Ask Debby Herbenick | Permanent contraception and pregnancy

Q I’m a 26-year-old virgin. Whenever my penis is erect, it is very hard for me to retract my foreskin. It is painful also after my penis is out—it is uncomfortable and unpleasurable for me to touch my penis then as compared to when my penis is still protected by my foreskin. That’s why I enjoy masturbating my penis when it is still inside my foreskin. Is this normal? I have a feeling that it will be very uncomfortable for me to put my penis into a woman’s vagina. How can I make intercourse pleasurable?
A Although men’s penis sensitivity varies, most men are able to experience pleasurable masturbation and intercourse whether or not they have foreskin (that is, whether or not they are circumcised). As you have difficulty retracting your foreskin and uncomfortable sensitivity when it is retracted, check in with a urologist or dermatologist for an exam. Some men have genital skin conditions that cause inflammation, which can make it difficult to retract their foreskin and change the sensitivity of the penile skin. Sometimes these skin conditions are treated with creams; other times circumcision may be recommended. In the meantime, you might try different ways of stimulating your penis during masturbation such as by using a water-based lubricant or masturbating in the shower. You might even try masturbation while wearing a desensitizing performance-enhancing condom, as these contain small amounts of benzocaine that slightly dulls sensations to the penis. By decreasing sensation, these condoms can help men last longer (delay ejaculation). However, it might also help you to more comfortably masturbate. If it works, you can use it during intercourse with a partner while you (hopefully) work together with a health-care provider to get at the root of the issue.

Q I have three beautiful children, and that’s all I can handle. I am tired of the routine and cost of temporary birth control, and condoms are out of the question for my husband and me. I was thinking about getting my tubes tied, but I really don’t want to have surgery. Do you have other recommendations for permanent birth control? Have you heard of something called Essure? I heard about it on the radio and it sounded intriguing, but I don’t know anything about it.
A Essure is an interesting form of permanent birth control for women who are absolutely certain they no longer want to bear children. Essure involves a trained doctor inserting little coils into a woman’s fallopian tubes by way of her vagina, so there’s no need for surgery. Once the coils are in place, scar tissue is supposed to form around the coils over the next three months, blocking the fallopian tubes so that sperm can no longer make their way to a woman’s eggs, thereby preventing pregnancy. It’s a relatively new form of birth control, and studies on it have mostly involved physicians who are highly trained in inserting Essure. Not all doctors may insert Essure with the same ease. Some women’s bodies may not be able to accept both coils, so you’d need to consult with a health-care provider to see if you’re a candidate for the procedure. While you’re there, ask roughly how many Essure placements your doc has done and what his or her success rate is—one study, for example, found that about four out of five women were able to have the Essure placed in both fallopian tubes. In some cases, women’s tubes are not fully blocked at the three-month mark (a confirmation X-ray is done to make sure), and it can take up to six months for them to fully block. As far as other forms of permanent birth control, aside from female tubal ligation (“getting your tubes tied”), has your husband considered vasectomy? These days, it can be done in-office with very few complications; it also tends to be cheaper than tubal ligation and less risky.

Q I need help. I have a butt plug that I designed myself. It feels great and I can be hard for my wife for many hours of fun. I try to keep it very clean, but I continue to get bad prostate infections every year or two. Am I not being clean enough? Am I over-stimulating? Help, please: It would be embarrassing to tell my family doc that I use a butt plug.
A Prostate infections are quite common among adult men and may or may not be related to your butt-plug play. In fact, doctors have no idea what causes most prostate infections. Some men get them quite frequently. Others get them more sporadically, as you do. In some cases, it’s thought that bacteria make their way down a man’s urethra and into his prostate, but most of the time doctors scratch their heads as to a cause and do the best they can to relieve the pain and get rid of the infection through antibiotics. Interestingly enough, sometimes men who have chronic prostate infections are helped by prostate massage, which you are doing all on your own. So who knows? Maybe your prostate play is even helping to prevent some problems you would otherwise have. Then again, it may be causing your problems—after all, even bike riding and horseback riding are thought to raise a man’s risk for prostate problems. If the butt plug is causing your problems, you may need to decide whether your prostate play is worth the occasional risk of infection. Whether or not the plug is the problem, it is always wise to keep things clean. If you can design a new butt plug for yourself every year or so, that would be great. Depending on the materials you made it with, you can sterilize it between uses (by boiling it, running it through the dishwasher or cleaning it with antibacterial soap or rubbing alcohol). Do consider letting your doc know about your butt-plug play in case he has suggestions about how to make things safer for you.

Q A week ago, I was with a guy and he put his penis in me for a few seconds. He didn’t get his penis in me all the way before I pulled away. I went to the pharmacy that same day and took Plan B. My breasts are starting to hurt and my period is supposed to start next week. What are the odds of me being pregnant? I am freaking out!
A It’s extremely unlikely that you’re pregnant if the guy did not ejaculate in your vagina or around its entrance. Taking Plan B very soon after unprotected sex, as you did, gives you even greater protection. Plan B contains strong hormones, though, so your breast tenderness may be due to those hormones, the fact that your period is coming soon and/or stress about being pregnant. You should get tested for STIs—and avoid unprotected “just for a minute” penis-in-the-vagina situations in the future.