Ask Debby Herbenick | big dicks, lame orgasms

Q   I am a 30-year-old male, married for the past eight. I hope you can provide insight: I cannot have an orgasm, although I do ejaculate. Sexual activity feels good…feels better…then just ends. About a quarter of the time I feel completely unsatisfied and horny, as though I had not had sex. I think I’ve had an orgasm once, but that was a long time ago. I have no difficulty getting an erection.
A  Although rare, some men don’t experience a sense of orgasm or pleasure when they ejaculate. Some men never have. Others used to experience orgasms and then find that things change for them (often when starting a new medication that may cause that as a side effect). This is often called “ejaculatory anhedonia,” referring to the lack of pleasure associated with ejaculation. For some men, ejaculatory anhedonia is linked to a medical issue such as prolactin levels, testosterone levels or thyroid function. As such, I’d recommend checking in with a health-care provider—perhaps a urologist who’s experienced in treating ejaculatory issues or an endocrinologist, as they focus more on hormonal issues. People come to doctors all the time with sexual concerns, so don’t let embarrassment get in the way. If everything checks out, consider meeting with a sex therapist (find one through sstarnet.org). In some instances, sex therapy can help this issue.

Q  My girlfriend is divorced; we have not had sex. Just recently she told me her ex-husband was rather large and now she’s fearful that she may not be able to satisfy me if we have sex because I am not as large as her ex-husband. I don’t know what to tell her.
A  Tell her to give it a try if she’s willing! Also let her know that vaginas are wondrous and that I assured you that her vagina has not gotten monstrously big even if her husband’s penis was monstrously big. The vagina gets bigger when it needs to get bigger, like when it’s birthing a baby, taking in tampons or accepting a penis. Then it returns to its regular size. Kind of like a bigger, wetter, cooler version of a slow-moving rubber band. That said, she may not feel as much sensation at first during sex with you as she’s likely been used to with her husband (not that that’s always a good thing, as sometimes sex with a very large penis can be uncomfortable). It can take time for her body to readjust how it feels during sex, and you may not need to use extra lubricant, or to use it often, but then again you might. I’d encourage you to just play it by ear, see how it goes and remind yourselves of something that is true for many couples: Sex takes practice. And practice, at least in sex, can be lots and lots of fun.

Q I was wondering if you could recommend any books that have published people’s descriptions of what their orgasms feel like, for both men and women. I’m kind of fascinated by the subject, but I can’t seem to find a book solely devoted to that or that includes a section about it.
A  I seem to recall that O, The Intimate History of the Orgasm (Grove Press, $12) has a small section that includes descriptions of both men’s and women’s orgasms. This section is in reference to a study from years ago that asked men and women to write about how their orgasms felt. The scientists then took these descriptions, removed any terms such as “penis” or “vagina” that would give a person’s sex away, showed them to a bunch of professionals and asked if the orgasm being described belonged to a woman or a man. In the end, most couldn’t tell with any certainty, suggesting that male and female orgasm are more similar than different in the way that they feel when they’re happening. The book The G Spot: And Other Discoveries About Human Sexuality (Holt, $17) also has some good first-person stories about orgasm and female ejaculation from women.

Q  For several years, I have experienced bleeding during and usually after intercourse. It is never accompanied by pain, but it can be surprising and embarrassing. I’ve seen three doctors and every one of them has had a sort of shrug/“this is the way you’re made” response. Last year, a diagnosis of a friable cervix was made, but no solutions were offered. Doctors have suggested more lube, which worked only a small percentage of the time; others suggested tea-tree oil vaginal suppositories, which didn’t work at all. If I don’t bleed during sex, I will almost always bleed after. It always lasts for days, sometimes up to a week. It’s so frustrating and there is virtually no information on it anywhere. My next step is acupuncture and, aside from a total hysterectomy, I don’t know what else to do.
A  I wish I had a magic solution for you, but unfortunately I don’t. I do have a couple of ideas that you might try, though. First, I’d encourage you to contact the International Society for the Study of Vulvovaginal Disease and get a referral for a vulvovaginal health specialist. You might even more specifically ask for a doctor who has expertise in bacterial and yeast infections. When I go to the ISSVD meetings, I am frequently impressed by the hard work that goes in to helping solve medical riddles related to the vagina and vulva. Personally, I think that’s your best bet. That said, if you want to try one last thing before going the specialist route, I wonder if you’ve talked with your doctors about the possibility that you may have an infection that they haven’t, or frankly can’t, test for. Years ago, I met some medical doctors who were working on a study about a sexually transmissible infection called mycoplasma genitalium. MG is a very tiny bacteria and testing is not widely available. As such, sometimes women have symptoms similar to chlamydia but they test negative for chlamydia and don’t get better and just live with their symptoms. I’m not saying you have MG, but there are a number of infections doctors are just learning about. In other words, you may have some kind of infection that has irritated your cervix enough that it is “friable,” which basically means it’s prone to bleeding. I’ve shared this information with a number of women and encouraged them to ask their doctor to try them on a course of antibiotics that might target any unidentified bacterial infection. In several cases, the doctors agreed to the experiment and within a week or two, the women stopped bleeding. I am not a medical doctor; I cannot diagnose you. But it would be worth a conversation to see what your doctor thinks of this idea. If it doesn’t work, then do keep hunting.

Debby Herbenick, Ph.D., M.P.H., is a research scientist at Indiana University, sexual health educator at the Kinsey Institute and author of Because It Feels Good: A Woman’s Guide to Sexual Pleasure and Satisfaction. Send letters to Debby Herbenick, Ph.D., c/o Time Out Chicago, 247 South State Street, 17th floor, Chicago, IL 60604, or send e-mail to inandout@timeoutchicago.com.