Orgasm, erection or pain a problem?

Problems with having orgasms
There is still a lot that we don’t know about orgasms. What we do know is that they are your brain’s way of rewarding you for having sex. Orgasms are experienced in very different ways, but they are always peak experiences of intense pleasure. It is as if they carry you to a different level of consciousness. You get a feeling of release, and your pelvic diaphragm, your anus and – in women – your uterus all start contracting. You are considered to have a problem with having orgasms if, after normal sexual stimulation, you are unable to come, can come only with difficulty, or come too quickly and if you experience that as a problem.

 

About one out of every three women regularly comes during sex with a partner. There are women who can come when they masturbate, but not during sex. Some women see that as a problem, but others do not. ‘Premature ejaculation’ is when a man comes within one minute of penetrating his partner, without being able to control his ejaculation. The term also implies that someone experiences that as a problem.

Problems with getting an erection
Having an erection problem, means that you cannot (always) manage to get and maintain a good erection. As with many other sexual problems, physical and psychological factors can also play a role in erection problems. Your (sex) relationship could be of influence, for example if a partner responds by rejecting you. An erection problem could also be a side effect of HIV medicines or antidepressants. If you sometimes have a ‘morning’ erection or if you can manage to get an erection when you masturbate, then you know that it ‘works’. That means nothing is physically wrong, so the reason must be psychological. If your problem with getting and keeping erections has developed gradually over time, the cause is often physical. There are three different kinds of erection pills available by prescription in pharmacies. Each of those medications works effectively and safely. They each come with a warning against using them together with poppers and/or protease inhibitors.

If someone is suddenly no longer able to get or maintain an erection, the reason is usually psychological. If you become fixated on the erection, that can make the problem worse. With younger men, an erection problem only has a psychological cause. The older you are, the greater the chance that physical factors will also play a role.

From performance and frustration to pleasure and arousal
I enter into discussion with the client: What does the erection problem mean for you? And for your relationship? How do you deal with it? It often happens that someone with an erection problem will start to avoid having sex. In that case, sex is no longer linked with reward and pleasure, but with frustration: ‘You are a failure as a man.’ In their heads, men have the idea that good sex involves a hard-on, fucking and coming. ‘If you don’t have a hard-on, that means you are not aroused and nothing can happen.’ If that is your definition of good sex, then the emphasis lies more on performance than on pleasure. If someone has an erection problem, it is good to remove that fixation on the idea of performance. My advice in such cases is to stop fucking for a while and to look for other techniques that you find pleasurable. I often say there are just as many nerve endings on the head of a flaccid penis as there are on the head of a hard-on. You can also get an orgasm with a soft penis. Good sex is about playing with pleasure and arousal. If you are fixated on your inability to get an erection, you take away the arousal. I encourage men to shift their focus from their erection to their connection with the other person.
Adrie Heijnen, doctor and sexologist

Breaking patterns
How come someone can’t get or keep an erection? If fear plays an important role, we will start by looking at that. If a man loses his erection, he often thinks: ‘Oh no, it’s never going to come back again.’ In that case, he is completely wrapped up in his thoughts. I will give him some homework exercises that he can use to break that pattern: ‘Focus your thoughts on things that arouse you.’ The person can practice that first on his own while masturbating and later with his partner.
Eva Buitenhuis, psychologist and sexologist

Acceptance
If you can no longer get an erection, for example due to some other condition, this will raise questions in your relationship: ‘How are we going to deal with this together? How can we maintain the intimacy? Do you want to have sex with someone else from now on? Does this mean the end of our relationship? Or is there some other way that we can have a good relationship?
Eva Buitenhuis, psychologist and sexologist

If you have no sex drive, that pill won’t work
Sometimes an erection pill can help, for example if you can’t manage to maintain a hard-on very long. In that case, such a pill can boost your confidence and help you ‘rise to the occasion’. But if someone has no sex drive to begin with, or can’t manage to become aroused, then an erection pill won’t work. Erection pills can be prescribed by your family doctor or by a medical doctor who is also a sexologist. Some HIV doctors may prescribe erection pills for their patients, while others will leave that to other doctors. If you do get a prescription for erection pills from a doctor, you will still need to pay for them yourself in the pharmacy. They cost about ten euros per pill. Many people buy erection pills, for example Kamagra, through the Internet. Those closely resemble Viagra but are much less expensive. The disadvantage is that you never know for certain what such pills contain: it is possible that they will not work or they could also be dangerous to your health.
Loek Elsenburg, HIV nurse

Erection pills
Three different types of erection pills are available with a prescription at pharmacies. Each of those medications is both effective and safe. As the first such medication to appear on the market, Viagra is the also best known. Cialis is prescribed most often and works the longest. The third medication is called Levitra.

If you are going to use erection pills, it is good to know the following:

  • The medications will not take effect immediately; they will only start working after an average of 30 minutes.
  • The medications will only lead to an erection if you are already sexual aroused.
  • The medications will only be really effective after four to six times.
  • The most common side effect is a headache. After a couple of times, the side effects will often decrease in intensity or disappear altogether.
  • Viagra and Levitra need to be taken at last three hours after a meal, since fatty foods will slow down the absorption of the medication.
  • It is a myth that erection pills and sex will put you at greater risk of developing cardiovascular diseases.

Watch out for the combination of erection pills and poppers
Using poppers while you are using erection pills can be dangerous.

Watch out for the combination of erection pills and protease inhibitors
Protease inhibitors (a category of HIV medicines) will strengthen the effect of erection pills, making an overdose more likely. In such cases, it is important to use a lower than normal dose of the erection pills. When combining Viagra with protease inhibitors, take only the lowest dose: 25 mg of Viagra per 48 hours.

Sex addiction
Particularly among gay men, sex addiction is not uncommon. There is no standard that can tell you that if you have sex more than so many times a week, you are addicted. The difference between having ‘a lot of good sex’ and being addicted to sex is this: sex is an addiction if you or someone close to you experiences it as a problem and if it is uncontrollable – if you have the feeling that you have to do it. If you are addicted to sex, it is as if you don’t have a choice. Sex is compulsive and controls a large portion of your day-to-day life.

Filling emptiness
In the past you had to go out to find sex. Now, thanks to the Internet, you can spend your entire day being focused on sex. That is often something people do to make up for a feeling of emptiness in their lives. What matters is whether or not that causes problems for you – or for your partner. It doesn’t make any sense to focus on all the things you shouldn’t do anymore. I encourage people to think about it what it is that makes them continually go out looking for sex. Sex gives you a shot of adrenaline and that can be addictive. If someone has a flourishing sex life, sex will give him or her energy. But if you are addicted to sex, you will tend to feel empty after sex. Sex addiction often goes hand in hand with a feeling of depression and a lack of self-respect. When I ask someone who is addicted to sex ‘What exactly do you like about sex?’ it often becomes quiet. That’s when I see that the person’s self-esteem diminishes every time he or she has sex.
Adrie Heijnen, doctor and sexologist

Changing appearance
Plenty of people with HIV have lipodystrophy, which means a redistribution of fat. Their bodies undergo changes due to the medications they are taking or due to HIV itself. (The HIV medications that used to cause lipodystrophy are hardly prescribed anymore.) Their altered appearance can affect their sexuality.

It can often be difficult for people with lipodystrophy to accept themselves. I don’t hesitate to involve a plastic surgeon. The cost of that is often reimbursed by their health insurance. Looking better can boost your confidence. But your sexual problems will not necessarily disappear like snow in summer after having plastic surgery.
Jolanda Schippers, HIV nurse

Pain
Some people actually seek out pain during sex. But sex can also function like a good painkiller if you have chronic pain. And pain can also keep you from enjoying sex.

What kind of pain can get in the way of your enjoyment of sex?

  • Pain that you have the whole day
  • Pain in your vagina, anus, penis or breast
    Women sometimes have so much pain that penetration is hardly possible, if not impossible. That pain often comes from a combination of physical and psychological factors. A common physical factor is that the vagina is dry and the lips do not swell at all. There are various different kinds of vaginal pain:
    - The penis can cause pain both when it enters (surface pain) and when it pushes further inwards (deep pain).
    - The entire vulva can be painful but also just part of it can be painful.
    - The pain can come from touching or it can be present all the time.
    Men can also suffer from pain, including pain in the pelvic diaphragm, pain from a foreskin that is too tight or other types of pain in the lower body.
  • Pain in other parts of the body that are used during sex.

 

 

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