Dr. Anoop Kumar Sonker

Fibroadenomas are non-cancerous (benign) and harmless tumors which are made up of fibrous tissues of the breast. These are common in adolescent and young women. The incidence of fibroadenoma reduces with increasing age.

Signs and symptoms-

• Fibroadenomas are smooth, round and easily movable swellings. It is referred as ‘breast mouse’ or ‘floating tumor’ as it easily sleeps away from fingers. Size of the tumor may vary from one to five centimeters.
• It could be single or multiple. Generally, it is painless and may affect both breasts.
• Pain and tenderness (pain when touched) may be present especially before periods and subsides after periods. These cyclical changes are because of the hormonal changes. This is the reason why it is less common after menopause.

Causes of fibroadenoma-

The exact cause of fibroadenoma is unknown. It is because of the cyclical hormonal changes that take place in the body of women of childbearing age.

Diagnosis-

• Clinical history
• Physical examination
• Mammography – it is the process of using low amplitude x rays to examine breast.
• Biopsy – women in their teens do not need a biopsy if the lump dissolves on its own.
• Dangerous signs
• Sudden increase in size of tumor
• Pain in breast not affected by menstrual cycle
• Hard, immovable tumors
• Transformation of fibroadenoma into the cancerous tumor is very rare. Only 0.002-0.012% of the fibroadenoma convert into a cancerous growth.

Treatment conventional treatment

1) fibroadenoma can subside on its own.

Cryoablation (use of extreme cold to destroy tissue) is safe and effective and less invasive method of treatment for fibroadenoma.

Surgical removal may be required in case of large fibroadenoma.

Homeopathic treatment

Homeopathy is strongly suggested in the treatment of fibroadenoma. Homeopathy can be given as a baseline treatment in mild and moderate cases whereas it has a good supporting role in advanced cases of tissue changes. The results using homeopathy in the cases of fibroadenoma are very good.

Homeopathic medicines are prescribed after studying patient’s complete case history. It enhances the body’s self-healing mechanism (immunity) thus a further recurrence of fibroadenoma can be prevented.

Curvature of the penis (peyronie's disease)
 

In peyronie's disease, inflammation and scar tissue form along the shaft of the penis. No one is certain why this problem occurs. It may be triggered by repeated mild trauma during sexual intercourse.You may feel the inflammation and scar tissue as a painful lump or area of unusual firmness. In many men, the scar tissue causes the penis to bend or shorten. This is because it prevents the penis from expanding normally.Men with peyronie's often have difficulty achieving a firm erection. But it is unclear whether this occurs first or is caused by the scar tissue.Most men with the problem are between the ages of 45 and 60. The disease runs in families.In one-third of men, peyronie's is associated with the formation of scar tissue in other parts of the body. These include the palms of the hands, the soles of the feet and the eardrums.Sometimes, a serious curvature of the penis is seen in boys at or shortly after birth. This is not peyronie's disease. Most of these cases are thought to be caused by abnormal development in the womb. They may be associated with other abnormalities of the penis.

Symptoms

About half of men with peyronie's disease will first notice pain during intercourse. Symptoms may appear suddenly, or may develop slowly over time. Often the penis will feel firm or lumpy at the painful site.Other men with peyronie's will notice a painless curve of the penis that can occur suddenly or get worse over time. The penis may curve up, down or to either side. Severe changes in the shape of the penis may prevent the man from having intercourse.

If the penis has been injured by sudden trauma, most men will be able to recall the event. Often there will be a sensation or sound of a" snap" followed by loss of erection and the appearance of a bruise. Part of the penis will remain painful for a time. But usually the area will heal over time. However, scar tissue may form and cause a new curvature. This problem is different from peyronie's. It rarely results in difficulties with erections or shortening of the penis.

Your doctor will ask you about your symptoms. He will examine your penis, looking for tender, firm areas of scar tissue. Usually, this is all that is needed to diagnose the problem.
If your doctor needs more information, he or she may order an x-ray to look for calcium deposits in scar tissue. Your doctor may ask you to bring in photographs of your erect penis to better determine the extent of the damage.Men who are considering surgery may be asked to undergo special testing of sexual function. This will help determine the best method of repairing the problem.

Expected duration

A curve in the penis that is present since birth or is caused by scarring from an injury will not go away unless it is corrected with surgery.How long peyronie's disease lasts is difficult to predict. In more than a third of men, there is gradual improvement over 12 to 18 months without any specific treatment. In others, the scarring is permanent or worsens over time. 

Prevention

There is no way to prevent peyronie's disease.However, middle-aged men who engage in more vigorous or frequent intercourse appear more likely to develop peyronie's.

Treatment

There are lots of medicine to cure this problem like silicia, graphitis, calcarea flour, lycopodium etc.

Masturbation is the process of bringing about a voluntary excitement of the sexual centers following generally by the discharge of semen, through some method other than normal sexual intercourse. In other words, “masturbation” means ejaculation of semen by hand. There are various devices resorted to for the purpose, but because of the hand to practise it, it is widely known as “hand practice”. This habit is also known as “self-abuse”, since it is done by one’s own self by his own hand.

There are exceptions, when masturbation is also done by some one else i.e., one engages one’s own wife for this act and rather prefers it even to normal coitus. This sort of device is found among those who are accustomed to hard friction and this habit is formed since childhood and therefore they cannot derive much thrill and pleasure from normal coitus. The other common device is to lie down on the abdomen and rubbing the penis against the pillow or the bed as if performing the sexual intercourse and to discharge semen with thrill and pleasure.

There is haradly any young man who does not masturbate at one time or the other. The self-abuse is the prime cause of various sexual disorders and it is one of the earliest abuses when a boy engages himself in this evil act. Masturbation has serious consequences since it drains the young men of his vital forces and in many case it causes impotency, if it is over-indulged. Therefore, parents are advised to keep a watch on their children against all possible factors which can tempt their children to masturbate.

Causes which incites young men to undertake this evil practice:
1. The main cause is bad company, where children hear and discuss sexual topics and in the bad society they themselves engaged in masturbation collectively without any shame. This is the very first and wrong step which leads to many bad practices to play with the immature sexual organs at the very tender age. Since this evil act gives intense pleasure, they keep on doing quite regularly without knowing the adverse effects of the masturbation in the future to come. If this practice is over done, it ruins the matrimonial lives due to impotency.

2. Secondly, house servants also incite young boys to this vice by playing with their sexual organs. Thus, parents should keep an open eyes and they should not allow their children for longer hours to be with their domestic servants in seclusion. Furthermore, sending their boys to distant schools along with their young children, without any supervision, may also lead to similar consequences since servants can caress the children if they find lonely road or place. Further, young children should also not be carried on cycles in front of the servants or in a car beside the driver.

3. Not only domestic servants, but even young friends or relatives should be relied upon. Therefore, children should not be allowed to sleep on a common bed along with the relatives or friends as some of them may pollute the children or young boys.

4. It has also been found that in many instances, the young ones are taught the first sexual lesson by the maid-servants. Thus, boys should not be allowed to be with maid-servants in seclusion or to lie in the same bed.

5. The parents, in the best interest of the boy’s future, they should also take guard to avoid his boy to lying in the same bed with other young ladies who are separated from their husbands since it has also been noticed on several occasions that such ladies due to their ungratified sexual desire, they lure the boy to spoil him.

6. Furthermore, sleeping more than one children in the same bed should also be avoided, since they may handle one another’s male organ. Once they are habitual of this, they would like to masturbate in seclusion places like bathroom, latrine or in lonely places.

7. The parents should also take care not to indulge themselves in interecourse where the children are present since it is one of the prime cause of this evil as the children imitate their parents out of their curiosity.

8. Another cause which invites boy to masturbate is the uncleanliness of the genital organ, since collection of smegma in the pit of glans leads to sexual excitement in several cases. Therefore, daily cleanliness of the genital is needed.

9. The other cause of masturbation is rectal worms. The worms cause irritation to the anus and consequently it gives rise to erection of penis. In such circumstances, boy handles his penis which gives intense pleasure to masturbate and later it forms the habit of masturbation.

10. Over and above, following are also the causes to excite sexual organs to masturbate:
A. Chronic constipation.
B. Excessive use of sour foods.
C. Excessive use of stimulating diets such as meat, eggs, tea etc.
D. Seeing of sexual and love scenes in t. V, cinemas.
E. Reading of amorous literature, novels etc.
F. Talking of sexual problems with young ladies in seclusion.

Chest pain is a common problem that most people experience. Chest pain can signal anything from a muscle cramp to even an impending heart attack. You should never ignore symptoms of chest pain as it can signal a serious underlying disorder. The details about chest pain are not described here as it is beyond the scope of this article. The focus is on various homeopathic remedies to treat symptoms of chest pain.

Why homeopathy?
Homeopathy is an alternative system of medicine that was started in the year 1796, by Samuel Hahnemann. It is based on the premise that the substance that causes a disorder, if introduced in the right quantity in the body, will cure the same disease. Compared to mainstream medicine, homeopathy products are not synthetic and are free from any side effect.
Homeopathic remedies for chest pain:

The homeopathic remedies that are given below not only treat pain effectively, but also get rid of the actual cause of the pain. The best thing about these remedies is that they are completely free from any side effect, whatsoever. The various homeopathic remedies for chest pain are:

1. Rhus Tox: This remedy is effective in treating pain that spreads to the shoulders from the chest; these symptoms tend to worsen in damp and cold weather.
2. Arnica Mont: If you experience chest pain along with soreness in the body, this remedy is prescribed.
3. Ranunculus B: In case of intercostal rheumatism wherein you experience pain in the muscle between the ribs, this remedy is usually recommended by the practitioner.
4. Kali carb: Kali carb is used to treat stitching pain in the chest that worsens during the early hours of the morning.
5. Rumex C: This remedy is used to treat pain that develops in the left lung, followed by coughing.
6. Bryonia: For a stabbing or a burning chest pain that worsens when you move, Bryonia is considered to be the appropriate remedy.
7. Phosphorus: This remedy is recommended when you experience heavy coughing and chest pain caused by pneumonia or tuberculosis.
8. Carbo-veg: Carbo-veg is used to treat chest pain resulting from acidity, gas and indigestion.
9. Robinia: This remedy is used to treat symptoms of chest pain that originates from behind the sternum (breastbone) as a result of acidity. In case you have a concern or query you can always consult an expert & get answers to your questions!

Gynecomastia or'woman-like breasts.

It is a benign enlargement of the male breast resulting from a proliferation of the glandular component of the breast.

Gynecomastia is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. The condition known as pseudogynecomastia, or lipomastia, is characterized by fat deposition without glandular proliferation. Although it is usually bilateral, it can be unilateral.

It is an abnormal development of mammary glands in males resulting in breast enlargement. It is not normal for men to have breasts and this makes this condition very embarrassing and may causes low self-esteem especially in teenagers.

It is very common in adolescents. It occurs due to hormonal imbalance in the male body between the age of 12- 18 when estrogen is sometim

Causes

• A number of researchers believe that in many cases an altered androgen / estrogen ratio causes changes in cellular elements in breast tissue. This could be due to:
• Decrease in production of androgen
• Increase in estrogen formation
• Decrease in sensitivity of breast tissue to androgens
• Physiological during infancy and at puberty: gynecomastia can occur physiologically in neonates (due to female hormones from the mother) and sometimes at puberty.
• Refeeding: recovery from wasting diseases.

Testicular causes

• Testicular agenesis: failure of testes to develop.
• Orchitis: inflammation of testes.
• Tumor of testes.
• Klinefelter’s syndrome.
• Imbalance of sex hormone: imbalance of estrogenic and androgenic hormones causes gynecomastia.

Drugs: digitalis, spironolactone, phenothiazine and so on. Approximately 4-10% cases are due to drugs. Spironolactone is a common cause, inducing gynecomastia in 10% of those receiving it as a treatment for heart failure. Digoxin and furosemide are also reported to cause gynecomastia.

Certain medications can promote breast growth. They interact with the natural levels of testosterone and estrogen, and upset the balance in some manner. Gynecomastia is a common consequence of estrogen treatment in patients with prostate cancer.

Drugs that may cause it include:

• Hormones (androgens, anabolic steroids, estrogen agonists)
• Antiandrogens or androgen-synthesis inhibitors
• Antibiotics (isoniazid, ketoconazole, metronidazole)
• Anti-ulcer medications such as cimetidine
• Cancer chemotherapeutics, especially alkylating agents
• Cardiovascular drugs, such as captopril and digitoxin
• Psychoactive agents, such as diazepam and tricyclic antidepressants
• Recreational drugs, such as alcohol and marijuana

Penicillamine

Alcohol and drugs can cause gynecomastia by mimicking estrogen and stimulating androgen production. Steroids and other excess androgens are sometimes converted by the body into estrogens and consequently cause male breast problems.

Men over the age of 50 tend to produce fewer androgens such as testosterone or gain fat tissue that converts androgen into estrogen. In 3 percent of reported cases, gynecomastia can signal lung, liver, or adrenal cancer. Tumors can secrete estrogen, upsetting the hormonal balance.

• Breast prominence due to excessive adipose is often termed pseudogynecomastia or lipomastia.
• Cirrhosis of liver, rheumatoid arthritis, leprosy is associated with it.
• Any of the conditions that interfere with normal testosterone production, such as klinefelter’s syndrome or pituitary insufficiency, can be associated with gynecomastia.
• Aging: hormone changes that occur with normal aging can cause it, especially in men who are overweight.
• Tumors: some tumors, such as those involving the testes, adrenal glands or pituitary gland, can produce hormones that alter the male-female hormone balance.
• Hyperthyroidism: in this condition, the thyroid gland produces too much of the hormone thyroxine.
• Kidney failure: about half the people being treated with regular hemodialysis experience gynecomastia due to hormonal changes.
• Liver failure and cirrhosis: hormonal fluctuations related to liver problems as well as medications taken for cirrhosis are associated with it.
• Malnutrition and starvation: when the human body is deprived of adequate nutrition, testosterone levels drop, but estrogen levels remain constant, causing a hormonal imbalance.

Gynecomastia in bodybuilders

Some bodybuilders who abuse steroids develop it. It is often hidden behind the well developed chest muscles, but in later life, when the athlete becomes less active and the muscles become less prominent, the gynecomastia effects show up.

Signs And symptoms

• Enlargement of breast
• Pain in breast
• Tenderness
• Severe embarrassment or
• Emotional disturbance

Classification

Puffy nipples is among the most common forms of gynecomastia. This glandular tissue accumulation is concentrated under and typically confined to the areola, or can be slightly extended outside the areola forming a dome shaped appearance to the areola.

Pure glandular gynecomastia is common in bodybuilders and is thought to be a result of the use of anabolic steroids. In this case it is known as anabolic-androgenic steroid (aas) induced gynecomastia. Due to excess testosterone levels from steroids, which is converted to estrogen, bodybuilders and other athletes are sometimes afflicted with gynecomastia in its purest form. Gynecomastia in lean men is usually only a breast tissue gland with little to no adipose tissue.

Congenital or hereditary gynecomastia is typically evident by the ages of 12 to 18 in boys. Thirty percent to sixty percent of young boys suffer from large male breasts. As many as thirty percent may live with enlarged male breasts for the rest of their lives, but in other cases it will recede with age. However, severe forms of adolescent gynecomastia may require an intervention, in consultation with the patient, the parents, and child development professionals.

Pseudogynecomastia is typical of enlarged diameter and or excessive areola projection. However, it is not composed of glandular tissue, but of adipose tissue. It looks much like typical gynecomastia but requires different treatment. Exercise and diet may be effective in combating pseudogynecomastia.

Unilateral / asymmetrical gynecomastia occurs when only one breast is larger due to gynecomastia, the other breast is typically normal in both size and shape. Bilateral asymmetry occurs when it is present in both breasts.

Diet

Green tea can effectively tone down your breast. According to recent studies, people who took green tea on a daily basis tend to burn more chest fat faster than who didn’t drink it.

Flax oil is a very effective appetite suppressant; means it makes you feel satiated. As a result you consume less food and there will be less deposition of fat on your body.

Stop taking all recreational drugs, such as marijuana.

Stop taking all nutritional supplements or any drugs you are taking for bodybuilding.

Exercise

Gynecomastia is a problem affecting more men in society today. There are several causes of man boobs which could include hormonal imbalance and excess body fat. In addition, medical studies have shown that breast enlargement can be due to certain health issues or medical drugs. Diet and exercise along with homeopathy is one way to treat gynecomastia and in most cases are excellent alternatives to surgery.

If you have gynecomastia or man boobs, then it means that you have chest fat. Some people think that surgery is the only cure for the problem, but there are a couple of great chest exercises for gynecomastia. Most likely, the fat will be on your lower chest, so it is best to perform a chest exercise that will target your upper chest.

An exercise recommend for this is the incline bench press exercise. In this exercise, you need an incline weight bench. Most flat benches can be made to incline in case you didn’t know. To perform the exercise, you should lie on the incline bench and raise the weight bar vertically towards the ceiling. To complete one repetition, lower the weight to your upper chest and then raise it again. Try to complete 6 to 8 repetitions with each set, and try to perform 3 sets whenever you do the exercise. You should also adjust the weight such that 6 to 8 repetitions are achievable in each set.

A modification of this exercise is the incline dumbbell press in which dumbbells are used instead of a weight bar. Dumbbells have the advantage of allowing you to work each side of your body independently. When we use weight bars, our body’s stronger side tends to do more work while the other side gets shortchanged.

A treatment doesn’t get any more natural than this. Performing these exercises a couple times per week will have the effect of making your gynecomastia decrease over time along with homeopathy remedies.

Prognosis

Gynecomastia is not physically harmful, but in some cases can be an indicator of other more serious underlying conditions, such as testicular cancer.

Growing glandular tissue, typically from some form of hormonal stimulation, is often tender or painful.

Furthermore, it can frequently present social and psychological difficulties for the sufferer.

Weight loss can alter the condition in cases where it is triggered by obesity, but losing weight will not reduce the glandular component and patients cannot target areas for weight loss. Massive weight loss can result in sagging tissues about the chest, chest ptosis

One of the things that we were always told about in school was the importance of hygiene. Washing our hands properly after eating, brushing our teeth twice a day, wearing clean clothes are just some practices we were taught. Our desire and need to maintain personal hygiene is one of the things that makes us human. Maintaining proper sexual hygiene is also important, as failure to do so can result in infections.

Additionally, poor sexual hygiene can result in you turning off your partner which will create an embarrassing situation for the both of you. Here are some tips that will help you have a healthy and happy sex life:

Dress fresh/ wash daily your undergarments

One of the foremost pieces of advice for member of both sexes is to always wear fresh and clean undergarments. You should always try and avoid wearing undergarments that are drenched in sweat. This can occur particularly after you work out; you just have to change out of your sweaty undies, even if the sweat has dried it can create a breeding ground for bacteria and make your private parts vulnerable to infection.

In addition, sweat can block the skin pores on your private parts, causing folliculitis, which are inflamed and infected hair follicles. Another important thing to keep in mind is that you should always leave a good amount of space for breathing room and ventilation. Men should avoid wearing tight underwear, particularly briefs (v-cut ones). You should switch to briefs or boxer shorts for more comfort. Also cotton is a far better choice than other synthetic materials, since it s comfortable and porous.

Don t hold nature's call

Whenever you feel the urge to relieve yourself, don t hold it in. Urinating helps clean out bacteria in the urinary tract. If you force yourself to delay urination, you allow bacteria growth.

While these are the very basics, here s a rundown on tips that are specific to the two genders in order to achieve better sexual hygiene:

Men

Men s sexual parts are outside the body and thus it is imperative that it is kept clean. While having a bath, you should not ignore washing your penis. If you are uncircumcised, you should gently pull back your foreskin as far as possible without causing any discomfort, till the head of your penis reveals itself. You don t need to rub soap or anything else; instead you should just use lukewarm water to wash it. Only wash the head of the penis and don t even think of washing the urethra and/or urinary tract as you could damage it. Not washing this part will result in a build-up of smegma. Smegma which is white in colour is just dead skin cells and normally harmless. However, sufficient build up can cause irritation and infection.

Women

Women have the added hassle of periods. When you are undergoing your menstrual cycle, change your tampons or sanitary pads every three to six hours, depending on your menstrual flow. Leaving a stale tampon or sanitary pad for a very long time encourages bacteria to grow causing infections and bad odour.

While menstruation cleans your urethra, uterus and vagina, it is important that you clean your vagina every day. The external part of the vagina, the labia needs to be cleaned only once a day. Wash your vagina mildly and gently with soap and warm water. For many women it is easy to over-do this washing; you should not go overboard with washing by vigorous flushing or douching your vagina with scents. This can be very harmful. Douching is known to affect the ph balance of vaginas and makes you prone to infections. Not washing the external part of the vagina would result in formation of smegma (yes, in women too!). When you are drying your private parts, avoid roughly rubbing it dry and instead try patting it dry. 

Maintaining good sexual hygiene adds to the whole hygiene of your body. These tips will help you take care of your private parts better and live a healthier life.

Masturbation can have several physical (physiological) benefits. Self-stimulation of the genitals may be used as part of sexual therapy to help women learn how to experience orgasm or help men learn how to delay orgasm.

• Masturbation can help relieve pelvic pain and discomfort associated with non-bacterial prostatitis (inflammation of the prostate gland) in males or menstrual periods (menstruation) in females. It also can help to relieve stress and improve sleep. Male infertility usually is diagnosed using a semen sample that is obtained through masturbation.
• Masturbation also can have a number of mental and emotional (psychological) benefits. It can improve self-esteem by helping people become more confident in their sexuality and more aware of their bodies. Self-stimulation may improve intimacy by helping people discover what sexual techniques are most pleasing to them.
• Although masturbation can be a healthy part of human sexuality, it may have a negative impact on relationships and on psychological health in certain circumstances. For example, masturbation that becomes compulsive, obsessive, or uncontrollable, or that takes the place of a healthy sexual relationship can have an unhealthy effect on psychological well being. It is important for sexual partners to openly communicate about all aspects of sexuality and sexual behavior, including masturbation.
• In the past, masturbation was thought to be a sexual perversion and even today, certain cultures and religions oppose the practice and regard it as" sinful" behavior. These conceptions can cause stress and lead to feelings of guilt and shame in some people.
• Like other types of sexual behaviors, masturbation should only be performed in a safe, comfortable, private environment. Most communities have laws against performing sexual acts in public, as well as laws prohibiting exhibitionism (e. G, exposing the genitals in public). Masturbating in public is considered public indecency, is unhealthy, and is against the law.
• In some cases, people use lubricants or insert sex toys (e. G, vibrator, dildo) or other objects into the vagina or anus during masturbation. It is important to avoid using lubricants containing harsh chemicals (e. G, scented lotions and creams) in the genital area. These substances can cause a serious reaction (e. G, skin irritation). It also is important never to insert a breakable object or an object that is not easily removed into the body. These objects can cause injury.
• Frequent and/or vigorous masturbation can result in minor skin injuries (e. G, abrasions, bruising) in the genital area. The extended use of battery-operated sex toys can cause them to overheat, resulting in severe burns.
• Many people fantasize during masturbation. Fantasizing usually involves using the imagination or reading, listening to, or watching material that increases sexual arousal or pleasure. Sexual fantasies are a normal part of human sexuality as long as they do not interfere with relationships or daily life.
• Preoccupation with sexual fantasies can sometimes lead to damaging consequences, such as sexual addiction, sexual obsession, and spending too much time and money on sexual materials (e. G, pornographic web sites, chat rooms, magazines, videos, phone calls, sex toys).

Oral sex: what is it?

Oral sex refers to oral (mouth and tongue) stimulation of the genitals or other areas of the body. Fellatio refers to oral stimulation of the penis; cunnilingus refers to oral stimulation of the vulva (the external part of the vagina). Anilingus refers to oral stimulation of the anal opening also known as" rimming" or anal oral sex.

The penis is the most sensitive at the tip, or glans, including the frenulum (y-shaped area), the underside of the penis where the glans meets the shaft. The bottom ridge of the glans or the corona is also very sensitive.

The part of the vulva that is frequently stimulated during oral sex is called the clitoris. It’s a small, round lump of tissue about the size of a button, just above the vaginal opening, and is highly sensitive to touch because of the large network of nerve endings. The clitoral glans is covered by a hood when not aroused or when highly aroused. Individuals may prefer to be touched on the hood, which partly covers the clitoris, since the clitoris is highly sensitive to the touch. The clitoris extends into two branches on either side of the vaginal opening about 3.5 inches long and fills with blood when highly aroused.

What part does communication play during oral sex?

It’s been said many times before: people need to find a way to communicate with each other in order to enhance their sexual experience. It’s certainly true during oral sex. The receiving partner should communicate their sexual needs. Acknowledging at the beginning that making adjustments is normal and fun. You might find that saying what feels good works well, or you might prefer not to speak but rather to indicate your likes and dislikes in other ways. This could include making sounds or using your hands to help guide or move the person to another place on your body.

Orgasm and women

Sex surveys of women report that most achieve orgasm more easily from oral or manual stimulation rather than during penetrative intercourse. Because the tongue is soft, warm and lubricated, a woman may find that this provides such intense stimulation that it becomes the best means for achieving orgasm. Each person is unique. For some women, oral sex will become part of a sexual repertoire. For others, it will become the primary sexual behavior of choice.

Are there risks associated with oral genital contact?

Many people feel safe engaging in this behavior because they know there is no risk of pregnancy. There are, however, other considerations. Some stis (sexually transmitted infections), such as herpes, chlamydia, gonorrhea, hiv, hpv, trichomoniasis and syphilis can be transmitted through oral-genital contact. For example, oral herpes (cold sores) can be transmitted to the genitals and genital herpes can be transmitted to the mouth. The herpes virus can be transmitted without visible sores or an outbreak. Hiv may be transmitted through oral genital sex when hiv is in semen, vaginal secretions, or blood that enters the mucus membranes or abrasions in the mouth and throat. Hiv is not spread through saliva.

 Now a word about hygiene

For most people, cleanliness is an important consideration. Consider showering or bathing prior to sexual activity. It removes the daily dirt, sweat and other materials that accumulate over the course of the day.

Vaginal douching is not recommended. Douching is washing or “cleaning” out the inside of the vagina with water or other mixtures of fluids, which can lead to various health problems such as making a person more susceptible to infection due to changing the normal flora in the vagina. Anal douching is also not recommended. Using a mild soap and warm water is all that is needed.

For an individual with an uncircumcised penis, pull back the foreskin to wash thoroughly.

Circumcised individuals also need to maintain good hygiene as the absence of foreskin can cause the glans of the penis to come in direct contact with sweat and bacteria.

 Questions about oral sex-

What if my partner doesn’t want to perform oral sex?

Individuals have different sexual likes and dislikes. These differences should be respected. However, it’s possible that a person’s dislike of this sexual act is based on hygienic concerns. If so, see our section on hygiene. It’s also possible that a person is concerned about disease transmission. Try talking with your partner about their feelings and why they’re feeling that way. Time and increasing intimacy can help an individual be more comfortable with oral sex.

What is safer oral sex?

It’s possible that the use of a latex barrier such as an oral (dental) dam, a thin square of latex used to cover a person’s body part or a non-lubricated condom cut open placed between the mouth and genitals would make the behavior more appealing, and certainly less risky in terms of sti transmission.

For oral sex on a penis, should I spit or swallow the ejaculate?

This is a personal preference. Some don’t mind swallowing while others may find it unappealing. For others, it might be strictly based on the taste (salty or bitter) and texture (thin or viscous) of the ejaculate. It is important to spit or swallow immediately following to keep the ejaculate from entering any cuts on the inside of the mouth. If your concern about swallowing is about ingesting hormones, rest assured that even though the testicles produce most of the hormones, they are not released into the ejaculate. If the concern is about calories, the approximate teaspoonful of ejaculate is low calorie (about 5 calories). Based on information from the cdc, you can reduce your risk for stis by not allowing your partner to ejaculate in your mouth.

I’ve never done this before…will I enjoy it?

There is a range of feelings expressed about this sexual behavior. They include those who truly enjoy performing oral sex, to those who don’t find anything particularly special about it but want to do it for their partner, to those who don’t want anything to do with it. Many people would probably say that it indicates a degree of intimacy for another person, intimacy that can’t be expressed in any other way. A person’s feelings can change over time and from one partner to another. If it is something you’re intrigued about, you can find books and other resources with additional information and insight.

Every single woman is an individual, and you can’t generalize to all women.

• But you’ll be happy to know that actually, size really doesn’t matter to most females. It does matter to some females.
• Some women can have just a little bit wider vaginas than other women do. For example, women who have given birth vaginally to children, and/or who are not very physically active, and/or who do not practice kegel exercises regularly can sometimes (but not always) be a little wider. These women may prefer men who are a little bit thicker (but not necessarily longer).
• In fact, where size is concerned, most women think it’s girth that matters, not length. She just want to be able to feel you inside. So if there’s a mismatch between the girth/width/whatever of a woman’s vagina, and the girth/width/whatever of a man’s penis, that can be disappointing – as much for the man as it is for the woman.
• An average-sized penis is perfectly adequate to satisfy the vast majority of women. And a particularly long penis can actually hurt.
• The size of a man’s penis is not a reflection of his sexual adequacy any more than the size of a woman’s vagina is a reflection on hers.
• One more very important point: most women do not orgasm through penis-in-vagina intercourse. Some do (approximately 25%,). The remaining 75% need a man to focus on stimulating her clitoris and/or other parts of her vulva, and/or her g-spot. This can be done with the penis, but in that case the size of your penis really doesn’t matter one bit. And a majority of women seem to prefer oral sex (cunnilingus). No penis needed at all.
• For women, achieving orgasm isn’t a simple in-and-out procedure the way it is for men. You’re going to have to start all over again with every single woman you have sex with, learning what works for her. So you may be figuring out by now, verbal communication is key.

Whether the problem is big or small, there are many things you can do to get your sex life back on track. Your sexual well-being goes hand in hand with your overall mental, physical, and emotional health. Communicating with your partner, maintaining a healthy lifestyle, availing yourself of some of the many excellent self-help materials on the market, and just having fun can help you weather tough times.

Enjoying a satisfying sex life

Sex. The word can evoke a kaleidoscope of emotions. From love, excitement, and tenderness to longing, anxiety, and disappointment—the reactions are as varied as sexual experiences themselves. What's more, many people will encounter all these emotions and many others in the course of a sex life spanning several decades.

But what is sex, really?

On one level, sex is just another hormone-driven bodily function designed to perpetuate the species. Of course, that narrow view underestimates the complexity of the human sexual response. In addition to the biochemical forces at work, your experiences and expectations help shape your sexuality. Your understanding of yourself as a sexual being, your thoughts about what constitutes a satisfying sexual connection, and your relationship with your partner are key factors in your ability to develop and maintain a fulfilling sex life.

1. Talking to your partner

Many couples find it difficult to talk about sex even under the best of circumstances. When sexual problems occur, feelings of hurt, shame, guilt, and resentment can halt conversation altogether. Because good communication is a cornerstone of a healthy relationship, establishing a dialogue is the first step not only to a better sex life, but also to a closer emotional bond. Here are some tips for tackling this sensitive subject.

2. Find the right time to talk

There are two types of sexual conversations: the ones you have in the bedroom and the ones you have elsewhere. It's perfectly appropriate to tell your partner what feels good in the middle of lovemaking, but it's best to wait until you're in a more neutral setting to discuss larger issues, such as mismatched sexual desire or orgasm troubles.

3. Avoid criticizing

Couch suggestions in positive terms, such as" I really love it when you touch my hair lightly that way" rather than focusing on the negatives. Approach a sexual issue as a problem to be solved together rather than an exercise in assigning blame.

4. Confide in your partner about changes in your body

If hot flashes are keeping you up at night or menopause has made your vagina dry, talk to your partner about these things. It's much better that he know what's really going on rather than interpret these physical changes as lack of interest. Likewise, if you're a man and you no longer get an erection just from the thought of sex, show your partner how to stimulate you rather than let her believe she isn't attractive enough to arouse you anymore.

5. Be honest

You may think you're protecting your partner's feelings by faking an orgasm, but in reality you're starting down a slippery slope. As challenging as it is to talk about any sexual problem, the difficulty level skyrockets once the issue is buried under years of lies, hurt, and resentment.

6. Don't equate love with sexual performance

Create an atmosphere of caring and tenderness; touch and kiss often. Don't blame yourself or your partner for your sexual difficulties. Focus instead on maintaining emotional and physical intimacy in your relationship. For older couples, another potentially sensitive subject that's worth discussing is what will happen after one partner dies. In couples who enjoy a healthy sex life, the surviving partner will likely want to seek out a new partner. Expressing your openness to that possibility while you are both still alive will likely relieve guilt and make the process less difficult for the surviving partner later.

7. Using self-help strategies

Treating sexual problems is easier now than ever before. Revolutionary medications and professional sex therapists are there if you need them. But you may be able to resolve minor sexual issues by making a few adjustments in your lovemaking style. Here are some things you can try at home.

8. Educate yourself

Plenty of good self-help materials are available for every type of sexual issue. Browse the internet or your local bookstore, pick out a few resources that apply to you, and use them to help you and your partner become better informed about the problem. If talking directly is too difficult, you and your partner can underline passages that you particularly like and show them to each other.

9. Privacy concerns and internet use

The internet is a valuable source of all types of information, including books and other products (such as sex toys) that can enhance your sex life. Although it may be obvious, never use your workplace computer to do such searches, to avoid potential embarrassment with your employer, who is likely able to track your search history. People who feel uneasy even about using their home computers and credit cards to order sex-related information or products online might be able to find a nearby store (especially in major cities) and pay with cash.

10. Give yourself time

As you age, your sexual responses slow down. You and your partner can improve your chances of success by finding a quiet, comfortable, interruption-free setting for sex. Also, understand that the physical changes in your body mean that you'll need more time to get aroused and reach orgasm. When you think about it, spending more time having sex isn't a bad thing; working these physical necessities into your lovemaking routine can open up doors to a new kind of sexual experience.

11. Use lubrication

Often, the vaginal dryness that begins in perimenopause can be easily corrected with lubricating liquids and gels. Use these freely to avoid painful sex—a problem that can snowball into flagging libido and growing relationship tensions. When lubricants no longer work, discuss other options with your doctor.

12. Maintain physical affection

Even if you're tired, tense, or upset about the problem, engaging in kissing and cuddling is essential for maintaining an emotional and physical bond.

13. Practice touching

The sensate focus techniques that sex therapists use can help you re-establish physical intimacy without feeling pressured. Many self-help books and educational videos offer variations on these exercises. You may also want to ask your partner to touch you in a manner that he or she would like to be touched. This will give you a better sense of how much pressure, from gentle to firm, you should use.

14. Try different positions

Developing a repertoire of different sexual positions not only adds interest to lovemaking, but can also help overcome problems. For example, the increased stimulation to the g-spot that occurs when a man enters his partner from behind can help the woman reach orgasm.

15. The g-spot

The g-spot, or grafenberg spot, named after the gynecologist who first identified it, is a mound of super-sensitive spongelike tissue located within the roof of the vagina, just inside the entrance. Proper stimulation of the g-spot can produce intense orgasms. Because of its difficult-to-reach location and the fact that it is most successfully stimulated manually, the g-spot is not routinely activated for most women during vaginal intercourse. While this has led some skeptics to doubt its existence, research has demonstrated that a different sort of tissue does exist in this location.

You must be sexually aroused to be able to locate your g-spot. To find it, try rubbing your finger in a beckoning motion along the roof of your vagina while you're in a squatting or sitting position, or have your partner massage the upper surface of your vagina until you notice a particularly sensitive area. Some women tend to be more sensitive and can find the spot easily, but for others it's difficult.

If you can't easily locate it, you shouldn't worry. During intercourse, many women feel that the g-spot can be most easily stimulated when the man enters from behind. For couples dealing with erection problems, play involving the g-spot can be a positive addition to lovemaking.

Oral stimulation of the clitoris combined with manual stimulation of the g-spot can give a woman a highly intense orgasm.

1.  About your fantasies

This exercise can help you explore possible activities you think might be a turn-on for you or your partner. Try thinking of an experience or a movie that aroused you and then share your memory with your partner. This is especially helpful for people with low desire.

2. Do kegel exercises

Both men and women can improve their sexual fitness by exercising their pelvic floor muscles. To do these exercises, tighten the muscle you would use if you were trying to stop urine in midstream. Hold the contraction for two or three seconds, then release. Repeat 10 times. Try to do five sets a day. These exercises can be done anywhere—while driving, sitting at your desk, or standing in a checkout line. At home, women may use vaginal weights to add muscle resistance. Talk to your doctor or a sex therapist about where to get these and how to use them.

3. Try to relax

Do something soothing together before having sex, such as playing a game or going out for a nice dinner. Or try relaxation techniques such as deep breathing exercises or yoga.

4. Don’t give up

If none of your efforts seem to work, don’t give up hope. Your doctor can often determine the cause of your sexual problem and may be able to identify effective treatments. He or she can also put you in touch with a sex therapist who can help you explore issues that may be standing in the way of a fulfilling sex life.

5. Maintain good health

Your sexual well-being goes hand in hand with your overall mental, physical, and emotional health. Therefore, the same healthy habits you rely on to keep your body in shape can also shape up your sex life.

6. Exercise (no excuse)

Physical activity is first and foremost among the healthy behaviors that can improve your sexual functioning. Because physical arousal depends greatly on good blood flow, aerobic exercise (which strengthens your heart and blood vessels) is crucial. And exercise offers a wealth of other health benefits, from staving off heart disease, osteoporosis, and some forms of cancer to improving your mood and helping you get a better night's sleep. Also, don't forget to include strength training.

7. Use alcohol in moderation

Some men with erectile dysfunction find that having one drink can help them relax, but heavy use of alcohol can make matters worse. Alcohol can inhibit sexual reflexes by dulling the central nervous system. Drinking large amounts over a long period can damage the liver, leading to an increase in estrogen production in men. In women, alcohol can trigger hot flashes and disrupt sleep, compounding problems already present in menopause.

8. Eat right

Overindulgence in fatty foods leads to high blood cholesterol and obesity—both major risk factors for cardiovascular disease. In addition, being overweight can promote lethargy and a poor body image. Increased libido is often an added benefit of losing those extra pounds.

9. Putting the fun back into sex

Even in the best relationship, sex can become ho-hum after a number of years. With a little bit of imagination, you can rekindle the spark.

10. Adventurous

Maybe you've never had sex on the living room floor or in a secluded spot in the woods; now might be the time to try it. Or try exploring erotic books and films. Even just the feeling of naughtiness you get from renting an x-rated movie might make you feel frisky.

11. Sensual

Create an environment for lovemaking that appeals to all five of your senses. Concentrate on the feel of silk against your skin, the beat of a jazz tune, the perfumed scent of flowers around the room, the soft focus of candlelight, and the taste of ripe, juicy fruit. Use this heightened sensual awareness when making love to your partner.

 12. Playful

Leave love notes in your partner's pocket for him or her to find later. Take a bubble bath together—the warm cozy feeling you have when you get out of the tub can be a great lead-in to sex. Tickle. Laugh.

13. Be creative

Expand your sexual repertoire and vary your scripts. For example, if you're used to making love on saturday night, choose sunday morning instead. Experiment with new positions and activities. Try sex toys and sexy lingerie if you never have before.

14. Be romantic

Read poetry to each other under a tree on a hillside. Surprise each other with flowers when it isn't a special occasion. Plan a day when all you do is lie in bed, talk, and be intimate. The most important tool you have at your disposal is your attitude about sexuality. Armed with good information and a positive outlook, you should be able to maintain a healthy sex life for many years to come.