sexuality | MY SPECIAL DOCTOR

Premature ejaculation

25 February 20246 January 2024 by gpaulis

Premature ejaculation is the most common sexual dysfunction, affecting more than 20% of the adult male population, with no significant differences in age, and manifested by persistent or recurrent excessive rapidity of ejaculation. What are the causes? What are the types of this dysfunction? What are the therapies to overcome it?

Premature ejaculation results from the inability to exert voluntary control over the ejaculatory reflex and can occur before, during, or immediately after penetration and in any case within two minutes unlike erectile dysfunction age is not a significant factor in this disorder in more than half of males.

It is very common to have premature ejaculation during early sexual intercourse, a disorder that disappears with increased sexual experience and better control of ejaculation. In cases of primary premature ejaculation or lifelong ejaculation, the disorder has always been present, and the precise causes are not yet known although genetic predisposition is speculated. Anxiety, excessive penile skin sensitivity, and a central nerve transmission disorder where serotonin is involved could be the main causes.

In secondary or acquired premature ejaculation, on the other hand, the male begins to experience the disorder gradually or suddenly after a period of normality; in general, in these cases the rapidity of ejaculation is slightly less than in lifelong ejaculation but is still pathological. Among the causes are genito-urinary inflammation particularly prostatitis between 42.3% and 64% of cases (practically one in 2 patients), other possible causes are urethritis, inflammation of the glans of the foreskin and frenulum or even erectile dysfunction, hyperthyroidism, diabetes mellitus, neurological diseases effect of drugs or alcohol and psychological causes. Psychological causes then can also trigger premature ejaculation, e.g., performance anxiety, relationship problems in couples.

To treat primary premature ejaculation, drug therapy and psychotherapy with a psychosexologist are used; for secondary premature ejaculation, on the other hand, the specific cause that triggered it must be treated including the psychological cause, which must be treated as in the case of psychogenic primary ejaculation.

Difference between andrologist and urologist

The differences between urologists and andrologists arise from individual physician choices, rather than an inherent difference in specialties. Every andrologist is a urologist, but he is one who has narrowed his practice to a specific subset of patients.

Urologists treat patients of both genders, and for urinary problems and male reproductive problems. Andrologists are the male equivalent of gynecologists, focusing entirely on male reproductive issues. An andrologist may choose to specialize further, treating only reproductive problems or only impotence and erectile dysfunction.

Sex education : let’s address the issue

25 February 20246 January 2024 by MinnieLuongo

Talking about sex? Sure, but with whom? For years, we have witnessed the unfortunate back-and-forth between family and school, with neither taking responsibility for addressing the sensitive topic in depth with the youngest. In a new study supported by Bayer, GKF Health-a social and market research institute- surveyed 3,000 adolescents about their attitudes about sexuality and contraception. The results are both encouraging and alarming. And many of the responses turn out to be contradictory: on the one hand, respondents agreed, regardless of nationality, that the topic of sexuality should not be considered taboo, but on the other hand, many also said that they could not talk about it freely with their partners. According to the study, in many countries it is still teachers who provide the first information about sexuality through sex education in schools. However, adolescents say they are not totally satisfied with this kind of information and prefer to find it on the Internet. Difficult, therefore, is the dialogue between generations because of different habits and lifestyles, and to address the issue satisfactorily, a one-way exchange of information is not enough.

We at EducareYou have gone a step further and chosen to talk about sex thanks to two insightful specialists who, through videos and interviews, will take our readers by the hand and, with simplicity but rigor at the same time, regularly address not only evergreen issues that affect children and adolescents, but also new issues that arise in an age when life expectancy continues to lengthen and-unfortunately-the sexuality of third and fourth age is no longer (or almost) taboo.

Who are our experts? Two well-known names whose qualifications alone explain their experience and professionalism.

Marco Rossi, who in 2001 participated in the birth of a successful TV show on the sexuality, “Loveline“, is a specialist in psychiatry, clinical sexologist, and president of the Italian Society of Sexology and Sex Education. In addition, he is scientific director and lecturer of the master’s degree program in sexology PL (Psychologists of Lombardy), as well as president of Sises, Society for Sexology and Sex Education. (www.marcorossi.it. Facebook: Marco Rossi, sexologist and psychiatrist). He will have the arduous task of framing and explaining the most diverse topics especially from a psychological point of view.
And, among other things, he will explain what intramarital seduction consists of, whether indeed the so-called “macho” can be called uninhibited, when it is purported to be singletude
as a way of life.
Alexander G. Littara instead is a medical surgeon, a specialist in general surgery, genital plastic-aesthetic surgery, and an andrologist/sexologist. A firm believer in computerization, Dr. Littara is the author of the first Italian website dedicated to andrology, www.androweb.it, as well as www.falloplastica.net. Among Dr. Littara’s apps, that will provide us with explanations species organic, there is also SexOS (free, interactive and multimedia) which aims to popularize andrology to help men, who are often embarrassed when faced with certain situations, learn more about their bodies and sexuality.

The enemies of pleasure: if you know them, you avoid them

20 February 20246 January 2024 by Redazione My Special Doctor

The Western lifestyle, busy days, work with no regular schedule or rhythm anymore, and family obligations certainly do not help the mind to relax and the body to indulge in tenderness and benefit from a serene sexuality. Knowing the enemies of pleasure is the first step to changing your habits and improving desire and performance. Here are what are the main
behaviors to avoid
for a fulfilling couple life and why.

Sexuality at risk? Improve it like this

17 February 20246 January 2024 by Redazione My Special Doctor

Sexuality is often taken for granted, as if it were an automatic reaction of the body that must always activate and function perfectly on its own, without needing too much care. Reality shows that this is not the case, especially after the age of 40, but sometimes even earlier. A first step to improving it is to
avoid certain mistakes
very common, at the individual and couple level, and to remember that mental and physical well-being is the prerequisite for a satisfying relationship life.

Sexuality: the most common problems

22 November 20246 January 2024 by rosanna.feroldi

A satisfying sexuality is a fundamental element of physical and psychological health and must be protected at any age. When problems arise, open communication between partners and medical support are the key to resolving the situation.

Sexuality is not just a source of pleasure, but an essential aspect of the physical and psychological health of every person, man or woman, regardless of age. This has been recognized and affirmed for several decades by the World Health Organization (WHO), which includes sexuality as one of the pillars of the official definition of health.

However, at every age, men and women experience sexuality differently and may encounter various issues that risk turning what should be an extraordinary source of balance and well-being into a significant problem, sometimes leading to the avoidance of sexual relations altogether to avoid feeling uncomfortable.

An essential concept to remember in these cases is that sexuality is never an individual matter, but an experience shared by a couple. It should be addressed as such, whether everything is going perfectly or something is wrong. There are many effective solutions in most cases, but they work best when handled together, with serenity, cooperation, and mutual affection.

The difficulties of youth

In youth, in the absence of specific pathologies of the genitourinary system or severe systemic diseases, the main sexual issues are generally related to insecurity and the fear of “not measuring up” (because one feels not fit enough, sensual enough, or “technically prepared”), or to inexperience and a lack of confidence with one’s own body, which leads to difficulty in managing one’s emotions and the physical reactions that accompany them.

All of these unresolved psychological difficulties can interfere with desire or lead to reaching the peak of pleasure too soon, too late, with great difficulty, or even never. These types of sexual dysfunctions include performance anxiety, erectile dysfunction, premature or delayed ejaculation on the male side, and insufficient desire, unpleasant or painful intercourse, and difficulty reaching orgasm on the female side.

Problems can arise from the very first sexual encounters and may be particularly difficult to face due to both partners’ limited experience and, often, the instability of their relationship. These early issues can affect the quality of future sexual life if not addressed early, by openly discussing it with one’s partner and/or seeking support from a trusted doctor or, if necessary, a psychologist specializing in sexual disorders.

Generally, disorders that have no clear organic basis are more common and significant in brief relationships and those marked by a lack of empathy, whereas they improve significantly (even disappearing) when a deep and lasting relationship is established, allowing for good physical and psychological harmony and a more relaxed and natural experience of sexuality.

On the other hand, even young, healthy, and initially well-matched couples may, at some point, lose interest in sexual activity or derive less pleasure from it. In such cases, the origin of the problem often lies in various factors, such as instability or work stress, concern over financial difficulties, exhaustion from too many commitments, lack of sleep, or an unhealthy lifestyle.

It should be remembered that smoking, alcohol, being overweight, lack of physical activity, and disorganized lifestyles are declared enemies not only of general health but also of sexual health (especially for men). Their negative impact is felt at every age and becomes increasingly pronounced as one approaches middle age.

Another critical phase for couples of childbearing age is pregnancy and the postpartum period, due to a mix of physical and psychological factors that can test both partners, for different and sometimes opposite reasons, especially during the first child.

Reduced desire, fear of harming the fetus, anxiety about becoming parents, physical and psychological disorders following childbirth, the arrival of the newborn, and the redefinition of family dynamics can seriously interfere with sexuality for several months, especially if these issues are not discussed within the couple and if support from the gynecologist (for the woman) and possibly a psychologist (for both partners) is not sought.

Disorders of middle age

Like all bodily functions, sexual function also changes over time, and while some may find this change bothersome or disappointing, it must be accepted as inevitable. However, it does have some positive aspects, such as increased experience, a more relaxed approach to sexual relations, a deeper understanding of oneself and one’s partner, etc.

In both men and women, the main factor driving this transformation is the gradual decline in the levels of sex hormones (androgens and estrogens, respectively) starting from the ages of 40-50, along with a gradual decrease in muscle and cardiovascular performance. Additionally, in many cases, the onset of health conditions or disorders can directly interfere with sexuality or affect it as a consequence of the treatments required to manage these conditions.

In men, for example, many cardiovascular diseases, type 2 diabetes, and prostate disorders can reduce the ability to achieve or maintain an erection. Similarly, medications needed to lower blood pressure or blood sugar, treat coronary heart disease, or manage the symptoms of benign prostatic hyperplasia, improve heart function in cases of atrial fibrillation, or heart failure, can also have an impact.

In women, sexual function can be affected by ovarian, thyroid, or pituitary dysfunctions, as well as symptoms associated with menopause or post-menopause, starting with decreased lubrication and gradual changes in the sensitivity and structure of the vaginal mucosa (all changes that can result in unpleasant or painful intercourse).

Psychological distress should also not be overlooked, as it can become particularly widespread and pronounced in women over 40, with depression and anxiety being the most common conditions (which are less frequent in men). The negative effects of certain medications needed to treat these conditions (antidepressants, mood stabilizers, etc.) can also affect sexuality. On the psychological front, especially when facing a new partner, older individuals may experience issues related to concerns over their body not being aesthetically desirable, at least according to prevailing standards. In such cases, greater self-awareness and a bit of self-irony are key to success.

How to solve the situation?

Since sexuality is a matter for the couple, the first piece of advice for addressing any physical or psychological issues is to talk openly with your partner, with simplicity and serenity. This will also help the partner avoid feeling like the “cause” of the reduced desire or lesser pleasure and will increase the level of intimacy and cohesion in the couple. Sometimes, it will also make it easier to find an appropriate solution together.

If sharing the problem and tackling it together with simple strategies (such as creating more stimulating situations, extending foreplay, changing positions, adjusting the timing of orgasm, etc.) is not enough to improve the situation, the next step is to consult a trusted doctor to check overall health, evaluate the specific issue, and determine possible interventions to alleviate it (e.g., medications for erectile dysfunction or hormone therapies).

Consulting a doctor before taking any medication or supplement is essential, as medications to improve sexual performance may have various side effects and can be dangerous in certain clinical contexts. Additionally, sometimes sexual dysfunction may be a sign of an underlying undiagnosed condition that needs to be evaluated and managed (such as cardiovascular diseases, hormonal disorders, or prostate problems).

When sexual dysfunction appears to be related to genitourinary issues, it is important to seek a gynecological consultation (for women) or andrological/urological consultation (for men). Especially after the age of 50, it is primarily at this level that disorders can arise that significantly reduce the ability to have satisfying (or any) sexual relations. It is crucial to have an experienced specialist explore the causes and suggest appropriate solutions, whether pharmacological or surgical.

Sources:

National Institute on Aging – NIH (https://order.nia.nih.gov/publication/sexuality-in-later-life)
Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/symptoms-causes/syc-20372549)
Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776)
Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/premature-ejaculation/symptoms-causes/syc-20354900)
Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/symptoms-causes/syc-20371358)
von Hippel C et al. Sexual Function among Women in Midlife: Findings from the Nurses’ Health Study II. Women’s Health 2019;29-4:291–298
Hatzichristou D et al. Clinical Evaluation and Management Strategy for Sexual Dysfunction in Men and Women. Journal of Sexual Medicine 2004;1(1):49-57
Knoepp LR et al. Sexual Complaints, Pelvic Floor Symptoms, and Sexual Distress in Women over Forty. Sex Med 2010;7:3675-3682
Avasthi A et al. Clinical Practice Guidelines for Management of Sexual Dysfunction. Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian J Psychiatry 2017;59(Suppl 1):S91-S115
Mernone L et al. Psychobiological Factors of Sexual Functioning in Aging Women – Findings From the Women 40+ Healthy Aging Study. Frontiers in Psychology 2019;10:546

Sexuality at risk if you don’t love your image

14 February 20246 January 2024 by Redazione My Special Doctor

Almost everyone would like to change something about themselves. Being a little taller or thinner, having a straighter nose or softer mouth, smaller feet or smoother skin. Fortunately, most people are able to accept their small or large “imperfections.” And, overall, to love herself: if not a lot, at least enough to feel in tune with her body and others, even when she literally has to “bare herself.” When this does not happen relationships in general and sexuality in particular can suffer, and not a little.
Here are a few tips
to avoid falling into the mistake of believing oneself unattractive or desirable and to indulge peacefully in pleasuring oneself.

Does sexual desire grows old or not?

14 February 20246 January 2024 by Redazione My Special Doctor

In a society where being and staying young is a absolute imperative and the body is at the center of all forms of communication, any sign of aging that naturally our body sends with the passage of time is seen as a personal failure and something to be hide. The sexual sphere is no exception to this rule; on the contrary. Often, The very desire and accompanying physicality become one of the Most critical aspects after “age”. But what really changes in Men and women with the transition to a more mature age? Desire grows old or not? And can the way of lovemaking remain the same? Some (reassuring) answers .