Intercourse is meant to be a pleasurable and intimate experience. But it might become an unpleasant act if you are suffering from performance anxiety. When you are mentally occupied by questions such as "Do I look too fat?" or "Did I do that right?", sex stops being a gratifying experience.

Incessant anxiety over your ability or appearance can result in sex becoming nerve-wracking and stressful for you. It might even have you avoiding sex altogether. This psychological condition is termed as sexual performance anxiety.

Sex isn't only a physical reaction, there are emotions tied to it as well. If you are too stressed out and your mind is preoccupied, your body reflects your inner turmoil and you cannot get aroused.

Causes
The causes of sexual performance anxiety include:
1. Fear that you wouldn't be able to satisfy your partner and perform well sexually
2. Body image issues (Such as stressing about your weight)
3. Problems in your relationship
4. Men worry that their penis don't 'measure' up
5. Men might be concerned about taking too much time to orgasm, or about premature ejaculation
6. Women worry about not enjoying the experience or being unable to have an orgasm

Symptoms
Your mental state has a deep impact on your physical state. The effect of stress hormones norepinephrine and epinephrine can hinder your sexual performance. Symptoms of sexual performance anxiety include:

1. In men, blood vessels constrict due to the effect of stress hormones. This leads to reduced blood flow to the penis, thus making it difficult for the man to get an erection.

2. Often though it is less diagnosed in women, sexual performance anxiety leads to trouble in lubrication during sex. Lack of lubrication dims the desire to have sex.

Sexual performance anxiety is a vicious, inescapable cycle. Increased anxiety hampers you from having sex, making you think you won't be able to perform well, which causes even more anxiety.

Treatment
Consult a doctor you will be comfortable with discussing your problems. Sexual performance can be either treated by medication (if you have an underlying medical condition such as erectile dysfunction) or through therapy.

Talking to a therapist or counsellor about your problems can help you in several ways. You can learn to become more comfortable with yourself and your body. You can also understand your problems better, which can eliminate your anxiety.

All About Sexual Performance Anxiety

Knowing premature ejaculation - part 3: management and techniques (non-medical methods)

As shared in part 1and 2 of this series, because of premature ejaculation (pe), both the partners may end up experiencing highly unsatisfactory sex. In fact, it can increase anxiety, which may deteriorate the problem. 
Remember there is not a single magical drug or medicine in the chemist shop which can solve your problem overnight especially if you have chronic pe. Before seeking any medical treatment for pe, it is appropriate to consider the varied options for solving this issue. These include counseling with a sexual therapist, non- medical treatments like various exercises/ techniques and medical treatments including both modern and alternative medicine.

A. Counseling from an expert - sexual therapist or sexual medicine practitioner:
It is well understood that sex is in the mind. However, repeated pe/ failures can lead to lot of stress and disappointments. Anxiety due to pe itself is a big issue and can lead to recurrence of pe.
Reassurance from sexual therapist / counselor that pe is not a disease and can be easily treatable is relaxing for men who are facing this problem. So please share your detailed history and sexual habits with the expert. This may help the expert to guide you well.

B. Behavioral changes:

Some basic things may also help you to deal with the problem. 

1. Some men attempt to treat themselves for premature ejaculation by distracting themselves by thinking nonsexual thoughts (such as naming cricket players and records) to avoid getting excited too fast when approaching their partners. This helps them to focus their attention away from the sexual stimulation.

2. It is also suggested to men that they should relieve themselves of the sexual tension by ejaculating with self masturbation 1-2 hours before attempting sexual intercourse with their partner.

3. Using condoms is known to help in premature ejaculation in some men by decreasing sensation.

4. Women on top position usually helps to delay orgasm in men

 
C. Exercises &amp; techniques:

There are several exercise and techniques you can try sitting in your home.

1. The" stop and start" method:
This technique involves sexually stimulating the man by self until he feels like he is about to reach orgasm. Then he needs to stop the stimulation for about 20-30 seconds and then start it again. Repeat this pattern until the man wants to ejaculate. This can be continued for 10-15 minutes. At the end of say, 10th or 15th minute, continue stimulation until the man reaches orgasm and ejaculates.
2. The" squeeze" method:
 This technique involves sexually stimulating the man by self or by his partner until he recognizes that he is about to ejaculate. At that point, the man or his partner gently squeezes the end of the penis (where the glans penis meets the shaft) for at least 15 seconds. Stop sexual stimulation for about 60 seconds, and then start it again. The person or couple may repeat this pattern for at least 10-15 minutes. At the end of say, 10th or 15th minute, continue stimulation until the man reaches orgasm and ejaculates.
3. Practice breathing exercises 

Deep breathing can greatly help in controlling the arousal and tension that cause early ejaculation. Men must avoid shallow breathing as it can trigger premature ejaculation. Instead, what you should do is spend 5 seconds taking in a long deep breath; then hold it for 3 seconds and then exhale for the next 5 seconds. If you can do this for 5 minutes in the bedroom without pause then you can control premature ejaculation.

If you would like to consult with me privately, please click on'consult.

Knowing Premature Ejaculation - PART 3: Management and Techniques (Non-medical methods)

STDs or diseases that spread due to the exchange of bodily fluids and most of them are treatable in nature, but one should get them treated as soon as poosible and should not ignore them as them can turn fatal as well. And, yes STDs can also spread without having sex. Some of the most common way of getting STDs without penetrative intercourse is mentioned below.

The most common way of contracting Sexually transmitted disease without sexual intercourse is:
1. Pucker up: Kissing can also cause STDs. Infections can be transmitted through the saliva if you swap your spit. Diseases like Mononucleosis and STD s like herpes can be transmitted through kissing. This can cause cold sores and infections in the mouth.

2. Oral sex: If a person has an STD, he or she can easily transmit the disease to their partner by having oral sex. During oral sex, fluids from the genitals can flow to the mouth and vice versa. For example STDs caused by herpes simplex virus 2 can be easily transferred by oral sex. Chlamydia can also be transferred by oral sex. This can cause infections and immense discomfort in your throat. STDs can be prevented by wearing a condom or using a dental dam during oral sex.

3. Contaminated foods: You can also develop STD like Hepatitis A from food which is contaminated. If a person infected with an STD prepares your meal without washing his or her hand after using the restroom, it can easily contaminate your meal thus, transmitting the disease.

4. Touching bases: Skin to skin contact or indirect contact with a person who already has an STD can make you prone to contracting STDs. It can be caused by using an unwashed sex toy with an infected person and also with hand to genital contact.

5. Tanning salons: STDs can be easily spread from person to person by means of a tanning bed. If the surface of the tanning bed is contaminated by someone who has STDs, the risk of developing an STD increases for the next person who ends up using the same bed.

6. Razors and syringes: Sharing a razor or anything which pierces or cuts the skin is an easy and common cause behind contracting an STD. If the razor cuts the skin of an infected person and is contaminated with blood, the next person using that razor can develop STD due to blood contact. The same may be said of a syringe where users share them. Many people, especially drug users shared common syringes which resulted in large scale transmission of HIV.

Can STDs Spread without Having Sex?

Tuberculosis is an opportunistic infection caused by the bacteria Mycobacterium tuberculosis. The infections occurring in people with weak immunity as compared to the people with a healthy immune system are called as opportunistic infections. As, HIV enters the human body, it replicates and weakens the immune system which in turn increases the risk of contracting Tuberculosis in people already suffering from HIV infection.

An HIV and Tuberculosis co-infection occurs when an individual has both, the HIV infection and an either latent or active TB disease simultaneously.  Each disease acts in speeding up the progress of the other, when HIV and TB infection is present together in the body. HIV infection speeds up the progression from latent to active Tuberculosis, Mycobacterium tuberculosis also accelerates the progression of replication and spread of the HIV infection.

HIV infection and Tuberculosis are totally different type of infectious diseases. HIV is a viral infection and TB is a bacterial one. An HIV infected person will not contract TB unless a contact happens with a TB infected person. TB spreads via droplet infection and is communicable. If a person lives in a country with a high prevalence rate of TB, an HIV patient is highly susceptible to contracting the infection. In the similar manner, a person suffering from TB gets infected with the HIV infection only through the blood and bodily fluids borne route, with unprotected sexual intercourse with an HIV infected individual being the most important cause.

Amongst all the other opportunistic infections, TB occurs at an earlier stage in the course of an HIV infection than most other opportunistic infections. Mortality rate in the co-infected patients is more than twice that of HIV infected individuals without a TB infection. Even if a patient is undergoing anti-retroviral therapy, the death rates remain high in co-infected individuals.The natural history and course of TB gets altered in people with an infected immune system. The damage to immunity due to HIV infection causes a drastic reduction in the pathogen killing capacity of the body. In such patients if there is no anti-retroviral treatment prescribed, then the latency period between the infection and progression of disease gets eliminated. 

An active phase of TB is observed in such individuals progressing within a short span of time, ranging from weeks to months, rather than years as it normally should be spanning. Risk of progression from a latent stage to an active stage of TB is around 10-15 times greater in an HIV infected individual as compared to the non-infected person. Such individuals also communicate the disease more rapidly to others.Pulmonary tuberculosis in an HIV infected person can present similar symptoms like that of a classic TB disease. However, a co-infection can sometimes show less presenting TB symptoms, where even the chest X-ray scans can be observed to be normal. A  subclinical  phase of Tb in co-infected patients can cause delay in the diagnosis of the symptoms and subsequently affect the prognosis due to lack of timely treatment.

Social stigma and discrimination has caused an obstacle in provision of adequate treatment for people with HIV. Proper counseling  and initiatives taken to provide indiscriminate care can aid in identification of co-infection and earlier stages. Anti-retroviral treatment teamed up with anti-tubercular drug regimen is prescribed and a successful treatment for drug sensitive cases of TB can be provided with medications for 6-8 months.

How HIV & TB  Are Related?

The condition of enlarged prostate occurs due to the enlargement of a man s prostate gland, with the passage in time. Also known as benign prostatic hyperplasia (BPH), it is more common in men over the age of 60. Some cases might have symptoms and others may be symptomless. Although the causes are relatively unknown, it is evident that BPH is not a form of cancer, neither does it cause cancer. The prostate is located below the bladder and is responsible for producing the fluid needed by semen. The growth of the prostate tissue that is associated with benign prostatic hyperplasia begins near the inner prostate which is a tissue ring around the urethra. Its growth is generally inward.

Causes
It is of common knowledge that in males, the urine originates from the bladder and flows through the urethra. BPH is a condition where the prostate experiences a benign i.e. non cancerous enlargement which leads to blockage of urine flow through the urethra (the urinary duct). The resultant enlargement, caused due to the gradual multiplication of cells, subjects the urethra to extra pressure. Further narrowing of the urethra causes more contraction of the bladder, resulting in the urine being forcefully pushed out of the body.

With time, the condition leads to the bladder muscles gradually becoming thicker, stronger and oversensitive. Contraction occurs even due to the presence of small amounts of urine, giving rise to frequent needs of urination. At one point, the bladder muscle is unable to overcome the effects of the narrowed urethra. Due to this, urine does not pass properly and the urethra is not emptied.

Some of the common symptoms of enlarged prostate include:
1. Frequent urination
2. Urgency to urinate
3. Difficulty during urination
4. A slow or weak urinary stream
5. Requirement of extra effort to urinate
6. Interrupted sleep due to need of urination

Further risks
Sometimes, when the bladder is not emptied completely, a risk of urinary tract infections develops. Some other serious problems which can be a result of enlarged prostate include blood in urine, bladder stones as well as acute urinary retention (inability to urinate). In some rare cases, kidney and/or bladder damage might also result from such a condition.

Frequent Urination - Can it be a Sign Enlarged Prostate

Chlamydia is a STD, caused due to intercourse, or even sexual contact. This is often accompanied by vaginal discharge or genital pain. Chlamydia can affect both the sexes to any age group, though young sexually active women are mostly diagnosed with it. If left untreated, this STD can cause further complications, some of them, fatal.

Symptoms of Chlamydia in women
1. Abnormal odorous vaginal discharge
2. Bleeding resulting from intercourse or even between periods
3. Pain during menstruation or sexual intercourse
4. Soreness in the lower abdomen
5. A burning sensation or itching around the vagina
6. Painful urination
7. Green or yellow vaginal discharge

Further complications
Infection can extend to the fallopian tubes, leading to a disease called Pelvic Inflammatory Disease (PID). PID can bear symptoms such as nausea, severe pain in the pelvic region, fever and unusual bleeding during one s periods. There are also high chances of contracting the chlamydia infection in the anus, the indications being pain, bleeding and discharge from the anus. Oral sex with a person diagnosed with this condition can also result in you contracting this infection in the throat, resulting in soreness, fever and cough.

Causes of Chlamydia in women
1. Chlamydia, being a sexually transmitted infection, primarily spreads through unprotected sex. However, sexual intercourse need not always be the reason behind this disorder. Sexual contact or even indulging in oral sex without using protection (in the form of dental dams) can result in this disease.
2. Newborn infants are also prone to acquiring this infection that is passed on to them by their mothers during birth. Therefore, pre-natal checkups are a must for detection.
3. Rarely, one can contract the infection in the eyes as well, through any form of oral or genital contact.

Chlamydia - 7 Common Signs in Women

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