Dr. Amit Joshi

To be considered healthy, one must not only be physically and mentally sound, but one must also be sexually and reproductively healthy. Sexual and reproductive health includes a person’s ability to enjoy a satisfying sex life and capability of reproducing. Sexual and reproductive health is important for both men and women. 

When it comes to women, sexual health problems can refer to

• Lack of sexual desire
• Inability to be sexually aroused
• Inability to achieve an orgasm
• Painful intercourse

There are many factors that could trigger these problems, such as

• Relationship problems
• Emotional distress
• Gynaecological problems

Some of the common gynaecological problems that affect women’s sexual health are

• Vaginal dryness
• Pelvic inflammatory disease
• Vaginismus
• Endometriosis
• Uterine fibroids
• Gynaecological cancer
• Interstitial cystitis
• PCOS

Endometriosis and some of the above mentioned diseases can also affect a woman’s reproductive health and cause problems with pregnancy. Exposure to STDs is another major reproductive health problem. STDs such as HIV, gonorrhoea and HPV are dangerous not only for the mother, but also affect the health of the baby. Reproductive health problems or women also include unwanted pregnancies, unsafe abortions and maternal death.

Being a victim of sexual violence affects both sexual and reproductive health. Sexual violence can be defined as a non-consensual sexual activity. While anyone can experience this, women have a higher risk of facing such violence than men. Sexual violence can cause a person to fear sex itself and in some cases can interfere with their ability to reproduce.

Though men’s interest in sex is often joked about, men too can face sexual health problems. This could be triggered by a physical or psychological condition. Erectile dysfunction and ejaculation disorders such as premature ejaculation or retrograde ejaculation are the two most common sexual health problems faced by men. Anxiety and depression along with illnesses such as diabetes and high blood pressure can also cause a loss of libido and sexual disinterest. 

Men can also suffer from a low sperm count and low testosterone. In many cases, this can make a man infertile. Peyronie's disease and testicular cancer are other conditions that can affect a man’s sexual and reproductive health. Like women, men also need to protect themselves against STDs to ensure they remain sexually healthy. 

Thankfully, most sexual and reproductive health problems can be treated and cured with a combination of medication and psychological counselling. Hence sexual and reproductive health problems should not be considered taboo but should be addressed as soon as possible.

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Though the act of intercourse is portrayed as an act of pleasure, achieving an orgasm is an indication of a satisfying sexual act. Inability to achieve an orgasm is far more common in females than in males and this can be due to various reasons.

Read on to know some more about the causes and ways to manage this:
A mix of psychological, social, and physical conditions can lead to orgasmic disorders in female. Some of the common causes are listed below:

1. History of sexual abuse
2. Stress
3. Poor self-esteem
4. Relationship issues, lack of trust, conflicts, etc.
5. Cultural or social beliefs
6. Advancing age
7. Chronic medical conditions like diabetes
8. Medications like selective serotonin reuptake inhibitors (SSRIs), which are frequently used in depression (depression is common in women)
9. Gynecologic issues like hysterectomy

It is a vicious cycle that is contributed by more than one of these factors, which leads to strengthening of the disorder in the future. Types of orgasmic disorders: There are four types of orgasmic disorders, which are as follows:

1. Primary anorgasmia: Women with such disorders have never been able to achieve an orgasm.
2. Secondary anorgasmia: Over a period of time, women who previously have had orgasms are unable to achieve an orgasm.
3. Situational anorgasmia: Women suffering from it would be able to achieve an orgasm only during certain situations like oral sex or masturbation, but may not climax during regular sexual intercourse.
4. General: These women could be highly stimulated and aroused, but would still be unable to achieve climax.

Management and diagnosis
The first step in management is diagnosis. A detailed discussion with the doctor about sexual history followed by physical examination can help identify the problem. Being open about discussing this private topic is very important in diagnosis and treatment.

Treatment would depend on the underlying cause, and include the following:

1. Diagnose and treat/manage underlying medical conditions like diabetes.
2. Switch to an alternate antidepressant if SSRIs are being used.
3. Involve in sex therapy where cognitive behavioral therapy is a big component. Becoming aware of what can be is very important.
4. Sexual counseling with the partner to resolve any conflicts, improves trust levels and the overall health of the relationship. This is often a major cause for this disorder.
5. Involving the partner to help in achieving an orgasm by clitoral stimulation, etc.
6. Hormone therapy in the form of a pill, patch or gel may be used to increase sensitization in the genital area. These help by improving blood flow to the genitals and increasing sexual desire.

It is important to understand that female anorgasmia is very common and though it can be frustrating, it can be managed effectively. But do not forget to admit the problem and seek help. If you wish to discuss about any specific problem, you can consult a gynaecologist and ask a free question.

It is popular belief that men are more easily aroused erotically as compared to women. However, truth is the reduced sexual arousal, or loss of libido, as it is called in medical circles, is very common. For most people, given the private nature of the topic, it is not openly discussed. Often, the only source of cures comes from reading books and online content. For some, a few close confidants may be aware of the problem. This again builds stress and becomes a major contributor to loss of libido. The best way to break this vicious cycle is to begin by admitting the problem and seeking professional help to overcome it.

There are physiologic and psychologic causes for reduced libido. The most common physiologic problem is low testosterone levels. This can be managed through lifestyle changes including exposure to sun, diet modifications, workouts and stress management. Read on for more details.

1. Diet: A heart-healthy diet is healthy for sexual life too. A diet loaded with nutrients including fresh fruits and vegetables, fish oils, omega-3 fatty acids, nuts and seeds, etc., will definitely contribute to a healthy sex life too. Avoid processed, canned and packaged foods. Ensure the diet is packed with good amounts of cholesterol, vitamins (A and E in particular), and minerals (zinc and selenium) as these are required for the production of testosterone and thereby, enhancing sexual life.

2. Smoking: Another major reason for reduced libido (and even impotence) is smoking. Those who have reduced or quit smoking can vouch for connection between sex life and smoking.

3. Alcohol: While it is popular belief that alcohol allows for a great sexual experience, the truth is far from it. Though alcohol helps shed initial inhibitions, it reduces performance. Therefore, excessive alcohol should be avoided.

4. Exercise: A healthy heart directly translates to an active sexual life. Any vigorous activity for 30 to 45 minutes (running, jogging, swimming, or cycling) which pumps up the heart works wonders for the sexual life too.

5. Sun Exposure: Vitamin D is essential for the optional production of testosterone and effective functioning of the male reproductive system. If you can get about 15 minutes of sun a day, great! Else, try vitamin D supplements and see the difference.

6. Stress Management: One of the major reasons for reduced arousal is stress. When you are stressed about something or the other, the chances that you enjoy a good sex life are very less. Beat the stress and see the change.

7. Invest in the Relationship: Your partner and you should take some quality time out and invest in building a long-lasting, trustworthy, healthy relationship which will naturally lead to a great sexual life. If you wish to discuss about any specific problem, you can consult a sexologist.

There are a lot of misleading information going around, especially online. So all that you read online, may not be correct. Sex is a topic that has been much hushed about, thus leading to the birth of many baseless rumours and embarrassing myths. Don’t believe in every single detail you come across online, they have got their own glitches. But hey! You do need to know the truth about it all, and this article tries to do just that.

Here are a few embarrassing myths and facts about sex which you may come across:
1. Myth: You do not get pregnant the first time you have sex
Fact: You can get pregnant anytime after you have penetrative sex. There is no such stipulated count or time as to when you get pregnant. The moment you have penetrative sex, certainly without any protective measure, the chance of pregnancy goes up.

2. Myth: Men think and want more of it as compared to women.
Fact: This is not true. The desire for intimacy and sex varies among individuals, irrespective of the gender.

3. Myth: Having sex in a pool drastically reduces the chances of contracting any STD.
Fact: Generally, maximum STDs (sexually transmitted diseases) are contracted by coming in sexual contact or through unprotected sexual intercourse. Having sex in a pool with a person already infected with any STD will automatically up your chance of contracting the STD as well. Water cannot prevent the transmission of any STD.

4. Myth: Douching after indulging in sexual intercourse can prevent a pregnancy.
Fact: Douching is definitely not a method to prevent pregnancy. And it’s about time this myth gets busted. Douching with soda, water or any other fluid can only guarantee infections in the genitals and nothing more. This is because douching disrupts the natural balance of the vaginal bacteria, thus also disturbing the pH balance of the vagina. The only way you can prevent a pregnancy is by using protection or taking birth control pills if you’ve had unprotected sexual intercourse.

5. Myth: It isn’t possible to contract STDs if you just have oral sex.
Fact: While it is true that maximum STDs are spread through unprotected vaginal intercourse, there are certain STDs, the transmission of which might not be only dependant on vaginal penetration. STDs such as HPV, Herpes and Syphilis can spread even if you just have unprotected oral sex. So, even if it is oral sex that you want to enjoy, do not give the protection a miss. Dental dams are always available at your disposal; using which might curb risks of such STDs. If you wish to discuss about any specific problem, you can consult a sexologist.

Gonorrhoea is a bacterial STD that can affect both men and women. It can be transmitted from one person to another through oral, vaginal or anal intercourse. A person who is already suffering from an STD is at a high risk of suffering from Gonorrhoea as well. This disease affects the eyes, throat, vagina, urethra, anus and female reproductive tract. Gonorrhoea can be treated with antibiotics as long as it is diagnosed in time. In order to do so, it is essential to understand the symptoms of this disease.

Some people do not show any visible symptoms of gonorrhoea. This is known as nonsymptomatic Gonorrhoea. Even though there are no symptoms, these people can infect others through unprotected intercourse. However, in most cases, the symptoms of this STD can be seen in 2 to 14 days after exposure to the bacteria. These symptoms are different for men and women.

Men infected with this disease may not show symptoms for several weeks. Some of the symptoms of this disease as seen in men are:

1. Frequent urge to urinate
2. A burning or painful sensation while urinating
3. Pus-like discharge from the penis
4. Inflammation and redness of the tip of the penis
5. Swelling that may or may not be accompanied by pain in the testicles
6. Sore throat

In some cases, the pain may even spread to the rectum.
Gonorrhoea is more difficult to diagnose in women as the symptoms were shown are milder and tend to be similar to other infections. Some of the symptoms to look out for are:

1. Watery or creamy discharge from the vagina
2. Painful or burning sensation while urinating
3. Increased urge to urinate frequently
4. Heavier periods
5. Spotting in between periods
6. Sore throat
7. Painful intercourse
8. Pain in the lower abdomen
9. Fever

Gonorrhoea can be diagnosed with a simple blood test or by taking a sample swab from the infected area and subjecting it to lab tests. Once diagnosed, it can be treated with antibiotics. In some cases, an injection may also be required. It is important to complete the full course of antibiotics even if the symptoms disappear in a few days. As with any other STD, prevention is better than cure. To avoid suffering from this disease, always use a condom while having intercourse. If you have more than one partner, insist on getting tested regularly. This is extremely important as many cases of Gonorrhoea go undetected for the lack of symptoms shown. If you wish to discuss about any specific problem, you can consult a sexologist.

Nightfall or night discharge is a condition when some men ejaculate in sleep usually in the early hours of the morning or late night. This problem usually worsens due to the weakness in muscles and nerves of the penis due to past bad history of excessive masturbation, thinning of semen viscosity, fluctuation in hormones and a full bladder. Usually, men are able to hold the semen, but when in excess then it is eliminated in the form of nightfall or late night. This problem usually worsens due to the weakness in muscles and nerves due to bad history of excessive masturbation, thinning of semen viscosity, fluctuation in hormones and a full bladder. Men are able to hold the semen but when it excess then it is eliminated in the form of nightfall.

In the case of excessive semen flow and nightfall, a person might experience insomnia, dizziness, weakness, loss of memory and sight, pain in knees, weaker sexual incapacity, infertility, erectile, dysfunction and not to forget stress. In rare cases, a person might pass urine along with semen. of excessive semen flow and nightfall, a person might experience insomnia, dizziness, weakness, loss of memory and sight, pain in knees, weaker sexual incapacity, infertility, erectile, dysfunction and not to forget stress. In a rare case, a person might pass urine along with semen.

Treatment for nightfall:

It is believed that the best way to stop nightfall is by changing the lifestyle and treating with guidance of doctor. This includes reducing the frequency of masturbation and avoiding porn and nude pictures. However, there are some ways to cure nightfall naturally by doing the following:

1. Meditation increases concentration and inner feelings can be controlled. This helps distract men from indulging in unwanted activities and is very effective in controlling nightfall.
2. Exercise and yoga allow a person to have full control of their mind, body and soul. By doing regular yoga and exercises sex-related activities which induce nightfall can be avoided.
3. Bathing with essential oils before going to bed is helpful as it relaxes the body and mind and allows a good sleep.
4. Change in diet can prevent nightfall. Men who suffer from this problem should avoid acidic food.

And if the nightfall persists you need to consult a sexologist and with proper treatment of the underlying cause you can cure your problem completely with your lost physical and sexual strength.

Curing nightfall is easy and should be recognized so that it does not hamper the sex life of a man.

Following home remedies can also be taken to control or prevent the situation:

1. Bottle gourd has a cooling effect thereby cools the system which is responsible for nightfall. It can be used in two ways, either by drinking bottle gourd juice before bedtime or by mixing the juice with sesame oil and massaging it.
2. Gooseberry or amla helps in increasing the immunity of the body. It is believed that drinking a glass of gooseberry juice can help get rid of nightfall.
3. Onions and garlic are known to cure many health related conditions. 3-4 cloves of raw garlic and onions in the form of salads should be had to cure nightfall.
4. Milk, when combined with pre-soaked almonds, banana, and ginger, helps to eliminate this problem. Banana has a cooling property which helps to control the problem. Also, eating curd is beneficial as it has healing properties which cool the system and increase immunity.
5. Juice of celery and fenugreek are very helpful in nightfall as well as premature ejaculation. These juices can be mixed with honey in a ratio of 2:1.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Your good intention during intercourse might be to give your partner an intense orgasm, but orgasms aren’t something one can “give”. All you can do is make the conditions more favorable for the other person to have them by manipulating your moves.

Here are six ways in which you can orgasm better: 

1. Don’t skip the foreplay: Just like it is not a good idea to run a marathon without sufficient warm up, it isn’t advisable to skip or shorten the foreplay. Explore and find out and choose the right kinds of foreplay that take the arousal to great heights. Oral sex, clitoral stimulation and self-stimulation during sex are incredible in achieving a better climax. 
2. Experiment with edging: Try what we call 'edging'. That is, bring yourself close to climax, then stop short of reaching climax, and after a pause a few seconds, rebuild your arousal – again just close to climax. Repeat this until you can't hold any more and then come! The resulting orgasm is very intense and worth the effort. 
3. Try sex toys: Once in a while let a sex toy join the fun. Sex toys are useful in maximizing the pleasure levels during intercourse or solo. 
4. Use a lubricant: Don’t think that a lube just addresses the vaginal dryness and painful intercourse. Research shows that as many as 50% women get better orgasms when they use lubricants. The lubrication adds sensitivity to the genitals and helps get good orgasms. 
5. Target the C-spot: A lot of women have problems in getting orgasms during intercourse as the clitoris isn’t stimulated enough. The clitoris has the maximum number of nerve endings and during intercourse, clitoral contact is needed for most women to reach orgasm. Tip: Try out woman-on top, side-to-side and doggy style positions for clitoral stimulation. There are many more options too. 
6. Do not overlook the testes: Stroking your sack upwards right before getting an orgasm adds more power to the orgasms in men. The testes are tremendous pleasure points for a man and gently stroking them is useful in heightening the arousal which leads to a stronger orgasm. If you wish to discuss about any specific problem, you can consult a sexologist.

When a person is preoccupied with physical fantasies to the point of dysfunction for at least six months, he or she suffers from hyper sexuality. Hyper sexuality is also known as nymphomania or compulsive sexual behavior. These sexual fantasies are usually combined with a compulsive pursuit of non-intimate or casual sex, excessive masturbation habit, pornography, objective partner sex and romantic intensity.

It is more complex than just having an unusually high sex drive because sexual activity gives the addict an intense feeling of euphoria, suppressing other thoughts which cause distress, self-loathing and shame. This interferes with the daily regimen of activities. Treatment and management of sex addiction is imperative because it is disruptive and harmful not just to you but also to others.It also damages relationships, careers and self-esteem. 

People suffering from hyper sexuality exhibit the following symptoms: 
1. They engage in compulsive masturbation
2. They frequently hire prostitutes
3. Usage of phone sex services excessively
4. They have multiple extramarital affairs
5. They plan out sexual activities excessively
6. They engage in one night stands frequently
7. They are emotionally detached from their sexual partners
8. They prefer unprotected sex
9. They obsess about an unattainable sexual partner
10. They show tendencies of paraphilia

The primary and identifiable causes of hyper sexuality are as follows:
1. Biochemical imbalances in neurotransmitters and nervous system disorders
2. Medical conditions that damage certain parts of the brain of affect brain functioning
3. Overproduction of hormones such as androgens (present in males and females) 
4. Being predisposed to hyper sexuality due to genes 
5. Altered neural pathways
6. Suffering from childhood abuse
7. Dysfunctional family dynamics

Sexual addiction is believed to be a dysfunctional adult response towards emotional or character regulatory deficits and innate personality as well as abuse, early detachment disorders and trauma. Hyper sexuality is a symptom of a lot of mental disorders such as bipolar disorder, adult attention deficit disorder or obsessive compulsive disorder. 

Sex addicts usually do not seek treatment for their addiction until the consequences of their activities are dire and have an overt negative effect on their health, relationships, finances and career. Since addicts feel ashamed and despise themselves, they usually do not seek help until they hit rock bottom. However, it is crucial to treat this disorder in order to lead a happy and fulfilling life where one is not controlled by their addiction.  You can also take the package for having safe sex.

Hyper sexuality can be treated using the following methods:

1. Psychotherapy
2. Group Therapy
3. Family and couples therapy
4. Support groups
5. Self-help groups
6. Medications
   1. Antidepressants
   2. Anti-androgens
   3. Luteinizing hormone releasing hormone (LHRH)
   4. Mood Stabilizers
   5. Naltrexone

In case you have a concern or query you can always consult an expert & get answers to your questions!