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Transgender: Shallow vaginal canal, vaginal dryness, lack of vaginal elasticity, lack of orgasm.

Intersex: Lack of Orgasm. 

Women: Female erectile dysfunction, Vaginismus, Vaginitis, PID, cysts, tumors, cystitis, priapism, uterine prolapse, rectocele, cystocele, Endometriosis, adhesions, sealed hymen, episiotomy, assault, retroverted uterus, menopause.   

Men: Male erectile dysfunction, premature ejaculation, Peyronie’s disease, priapism, testicular torsion, Epididymitis, penile fracture, balanitis, phimosis, prostatitis, inguinal hernia, hydrocele, varicocele, micropenis.  

Everybody: Persistent Genital Arousal Syndrome, STI’s, illness, psychological and medical causes, sex addiction. 


You Are Not Broken!

Most people experience some form of "sexual dysfunction" during their lifetime. This doesn't mean that you're abnormal or 'broken'. Whether you ejaculate before you want to (Premature Ejaculation), develop vaginal adhesions, or have a hormonal imbalance, coping with these common conditions simply means learning to manage your sexual wellness effectively.


Shallow Vaginal Canal

A frequent source of pain and discomfort for Male -to- Female transgender recipients of SRS, discomfort with the depth of your vaginal canal may require one or more additional surgeries to attain a large enough canal canal for your individual comfort. 

Dry Vaginal Canal

Your surgically constructed vaginal canal will not secrete hormonal lubrication. It is essential that you use a high-quality vaginal lubricant during sex to prevent friction and discomfort.  

Lack of Vaginal Elasticity

Your surgically crafted vaginal canal will not have the same elasticity of a biological vagina, which can feel uncomfortable at first, but you can compensate by becoming familiar with using your vagina for sexual activity - and regularly practicing the controlled use of your PC muscles

Lack of Orgasm in Male to Female Transgender People

You now have a clitoris. It's smaller and will feel different than a penis, but it should still give you satisfying orgasms. Learning to pleasure this sized-down organ is crucial to achieving sexual satisfaction with your transition.  

Lack of Penile Orgasm in Female to Male Transgender People with Phalloplasty

If you have had Phalloplasty, your surgically crafted penis will not achieve orgasm. Your clitoris remains the source of your orgasm, and should be accessible  above your penile shaft.


 Lack of Orgasm

Lack of orgasm can occur for many reasons in intersex people. It may be due to a lack of hormone, or to underdeveloped sexual organs. Hormones can usually be adjusted through hormone therapy, and underdeveloped sexual organs may be successfully treated with surgery.


Erectile Dysfunction

During sexual stimulation, the nerves in the genitals direct the female erectile tissue arteries to expand and allow increased blood flow into the spongy genital tissues. As the spongy tissues swell with blood, they compress the veins through which the blood flows out of the erectile tissues, trapping blood in the tissues and causing engorgement, a crucial phase in orgasm. Female erectile dysfunction is the inability of the erectile tissues to become engorged, or to remain engorged, until orgasm.

Causes Of Female Erectile Dysfunction 


With this common condition, the build-up of cholesterol and plaque inside the genital arteries causes arterial blockage, preventing blood from flowing into the spongy clitoral erectile tissues during sexual stimulation. Also called “hardening of the arteries”, arteriosclerosis is the number one culprit in erectile dysfunction, as well as in heart disease.


Photo: "Carotid Plaque" by Ed Uthman. Licensed under CC BY 2.0 via Wikimedia Commons

Treatment for Arteriosclerosis 


In some cases, plaque and cholesterol build-up can be significantly reduced by a plant-based, heart-healthy diet. Plant-strong diets such as those pioneered by Olympic triathlete Rip Esselstyn and Dr. Joel Fuhrman may slow or even reverse arteriosclerosis.  

Rip Esselstyn Engine 2 Diet


Dr. Joel Fuhrman



Exercise increases the blood flow and strengthens the heart, the muscular organ that pumps blood into every part of the body – including the genitals. Aerobic exercise helps fight arteriosclerosis by keeping the cardiovascular system healthy.  

Vascular Surgery

Surgery to open or bypass clogged genital erectile blood arteries can be performed in much the same manner that it is performed to open or bypass clogged heart arteries. The surgeon either removes the build-up of plaque and cholesterol in the artery (this is called an endarectomy), or performs a bypass by rerouting blood around the blocked artery. As with all surgery, some risks are involved. Other options are usually exhausted first.

Medications Can Affect Sexual Functioning

There are a numbers of medications documented to reduce or break down cholesterol and plaque. Some of them may adversely affect sexual function. If you experience any pharmaceutical side effects of a sexual nature discuss them with your doctor to determine whether another medication or a dosage adjustment is feasible.


Vaginismus is the involuntary contracting of the vaginal muscles. The muscles in the lower vaginal canal, the pelvic floor muscles - especially the pubococcygeal muscles, and in some cases the inner thighs, constrict and lock close. Vaginal penetration becomes painful or impossible.



A number of things can cause Vaginismus: a physical condition that causes pain during vaginal entry, leading you to dread penetration and clench your muscles to prevent it; or psychological factors such as a somatic response to sexual assault or to negative messages about sex.


Treatment and Healing

It’s important to determine any physical cause of vaginismus, such as an STI, vaginal adhesions, uterine cysts, vaginal dryness, scar tissue, endometriosis, etc.


Take careful note of your symptoms: when do they occur; if there is pain, where is it; is there any symptomatic manifestation such as a rash or discharge?


Have a thorough pelvic examination and share your observations with your doctor.


If there is no evident physical cause, then duress, fear, or some other psychological factor may be involved. If this is the case, nurture yourself with tons of love and patience. If your symptoms persist, consider seeing a supportive, experienced counselor or joining a support group.


↓The medical treatment for Vaginismus is gentle, gradual, methodic relaxation of the tense vaginal muscles. This is done by very gradually inserting size-gradated phallic-shaped dilators into the vaginal canal.


Starting with the smallest dilator, you will ease it slowly into the vagina and allow it to remain until it is comfortable. You will do this for about fifteen minutes three or four times a day, for as long as it takes to relax the vaginal muscles.


When you can move your pelvis and masturbate with the smallest dilator inside, you are ready to insert a slightly larger dilator, and then a slightly bigger one than that, until the vagina is comfortable with a penis-sized dilator.


This process can take several weeks, and may be accompanied by supportive counseling, depending on your needs.


Vaginismus Healing Exercise


Start with a warm, quite, relaxing bath. Do some deep relaxation breathing.


Make your bedroom or chosen place to focus on this exercise comfortable, safe, and private. Be sure that you won’t be interrupted.


If you share choice to share your healing process with a partner, choose carefully. Only be with someone you trust to be caring and nurturing, whom you can relax with and feel certain that they won’t place any pressure on you to “get better”.


Try imagining breathing into and exhaling through the vaginal canal. Use this exercise to help you relax and tune in. Then using your hands or a vibrator, massage your external vaginal muscles gently. Don’t forget your favorite warm lubrication.


Have a clitoral orgasm; manually, with a vibrator, through oral sex, or however you wish. This will help relax your muscles.


Gently insert the first, smallest dilator. Do not force. Breathe with it, relax, and go very slowly. Once it is inserted, just allow yourself to become accustomed to its feel. Do this three or four times a day for about fifteen minutes.


When you’re ready – and it may take several sessions before you are – begin moving your pelvis pleasurably.


  Practice kegel contraction and releases.


When you feel comfortable with this, masturbate to orgasm.


As you become comfortable with using the smallest dilator, then you can insert the next size dilator, and go through the same process.


Eventually, you can work through all the sizes and can try inserting a penis or a partners’ strap-on. Use lots of lubrication, and go very slowly, stopping to relax if your muscles begin to tense.


Be patient and loving. There is no hurry.




An informative website


Other Sources of Pain and Discomfort



Vaginitis is characterized by vaginal itching, burning, and discharge. Categorized as an STI, it can be caused by a bacterial, fungal or parasitic infection, as well as by low estrogen levels or an allergic reaction to the chemicals in condoms, spermicide, feminine hygiene products, soap, bubble bath, and other body products.


The most common forms of vaginitis are candida, trichomoniasis, and chlamydia. See STI’s for information on symptoms and treatment.

 Pelvic Inflammatory Disease (PID)

PID is a sexually transmitted infection that can cause intense pain during vaginal penetration and during orgasm when tissues inflamed or scarred by PID are affected.


An acute infection and inflammation of the internal reproductive organs, PID is a progressive disease that must be treated with antibiotics as soon as possible. For a chart of symptoms and treatments, see STI’s.


Cysts and Tumors

←Cysts are the frequent culprits in sexual pain. There are several kinds; the most common are fibroid cysts, balls of tissue which grow inside the uterine wall. Cysts may also form in or on the ovaries, vaginal canal, and fallopian tubes. Pain during sex is frequently the way they are brought to attention.


Uterine tumors are also a form of tissue growth that may cause pain during sex.



Cysts and tumors should be checked to ascertain that they are non-cancerous.


Birth control pills may relieve pain and help prevent further growth. Surgery to remove the tissue growth is also an option. Talk to your doctor about what is best for you.



Cystitis is a painful infection of the urinary tract that can extend into the bladder.



Cystitis is usually cured with antibiotics. Drinking fluids to flush the urinary system, being careful to wipe the urethral-vaginal area separately from the anus, and peeing after sex are good proactive habits to reduce the risk of cystitis.



Priapism is a condition wherein the clitoral erectile tissue does not return to it's pre-excitement state but continues to be engorged and erect. There are two types of priapism: low-flow and high-flow; 80% to 90% of clinically presented priapisms are low flow disorders. Low-flow involves the blood not adequately returning to the body from the organ. High-flow involves a short-circuit of the vascular system partway along the organ.



If erectile tissue is still engorged after four hours, emergency medical treatment should be sought. This usually means medicating with an alpha-agonist that facilitates blood outflow from the swollen erectile tissue. If tissues are non-responsive, blood may be aspirated under a local  anesthetic. If this is still insufficient, an injection of phenylephrine may be required.


Uterine Prolapse

Uterine prolapse is a painful condition when the uterus drops down into the vaginal canal. It frequently occurs as a result of structural weakening in the connective ligaments and pelvic muscles that support the uterus.


An incomplete prolapse is when part of the uterus bulges into the vaginal canal. During complete prolapse, part of the uterus hangs out of the vaginal canal.



There are various methods of treatment: pelvic exercises to strengthen the support muscles; the insertion of a vaginal pessary device, a donut shaped apparatus that helps hold the uterus up in place; and hormone replacement therapy, are frequent approaches for a mild, incomplete prolapse. Pessary devices must be cleaned frequently.


For serious cases of complete prolapse, a surgical procedure called a sacrocolpoxy is often performed during which a mesh is inserted to hold the affected pelvic organs in their correct anatomical position.


Rectocele and Cystocele

Rectocele is the displacement of the bladder into the rectum; cystocele is the bulging of the bladder into the rectum. They are treated in a similar manner as a uterine prolapse, with minor treatment differences.



←Endometriosis is a disorder of the hormone and immune systems in which the endometrial lining in the uterus grows outside the uterus and attaches to other organs. Pressure against these areas of abnormal growth can cause pain during sex.



There are several ways to treat endometriosis, depending on its level of severity. Mild to medium levels of endometriosis may be treated with aspirin or prostaglandin inhibitors like ibuprofen, or possibly prescription painkillers. Hormonal therapy may also be utilized.


In severe cases, when infertility and dire pain are issues, surgery may be required to remove endometrial tissue formations. Occasionally, endometriosis is extensive enough to require a hysterectomy (the removal of the uterus), and possibly the ovaries and fallopian tubes as well.



Phimosis is a painful condition that occurs when the clitoral hood, or foreskin, is too tight. It must be surgically treated or sexual engorgement is prohibitively painful.


Vaginal Adhesions

←Adhesions can develop inside the vaginal canal that can block vaginal penetration. They may also develop under the hood of the clitoris, attaching the hood and the clitoris together with fibrous strands which prevent the clitoris from moving freely. Both can be painful and interfere with sexual pleasure.



Fortunately, all it takes is a few snips in your doctor’s office to remove these pesky impediments.


Sealed Hymen

Sometimes a woman’s hymen is completely or nearly sealed, making attempts at vaginal penetration very painful. If this is the case, don’t try to force the hymen to “break”!



It’s a simple procedure for your doctor to remove the sealed hymen. The pioneering sex researcher Alfred Kinsey and his wife suffered from this obstacle and were infinitely relieved and gratified to learn how easy it was to remove it!



←Episiotomy is a surgical procedure that is used during birth when it’s necessary to enlarge the birth canal by cutting an incision in the vaginal opening. While this procedure is performed with care, occasionally scarring of the tissue results, which tightens with age.



A surgical procedure may be required to release or remove the scar tissue.


Sexual Assault

Violence during sexual assault can result in tears and cuts in genital tissue which leave scar tissue. Scar tissue is less elastic then ordinary tissue and may impede sexual pleasure or cause pain or discomfort if it prevents movement in the scarred areas.



Surgery may be needed to release or remove the scar tissue. 



A number of the symptoms of menopause are associated with discomfort or pain during sex; vaginal dryness, shrinkage and the loss of elasticity in the vaginal canal, and diminished hormone production can all be problematic.

For symptoms and treatment, see Menopause

Retroverted Uterus

Sex may be painful for women with a retroverted uterus, especially vaginal penetration. The pressure on the rectum and ligaments of the tailbone make penetration and thrusting uncomfortable for some women. Since the body of the retroverted uterus lies just at the end of the vagina, it can get hit during intercourse, kind of like a punching bag. This is even more likely in the event of adenomyosis, a type of endometriosis that is within the walls of the uterus itself. Pain can also occur during a bowel movement if a tilted uterus has adenomyosis or some other uterine problem. This is because the tipped uterus is lying against the rectum and it gets scraped by stool coming through the rectum.



A change in sexual positions as well as depth of thrusting can make a significant difference in such cases.



Erectile Dysfunction (ED)

During sexual stimulation, the nerves in the penis direct the penile arteries to expand and allow increased blood flow into the spongy tissues of the penile shaft. As the spongy tissues engorge with blood, they compress the veins through which the blood flows out of the penis, trapping blood in the tissues and causing erection. Erectile dysfunction is the inability of the penis to become erect or to stay erect until orgasm.


Causes of Erectile Dysfunction



With this common condition, the build-up of cholesterol and plaque inside the penile arteries causes arterial blockage, which prevents blood from flowing into the spongy erectile tissues during sexual stimulation. Also called “hardening of the arteries”, arteriosclerosis is the number one culprit in erectile dysfunction, as well as heart disease.


ED Treatment



Plaque and cholesterol build-up may be slowed and even significantly reduced by a plant-based, heart-healthy diet. In some cases, plant-based diets such as those pioneered by Olympic triathlete Rip Esselstyn and Dr. Joel Fuhrman have been shown to reverse arteriosclerosis.



Rip Esselstyn Engine 2 Diet



Dr. Joel Fuhrman




Exercise increases the blood flow and strengthens the heart, the muscular organ that pumps blood into every part of the body. Exercise is essential to sexual health and helps fight arteriosclerosis by keeping the cardiovascular system toned and healthy.


Vascular Surgery

Surgery to open or bypass clogged penile blood arteries can be performed in much the same manner that it is performed to open or bypass clogged heart arteries. The surgeon either removes the build-up of plaque and cholesterol in the artery (this is called an endarectomy), or performs a bypass by rerouting blood around the blocked artery. As with all surgery, risks are involved. Other options are usually exhausted first.


ED Medication: Viagra (sildenafil citrate), Cialis, Levitra, Staxyn, and Stendra

Viagra, Cialis, Levitra, Staxyn, and Stendra are the five drugs currently approved by the FDA to treat erectile dysfunction. Although there are subtle differences between these drugs in terms of how quickly they are effective and how long they last, they act in much the same way. I’ll describe the most commonly prescribed drug, Viagra, as an example of how this class of ED drugs works.


A pill of Viagra taken an hour prior to sex will help block a particular enzyme that decreases penile blood flow, thus increasing the flow of blood into the spongy tissues of the penile shaft.


Viagra is not a panacea. It’s about 66% effective in men experiencing erectile dysfunction, and it does not improve the erectile capacity of men who are already functional. It is not an aphrodisiac, and should not cause erection unless the penis is sexually stimulated.


For best results, avoid taking Viagra with high-fat foods.


Viagra should only be used under a physicians’ supervision due to its’ potential hazards. Men using nitrate heart medicines, high blood pressure medication, or experiencing any issues with blood dilation should not use Viagra because it increases arterial dilation.


If a Viagra-assisted erection does not subside naturally after orgasm but persists without change, seek medical treatment. This is a potentially dangerous situation that requires immediate attention. Sustained erection lasting longer than four hours can cause permanent damage to the penile tissues.


Unfortunately, Viagra is very expensive, making it out of the financial reach of many middle and low income men. It is also not covered under most medical insurance plans. Until sexual wellness is recognized by the medical community as essential to human health, Viagra will remain categorized as a luxury drug. Let’s change that by changing our society’s values about the overall importance of human sexual health!



Apomorphine is a pill which acts on the region of the brain associated with erections by chemically stimulating dopamine, a precursor of other blood-vessel constricting chemicals. Originally used by veterinarians to stimulate vomiting in animals, nausea can be a serious drawback in its use.


Penile Implants

Penile implants involve a surgical procedure in which apparatuses are placed in the corpora cavernosa, the two spongy bodies of tissues running the length of the top of the penile shaft.


There are two types of apparatus:


1. The first type of penile implant is an inflatable prosthesis with two balloon-like devices attached to a tube leading to a manual hydraulic pump and a container of liquid, placed inside the scrotum or lower abdomen. When erection is desired, the man locates the pump through his skin and uses it to inflate the balloon devices in his penis.


2. The second type of penile implant consists of flexible rods inserted into the corpora cavernosa that cause the penile to be semi-erect at all times. A man simply bends it up to use during sex and then bends it back down when he’s finished.



Injections of medications that promote blood flow into the penis by relaxing artery wall muscles are an option, if nothing else works. I have several concerns about them that place this method last on my list: Erections resulting from injections last until the medicine wears off, rather than subsiding naturally after orgasm. This can be uncomfortable and potentially harmful. Long term use of injections can also result in scarring inside the corpora cavernosa, the spongy tissue on top of the penile shaft. Scarring can inhibit the penis’ ability to fully expand, or may cause twisting of the shaft. Lastly, injections can be painful, and the very fear of this pain can cause sexual inhibition and dysfunction.


That being said, some men find injections an effective way to counteract erectile dysfunction.


Hormonal Imbalances

A low level of the hormone testosterone can decrease the sexual drive, as can an excess of the hormones FSH and LH. Testing and adjusting these hormone levels may alleviate ED.


The most common treatments for low testosterone are: an injection of testosterone every few weeks; wearing a skin patch with testosterone cream; or using tablets that are placed under the tongue and allowed to dissolve for direct systemic absorption.


Other methods are less successful. The testosterone pills commonly found on the black market are not effective because the digestive process destroys testosterone. These pills are also associated with liver damage.


NOTE: Testosterone is not an aphrodisiac. It does not elevate the sex drive in men who already have sufficient amounts of it.


Because certain health risks are associated with the use of testosterone, including elevated blood pressure, elevated liver levels, increased cholesterol, and the suppression of clotting factors, it should never be taken except under careful medical supervision.



Alcohol inhibits the nerve impulses and messages sent through the spinal cord to the genitals, decreasing erectile firmness. Prolonged alcohol use is associated with lower testosterone levels and shrinkage of the testicles.


Don’t ever drink to excess, and don’t drink for at least an hour before sex.



Nicotine constricts the blood vessels of the penis, impeding erectile function considerably. Its use contributes to arteriosclerosis, respiratory failure, heart disease, and cancer, all of which can cause sexual and erectile dysfunction, not to mention death. Stop smoking, don’t start smoking, and if you’re addicted, get help.


Other Causes of ED

Diabetes, heart disease, cancer, STI’s, respiratory problems, prostatitis, obesity, depression, stress, fatigue, anxiety, repressed anger, guilt, and other causes, including clinical mental illness, can contribute to or directly cause erectile dysfunction. A number of medications used to treat these conditions can also adversely affect sexual functioning. It’s crucial to work with a qualified doctor to seek out the cause of your individual case of erectile dysfunction, and develop the best course of treatment.


NOTE: Erectile dysfunction and orgasmic dysfunction is not the same thing. A very satisfying orgasm can be experienced without the presence of erection, just as erection can occur without an orgasm, because the nerves that stimulate erection and orgasm are different. Ejaculation is also not required for orgasm. This is why men who have suffered spinal cord damage which prevents erection and/or ejaculation may still be able to have a satisfying, orgasmic sex life.


Premature Ejaculation (PE)

Premature ejaculation is the experience of consistently ejaculating before you want to ejaculate. At least one out of every three men has concerns about premature ejaculation. Some men have a hair-trigger response and ejaculate the moment their penis is touched, or that they enter their partner. The good news – PE is highly treatable.


Behavioral Causes of PE

Learned sexual response behavior patterns acquired during masturbation or early sexual experiences can persist for life. Many boys and young men end up learning to hurry ejaculation because they either lack a comfortable level of privacy in their homes, or are taught negative beliefs about eroticism and sex. Others simply don’t realize that learning to prolong ejaculation is of value. Their hurried ejaculatory pattern becomes an ingrained sexual behavior pattern that they don’t know how to change.


Physical Causes of PE

Recent studies have indicated that some cases of premature ejaculation may be related to physical problems with the serotonin signals in the brain that control ejaculation.

Two Tips On Premature Ejaculation

 Try masturbating to hour or so an hour or so before having sex with your partner. This may help relax you and slow down your sexual arousal speed.

 Use a condom to help desensitize your penis and prolong ejaculation.  “Long love” condoms contain benzocaine or lidocaine to act as numbing agents.

Treatment of Behavioral Premature Ejaculation


1. The first step is to cultivate equanimity and compassion towards yourself. It will take time to change an ingrained behavior pattern, or treat a physical condition. Be patient.


2. Begin with dry masturbation. That is, masturbation without the use of any lubrication, including saliva.


3. Study how it feels when you approach your “point of no return” (PONR) when ejaculation becomes involuntary. When you’ve identified this moment, practice stopping your ejaculation 15-20 seconds before it occurs by pressing firmly on the penis shaft right under the penile gland /coronal ridge, with your thumb on the bottom and your opposing fingers pressing on top. Use both hands if you need to. Hold this for thirty seconds or as long as needed to relax the impulse to ejaculate.


You can also use a firm grip at the base of the penis, and/or contract your pelvis muscles.


4. Breathe deeply and evenly to slow your respiration and help you relax your sexual excitation level.


5. Thinking boring or unrelated, decidedly unsexual thoughts may help you as well. Baseball scores. Old dentures sitting in a glass of dirty water. Whatever turns you off.


6. Do this exercise three times in a row. The fourth time, allow yourself to ejaculate.


7. Practice this at least once a day until you gain control over the impulse to ejaculate.


8. When you are comfortably in control masturbating with dry lubrication, add lubrication, and repeat this process until you again feel comfortable with prolonging ejaculation.


9. Once you’re comfortable with your ejaculatory control during lubricated manual stimulation, you can try penetrating a toy vagina or anus with your penis. Apply the same technique you’ve developed, using your hand or pelvic muscles to stop ejaculation 15-20 seconds before the PONR.


10. Try shallow penetration, entering only the first third of the vagina or anus. Most of your partners pleasure nerves are in this area, and you may find it easier to control ejaculation and highly pleasurable to concentrate penetration here.


11. Also experiment with modifying your movement pattern when approaching the PONR. For example, try circular pelvic movements rather than direct thrusts, and changing your rhythm.


12. When you are comfortable with this on your own, it’s time to include your partner. It’s essential that your partner be patient and informed, with a clear understanding of what their supportive role will be.


13. Teach your partner how to stimulate your penis. When the PONR is approaching, show them how and where to press to stop ejaculation. Practice until you feel comfortable with this together.


14. You can also apply this technique with oral stimulation.


15. When you are comfortable together with your partner’s ability to sense  and stop your PONR, it’s time to learn how to penetrate your partner. Begin by “stuffing” your penis inside your partners vagina or anus before it is fully erect, and just accustom yourself to the feeling of being inside them without ejaculating.


This will be easier if you are in a position where you don’t have to put weight on your arms, such as lying on your back while your partner straddles you, or spooning.


16. When you are comfortably being still together, experiment with controlled breathing, shallow thrusting and modified movement patterns while applying the technique of stopping ejaculation 15-20 seconds before the PONR. Practice until you feel able to control ejaculation.


If this exercise doesn’t work for you, don’t worry! Changing our own behavior patterns is very hard for most of us. You may benefit the most from working with a sex therapist on your ED.

Medical Treatment

Medical treatment usually involves the use of a class of selective serotonin reuptake inhibitor anti-depressants that prolong ejaculation. These drugs include Prozac, Zoloft, and Paxil, all of which may take up to ten days before becoming effective.


If they don’t help, your doctor may prescribe the tricyclic anti-depressant Anafranil, which has also demonstrated some ability to alleviate PE.


Homeopathic supplements have also achieved some success.


Topical anesthetic creams may be applied to numb the penis, which can aid the ability to have a prolonged erection without ejaculation. These creams should be rinsed off the penis entirely before making penile contact with a partner.


The use of condoms can also desensitize the penis and help prolong ejaculation. Condoms containing the numbing agents’ benzocaine or lidocaine intensify their desensitizing effect.


Premature ejaculation may be a symptom of physical illness. It’s always a good idea to talk to your doctor about persistent PE, for your peace of mind







Other Causes of Pain and Discomfort

Peyronie’s Disease

←Peyronie’s disease results in the radical twisting or bending of the penis. This occurs when the inner lining of one or both of the corpora cavernosa develops plagues, or is becoming fibrotic due to an injury to the penis or to a hereditary factor such as Sickle Cell Anemia. Fibrous tissue or tissue laden with plague doesn’t stretch as well as normal tissue during engorgement and erection, causing the penis to bend or twist in the direction of the blockage.



If this condition doesn’t cause you pain, loss of sensation, or prevent intercourse, there is no need to treat it. If the condition causes a serious problem in any of these regards, surgery to release the blockage is an option.



Priapism is sustained, involuntary penile erection. It occurs when the normal process of blood draining from the penis is impeded, and blood remains trapped in the spongy tissues of the cavernosa.



If this condition lasts more than half an hour, drink water to try and break up the clotted blood cells, and place an ice pack on your penis. If the priapism does not quickly subside, see a doctor immediately. Delaying may result in damage to the cavernosa and permanent erectile dysfunction.


If erectile tissue is still engorged after four hours, emergency medical treatment should be sought. This usually means medicating with an alpha-agonist that facilitates blood outflow from the swollen erectile tissue. If tissues are non-responsive, blood may be aspirated under a local anesthetic. If this is still insufficient, an injection of phenylephrine may be required.

Testicular Torsion

Testicular torsion occurs when a testicle twists at its attachment point in the spermatic cord, cutting off its’ normal blood flow. This usually results in pain, and then swelling.



IMMEDIATE MEDICAL ATTENTION IS REQIURED: if testicular torsion lasts more than four hours, the blood restriction may result in the tissues of the testicle dying. Emergency surgery is usually necessary.



Epididymitis is an infection of the epididymis, two tubes in the sperm tract that are connected to the testicles and store sperm. Symptoms include a burning sensation during urination, fever, and scrotal pain and swelling. Pain may extend into the lower abdomen.



The usual treatment is antibiotics and anti-inflammatory medicines combined with bed rest for several days, and possibly wearing a scrotal support.


Report any sudden pain to your doctor immediately, as testicular torsion sometimes occurs with epididymitis.


Penile Fracture 

←Penile fracture usually occurs during forceful penile thrusting when the penis impacts a barrier and the sheath around the cavernosa is ruptured. It’s often accompanied by a “cracking” sound.



When a penile fracture occurs, it will not go away on its own: treatment is required. See a doctor right away. Neglect of this condition may result in permanent erectile dysfunction.



Balanitis is a bacterial infection of the foreskin. It occurs most frequently in uncircumcised men. When the infected foreskin is stimulated by erotic friction or rubbing, it hurts so much that orgasm is usually impossible.



Balanitis can be cured by applying a topical antibiotic ointment and keeping the infected area clean and dry. If symptoms persist for more than a couple of days, consult your doctor again.



←Phimosis is a painfully tight foreskin. During erection it may restrict the penile blood flow to the extent that the foreskin cannot retract.



Phimosis is usually corrected with surgery to release the tight foreskin, either by an incision in the foreskin, or it's complete removal.



Prostatitis occurs when the prostate gland becomes inflamed by an irritant- frequently a bacterial infection. Symptoms include fever, chills, fatigue, pain in the lower back, painful urination, pain in the penile shaft, and the frequent urge to urinate even when the bladder is empty.



Treatment includes taking antibiotics for two to three weeks and increasing your fluid intake to keep the urinary tract washed out.


During treatment, decrease the amount of fluid build-up in the prostate with frequent ejaculations. This eases pain and rinses out the prostate while drawing healing antibiotics into the prostate.


Sit in warm water daily for at least twenty to thirty minutes to soothe swollen tissues and increase blood circulation in the pelvis. Keep the water warm, between 105 to 110 degrees, unless heat is contraindicated by a medical condition.


Inguinal Hernia

An inguinal hernia occurs when the support muscles of the abdomen weaken, allowing a portion of the intestine to protrude into the inguinal canal inside the scrotum.

You may notice a lump or swelling in the scrotal sack that feels uncomfortable, or an odd feeling in the groin when walking or standing.



Inguinal hernia is usually treated surgically, by pushing the intestine back into the peritoneal cavity and inserting a mesh to hold the intestine in place.



A hydrocele is a fluid-filled sac surrounding the testicles that causes the scrotum to swell. It is usually the result of injury or inflammation to the testicle.



A hydrocele is not necessarily painful and may not require treatment. In the case of discomfort, surgical excision is a common treatment.



A varicocele is in an enlargement of a vein, or veins, within the scrotum. It may cause low sperm count and decreased sperm quality, contributing to infertility, or testicular atrophy.



Common treatment is to surgically seal off the effected vein(s) and to redirect the blood flow into normal veins.



A Micropenis is an unusually small penis,  smaller than about 3 inches for an adult when compared to an average erection of 5 inches. Micropenis occurs in about 0.6% of males.


Most micropenises are caused by "reduced prenatal androgen production or effect, such as abnormal testicular development (testicular dysgenesis), Klinefelter syndrome, Leydig cell hypoplasia), specific defects of testosterone or dihydrotestosterone synthesis (17,20-lyase deficiency, 5α-reductase deficiency), androgen insensitivity syndromes, inadequate pituitary stimulation (gonadotropin deficiency), and other forms of congenital hypogonadism. Micropenis can also occur as part of many genetic malformation syndromes that do not involve the sex chromosomes. It is sometimes a sign of congenital growth-hormone deficiency or congenital hypopituitarism. Several homeobox genes affect penis and digit size without detectable hormone abnormalities. In addition, in utero exposure to some estrogen based fertility drugs like diethylstilbestrol (DES) has been linked to genital abnormalities and/or a smaller than normal penis". -Wikipedia



Hormone treatment

Growth of the penis both before birth and during childhood and puberty is strongly influenced by testosterone and, to a lesser degree, growth hormone; but their value in the treatment of micropenis is mainly limited to conditions of hormone deficiency, such as hypopituitarism or hypogonadism



Because hormone treatment rarely achieves average size, several surgical techniques similar to phalloplasty for penis enlargement have been devised and performed; but they are not generally considered successful enough to be widely adopted and are rarely performed in childhood.






Persistent Genital Arousal Syndrome (PGAS)

PGAS is a state of sustained, involuntary genital sexual arousal that sometimes results in spontaneous orgasm. It occurs most frequently in women. PGAS is usually an acutely uncomfortable state of ongoing genital sexual tension that can last for hours, days, and even weeks. It has nothing to do with genuine sexual arousal, and orgasm seldom relieves it.


Treatment for PGAS

The cause of PGAS is currently unknown. Treatments include numbing agents, bio-feedback and relaxation techniques, anti-depressants, and hypnosis.


Psychological Causes of Sexual Dysfunction

Many psychic wounds can cause or relate to sexual dysfunction: Negative core beliefs about sex that instill shame, fear, or guilt; misinformation about sex; Post Traumatic Stress Disorder from exposure to violence and sexual assault; and poor body image, to name a few. Sometimes positive experiences in life heal these wounds spontaneously, and sometimes we need to take conscious measures to heal them by seeking therapy or finding another avenue to change our beliefs about, and our approach to, our sexuality.


The exercises on this website are a guidepost in the direction of self-healing. Much more is possible once

you begin following this road to growth. But at some point, many people find it productive to work with a compassionate, supportive, trained professional in order to cope with serious sexual wounds of a physical or emotional nature.



Illness and disease and the medications taken to treat them may contribute to sexual dysfunction. Sexually transmitted diseases, cancer, diabetes, heart disease, multiple sclerosis, Parkinson’s disease, high blood pressure, stroke, respiratory disease, and brain injury are only a few of the conditions that can significantly impact human sexual functioning. Sexual dysfunction should always be taken seriously, as a concern in of itself, and because it may be a symptom of other concerns that require attention. See Disability and Illness.


Sex Addiction

Sex addiction is characterized by obsessive sexual behavior and a lack of sexual impulse control. Sex addicts don't have loving, happy or mature sexual relationships; instead they are driven to engage in sex compulsively.


Sex addicts often have high risk sex, and experience disturbed social patterns that interfere with work and relationships. Partnerships are broken; jobs are lost. If you're addicted to sex, don't hesitate to reach out. There are a lot of groups and programs available for your support and help.


Sex Addicts Anonymous


Sex Addicts Anonymous is modeled on Alcoholics Anonymous and has adopted their Twelve Step program. 




The SAST test helps discern sex addiction


American Board of Sexology




American Association of Sex Educators, Counselors and Therapists




American Association of Marriage and Family Therapists






Good basic on-line information


Endometriosis Association




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