying sex. A person’s age, physical health, hormone levels, monthly cycles, drug use, emotions, recent sexual activity, and comfort level with a particular partner can all affect blood flow to the genitals, and therefore may affect erections and lubrication. It is possible to add extra lubrication (water-based lubricant, silicone-based lube, saliva [spit], or vegetable oil [NOT with latex condoms]) if needed, and fortunately there are many fun sexual activities which are not focused on the genitals (penis, vagina) at all.

The word “foreplay” implies that intercourse is the “main event,” the ultimate goal of sex. It’s not, or it doesn’t have to be. We can have hot, steamy sex with or without intercourse. Scientists who study sexuality have learned that many of us can have orgasms from stimulation to almost any place on our bodies—breasts, necks, noses, feet, ears, knees—anywhere!

Some have suggested replacing the term “foreplay” with “outercourse.” Whatever you call it, I’d suggest that you can think of all of those fabulous activities I listed (and more) as part of—rather than simply a prelude to—sex.

--Amy Stapleford, M.Ed.



I am a 64 year-old-woman, and I've been divorced for many years. More and more I find myself thinking about being with other women. I have only been with men, and I feel riddled with guilt by these urges. But I’m also excited about the thought of exploring them. How do I know if I am a lesbian or bisexual? What do I do?

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"Sexual orientation" idescribes one's pattern of sexual and/or romantic attraction to men, women, both genders, neither gender, or any gender expression in between. Though LGBTQ (lesbian, gay bisexual, transgender, queer and questioning) people still face social, political, and religious prejudice, today’s culture is generally more accepting of LGBTQ people than it was even a few decades ago. People who repressed or were not aware of their sexual feelings toward people of their same gender are now “coming out” as LGBTQ. Older adults who are curious about same-sex feelings are increasingly giving themselves permission to explore their attractions.

"Sexual orientation" also refers to the label one chooses to describe him/her/hirself. The labels lesbian, bisexual, straight, gay, homosexual, heterosexual, pansexual, and asexual are all examples of labels which may describe an aspect of one’s self-identity. One’s label does not necessarily reflect behavior, however. Some people who self-identify as heterosexual occasionally have sex with people of their own gender. Some who self-identify as homosexual occasionally have sex with people of a different gender. You get to choose the label that feels right to you.

Many people find that their sexual orientation (both pattern of attraction and self-identifying label) is fluid, sometimes changing multiple times over a lifetime. During one phase of life people might be primarily attracted to those of a different gender; during another someone might be attracted primarily to those of one’s own gender.

As you explore these feelings, I encourage you to find support either online or in your local community at an LGBT(Q) Community Center or a Gay and Lesbian Retirement Center.

For more information, try:

--Amy Stapleford, M.Ed.

 



I am a woman and I like watching porn . . . a lot. Is there something wrong with me?

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Many women and men enjoy and get aroused by watching other people have sex. You are likely to enjoy some porn but not others. Some people, for example, like only porn that looks realistic—in which the orgasms look real and the actors seem to really enjoy each other (“have chemistry”). Some like porn with a story-line; others prefer to skip the story and get straight to the visual images of sex. Some people like close-ups of genitals and other body parts; others like watching the actors’ faces or entire bodies.

You might like to watch porn alone while masturbating, with a partner before or during sex, or both. Watching porn may help you learn what kind of sex you might like to try, but keep in mind that a lot of porn is not terribly realistic. For example, you will rarely see porn actors lubricating their anuses on-screen, but we all need lots of lubricant to be able to have anal sex without injuring ourselves!

In addition, watching pornography or fantasizing about a certain kind of sex does not necessarily mean you want to engage in that kind of sex “in real life.” Sometimes people enjoy watching sex that they wouldn’t actually want to have themselves.

Some people object to pornography for religious, political, or other reasons. If porn makes you feel uncomfortable for any reason, it is absolutely fine to avoid it. If you enjoy it, however, you are in good company.

--Amy Stapleford, M.Ed.



I am a straight, single woman who has not had a partner for years, and I am extremely frustrated by the lack of sexual contact. I masturbate frequently and recently have even watched a few pornographic videos while doing so. But I feel guilty, that buying or renting porn supports an industry that exploits people for their bodies. The thought of men purchasing the bodies of young women sickens me, for example, but am I really so different, paying money for these videos? Is there "woman-friendly" porn you might recommend?

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NOTE: THE LINKS INCLUDED IN THIS REPONSE WILL DIRECT YOU TO SITES THAT INCLUDE ADULT-ONLY CONTENT. CLICK ON THESE LINKS ONLY IF YOU ARE OF THE LEGAL AGE OF CONSENT IN YOUR STATE AND ARE IN AN ENVIRONMENT APPROPRIATE FOR THE VIEWING OF ADULT CONTENT (LINKS ARE NSFW). ASHA is not responsible for the availability or content of these external sites, nor does ASHA endorse, warrant or guarantee the products, services or information described or offered at these sites.

I think it is great that you are empowering yourself to seek out sexual entertainment that you both enjoy and feel good about. It sounds like you want erotica that neither violates someone's privacy nor was made by people coerced, tricked, or forced to participate. Unfortunately, human rights violations happen in many industries, including sex. As a consumer it can be difficult to determine from watching a film or looking at a photograph whether an actor or actress made an active and informed choice to be there. Some women and men, for example, are highly aroused by and knowledgeably consent to being sexually humiliated, experiencing pain, or role-playing non-consensual sex, so it is generally impossible to determine from the content what motivated an actor's/actress's participation.

"Woman friendly" porn made by women and/or with a female consumer in mind is widely available, as is porn in which the actor/actress shares directly with the viewer about his/her/hir experiences. Keep in mind that the sexual tastes of both men and women vary widely, however, so don't get discouraged if it takes some searching to find porn that satisfies both your erotic pleasures and your ethical standards. One place to start is Violet Blue's resource Porn for Women.

You may find it useful to explore your thoughts and feelings about sex work, as well as cultural judgments around sexuality and the body. For example, what does it mean to exploit someone for his/her body, and how is that different from paying someone to perform a physical act that one enjoys or finds useful (sex, athletics, cleaning, construction, surgery, music, dance)? You may find some questions to ponder in my article, Sexual Embodiment Practice: Porn (2007). Consider Violet Blue's perspective on porn in, Our Porn, Our Selves and the sex-positive, pro-porn campaign (2010).

Here are some smart, self-aware women in adult film (and other sex work) whose perspectives may also be of interest:

  • Carol Queen, Ph.D.: sex writer, speaker, educator, activist, filmmaker, and former sex worker. Her book, Real Live Nude Girl: Chronicles of Sex-Positive Culture is an excellent resource which challenges some of the popular societal ideas about sexuality and sex work.
  • Tristan Taormino's Pucker Up: sex information, porn and sexually-explicit educational videos
  • Annie Sprinkle, Ph.D.: former porn star and prostitute, sexuality educator, artist, and lecturer
  • Audacia Ray: former sex worker, educator, and writer. Her book, Naked on the Internet, explores the role the internet has played in women's sexual exploration and expressions as well as the role women have had in building a sexual space on the internet.

--Amy Stapleford, M.Ed.



I’m a 22-year-old guy, and I feel really embarrassed. I can’t get a hard on, or if I get one it goes away before I come. I feel like this shouldn’t be happening to me since I am so young. Isn’t this normally a problem for older men?

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Men of any age can sometimes find it difficult to get or maintain erections. Few of us have bodies that always “perform” exactly as we want them to, and it is perfectly normal for erections to come and go during any period of sexual play.

If you’re concerned about your ability to get an erection, I would suggest that you first see a physician to rule out medical problems. Your doctor will likely ask you questions such as:

  • Do you get erections in your sleep? When masturbating alone? With a partner?
  • Do you drink alcohol, use recreational drugs, or take prescription medications?

Alcohol and other drugs sometimes make people feel less nervous about sex, but they can get in the way of being able to get and maintain erections. Some prescription drugs have sexual side-effects, and some medical conditions affect erections, as well.

If your doctor rules out medical causes, you might want to explore mental or emotional reasons that you are having trouble getting and maintaining erections.

  • Are you attracted to your partner(s)?
  • Do you feel nervous, anxious, or guilty about sex? About getting an erection? About pleasing your partner(s)?
  • Do you know and trust your partner(s) well enough so that you feel comfortable around him or her?

If you are anxious, nervous, or feel guilty about getting an erection or having sex, this can make it more difficult to get turned on physically. Your penis might be "shy," even when your mind is aroused, especially if you feel pressure to "perform" sexually, you don't know your partner(s) well, or if something happened in the past which left you feeling that an erection was unsafe or morally unacceptable.

Because our culture tends to have narrow ideas about what it means to be attractive, you may need to take some time to figure out what it is that attracts you. Do you enjoy looking at, smelling, touching and talking to this person, whether or not s/he looks like the ideal in your head? Would you prefer to be having sex with someone of another gender? Do you like and respect your partner(s)? Do they like and respect you? Many men find that they need to know, trust, and feel very attracted to their partner(s) before they can maintain erections with them.

I would also suggest you explore ways of giving and receiving sexual pleasure without an erection. Your hands and mouth can give someone a lot of pleasure, and every inch of our skin is sensitive to touch. (See more on foreplay)

You may consider talking with a counselor or therapist who specializes in sexual issues, such as those at:

The American Association of Sexual Educators, Counselors and Therapists
The Society for Sex Therapy and Research

 

--Amy Stapleford, M.Ed.



I started masturbating in childhood and I am not able to stop. Will there be problem if continue to do it? I do it practically every day.

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There are many benefits of sexual activity-both partnered sex and masturbation, also called "solo sex." In fact, frequent orgasms are correlated with:

  • Longer life-span
  • Stronger immune system
  • Decreased risk of heart disease and prostate problems in men
  • Decreased risk of breast cancer and endometriosis in women

Orgasms may help you fall asleep, relieve menstrual cramps, relieve migraines and other physical pain, increase genital muscle tone, decrease stress, and increase a sense of well-being. Plus, they are fun!

Masturbation is also a way for you to learn about your own sexual responses. If you learn about the kinds of sensations you enjoy while masturbating, you can better communicate with a partner the types of activities that give you pleasure (and which don't).

Masturbation doesn't need to stop when you have a partner, however. Many people find that even when they are having regular, satisfying partnered sex that they still enjoy masturbating alone. Some people enjoy masturbating to fantasies of their partner. Masturbation is simply different from--not "less" than--partnered sex.

You may also want to try "mutual masturbation", each person giving him/her/hirself pleasure in the company of others. It's a great "safer sex" technique and can be very hot watching someone else get off. You may learn new techniques to pleasure yourself or a partner(s) by watching others masturbate.

There are some occasions when a person may want to avoid masturbation. If a couple is trying to get pregnant, doctors often recommend that the man should refrain from ejaculating for 24 hours or more so that he can conserve sperm for intercourse. After certain surgeries or injuries, the strong muscle contractions of orgasms can cause problems. Talk to your doctor if you think there may be any medical reason to avoid masturbating.

Sometimes people report feeling like their masturbation is compulsive (that they can't stop). If masturbation gets in the way of life activities such as school or work, if you are masturbating without any enjoyment or satisfaction, or if you are chafed or bleeding, your masturbation may be problematic for you. Otherwise, continue enjoying masturbating as much as you like.

Resources:

If you feel your masturbation is problematic, you may want to talk with a sex therapist such as one certified by the American Association for Sexual Educators, Counselors and Therapists.

--Amy Stapleford, M.Ed.



I'd like your thoughts on the morality of using prostitutes. I'm no prude and am all for consenting adults doing what they want, but I worry about exploiting someone who is probably engaging in commercial sex work for a host of reasons that don't involve really wanting to do it. Can anyone ever be a sex worker by choice, rather than coercion of some type? I realize I'm asking your permission to "go for it" and even feel guilty about that!

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In the United States there are few places where you can legally pay for sex. Though I won’t encourage you to break the law, I can provide you with information about sex work.

"Sex work" includes both legal and illegal forms of sexual entertainment, including “peep show” performance, erotic dance, pornography, phone sex, and prostitution. The reasons for choosing sex work are as complex and varied as those for any other field of work. While some sex workers have few job opportunities because of limited time, socioeconomic status, family obligations, and/or education, many sex workers—including those with socioeconomic and educational privilege--actively choose sex work from among a wider range of opportunities.

The prevailing myth that most prostitutes are forced or coerced into prostitution is unsubstantiated by evidence and probably reveals more about negative cultural attitudes regarding sex than it does the actual lives of sex workers themselves. A report by the Sex Workers Project and Urban Justice Center of New York, titled Sex Worker Myths vs. Reality, reports that, "In a July 2006 study, the U.S. Government Accountability Office (GAO) found that current estimates of the number of people trafficked into any kind of work, including sex work, were questionable."

There are almost certainly prostitutes who would prefer to be doing other work, just as there are teachers, doctors, and trash collectors who don’t find their work fulfilling. Unfortunately, prostitutes can get “locked into” sex work by threat of legal punishment and social stigma if attempting to change their line of work. Writing “prostitute” on a job application could not only cost someone a job, but ensure they were arrested as well, in spite of the fact that being a successful sex worker requires many transferrable job skills, including customer service, marketing, advertising, communication, and financial management skills.

Further reading:

  • Desiree Alliance: The Desiree Alliance is a coalition of sex workers, health professionals, social scientists, professional sex educators, and their supporting networks working together for an improved understanding of the sex industry and its human, social and political impacts.
  • $pread magazine: "$pread’s editorial mission is decidedly open-minded: We’ll publish any perspective, even those we may privately disagree with, as long as it is the view of a current or former sex worker."
  • More from the Sex Workers Project and Urban Justice Center: Who are Sex Workers? and Sex Work and Human Rights.
  • For related questions about another kind of sex work, you may want to read "Is there such a thing as ‘woman-friendly’ porn?" on this page.

Note: To reduce your risk of an unplanned pregnancy or contracting or transmitting an STI, no matter who your sexual partner(s) is, please remember to use barriers such as condoms each time you have sex. Read more about how to asses and reduce your sexual risks in ASHA’s Sexual Health sections on reducing sexual risk and the safer sex toolbox.

--Amy Stapleford, M.Ed.



I am a girl and I look up pictures of boobs and videos of lesbians sometimes. I am somehow attracted to boobs and I think they look good, although I never feel attracted to girls. Does that mean I am a lesbian?

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The short and easy answer is, no: enjoying looking at breasts or lesbian erotica does not mean you are a lesbian. Someone is a lesbian if she calls herself a lesbian, and usually that means she is primarily attracted sexually, romantically and emotionally to women and rarely if ever attracted to men.

In fact, many other self-identified heterosexual women enjoy looking at other women’s bodies. I once heard a woman refer to herself jokingly as a "boob-isexual." She has always been attracted romantically, emotionally and sexually to men. She finds breasts arousing and attractive but has never wanted to be in a sexual or romantic relationship with a woman.

Most sexologists and psychologists agree that few people are exclusively heterosexual or homosexual. Most people, they say, fall somewhere on a continuum between gay and straight, and most people’s "sexual orientation" is fluid (changeable) over a lifetime. We humans are marvelously complex, and simple labels like "straight" and "gay" don’t account for our infinite diversity.

Alfred Kinsey is one scientist whose research suggested that people do not typically fall into the neat and easy categories of "heterosexual" and "homosexual." He developed a scale from 0 (exclusively heterosexual) to 6 (exclusively homosexual) with which to describe one’s sexual orientation. You can read more about the "Kinsey Scale" online.

Similarly, many people don’t think of attraction as a simple "either/or": "I am either attracted to someone or I am not." Instead they think of the many different ways they might be attracted to someone—whether for going on a hike, looking at someone, having a conversation, having non-genital sex, having genital sex, having children, or sharing a home. By asking themselves "the ways in which" they are attracted to someone instead of "whether or not" they are attracted to someone, they find they are "attracted" to many people in different ways and for different types of activities: some sexual, others not.

Using an expanded idea about what it means to be attracted to someone, it sounds like you may be "attracted to" looking at breasts and watching girls having sex with each other, but not attracted to having sex with girls yourself--a perfectly valid set of interests.

--Amy Stapleford, M.Ed.