Sexual Health Month:  the Questions Men Are Too Afraid to Ask

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Men often struggle when it comes to talking about their sexual health with their doctors and even their partners. “Many patients are uncomfortable discussing topics like erectile dysfunction, STDs and birth control,” says Dr. Mohit Khera, MD, MBA, MPH, a board-certified urologist and Professor of Urology at Baylor College of Medicine in Houston, Texas. “But men shouldn’t stress silently—having an open dialogue with a medical professional is one of the best ways to resolve any issues and reduce any related anxiety.”

In honor of Sexual Health Month, Dr. Khera shares the most important questions that men shouldn’t be afraid to ask when it comes to their sexual well-being.

Sometimes I ejaculate too quickly, what’s going on?

Studies show that a sexual encounter can last anywhere between 33 seconds and 44 minutes, with the average time being 5.4 minutes. That said, premature ejaculation, otherwise known as PE, is when there is a recurrent pattern of ejaculation occurring usually within two-minutes post vaginal penetration. It can be attributed to a number of factors, including anxiety, psychological issues or even a medical condition. Kegel exercises to strengthen your pubococcygeus muscles, reducing anxiety through yoga or meditation, and/or a mild delay spray, which can help slow premature ejaculation

Why is it difficult for me to finish during sex?

Delayed or impaired ejaculation is when it takes an extended period of sexual stimulation for a man to reach climax and release semen. “Sometimes it’s a lifelong problem, other times it’s acquired after a period of normal sexual function,” notes Dr. Khera. Possible triggers include certain medications, health conditions, anxiety, depression or prostate surgery. While there’s no set time to indicate a diagnosis of delayed ejaculation, it should be brought to the attention of your doctor if it causes frustration during lovemaking or if you need to stop your sexual activity due to fatigue or irritation.

What can I do if I suffer from erectile dysfunction?

Fifty-two percent of men between the ages of 40 and 70 have some degree of ED, and every man will develop ED in their lifetime. “ED is a progressive disease with roughly 70% of men suffering from this condition by the age of 70,” says Dr. Khera. Often a man’s first response to ED is to call to his doctor and request a prescription for a PDE-5 inhibitor like Viagra and Cialis, medications that work by blocking an enzyme in the walls of the blood vessels, allowing them to relax and increase blood flow to the penis. “But patients should be encouraged to focus on lifestyle modifications, such as weight loss, regular exercise, and a healthy diet, which could help improve ED without having to take any oral prescriptions.” Erectile dysfunction can also be the first sign of an underlying cardiovascular issue or a medical condition such as diabetes or depression, so it’s important to talk to your doctor.

Why is the amount of my ejaculate decreasing?

Erectile function isn’t the only thing affected by age. According to the National Institutes of Health, normal semen volume ranges from 1.5 to 5 ml, and men will most likely notice a gradual decrease after the age of 55. Certain medications, such as those used to help improve urination or antidepressants, may also reduce semen volume, as can neurological diseases like multiple sclerosis.

Is there such a thing such as men’s menopause?

Yes, although unlike women’s ovaries, the male testes don’t lose the ability to make hormones. But as men age, there are subtle changes in their function—testosterone levels can begin to decline in the mid-30s, which could result in fatigue, insomnia, muscle loss or weakness, trouble concentrating, lower sex drive, and a shrinking penis, scrotum and/or testicles. But before jumping to testosterone supplements, men should consider incorporating resistance training and weight-lifting, along with a diet that includes a healthy balance of fat, protein and carbs into their lives as these actions can naturally boost testosterone levels. “You also want to minimize stress as stress can decrease testosterone levels,” adds Dr. Khera. “And get enough sleep—one study showed getting only five hours of sleep a night was linked to a 15% reduction in testosterone levels.”

I’m concerned my penis is too small. What’s the average size?

Penis anxiety is often a common concern among men but one they rarely talk about. According to the National Institutes of Health, the average length of a penis is between 5.1 and 5.5 inches when erect and 3.6 inches when flaccid. A recent UCLA study suggests it’s not so much about length, but girth, when it comes to sexual satisfaction—it was found girth helped to bring the clitoris closer to the vagina, encouraging orgasms. At the same time, the research suggested that longer length penises could be linked to cervical pain.

Why do I have pain in my testes?

Signs of pain, lumps or swelling in the testes doesn’t always signal a serious illness like cancer. “There are many causes of testis pain including trauma, varicoceles (swelling of the veins above the testicle), and testicular cysts. Testicular tumors generally do not cause pain. Regardless, it’s important to have any testicular masses to be evaluated immediately,” says Dr. Khera.

How often should I get tested for STDs?

“Here’s where it’s important to share your sexual history with your doctor so he/she can decide whether you should be tested for certain STDs,” says Dr. Khera. According to the Center for Disease Control and Prevention, all adults and adolescents ages 13 to 64 should be tested at least once for HIV, while anyone who has unsafe sex should get tested for HIV at least once a year. Sexually active gay or bisexual men should be tested at least once a year for syphilis, chlamydia, and gonorrhea.

Source: Dr. Mohit Khera Professor in the Scott Department of Urology at Baylor College of Medicine and he holds the F. Brantley Scott Chair in Urology.

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