In an era where health information is often overwhelming and contradictory, HT Lifestyle has launched a reader-centric initiative: HT Health Talk. Every week, we invite readers to share their most pressing medical concerns, taking these burning questions directly to the country’s leading medical specialists. Also read | HT Health Talk: You asked, our experts answered how to manage migraine in summer
This week, HT readers reached out with a flurry of concerns related to sexual health – many readers expressed concerns regarding premature ejaculation, others shared concerns related to the physiological sensations associated with intercourse.
To provide clarity, comfort, and clinically backed solutions, we tapped two specialists from Bengaluru: Dr Santhosh Raj, consultant in general and laparoscopy surgery, male infertility, and sexual health at Motherhood Hospitals, and Dr Deepthi Ashwin, consultant obstetrician and gynaecologist at Aster Whitefield Hospital.
1. I struggle with reaching climax too quickly. Is premature ejaculation a condition that can be clinically treated or managed?
There can be various factors that can cause premature ejaculation including performance anxiety, and sensitivity. If the sensitivity is more in his glans penis, then it is to a very lesser extent a hormonal issue. The factors can also be that it might be a habit, not a strong pelvic floor and infrequent sexual intercourse; all these can lead to premature ejaculation.
It can be treated. Initially, we can do some changes with counselling on how to perform, how to delay, and how to handle anxiety. Another way to treat it is Behavioural therapy. Other treatment methods involve local applications that can reduce sensitivity and delayed climax; use of condoms, and there are also some medications that can help with delaying ejaculation. If nothing from the above is working, the issue can be treated surgically with circumcision.
2. I experience significant bodily tension and physical discomfort during intercourse or self-stimulation. What underlying medical or psychological factors could be causing this painful, constricted sensation?
The physical causes for such experience include issues with pelvic floor muscles, either too relaxed or too tight, or not well strengthened. Other causes might be any prostatic/testicular inflammation or tight prepucial skin like phimosis and paraphimosis. Prostate and testicular inflammation can cause painful ejaculation. If the foreskin is tight or if the paraphimosis, the foreskin of the penis is retracted back, the butt doesn’t go front. All these things can cause some kind of physical discomfort.
Psychological factors include stress and performance anxiety, where a person will always be very conscious about his performance or not to reach climax very soon. These experiences can also stem from relationship conflicts or past sexual trauma.
3. What is the recommended hygiene routine for maintaining the health and cleanliness of an uncircumcised penis?
A recommended hygiene routine for maintaining health and cleanliness of an uncircumcised penis is daily cleaning during bathing when you retract the penis fully and cleanse the glans with soap and water. It is also advised to touch or hold your penis while urinating after washing your hands. That way whatever the fomites or the infections you may come into contact with will not enter your body or the glans penis.
4. Is there any clinical evidence suggesting that common hair loss treatments can negatively impact male libido or sexual function?
Yes. Usually, we treat male pattern baldness with minoxidil. The topical application of minoxidil will have very little effect on sexual activity or libido. However, we also prescribe another medication called finasteride. Finasteride is a male hormone-suppressing agent, which may cause impotency on prolonged administration and high doses. It may not happen in every individual, but is seen in most cases. Clinically, it is proven that it causes impotence or loss of libido.
5. What are the physiological effects of masturbation on overall health? Additionally, is there a recommended frequency, and are there benefits or drawbacks to total abstinence?
Masturbation by itself generally does not have a significant impact on one’s overall health. However, excessive dependence on pornography for sexual stimulation may, in some individuals, influence expectations and arousal patterns in real-life intimate relationships. Sometimes, this can also affect emotional or physical intimacy with a partner. While there’s no recommendation on the frequency, it’s scientifically proven that in the long run, a person who has ejaculated less is at a higher risk of prostate cancer compared to one who ejaculates regularly. It is to be noted that there are no significant drawbacks to abstinence.
6. I experience a significant surge in sexual desire, specifically at night. Is this hormonal peak considered a normal variation of the human libido?
Desire to engage in sexual activities and feeling an increased level of libido is a completely normal occurrence and may be associated with numerous physiological causes. Evening tends to be a period when one is more relaxed, less stressed, and has more personal space for private affairs; hence, the desire can become stronger during that time. Hormonal rhythms may also play a role. For example, testosterone levels in men are often higher in the early morning, while in women hormonal function can vary depending on the menstrual cycle. Therefore, we can’t attribute this phenomenon solely to hormones. Factors such as privacy, the absence of work-related stress, and a calming environment can all contribute to increased desire at night.
7. For those experiencing erectile dysfunction, to what extent is the condition reversible or manageable through lifestyle changes and medical intervention?
The cause of erectile dysfunction may range from several different factors. It could be either physical, hormonal, or psychological. Psychological factors usually refer to anxiety and pressure. However, in some cases, erectile dysfunction has something unique when it comes to the psychological aspect, where, apart from the usual instances like anxiety, performance, pressure, marital problems, and others, there is one more problem. Which is experiencing erectile dysfunction only in the presence of one specific person/partner, while masturbation and intercourse with other persons are normal. Such problems can be easily addressed psychologically.
We would try to tackle the issue through psychological therapies, which include coping with anxiety, pressures and different ways of arousal. In case of hormonal issues, we need to consider the role of different hormones affecting a man’s erection. Rectifying this, along with many other aspects, will result in increased testosterone levels overall, which will help in ED as well. Physical measures include treating pelvic floor weakness using the exercise devised by Kegels, as well as parapelvic muscle strength, including gluteus, abdominals, quadriceps and hamstrings, will also be helpful up to some extent. Weight lifting exercises, proper and balanced diets, high protein content diets, a combination of strength training and cardiovascular exercises, weight reduction, muscle gain etcetera will all be responsible for increasing male hormones, improving erectile dysfunction.
8. What are the current medical perspectives on the health benefits versus the potential risks of circumcision?
A circumcised penis will have more medical benefits than an uncircumcised one. First, the number of infections is likely to be lower when a man is circumcised. Infections become minimal, and even sex becomes good, since when one experiences premature ejaculation due to increased sensations, circumcision makes the penis erect for a longer time. It is a cleaner practice since smegma formation underneath the foreskin is prevented.
9. Could you clarify the primary modes of HIV transmission and identify which behaviours carry the highest risk for infection?
The virus mainly spreads due to contact with infected blood or through unprotected sexual encounters and from an HIV-positive mother to her baby during pregnancy, delivery or breast feeding. One of the major risk factors for acquiring HIV is having unprotected sexual relations with a person that has HIV. There is a higher chance of getting HIV through anal, vaginal or oral sexual intercourse if there are any cuts, tears, bleeding and exposure to infected blood fluids.
10. Is it medically safe to use petroleum-based products like Vaseline as a sexual lubricant, or are there specific health risks involved?
Products based on petroleum, such as Vaseline, are not recommended for use during sex as a lubricant. Water-based lubricants would be much better compared to Vaseline. Vaseline causes irritation to the genital areas of the partner’s body. It tends to form a film coating inside the vagina and causes infections to occur. Thus, this is all the possible health hazards caused by using Vaseline. Lubricants that certain brands have manufactured can be more useful for the process of sexual intercourse.
11. What are the actual risks of contracting or transmitting an STI during oral sex, and what preventative measures should be taken?
Oral sex usually has a lower STI transmission risk than penetrative sex, like, honestly, it’s generally less likely, but it’s not a zero-risk kind of thing. The actual risk isn’t the same for every infection; some are more easily passed around than others, depending on the type of contact and whether symptoms are present. Higher transmission risk from oral sex: herpes, HPV, gonorrhoea, syphilis. Moderate risk: chlamydia. Low, but still not zero risk: HIV, and that chance climbs a lot when there are oral sores, bleeding gums, or genital ulcers
Here is what you can do to reduce risk, kind of in practical terms:
– Use condoms during oral sex when it’s being done on a penis.
– Use dental dams (or cut condoms ) during oral sex on a vulva or anus.
– Get regular STI screening, especially because oral infections can be silent for long periods.
– Consider HPV vaccination, it’s very effective against the strains most tied to oral and throat cancers.
– Don’t do oral sex when either partner has visible sores ulcers or an active outbreak.
– Keep up good oral hygiene, and avoid brushing or flossing right before oral sex, since micro-abrasions can raise the risk, kind of subtly.
12. From a medical standpoint, are there any physical markers that can definitively prove whether or not a woman has had sexual intercourse?
There are no physical markers to prove whether a woman has had sexual intercourse.
13. If a woman misses a dose of her hormonal birth control pill, what is the immediate medical protocol to ensure continued protection?
Missed by less than 24 hours: take the missed pill right away, then keep going with the pack like normal. Your protection is maintained, mostly. Missed by more than 24 hours (one pill): take the missed pill as soon as you remember, even if that ends up meaning two pills in one day. After that, continue as usual. For the next seven days, use backup contraception, like condoms. If you miss more than two pills, take the latest one you forgot right away, then discard the earlier ones, kind of move on with the pack like nothing happened, ok. Also, use extra backup contraception for seven days just to be safe. Now, if the missed pills happened in the third week, skip the placebo week altogether and start a completely brand new pack straight away, no delay.”
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
