Sexual Trauma Quiz
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Depression
Anxiety symptoms
Anxiety attack
Lower abdominal pain
Night terrors
Panic attacks
Trust issues
Pain during sex
Flashbacks
Vaginal pain
Fear of intimacy
Bad dreams
Not seeing your symptoms? No worries!
What is Sexual Trauma?
Genital trauma meaning injury to the genitals, can occur for a variety of reasons. Most often caused by sports injuries, accidents such as on a bicycle, or vigorous intercourse. Tears or injuries can also occur with childbirth. Sexual assault should also be considered.
Typical Symptoms of Sexual Trauma
- Pain or discomfort in the genital area
- Pain in my penis
- Vaginal bleeding or discolored discharge outside of your period
- Bleeding during or after sex
- Pain in the lower abdomen
- Affected area of skin has stinging or tingling
- Pain during sex
- Abnormal color, amount or odor of vaginal discharge
Diagnostic Questions for Sexual Trauma
Your doctor may ask these questions to check for this disease:
- Are you experiencing pain or discomfort in your genital area?
- Do you have pain in your penis?
- Have you experienced any vaginal bleeding or unusual discharge outside of your period?
- Have you experienced any bleeding during or after sex?
- Do you have pain in your lower abdomen?
Treatment of Sexual Trauma
Treatment depends on the injury sustained. It is common to receive stitches after childbirth to repair any tears. If there is concern for assault, it is suggested to report it to your medical provider and to the appropriate authorities so that evidence can be collected.
Reviewed By:
Ravi P. Chokshi, MD (Obstetrics and Gynecology (OBGYN), Critical Care)
Current Maternal Fetal Medicine Fellow with Dual board certification in Obstetrics & Gynecology and Critical Care Medicine. | 5+ years experience managing a general Ob/Gyn practice and working in the Intensive Care Unit. | Previously Physician Lead of a large single specialty practice with 8 Physicians and 10+ Advanced practitioners. | Member of the Society of Maternal Fetal Medicine Patient education committee. | Frequent Medscape Consult contributor.
Seiji Kanazawa, MD, PHD (Obstetrics and Gynecology (OBGYN))
Dr. Kanazawa graduated from the Niigata University Faculty of Medicine and received his Ph.D. from the Tohoku University Graduate School of Medicine. He is working on the front line of the General Perinatal Center, including the Tokyo Tama General Medical Center and the National Center for Research in Fertility Medicine, where he provides maternal and fetal care and undertakes clinical research. At Ubie, Dr. Kanazawa has been designing the Ubie AI Symptom Checker and has taken on the role of general obstetrics and gynecology consultation at FMC Tokyo Clinic by providing fetal ultrasound and prenatal consultation.
Content updated on Jul 3, 2024
Following the Medical Content Editorial Policy
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People with similar symptoms also use Ubie's symptom checker to find possible causes
- Pain around the vulva or vagina
- Pain in the genital area
- Penis pain
- Bleeding between periods
- Pain during intercourse
- Bleeding during sex
- Abnormal vaginal discharge
- Penis hurts
- Burning vagina
- Itching vagina
- Bloody vaginal discharge
- Vaginal soreness
- Penis pain during sexual intercourse
- Stinging vaginal pain
- Bleeding after sexual intercourse
See full list
Symptoms Related to Sexual Trauma
Diseases Related to Sexual Trauma
FAQs
Q.
BDSM Sex & Women’s Health: Managing Symptoms & Essential Next Steps
A.
BDSM sex and women’s health can align when consent, communication, and safety are prioritized, but there are several factors to consider. See below to understand more, including how to manage common physical symptoms like bruising, pelvic discomfort, urinary issues, or nerve changes, and emotional effects such as subdrop or trauma triggers, plus practical aftercare, lubrication, hydration, STI protection, and symptom tracking. For next steps, seek medical care for heavy bleeding, signs of infection, severe or worsening pain, numbness or weakness, or persistent emotional distress, and use the complete guidance below for when to talk to a clinician and consider gynecology, pelvic floor therapy, mental health support, and screening tools.
References:
* Sestak J, Sestak J, Sarnes E. Psychological well-being and sexual health in women practicing BDSM: a systematic review. J Sex Med. 2023;20(3):328-338. PMID: 36769972.
* Williams SK, Miller JR, Johnson K. Injury patterns in BDSM practices: A cross-sectional analysis. J Sex Med. 2019;16(10):1653-1660. PMID: 31548037.
* Barker L, Smith C, Lenton T. Sexual health and communication within BDSM relationships: a qualitative study. Cult Health Sex. 2021;23(1):114-128. PMID: 32267672.
* Weinberg MS, Williams CJ, Pfeffer CA. Safe, Sane, and Consensual: Exploring Health-Related Quality of Life and Coping Strategies in Kink Practitioners. Arch Sex Behav. 2017;46(1):151-164. PMID: 27807691.
* Eaton AD, Vencill JA, Scheyett AM. Beyond 'Just Sex': A Feminist Queer Theory Approach to BDSM Practice and Its Implications for Mental Health. J Homosex. 2017;64(14):1987-2007. PMID: 28414457.
Q.
BDSM Test for Women 30-45: Health Symptoms & Vital Next Steps
A.
BDSM test for women 30 to 45: what it is and is not, physical and emotional symptoms to watch, consent and communication essentials, and when to seek medical or mental health care to stay safe. There are several factors to consider, and your next steps can change based on your symptoms, medical history, and partner dynamics. See the complete guidance below for vital red flags, reflection tips, safer planning, and when to contact a clinician.
References:
* Grzanka, P. R., et al. (2020). A Systematic Review of the Health and Mental Health Outcomes of Kink-Identified Individuals. *Journal of Sex Research*, *57*(8), 1017-1033.
* Easton, C. L., et al. (2020). "Kinky Sex" and Mental Health: A Systematic Review. *Journal of Sex Research*, *57*(4), 405-422.
* Scheer, J. R., et al. (2021). Sexual health issues and their associations among people engaged in consensual non-monogamy and kink. *Sexual Health*, *18*(4), 304-311.
* Connolly, A., & Johnson, S. (2016). Negotiating Consent in BDSM: A Qualitative Study. *Journal of Sex Research*, *53*(3), 324-334.
* Klein, V., et al. (2020). Psychological well-being and attachment in BDSM practitioners. *Journal of Sex Research*, *57*(2), 231-244.
Q.
Anxiety Over 65: Identifying Emotional & Physical Triggers
A.
Anxiety after 65 can be triggered by emotional factors like grief, health fears, reduced control, loneliness, and past trauma, and by physical factors such as chronic illnesses, medication side effects, sleep problems, chronic pain, dehydration, or vitamin B12 deficiency; it is not inevitable with age and is often missed because symptoms overlap with medical issues. There are several factors to consider. See below for full symptom lists, guidance on reviewing medications safely, red flags that need urgent care like chest pain, sudden shortness of breath, fainting, new confusion, or self-harm thoughts, and the personalized treatment options to discuss with your doctor.
References:
* Olino MT, et al. Anxiety disorders in older adults: A review of the literature. Curr Psychiatry Rep. 2011 Apr;13(2):142-9. doi: 10.1007/s11920-011-0164-9. PMID: 21308365.
* Vinkers DJ, et al. Risk factors for anxiety in older adults: a systematic review and meta-analysis. J Affect Disord. 2019 Feb 1;244:27-38. doi: 10.1016/j.jad.2018.09.020. PMID: 30384210.
* Sun J, et al. Physical comorbidities and anxiety in older adults: a systematic review and meta-analysis. J Affect Disord. 2021 Mar 1;282:975-985. doi: 10.1016/j.jad.2021.01.036. PMID: 33549929.
* Kivelä AL, et al. The impact of life events on anxiety in older adults: A systematic review. Int J Geriatr Psychiatry. 2018 Oct;33(10):1343-1354. doi: 10.1002/gps.4939. PMID: 29882200.
* Wetherell JL, et al. Anxiety in later life: A systematic review and recommendations for clinical practice. J Clin Psychiatry. 2021 Jul 20;82(4):20nr13695. doi: 10.4088/JCP.20nr13695. PMID: 34293529.
Q.
Anxiety Symptoms in Women: Physical Signs & Coping Tips
A.
Anxiety in women can show up as constant worry, irritability, or trouble concentrating, and as physical symptoms like a fast heartbeat, chest tightness, shortness of breath, stomach upset, headaches, muscle tension, and sleep problems. Symptoms often shift with hormonal changes around periods, pregnancy and postpartum, or menopause, and can be influenced by stress or past trauma. There are several factors to consider, and the complete guidance below covers proven coping tips like breathing exercises, regular movement, sleep and nutrition habits, therapy and medication options, plus urgent warning signs that mean you should seek care now and how to choose next steps.
References:
* Vamvakopoulos, V., & Fountoulakis, K. N. (2018). Gender differences in anxiety disorders: an update. *Annals of General Psychiatry*, *17*, 30.
* Sklar, F., Strous, R. D., & Stein, D. J. (2016). Stress and coping in women with anxiety disorders: A qualitative study. *Annals of Clinical Psychiatry*, *28*(4), 282-288.
* Altemus, M., & Sarro, S. (2020). Sex Differences in Anxiety: A Review of Neurobiological Factors. *Current Psychiatry Reports*, *22*(11), 69.
* Gualdi, M. G., Montagnani, C. C., Lelli, L., & Agnese, S. (2022). Mindfulness-based interventions for anxiety in women: A systematic review. *Journal of Affective Disorders*, *299*, 390-401.
* Albert, P. R. (2021). Mental health in women: the role of gender in anxiety and depression. *Journal of Clinical Medicine*, *10*(10), 2162.
Q.
Body Discovery: Helping Teens Understand Self-Pleasure as a Normal Part of Health
A.
Self-pleasure is a common, developmentally normal part of adolescence and can support body awareness, stress relief, and healthy sexual development when it stays private, safe, and free of pain or distress. There are several factors to consider, including boundaries, hygiene, emotional wellbeing, and knowing red flags that warrant talking with a trusted adult or doctor such as pain, compulsive use, or trauma concerns; see the complete details below to guide your next steps.
References:
* Hales L, et al. Sexual self-pleasure and its association with sexual health outcomes in a sample of young adults in the United States. *Sex Health*. 2021 May;18(2):189-196. PMID: 33795155.
* Carroll J, et al. Masturbation: the secret sex of adolescents. *J Youth Adolesc*. 2011 Dec;40(12):1598-612. PMID: 21695420.
* Goldman JD, Goldman RJ. Adolescent masturbation: normative data and psychosocial correlates. *J Sex Res*. 2012;49(4):379-90. PMID: 22168532.
* American Academy of Pediatrics Committee on Adolescence. Sexual development and behavior in children and adolescents. *Pediatrics*. 2017 Jul;140(1):e20164344. PMID: 28620023.
* Shine N, et al. Masturbation and partnered sexual behaviors among adolescents and young adults: A longitudinal examination of developmental patterns and associations. *Arch Sex Behav*. 2015 Feb;44(2):297-307. PMID: 25442110.
Q.
Managing Vaginal Dryness: Medical Solutions for Intimacy After 65
A.
Vaginal dryness after 65 is common and treatable; effective options include immediate lubrication help with water or silicone-based lubricants, ongoing relief with vaginal moisturizers, and gold-standard low-dose vaginal estrogen with minimal systemic absorption. Non-estrogen choices like vaginal DHEA or oral SERMs, plus pelvic floor physical therapy and gentle sexual stimulation, can also improve comfort and desire. There are several factors to consider. See below to understand more. Know what to avoid and when to call a doctor: skip fragranced or numbing products and douching, and seek care for pain, bleeding after sex, persistent burning, or frequent UTIs; emotional factors and past trauma can also affect arousal. Important nuances, safety considerations, and step-by-step guidance on choosing treatments and next steps are explained below.
References:
* Davis SR, Baber RJ, Panay N, Bitzer M. Genitourinary Syndrome of Menopause: An Updated Review of Pathophysiology, Diagnosis, and Treatment. J Clin Endocrinol Metab. 2019 Oct 1;104(10):4233-4245. doi: 10.1210/jc.2019-00628. PMID: 31216005.
* Gandhi J, Chen A, Smith N, Khan S. Vaginal estrogen for the treatment of vulvovaginal atrophy. J Womens Health (Larchmt). 2016 May;25(5):455-66. doi: 10.1089/jwh.2015.5414. PMID: 26866410.
* Chen A, Smith N, Khan S, Gandhi J. Non-hormonal management of vaginal dryness. J Womens Health (Larchmt). 2016 May;25(5):467-74. doi: 10.1089/jwh.2015.5415. PMID: 26866411.
* Mirkin S. Ospemifene for the treatment of dyspareunia associated with vulvovaginal atrophy: a review of efficacy and safety. Therap Adv Reprod Health. 2018 Jun;12:2053363318784338. doi: 10.1177/2053363318784338. PMID: 30042898; PMCID: PMC6041695.
* Labrie F, Archer DF, Bouchard C, Vaillancourt E, Montesino M. Prasterone (intravaginal dehydroepiandrosterone) for the treatment of vulvovaginal atrophy. Expert Opin Pharmacother. 2017 Mar;18(4):413-424. doi: 10.1080/14656566.2017.1294895. PMID: 28240409.
Q.
Postpartum Dryness: Choosing a Lube That Is Safe While Breastfeeding
A.
While breastfeeding, water-based, pH-balanced, fragrance-free lubricants with low osmolality are generally safe for postpartum vaginal dryness. Silicone-based options can help if dryness is severe, but oil-based products are usually not recommended, especially with latex condoms. There are several factors to consider, and important details can affect your next steps. See below for ingredient cautions like glycerin, warming agents, and parabens, the difference between lubricants and vaginal moisturizers, toy and condom compatibility, practical use tips, medical options like low-dose vaginal estrogen, and when to speak to a clinician for persistent pain, bleeding, or infection signs.
References:
* Shifren JL, Schiff I. Management of atrophic vaginitis in breastfeeding women. Menopause. 2014 Apr;21(4):307-8. PMID: 24716155.
* Smith EM, Kunkel G, Clark SM, et al. Safety of vaginal lubricants during breastfeeding: a review. J Womens Health (Larchmt). 2019 Feb;28(2):227-234. PMID: 30427339.
* Ramezanali F, Ramezani A. Vaginal dryness in reproductive women: an under-recognized problem. Int J Womens Health. 2017 May 23;9:327-334. PMID: 28552197.
* De Bortoli F, De Paula L, Goulart C, et al. Breastfeeding and vaginal dryness: A narrative review of the mechanisms and management strategies. J Sex Med. 2024 Apr;21(4):e115-e124. PMID: 38318717.
* Mac Bride MB, Neal Perry GS. Nonhormonal management of vaginal atrophy. Maturitas. 2016 Nov;93:89-92. PMID: 27856755.
Q.
Safe Exploration: A Woman’s Guide to Communicating Boundaries and Needs
A.
Learn how to communicate boundaries and needs with partners through clear consent and direct “I” statements, understand what anal sex is, and protect your physical health with lubrication, condoms, slow pacing, and stopping if there is pain or bleeding. It also covers emotional safety, red flags for pressure or disrespect, aftercare check-ins, and when to talk to a doctor for persistent pain, bleeding, infection signs, bowel changes, or ongoing distress. There are several factors to consider; see below for important details that could shape your next steps.
References:
* Lencz, M., & Walsh, J. (2020). Women's Experiences of Communicating Sexual Boundaries and Desires in Intimate Relationships: A Qualitative Study. *Journal of Sex & Marital Therapy*, *46*(2), 154-167.
* Lencz, M., et al. (2019). The Role of Communication in Women's Sexual Health: A Systematic Review. *Journal of Sex Research*, *56*(5), 555-568.
* Abdolahi, S., et al. (2018). Impact of assertiveness training on communication skills, self-esteem and anxiety among women. *Journal of Education and Health Promotion*, *7*, 7.
* Peterson, Z. D., & Muehlenhard, C. L. (2007). Communicating sexual consent: The role of gender and power. *Journal of Sex Research*, *44*(4), 304-315.
* Lencz, M., et al. (2021). Women's Sexual Empowerment: A Systematic Review of Associated Factors and Outcomes. *Archives of Sexual Behavior*, *50*(6), 2419-2436.
Q.
The "Clove Water" Trend: Can This Spice Actually Boost Your Libido and Hormonal Health?
A.
There are several factors to consider. Early evidence suggests clove water can add antioxidants and may modestly support circulation and metabolic balance, but human data for boosting libido or hormones are lacking, so it should not replace care for sexual or hormonal concerns. Safety matters too: avoid high doses, be cautious in pregnancy, liver disease, bleeding disorders, or when using blood thinners, and seek medical advice for persistent low libido, erectile dysfunction, pain with sex, irregular periods, or sudden changes; complete guidance and key next steps are detailed below.
References:
* Kamini K, Singh PK, Verma PK, Singh A. Aphrodisiac effect of aqueous extract of Myristica fragrans (nutmeg) and Eugenia caryophyllata (clove) in male mice. BMC Complement Altern Med. 2005 Apr 14;5:10. doi: 10.1186/1472-6882-5-10. PMID: 15831122.
* Tajuddin M, Ahmad S, Latif A, Qasmi IA, Amin KM. Potential aphrodisiac effect of Syzygium aromaticum (L.) Merr. & L.M. Perry (clove) in male Wistar rats. J Ethnopharmacol. 2014 Jun 25;154(1):201-8. doi: 10.1016/j.jep.2014.03.047. Epub 2014 Apr 2. PMID: 24709405.
* Ahmed I, Ahmad N, Khan H, Zaki AA, Fatima N, Shah K, Hussain R, Khan W, Zaki A, Ali L, Zaki A. Antioxidant and androgenic effects of Syzygium aromaticum on male Wistar rats. Pak J Pharm Sci. 2022 Jan;35(1):171-177. PMID: 35074219.
* Mohammadi MM, Karami M, Mahmoudi R, Mohammadi N, Ghazanfari J, Momeni M, Hosseini SM. Effects of Syzygium aromaticum (clove) and its active compound, eugenol, on semen quality and antioxidant status in male rats treated with lead acetate. Environ Sci Pollut Res Int. 2023 Feb;30(8):21312-21323. doi: 10.1007/s11356-022-23769-y. Epub 2022 Oct 26. PMID: 36284131.
* El-Nashar AR, Abdulaziz H. Effect of eugenol on male reproductive system. Int J Reprod Biomed (Yazd). 2015 Oct;13(10):607-16. PMID: 26362846.
Q.
The "Quality" Secret: Why Couples Who Have Less Sex Are Often Happier
A.
Couples who have sex less often are often happier because quality, emotional safety, and respectful communication drive satisfaction far more than frequency, which commonly declines with time; many married couples have sex once a week or less and remain deeply fulfilled. There are several factors to consider. See below to understand more, including important details that can shape your next steps if low desire signals stress, pain, medication or hormonal changes, sleep or mental health issues, or unprocessed sexual trauma, along with practical ways to prioritize connection and when to talk with a clinician.
References:
* Muise, A., Schopfer, E., & Muise, E. A. (2016). Sexual frequency and relationship satisfaction in the general population: A novel analytical approach. *Journal of Social and Personal Relationships*, *33*(7), 896–909.
* Sprecher, S. (2006). The importance of quality of sexual activity to marital satisfaction. *Journal of Family Psychology*, *20*(4), 721–725.
* Maciel, S. I., Vilarinho, P., Leal, I., & Barreto, T. M. (2020). Sexual communication, sexual satisfaction, and relationship satisfaction in long-term relationships. *Archives of Sexual Behavior*, *49*(1), 161–172.
* Rollins, M. S., & Carr, D. (2010). Does sexual frequency matter? Relationship satisfaction and well-being among older adults. *Journal of Family Issues*, *31*(9), 1184–1204.
* Stephenson, K. R., & Byers, E. S. (2013). How important is sex for couples' well-being? A meta-analysis of the relationship between sexual satisfaction and relationship satisfaction. *Journal of Sex Research*, *50*(6), 570–580.
Q.
Brown Discharge But No Period? What Your Body is Trying to Tell You About Your Progesterone
A.
Brown discharge without a period is usually old blood and often signals progesterone shifts, most commonly low progesterone in the luteal phase or brief mid-cycle ovulation spotting. There are several factors to consider; see below to understand how timing, stress, life transitions, and recent birth control changes can affect this. Because pregnancy, thyroid issues, or infections can also be involved, and certain warning signs warrant prompt care, review the complete guidance below for when to test, what your doctor may check, and safe options to support healthy progesterone.
References:
* Balen AH, et al. The clinical relevance of luteal phase deficiency: a comprehensive review. Hum Reprod Update. 2023 Feb 1;29(1):96-121. PMID: 36768783.
* Gidwani L, et al. Luteal phase deficiency: a critical look at the diagnostic work-up and treatment options. J Hum Reprod Sci. 2018;11(1):3-9. PMID: 29778394.
* Sreelatha A, et al. Abnormal Uterine Bleeding: Pathophysiology and Clinical Management. J Clin Gynecol Obstet. 2020 Mar 22;9(2):29-39. PMID: 32675685.
* Kim JJ, et al. Endometrial responses to progesterone and their dysregulation in reproductive disorders. Hum Reprod Update. 2016 Mar-Apr;22(2):243-60. PMID: 26589947.
* Munro MG, et al. Pathophysiology of Anovulatory Bleeding. Womens Health (Lond). 2019 Nov 22;15:1745506519888995. PMID: 31835952.
Q.
Craving Salty Foods? The "Old Wives' Tale" for Predicting Your Baby’s Gender (And What Science Says)
A.
Craving salty foods does not predict your baby’s sex, there are several factors to consider. Science shows no reliable link between salty vs sweet cravings and fetal sex, which is set at conception, and cravings are more about hormones, energy needs, possible nutrient gaps, and culture. For your next steps, focus on healthy ways to manage cravings and speak with a clinician if they are extreme, affect blood pressure or blood sugar, or involve non‑food items, and use ultrasound or NIPT for accurate sex information, with important details and warning signs explained below.
References:
* Orloff NC, Hormes JM, Sim K, Mura C, Del Re AC, Johnson J, Munk C, Foran W, Rösler A, Fischer J, Schmidt MH. A longitudinal study of food cravings and aversions during pregnancy. *Hormones and Behavior*. 2014 Mar;65(3):308-16. doi: 10.1016/j.yhbeh.2014.01.006. Epub 2014 Feb 6. PMID: 24508930.
* Vlajinac HD, Marinkovic JM, Jovic-Vranes AG, Vukovic VM, Milosavljevic ND. Sex of offspring and maternal symptoms during pregnancy. *Archives of Gynecology and Obstetrics*. 2016 Jan;293(1):101-7. doi: 10.1007/s00404-015-3814-1. Epub 2015 Jul 29. PMID: 26220721.
* Hensel A, Brömer R, Kordfelder M, Ziegenbein M, Grön G. Are food cravings in pregnancy associated with fetal sex? A German prospective study. *Journal of Clinical Psychology in Medical Settings*. 2021 Sep;28(3):613-620. doi: 10.1007/s10880-020-09754-0. Epub 2020 Oct 21. PMID: 33083995.
* Mao X, Jiang Y, Lin Y, Huang Y, Lu J, Li K, Li Z. Influence of Maternal Diet and Lifestyle during Pregnancy on Offspring Sex: A Prospective Cohort Study. *Journal of Clinical Research and Medical Case Reports*. 2023;5(1):100155.
* Grant VJ. Maternal personality, stress, and the sex ratio. *Journal of Biosocial Science*. 2008 Jul;40(4):463-71. doi: 10.1017/S002193200700257X. Epub 2008 Apr 15. PMID: 18410651.
Q.
Did Sex Just Stop Your Period? The Strange Science of Uterine Contractions Explained
A.
It’s common for bleeding to slow or pause after sex because orgasm and even prostaglandins in semen can trigger uterine contractions that shift or speed menstrual flow, changing what you see without truly stopping your period. There are several factors to consider, including cycle timing, stress, and birth control changes, plus red flags like heavy bleeding, severe pain, fever, repeated bleeding after sex, or possible pregnancy; see the complete details below to know what to watch, when to test, and when to see a clinician.
References:
* Word RA. Physiology and Pathophysiology of Uterine Contractility. Semin Reprod Med. 2011 May;29(3):284-93. doi: 10.1055/s-0031-1275990. Epub 2011 May 19. PMID: 21598161.
* Kunz G, Leyendecker G. New insights into sperm transport in the human female genital tract. J Reprod Immunol. 2011 Nov;92(1-2):11-7. doi: 10.1016/j.jri.2011.08.003. Epub 2011 Aug 26. PMID: 21880424.
* Okolo S, et al. Uterine contractility: A key determinant of reproductive success. Gynecol Endocrinol. 2017 Jul;33(7):527-531. doi: 10.1080/09513590.2017.1304523. Epub 2017 Mar 21. PMID: 28322692.
* Pierro E, et al. Steroid hormones and uterine contractility: a concise review. Eur J Obstet Gynecol Reprod Biol. 2014 Mar;174:9-14. doi: 10.1016/j.ejogrb.2013.12.016. Epub 2013 Dec 21. PMID: 24412217.
* Jirikowski GF, et al. Oxytocin and its physiological effects in the female reproductive system. Vitam Horm. 2017;103:225-245. doi: 10.1016/bs.vh.2016.09.006. Epub 2016 Nov 21. PMID: 28076930.
Q.
Burning After Sex? Why Your Urethra Feels Irritated (Even If It’s Not a UTI)
A.
Burning when you pee after sex is often due to friction, dehydration, product or pH irritation, or post coital urethral syndrome, not just a UTI; infection is more likely if symptoms worsen over 24 to 48 hours, you have frequent urges with little output, cloudy or strong smelling urine, or pelvic pressure, and STIs or pelvic floor tension can also cause burning. There are several factors to consider. See below for practical self care and prevention steps and for the exact red flags that mean you should get tested or see a clinician soon, including symptoms lasting more than 2 to 3 days, severe or worsening pain, fever, back pain, blood in urine, or STI risks.
References:
* van der Heijden DJF, van der Meer JKW. Dysuria after intercourse: causes and management. Curr Opin Urol. 2023 Feb 1;33(2):160-165. doi: 10.1097/MOU.0000000000001053. PMID: 36733930.
* Rofeberg RJ, Payne CM, Sharda BW. Interstitial cystitis/bladder pain syndrome and sexual function: a comprehensive review. Neurourol Urodyn. 2019 Oct;38(7):1851-1860. doi: 10.1002/nau.24089. Epub 2019 Jul 23. PMID: 31336940.
* Ghafar AF, van der Meer JKW. Mechanical trauma to the urethra during sexual intercourse: A review. Arab J Urol. 2016 Jun;14(2):107-110. doi: 10.1016/j.aju.2016.03.003. Epub 2016 Apr 4. PMID: 27040439.
* Goldstein R, Stockman NP, Goldberg DLK. Vulvodynia: a review of current concepts. Sex Med Rev. 2019 Apr;7(2):224-230. doi: 10.1016/j.sxmr.2018.12.007. Epub 2019 Jan 16. PMID: 30678602.
* Gill BN, Reiner JLA, Glick CJ, Miller ESKA. Pelvic floor dysfunction and its impact on sexual health. Curr Sex Health Rep. 2021 Aug;13(4):259-267. doi: 10.1007/s11930-021-00330-w. Epub 2021 Jul 20. PMID: 34292850.
Q.
The "Garlic" Smell Down There: Is It Your Diet, or a Sign Your Vaginal pH Is Crashing?
A.
A garlic-like vaginal odor is often from sulfur-rich foods, but it can also indicate a pH shift like bacterial vaginosis, especially if it lasts more than 3 to 4 days or comes with gray or unusual discharge, itching, burning, pelvic pain, or if you are pregnant. There are several factors to consider and simple steps you can try, like hydration, breathable underwear, condoms if semen triggers odor, and avoiding douching; see below for the complete guidance and other important details, including when a retained tampon or other issues mean you should seek care.
References:
* Chee WJ, Chew SY, Than LTL. Influence of diet on the vaginal microbiota and susceptibility to bacterial vaginosis and vulvovaginal candidiasis. Front Cell Infect Microbiol. 2020 Jul 3;10:176. doi: 10.3389/fcimb.2020.00176. PMID: 32714777; PMCID: PMC7354922.
* Galarza C, Soria G, Rojas J, et al. Diagnostic accuracy of vaginal pH for bacterial vaginosis: a systematic review and meta-analysis. BMC Infect Dis. 2020 May 1;20(1):326. doi: 10.1186/s12879-020-05047-y. PMID: 32357876; PMCID: PMC7194689.
* Al-Mubarak AM, Poudyal N, Griesmeier A, et al. Vaginal and Urinary Volatile Organic Compounds as Markers for Bacterial Vaginosis: A Systematic Review. Diagnostics (Basel). 2022 Mar 30;12(4):854. doi: 10.3390/diagnostics12040854. PMID: 35453882; PMCID: PMC9029676.
* Muzny CA, Van Der Pol B, Aaron K, et al. Bacterial vaginosis: New insights into pathogenesis and treatment. J Infect Dis. 2023 Mar 15;227(6):708-720. doi: 10.1093/infdis/jiac398. PMID: 36240212; PMCID: PMC9951336.
* France MT, Farrand SL. The vaginal microbiome in health and disease. Best Pract Res Clin Obstet Gynaecol. 2023 Sep;90:102371. doi: 10.1016/j.bpobgyn.2023.102371. Epub 2023 Jul 21. PMID: 37550186; PMCID: PMC10476485.
Q.
Your Period Has Lasted 10 Days: When "Heavy" Becomes a Medical Emergency
A.
A 10-day period is longer than average and can be related to hormones, birth control changes, fibroids, or life stage shifts, but it may indicate menorrhagia if bleeding lasts over 7 days, includes large clots, or soaks protection every 1 to 2 hours. Seek urgent care if you soak a pad or tampon every hour for several hours, feel dizzy or faint, have chest pain or shortness of breath, severe lower abdominal pain, or any bleeding during pregnancy. There are several factors and next steps that can change your care plan, including anemia risks and what testing and treatments are appropriate, so see the complete guidance below.
References:
* pubmed.ncbi.nlm.nih.gov/28770513/
* pubmed.ncbi.nlm.nih.gov/26795059/
* pubmed.ncbi.nlm.nih.gov/28938215/
* pubmed.ncbi.nlm.nih.gov/33931478/
* pubmed.ncbi.nlm.nih.gov/35303126/
Q.
A Guide to Personal Lubricants: Water-Based, Silicone, and Oil-Based Options
A.
Water-based, silicone, and oil-based lubricants each offer different benefits and limits: water-based is condom and most toy safe and easy to clean but may dry out; silicone is long lasting, works in water, and is condom safe but should not be used with silicone toys; oil-based feels rich and lasts long but is not safe with latex condoms, can be harder to clean, and may raise infection risk for some. There are several factors to consider, including your sensitivity or history of infections, whether you use condoms or toys, session length, and medical changes like menopause. See complete guidance below for key tips, safety warnings, and when to seek care so you can choose the right option for your body.
References:
* Moench, T. R., & Moench, L. E. (2014). Safety and tolerability of personal lubricants for vaginal and rectal use: a systematic review. *Journal of Sex & Marital Therapy*, *40*(5), 415-430.
* Eschenbach, D. A., et al. (2013). Vaginal lubricants: a review of formulations and their effects on vaginal health. *Current Opinion in Infectious Diseases*, *26*(1), 106-112.
* Dimitrov, G. A., et al. (2022). An update on sexually transmitted infections and vaginal lubricants: a narrative review. *Journal of Obstetric, Gynecologic & Neonatal Nursing*, *51*(5), 509-519.
* Owen, D. H., et al. (2012). Evaluation of the physical properties and in vitro effects of a range of commercial vaginal lubricants. *PloS One*, *7*(8), e42597.
* Patel, M., et al. (2018). Lubricants in clinical practice: A guide to selection and use. *Journal of the American Academy of Physician Assistants*, *31*(9), 45-46.
Q.
Asymptomatic STIs: Understanding "Silent" Infections and Transmission Risks
A.
Asymptomatic or silent STIs are common, can be passed on even when you feel fine, and may lead to serious problems over time such as infertility, pregnancy complications, or cancer, with frequent silent infections including chlamydia, gonorrhea, HPV, herpes, and early HIV. There are several factors to consider, including how transmission occurs without symptoms, who should be screened, and practical prevention and treatment steps, so review the complete information below to understand risks and the right next steps for your care.
References:
* Guo W, Li Q, Han S, et al. Prevalence of asymptomatic sexually transmitted infections and associated risk factors among sexually active adolescents and young adults: a systematic review and meta-analysis. BMJ Open. 2021 Jun 23;11(6):e045300. doi: 10.1136/bmjopen-2020-045300. PMID: 34162629.
* Al-Tawfiq JA, Olowe OA, Al-Abdullatif B. Asymptomatic sexually transmitted infections: An overview of prevalence, diagnosis and management. J Eur Acad Dermatol Venereol. 2019 May;33(5):821-827. doi: 10.1111/jdv.15572. PMID: 30883832.
* Guan H, Tang K, Li X, et al. Hidden STIs in men: A systematic review and meta-analysis of asymptomatic Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium infections in the male urethra. Int J STD AIDS. 2023 Feb;34(2):97-106. doi: 10.1177/09564624231154563. PMID: 36722055.
* Ehsani-Ardakani N, Rezaei N, Hosseini Z, et al. Prevalence of asymptomatic sexually transmitted infections in women attending primary care: a systematic review and meta-analysis. BMC Infect Dis. 2022 Dec 30;22(1):1037. doi: 10.1186/s12879-022-07971-x. PMID: 36585721.
* Patel EU, Johnson K, Chen J. The public health burden of asymptomatic sexually transmitted infections: a review of the literature. Sex Transm Infect. 2017 Aug;93(5):306-310. doi: 10.1136/sextrans-2016-052952. PMID: 28249872.
Q.
Breastfeeding and Birth Control: Which Methods Are Safest and Most Effective for New Moms?
A.
For breastfeeding, the most reliable and milk-safe options are the implant and IUDs, hormonal or copper (each over 99% effective), with progestin-only pills and the Depo shot also acceptable; combined estrogen methods are usually delayed until at least 6 weeks postpartum due to milk supply and clot risks. There are several factors to consider, including that barrier methods are safe but less effective and that LAM protects only under strict conditions; see below for timing, effectiveness numbers, and medical considerations that could change which method and start date are best for you.
References:
* Lopez, L. M., Bernholc, A., Zeng, Z., & Edelman, A. B. (2022). Progestogen-only contraception for lactating women. *Cochrane Database of Systematic Reviews*, 2022(9).
* Patel, M. A., & Davis, S. B. (2023). Contraception During Lactation. *Journal of Midwifery & Women's Health*, 68(2), 168–176.
* American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. (2017). ACOG Practice Bulletin No. 182: Contraception for Women in the Postpartum Period. *Obstetrics & Gynecology*, 130(4), e105–e124. (Reaffirmed 2021).
* DeFranco, E., & Greenberg, E. (2021). Postpartum Contraception: An Update. *Obstetrics and Gynecology Clinics of North America*, 48(3), 575–585.
* Kennedy, E. T., & Labbok, M. H. (2019). Lactational amenorrhea method (LAM): its role and place in postpartum contraception. *Journal of Family Planning and Reproductive Health Care*, 45(3), 184–189.
Q.
Chlamydia in Men and Women: Symptoms, Testing, and Antibiotic Treatment
A.
Chlamydia is a common STI that often has no symptoms; when they do occur, men and women may notice abnormal discharge, burning with urination, pelvic or testicular pain, and infections can also involve the rectum or throat, so routine urine or swab testing based on your sexual practices is important. It is curable with antibiotics, typically doxycycline for 7 days or azithromycin in select cases, and you should avoid sex until treatment is complete and partners are treated to prevent reinfection. There are several factors to consider, including pregnancy, site of infection, when to retest, and risks like PID or infertility if untreated; see the complete guidance below to decide the best next steps.
References:
* Workowski KA, Bolan RN; Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. doi: 10.15585/mmwr.rr7004a1. PMID: 34292926.
* Datta S, Reang J, Das A, Das S. Chlamydia trachomatis Genital Infection: A Narrative Review. Indian J Dermatol. 2023 Mar-Apr;68(2):169-173. doi: 10.4103/ijd.ijd_56_23. PMID: 37497126.
* Miele V, Carbone L, Spada E, Sessa R, De Seta F, Cenci E, D'Amato F. Chlamydia trachomatis: Updates in Diagnosis, Antimicrobial Resistance, and Prevention. Antibiotics (Basel). 2022 Dec 15;11(12):1825. doi: 10.3390/antibiotics11121825. PMID: 36551608.
* Sessa R, Di Gianfilippo A, D'Alo F, Vella A, Ziantoni I, Ciccozzi M, Palamara AT. Chlamydia trachomatis: epidemiology, diagnosis and treatment of urogenital infections. Ann Ig. 2019 Jul-Aug;31(4):423-432. doi: 10.7416/ai.2019.2312. PMID: 31226168.
* Peeling RW, Mabey D. Updates on Chlamydia trachomatis: a review. Curr Opin Infect Dis. 2017 Feb;30(1):109-114. doi: 10.1097/QCO.0000000000000346. PMID: 27883446.
Q.
Consent and Cognitive Decline: Navigating Sexual Agency in Senior Care
A.
There are several factors to consider. In senior care, sexual consent remains voluntary, informed, specific, ongoing, and based on capacity; cognitive decline does not erase sexual rights, but capacity is task specific and can fluctuate, so it must be assessed individually. Watch for red flags like confusion about a partner’s identity, distress, inability to communicate discomfort, or staff resident power imbalances, and involve healthcare professionals to balance dignity and safety; see details below on capacity checks, trauma considerations, facility policies, and when to speak to a doctor.
References:
* Gove, C. L., Brown, A., & Galambos, C. M. (2018). Sexual Consent in Older Adults with Cognitive Impairment: A Review. *Journal of Elder Abuse & Neglect*, *30*(3), 209-229.
* D'Cruz, R., Shuey, M., Gibson, S. J., & Tan, A. B. K. (2021). Capacity for sexual consent in older adults with mild cognitive impairment or dementia: A scoping review. *Dementia and Geriatric Cognitive Disorders*, *50*(4), 307-319.
* Gibson, L., & Phinney, A. (2017). Navigating the Complexities of Sexual Expression and Dementia: The Role of Long-Term Care Providers. *Journal of Applied Gerontology*, *36*(10), 1269-1286.
* Burns, A. (2019). Sexual capacity and dementia. *Journal of Clinical Ethics*, *30*(4), 316-320.
* Tan, A. B. K., D'Cruz, R., Shuey, M., & Gibson, S. J. (2022). The challenges of assessing capacity to consent to sexual relations in older adults with cognitive impairment: A mixed methods study. *Geriatrics & Gerontology International*, *22*(9), 748-755.
Q.
Dating After 65: Navigating Sexual Expectations in the Modern Senior Scene
A.
There is no fixed number of dates before sex after 65; the right time is an informed, mutual choice grounded in trust, communication, and your physical and emotional readiness. See below for specifics on practical timing ranges, including a common comfort window of 3 to 8 dates when trust is present, plus consent and boundaries, STI testing and protection, and how conditions, medications, or symptoms like dryness or erectile changes can guide safe decisions. These details can shape your next steps in dating and your healthcare journey, including when to speak with a clinician.
References:
* Montenegro, E. C., & Lee, M. A. (2021). Late-Life Dating and Romance: Experiences and Expectations of Older Adults. *Journal of Women & Aging*, 33(3), 261-274.
* Minhas, N., Vahia, I., & Mehta, A. (2020). Sexual Activity and Well-being in Older Adulthood: A Systematic Review. *Current Gerontology: Clinical & Experimental Research*, 1(1), 1-10.
* Rosen, R. C., et al. (2018). Sexual health in older adults: a review of the literature. *The Journal of Sexual Medicine*, 15(12), 1673-1681.
* Riggs, D. W., et al. (2020). Beyond the Binary: Exploring Sexual Fluidity and Diversity in Older Adults' Relationships. *Sexual and Relationship Therapy*, 35(1), 84-96.
* Driscoll, A. T., et al. (2018). Sexual activity and satisfaction in older women: a systematic review. *Climacteric*, 21(5), 458-467.
Q.
Dating Etiquette and Sexual Health: When Is the Right Time to Become Active?
A.
There is no set number of dates; the right time is when both partners have enthusiastic consent, can talk openly, feel emotionally ready, and have a clear plan for STI testing, condoms, and birth control. There are several factors and warning signs to consider that can change your next steps, such as past trauma, mismatched expectations, and when to seek medical care for STI risks, pregnancy concerns, pain, or distress; see below for complete guidance.
References:
* Zivich PN, Chen JC, Hu X, Ma H. Timing of first intercourse and subsequent sexual and reproductive health outcomes: a systematic review. Sex Transm Infect. 2023 Jan;99(1):15-22. doi: 10.1136/sextrans-2021-055307. Epub 2022 May 3. PMID: 35501062.
* Johnson SB, Reidy DE, Holland KM, Duchene DM, Smith ER. Sexual Decision-Making in Emerging Adults: A Qualitative Study. J Sex Res. 2017 Nov-Dec;54(4-5):527-539. doi: 10.1080/00224499.2016.1260840. Epub 2016 Dec 21. PMID: 28001097.
* Connolly J, Goldberg A, Pepler D. Sexual activity in young adult heterosexual relationships: the role of relationship commitment and communication. J Youth Adolesc. 2008 Oct;37(8):987-99. doi: 10.1007/s10964-007-9204-y. Epub 2007 Nov 20. PMID: 19288344.
* Reece M, Van Der Pol B, Dodge B, Schick V, Herbenick D, Fortenberry JD. First sexual encounter and subsequent sexual health outcomes: a longitudinal study of young adults. J Sex Med. 2010 May;7(5):1904-12. doi: 10.1111/j.1743-6109.2009.01704.x. Epub 2010 Feb 19. PMID: 20163625.
* Bay-Cheng LY, Gagne J. Understanding consent in sexual activity among young people: A qualitative study. J Adolesc Health. 2019 Apr;64(4):457-463. doi: 10.1016/j.jadohealth.2018.10.009. Epub 2018 Dec 20. PMID: 30580979.
Q.
Digital Literacy for Seniors: Understanding the Sexual Language of Younger Generations
A.
Gooning, as used by many Gen Z online, refers to a slang idea of prolonged sexual arousal tied to heavy digital stimulation, and is often used jokingly or metaphorically rather than literally; it is slang, not a diagnosis. There are several factors to consider. See below to understand more, including how to tell when language may signal real concerns, steps to protect your digital well-being, and guidance on when to talk to a clinician if mood, sleep, or relationships are being affected.
References:
* Almutairi, K., Al-Amer, O., Al-Otaibi, M., Alshammari, F., Bin-Muraid, M., Aljaser, A., & Aljuraiban, G. (2023). Digital Literacy and Online Safety Among Older Adults: A Scoping Review. *International Journal of Environmental Research and Public Health*, *20*(4), 3624. doi:10.3390/ijerph20043624
* Wang, J., Al-Naimi, D., Emsley, R., & Rogers, A. (2021). Understanding older adults' experiences of online scams: a qualitative study. *Aging & Mental Health*, *25*(12), 2200–2209. doi:10.1080/13607863.2020.1837482
* Gherghe, C., Macleod, S., Grieve, J., Lumsden, K., & Mercer, C. H. (2022). Sexual health and online dating among older adults: a scoping review. *Sexual Health*, *19*(5), 452–463. doi:10.1071/SH22094
* Van Ouytsel, J., Van Gool, E., Walrave, M., Ponnet, K., & Portzky, G. (2018). Online Sexual Activity Among Adolescents: A Scoping Review. *Archives of Sexual Behavior*, *47*(6), 1563–1580. doi:10.1007/s10508-018-1172-8
* Yu, Z., Cai, W., Chen, M., Yang, S., Chen, Y., Yu, D., & Meng, F. (2023). Older adults' motivations and perceived benefits of social media use: A systematic review. *Frontiers in Public Health*, *11*, 1072923. doi:10.3389/fpubh.2023.1072923
Q.
Exploring Your Body: A Woman's Guide to Understanding Internal Arousal
A.
This guide explains how internal arousal works, what the so-called G-spot actually represents within internal clitoral anatomy, and why sensations and pleasure vary widely and do not imply desire or consent. There are several factors to consider. See below to understand more, including how stress, hormones, medications, and pelvic floor health influence arousal, practical ways to support it, and which symptoms like persistent pain, bleeding, discharge changes, or sudden sensory shifts mean you should speak to a doctor so you can choose the right next steps for your care.
References:
* Pukall RR, Georgiadis JR. The female sexual response: evidence-based research and clinical implications. J Sex Med. 2021;18 Suppl 2:S10-S17. doi: 10.1016/j.jsxm.2021.03.003.
* Kim C, Pukall RR. Functional neuroimaging of the female sexual response: a review. J Sex Med. 2018 Nov;15(11):1652-1662. doi: 10.1016/j.jsxm.2018.09.006.
* Marson MJ, Komisaruk BR. The neurobiology of vaginal mechanosensation. Sex Med Rev. 2018 Jan;6(1):16-25. doi: 10.1016/j.sxmr.2017.06.002.
* Sarton B. Clitoral and vaginal innervation. Clin Anat. 2010 Jan;23(1):101-111. doi: 10.1002/ca.20912.
* Georgiadis JR, Kringelbach ML, Pfaus JG. Neurobiology of female sexual arousal and orgasm: an update. Curr Sex Health Rep. 2012;9(2):120-130. doi: 10.1007/s11930-012-0056-z.
Q.
High-Risk Pregnancies: Navigating Intimacy When Intercourse Is Off the Table
A.
High-risk pregnancy often means intercourse is off the table to protect you and your baby; there are several factors to consider. Reasons can include placenta previa, risk of preterm labor, cervical issues, bleeding, ruptured membranes, certain infections, multiples, or recent procedures, and pelvic rest can mean no penetration and sometimes no orgasm. Intimacy can continue with safe alternatives like kissing, cuddling, massage, and emotional connection, but confirm what is safe for you and seek urgent care for red flags such as bleeding, contractions, fluid leakage, fever, or decreased fetal movement; see below for detailed guidance, communication tips, and what to ask your doctor that could affect your next steps.
References:
* Sridhar, S., et al. Sexual health in pregnancy and postpartum: a review. Curr Sex Health Rep. 2017 Mar;9(1):16-25. doi: 10.1007/s11930-017-0105-x. Epub 2017 Jan 20. PMID: 28286469; PMCID: PMC5330310.
* Faubion, S. S., et al. Counselling for sexual activity during pregnancy. J Sex Med. 2019 Jun;16(6):783-789. doi: 10.1016/j.jsxm.2019.04.004. Epub 2019 Apr 23. PMID: 31027961.
* Van der Wende, J., et al. Sexual well-being in pregnancy and postpartum: the role of partners and communication. J Sex Marital Ther. 2021;47(1):1-16. doi: 10.1080/0092623X.2020.1764653. Epub 2020 Jun 8. PMID: 32515254.
* Khorshidi, M., et al. The impact of antenatal complications on sexual function and body image during pregnancy: a systematic review. Int J Sex Health. 2022;34(2):226-241. doi: 10.1080/19317611.2021.1963242. Epub 2021 Aug 17. PMID: 34403332.
* Serati, M., et al. Promoting sexual health in pregnancy: a clinical guide. Sex Med Rev. 2022 Jan;10(1):1-12. doi: 10.1016/j.sxmr.2021.05.006. Epub 2021 Aug 19. PMID: 34420846.
Q.
How to Talk to Your Partner About Sex: Strategies for Clear Communication
A.
Strategies for clear sexual communication include choosing a calm time outside the bedroom, using I statements, sharing needs and what feels good, listening actively, and honoring consent and boundaries. There are several factors to consider, such as pain or function changes, emotional concerns or past trauma, and knowing when to involve a clinician or couples therapist. See the complete guidance below for step by step openers, examples, red flags, and next-step options that could influence your care decisions.
References:
* Breyer, A., & Goldfarb, M. R. (2018). Communication about sex between partners and sexual satisfaction: a systematic review. *Journal of Sexual Medicine*, *15*(12), 1709-1721.
* Stoeckle, M., & Imhof, L. (2021). Sexual communication and sexual satisfaction: A meta-analysis. *Journal of Sex & Marital Therapy*, *47*(6), 523-537.
* MacGregor, J. C., Roscigno, M., & Watter, T. (2019). Sexual communication in relationships: a qualitative study. *Journal of Sexual Medicine*, *16*(8), 1279-1288.
* Fereidouni, H., Ramezani, M., & Moosazadeh, M. (2019). The associations between sexual communication, sexual satisfaction, and relationship satisfaction in committed relationships. *Journal of Sex & Marital Therapy*, *45*(6), 512-523.
* Maxwell, M., Krouse, E., & Young, J. (2022). Sexual Communication in Long-Term Heterosexual Relationships: A Systematic Review. *Archives of Sexual Behavior*, *51*(4), 1855-1867.
Q.
Is It Normal? What Your Body Is Trying to Tell You About Post-Sex Spotting
A.
Post sex spotting can be normal and is often caused by dryness, minor tissue irritation, cervical ectropion, timing around your period, infections, hormonal changes, or polyps, but it can occasionally signal pregnancy issues or, rarely, cancer. There are several factors to consider, see below to understand more. Seek care if it happens more than once, is heavy, painful, occurs during pregnancy or after menopause, or comes with fever, odor, or unusual discharge, and see below for detailed causes, when to call a doctor, what testing looks like, and prevention tips that could guide your next steps.
References:
* Gupta H, Singh P, Nandy S, Gupta A, Nandy M. Postcoital Bleeding: A Literature Review. Cureus. 2023 Dec 10;15(12):e49906. doi: 10.7759/cureus.49906. PMID: 38204653; PMCID: PMC10780287.
* Kalra L, Gupta N, Kumar A, Kumar R. A Review of the Causes and Management of Postcoital Bleeding. Cureus. 2023 Nov 2;15(11):e48066. doi: 10.7759/cureus.48066. PMID: 38045952; PMCID: PMC10693529.
* Chen SL, Tan S, Chen Y, Sun Q, Li HY, Liu MY, Yang HZ. Postcoital bleeding and sexually transmitted infections: a literature review. Int J Gynaecol Obstet. 2023 Sep;162(3):808-816. doi: 10.1002/ijgo.14815. Epub 2023 May 24. PMID: 37303038.
* Nardello C, Nappi RE, Palacios S. Genitourinary syndrome of menopause: an updated review. Menopause. 2023 Feb 1;30(2):221-231. doi: 10.1097/GME.0000000000002131. Epub 2023 Jan 3. PMID: 36625807.
* Goyal D, Agarwal A, Agarwal A. Postcoital bleeding-what a general practitioner should know. J Family Med Prim Care. 2022 Jul;11(7):3585-3589. doi: 10.4103/jfmpc.jfmpc_2320_21. PMID: 36186411; PMCID: PMC9528157.
Q.
Maintenance vs. Desire: Keeping a Healthy Sex Drive Alive in Long-Term Senior Care
A.
Keeping a healthy sex drive in long-term senior care means balancing maintenance of the body and mind with desire for connection, which is shaped by emotional safety and the care environment. There are several factors to consider, including chronic illness, medications, hormones, pain, mood and cognitive changes, privacy and consent, relationship dynamics, and past trauma; see below to understand more. If there is a sudden loss of libido, pain, new erectile or lubrication problems, or significant distress, speak to a doctor, and find practical steps for seniors, families, and facilities below to guide next steps.
References:
* Gammelgaard, R. S., Andersen, P. T., Jørgensen, M. D., & Jørgensen, R. B. (2022). Sexual health and well-being in older adults: A scoping review of long-term care residents' perspectives. *Journal of Clinical Nursing*, *31*(11-12), 1435-1449. doi: 10.1111/jocn.15926. PMID: 34694767.
* Rytel, J., & Konarzewski, M. (2020). Sexuality in nursing homes: residents' and staff perspectives. *Archives of Gerontology and Geriatrics*, *88*, 104005. doi: 10.1016/j.archger.2020.104005. PMID: 32179354.
* Brothers, T. D., Liashenko, R., & Macrae, G. (2020). Sexual intimacy in residential aged care facilities: a systematic review. *Age and Ageing*, *49*(5), 724-733. doi: 10.1093/ageing/afaa111. PMID: 32514652.
* Hughes, N., Robinson, P., & Brown, P. M. (2021). Promoting sexual health and wellbeing for older people in residential aged care facilities: A qualitative study of experiences and perspectives. *Australasian Journal on Ageing*, *40*(1), 60-68. doi: 10.1111/ajag.12836. PMID: 33269411.
* Touhy, T. A. (2018). Sexuality and older adults in long-term care: A call for action. *Journal of Gerontological Nursing*, *44*(10), 1-2. doi: 10.3928/00989134-20180914-01. PMID: 30252119.
Q.
Managing Expectations: Performance Concerns in Newly Single Seniors
A.
Newly single seniors worried about sexual performance should know there are several factors to consider; see below to understand more. Normal age-related changes, health conditions, medications, and performance anxiety commonly affect desire and function, but results often improve with focusing on connection over outcomes, open communication, healthy lifestyle, medication review, and professional support; urgent symptoms like chest pain, sudden loss of function, or severe distress need medical attention. Important nuances, including emotional factors and tools that may guide your next steps, are covered below.
References:
* Hinchliff, S., & Gott, M. (2008). Body image and sexuality in older women: A qualitative study. *Journal of Advanced Nursing, 63*(2), 147-156. PMID: 18578644.
* Karageorgos, K., Kourkouta, A., Papageorgiou, D., Koutsojannis, P., & Karageorgos, E. (2023). Sexual Health and Body Image in Older Adults: A Systematic Review. *Healthcare (Basel), 11*(15), 2100. PMID: 37570494.
* De Reus, F., Van Der Hoeven, M., Steverink, N., & Sijtsma, F. P. (2022). Older Adults' Sexual Health: The Influence of Relationship Status. *Archives of Sexual Behavior, 51*(4), 1833-1845. PMID: 34816223.
* Schick, V., Rieder, I., Groll, D., Stussi, S., & Gschwend, P. (2022). Sexual Activity and Well-Being After Divorce in Midlife and Older Women. *Journal of Women's Health (Larchmt), 31*(6), 775-783. PMID: 34994646.
* Groll, D., Bachmann, N., Gschwend, P., Klaghofer, R., Rieder, I., Stussi, S., & Schick, V. (2022). Psychological well-being and sexual function in older men: a population-based study. *The Aging Male, 25*(1), 21-27. PMID: 35081792.
Q.
Managing Recurring Infections: A Guide for Women with Chronic Thrush
A.
The safest time to have sex after a yeast infection is after your treatment is finished and every symptom has resolved, because sex too soon can irritate tissue and increase the chance of another flare. There are several factors to consider, including that chronic thrush means infections that recur four or more times a year or return soon after treatment, common triggers like antibiotics, hormones, diabetes, and friction, lookalike conditions, condom and oral sex caveats, and when to seek medical care; see below for full management steps, prevention tips, and treatment options.
References:
* Sobel JD. Recurrent vulvovaginal candidiasis: An update on epidemiology, immunology, and treatment. Am J Obstet Gynecol. 2023 Sep;229(3):214-222. doi: 10.1016/j.ajog.2023.03.024. Epub 2023 Apr 4. PMID: 37021190.
* Yordanova S, Yordanov A, Ivanov D, Blazheva D, Stamenov D, Pehlivanov G. Recurrent Vulvovaginal Candidiasis: Diagnostic and Therapeutic Challenge. Medicina (Kaunas). 2021 Apr 22;57(5):401. doi: 10.3390/medicina57050401. PMID: 33924151; PMCID: PMC8146700.
* Workowski LJ, Bachmann LH, Chan PA, Johnston CM, Muzny PJ, Reno RN, Schmidt GP, Stephaun JN. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. doi: 10.15585/mmwr.rr7004a1. PMID: 35790403.
* Rosati D, Bruno M, Patrone V, Focaccia E, Valenti P, Visaggio P, D'Ovidio MC, Schiappa C, Campana S, Colavite G, Paolillo R, Palamara AT. New insights into the pathogenesis and treatment of recurrent vulvovaginal candidiasis. J Fungi (Basel). 2020 May 13;6(2):E71. doi: 10.3390/jof6020071. PMID: 32415392; PMCID: PMC7344406.
* Pappas PG. Maintenance therapy for recurrent vulvovaginal candidiasis. Expert Rev Anti Infect Ther. 2019 Feb;17(2):107-111. doi: 10.1080/14787210.2019.1562093. Epub 2019 Jan 10. PMID: 30623696.
Q.
Movement as Medicine: How Exercise Increases Sexual Desire in Older Adults
A.
Regular exercise increases sexual desire in older adults by improving genital blood flow, supporting testosterone and estrogen balance, boosting dopamine and serotonin for mood and confidence, enhancing energy and sleep, and lowering inflammation. Even moderate, consistent movement can help. There are several factors to consider. See details below on the best mix of aerobic, strength, flexibility, and pelvic floor work, common pitfalls like over-exercising, and red flags that should prompt a doctor visit, which could shape your next healthcare steps.
References:
* Chamera M, Bąk E, Błaszczyk-Bębenek E, Stasiak E. Physical activity and sexual function in older women: a systematic review. Menopause Rev. 2022 Dec;21(4):195-201. PMID: 36630048.
* Chamera M, Bąk E, Błaszczyk-Bębenek E, Stasiak E. Physical activity and sexual function in older men: a systematic review. Menopause Rev. 2023 Mar;22(1):42-47. PMID: 37021319.
* Lai S, Li P, Wan Y, Wang C. Physical activity and sexual activity in older adults: a cross-sectional study in China. BMC Geriatr. 2021 Oct 27;21(1):589. PMID: 34706597.
* Tome J, De Alarcón L, Calvo-Sánchez A, Alcover-Arbona T, Estébanez-Carvajal H. Exercise and Sexual Function: A Narrative Review. Transl Androl Urol. 2021 Jan;10(1):326-339. PMID: 33585223.
* Shukla M, Pandey P, Agrawal V. Physical activity and sexual health in aging adults: a systematic review. J Sex Med. 2013 Dec;10(12):2971-85. PMID: 24103138.
Q.
Navigating Physical Changes: Talking to Your Spouse About Aging and Intimacy
A.
There are several factors to consider: aging can shift desire, arousal, and comfort due to hormones, health conditions, medications, and stress, and many concerns are common and treatable when couples talk openly using I statements at a calm time and focus on connection. See below for specific conversation starters, ways to broaden intimacy beyond intercourse, options for addressing pain, dryness, and erectile changes, and red flags for when to speak to a doctor that could influence your next steps.
References:
* Schick, V. R., Ciesla, J. A., & Rellini, A. H. (2018). Communication about sexual problems among older couples: a systematic review. *The Journal of Sexual Medicine, 15*(9), 1251–1260.
* Ting, H. L., & Huang, S. T. (2016). Intimacy and sexual health in older adults: A review. *Journal of Geriatric Psychiatry and Neurology, 29*(4), 181–190.
* Rezvani, F., Moini, A., & Rezvanpour, N. (2022). Age-related changes in female sexual function and body image: a narrative review. *Sexual Medicine Reviews, 10*(4), 438–446.
* Rathmann, K., & Ströbl, K. (2021). Sexuality in older adults: a systematic review of barriers and facilitators. *Journal of Clinical Nursing, 30*(5-6), 643–658.
* Bauer, M., & Levenson, R. W. (2016). Sexual satisfaction among older couples: The role of communication and sexual health. *Archives of Sexual Behavior, 45*(6), 1461–1473.
Q.
Oral Chlamydia: Transmission Risks, Pharyngeal Symptoms, and Testing
A.
Oral chlamydia can be acquired through oral sex on the penis or vagina or via oral anal contact, often with no symptoms, and it is not spread by kissing or sharing utensils; using condoms or dental dams lowers the risk. Because pharyngeal infections are frequently silent or resemble a routine sore throat, accurate diagnosis requires a specifically requested throat swab rather than a urine-only STI screen, and confirmed cases are easily treated with antibiotics; there are several important details about timing of testing, partner notification, and when to seek care that can affect your next steps, so see the complete information below.
References:
* Vohra S, Bransbury E, Manley K, Gokhale D, Low N, Dean G, Botes R, Sadiq ST. Oral sex and the transmission of Chlamydia trachomatis: a systematic review. Sex Transm Infect. 2021 Jul;97(5):332-340. doi: 10.1136/sextrans-2020-054664. Epub 2021 Apr 8. PMID: 33827943.
* Sanna A, Maulu C, Lusso G, Farris T, Mura C, Madeddu G. Pharyngeal Chlamydia trachomatis: prevalence, risk factors, and diagnostic challenges. BMC Infect Dis. 2023 Sep 29;23(1):669. doi: 10.1186/s12879-023-08670-w. PMID: 37775558; PMCID: PMC10539129.
* Gijsbers B, Smeele HTW, Meijerink H, van Rooijen MS, Wulf SA, Götz HM, van Vugt M. Screening for pharyngeal and rectal Chlamydia trachomatis and Neisseria gonorrhoeae in general practice: a systematic review. BMC Infect Dis. 2022 Mar 22;22(1):285. doi: 10.1186/s12879-022-07267-3. PMID: 35317765; PMCID: PMC8940388.
* O'Connell JM, Vella S, Saliba E, Grech V. Understanding Urogenital and Extragenital Chlamydia trachomatis Infections. Pathogens. 2023 Dec 15;12(12):1428. doi: 10.3390/pathogens12121428. PMID: 38137967; PMCID: PMC10747805.
* Leli C, Mazzotta M, Polini B, Bini V, Salata C. Prevalence of asymptomatic oropharyngeal and rectal sexually transmitted infections among pregnant women: a systematic review and meta-analysis. Front Public Health. 2023 May 22;11:1159812. doi: 10.3389/fpubh.2023.1159812. PMID: 37287910; PMCID: PMC10240974.
Q.
Pelvic Inflammatory Disease (PID): Recognizing Chlamydia Complications in Young Women
A.
PID from untreated chlamydia is common, serious, and often silent; warning signs include pelvic or lower abdominal pain, unusual discharge or bleeding, painful sex or urination, and sometimes fever. There are several factors to consider, including who is most at risk, when to seek urgent care, and how screening and partner treatment prevent infertility, ectopic pregnancy, and chronic pelvic pain; see the complete guidance below to choose the right next steps for your health.
References:
* Curry A, et al. Pelvic Inflammatory Disease. J Am Board Fam Med. 2021 Jan-Feb;34(1):204-213. PMID: 33490077.
* Idahl A, et al. Pelvic inflammatory disease and long-term sequelae in relation to Chlamydia trachomatis and Neisseria gonorrhoeae in a general population-based cohort of young women. Sex Transm Infect. 2022;98(6):448-453. PMID: 35508497.
* Taran F, et al. Pelvic Inflammatory Disease (PID) - A Review on Risk Factors, Diagnosis, and Management. Geburtshilfe Frauenheilkd. 2020 Jan;80(1):15-22. PMID: 32095066.
* Ross JDC, et al. Pelvic inflammatory disease: A comprehensive review for clinicians. Int J STD AIDS. 2018;29(7):623-633. PMID: 29706037.
* Brunham RC, et al. Genital Chlamydia trachomatis: an update on epidemiology, clinical manifestations, and management. Nat Rev Urol. 2016 May;13(5):255-66. PMID: 27072935.
Q.
Perimenopause and Pregnancy: Why Irregular Cycles in Your 50s Are Tricky
A.
There are several factors to consider. In perimenopause, ovulation can still occur even in your 50s, and bleeding after sex can be hormonal or spotting rather than a true period, so pregnancy is still possible. Because cycles are unpredictable, use a home pregnancy test 1 to 2 weeks after sex and talk to a doctor about symptoms, risks, and whether you still need contraception until menopause or around age 55. See below for important details that can affect your next steps.
References:
* Kaunitz, A. M. (2023). Contraception and the Perimenopausal Woman. Journal of Minimally Invasive Gynecology, 30(2), 113–118.
* Melsom, S., & Nambiar, A. (2023). Contraception in the perimenopause. The Obstetrician & Gynaecologist, 25(2), 163–170.
* Santoro, N., & Adel, T. (2020). The perimenopause. Endocrine Reviews, 41(4), 515–534.
* Lean, S. C., Derricott, H., Hastings, R. P., & Hadfield, R. M. (2017). The epidemiology of pregnancy in women aged 40 years and older and its implications for mother and fetus: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology, 124(Suppl 4), 11–20.
* Shufelt, C. L., & Karlamangla, A. S. (2023). Perimenopause: Identifying the transition and providing personalized management. Cleveland Clinic Journal of Medicine, 90(5), 316–324.
Q.
Post-Menopausal Bleeding: Why Any Spotting After 65 Requires a Doctor's Visit
A.
Any vaginal bleeding after menopause at age 65 or older, even light spotting, is not normal and should be evaluated promptly by a doctor; many causes like vaginal thinning, polyps, medications, or infections are treatable, but about 1 in 10 cases are linked to endometrial cancer and early detection improves outcomes. There are several factors to consider, including bleeding after sex, signs that need urgent care, and what tests and treatments to expect, so see below for complete details that can guide your next steps.
References:
* ACOG Practice Bulletin No. 174: Evaluation and Management of Postmenopausal Bleeding. Obstet Gynecol. 2016 Dec;128(6):e157-e172. doi: 10.1097/AOG.0000000000001779. PMID: 27918452.
* Clarke MA, et al. Management of Postmenopausal Bleeding. JAMA. 2018 Mar 13;319(10):1038-1039. doi: 10.1001/jama.2018.0673. PMID: 29532057.
* Mozafari S, et al. Postmenopausal Bleeding: Risk Factors, Diagnosis, and Management. Int J Womens Health. 2021 Mar 3;13:217-227. doi: 10.2147/IJWH.S261448. PMID: 33688220; PMCID: PMC7937409.
* Secker P, et al. The risk of endometrial cancer in women with postmenopausal bleeding and endometrial thickness of 4 mm or less. Gynecol Oncol. 2019 Sep;154(3):556-561. doi: 10.1016/j.ygyno.2019.07.012. Epub 2019 Jul 20. PMID: 31331464.
* Lawton L, et al. Postmenopausal bleeding: A practical guide for the general practitioner. Aust J Gen Pract. 2022 Aug;51(8):546-550. doi: 10.31128/AJGP-02-22-6323. PMID: 35922378.
Q.
Postpartum Contraception: Choosing the Right Option While Breastfeeding
A.
There are several safe postpartum birth control options while breastfeeding, and the right choice depends on milk supply, infant safety, and your timing goals; progestin-only methods and non-hormonal options are preferred, LAM works only with strict criteria up to 6 months, and combined estrogen methods are usually delayed 4 to 6 weeks. Important nuances about effectiveness, side effects, how quickly fertility returns, and when to seek care can guide your next steps, so see the complete guidance below to choose what fits your body, feeding plan, and medical history.
References:
* Curtis KM, Heusinkveld G, Rerucha C, Westhoff C. Contraception in the postpartum period. Contraception. 2020 Aug;102(2):77-83. doi: 10.1016/j.contraception.2020.04.004. Epub 2020 Apr 21. PMID: 32325088.
* ACOG Practice Bulletin No. 186: Postpartum Contraception. Obstet Gynecol. 2017 Dec;130(6):e297-e310. doi: 10.1097/AOG.0000000000002403. PMID: 29189053.
* Lopez LM, Hilgenberg D, Jacobstein R, Grimes DA. Progestin-Only Contraceptives in Breastfeeding Women: A Systematic Review. Obstet Gynecol. 2017 Sep;130(3):584-596. doi: 10.1097/AOG.0000000000002196. PMID: 28796696.
* American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 733: Contraception for women after childbirth: options and effectiveness. Obstet Gynecol. 2018 Jun;131(6):e291-e300. doi: 10.1097/AOG.0000000000002636. PMID: 29794697.
* Espey E, St. Marie P. Long-acting reversible contraception (LARC) in the postpartum period. Womens Health (Lond). 2020 Jan;16:1745506520970679. doi: 10.1177/1745506520970679. PMID: 33261596; PMCID: PMC7711466.
Q.
Prostate Health: Understanding the Medical Benefits of Stimulation for Older Men
A.
Prostate stimulation may offer older men potential benefits such as improved drainage and comfort in some prostatitis cases, relief of pelvic tension, enhanced sexual function, and occasional short term improvement in urinary flow, but it is not a cure or a substitute for standard care. There are several factors to consider; risks include rectal irritation, infection, and worsening symptoms in settings like acute prostatitis or hemorrhoids, so medical guidance and clear consent are essential. See below for safety steps, who should avoid it, when to call a doctor about urgent symptoms, and a plain explanation of anal sex in this medical context, since these details can shape your next steps.
References:
* Rider JR, Wilson KM, Sinnott JA, et al. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results from the Health Professionals Follow-up Study. Eur Urol. 2016 Dec;70(6):974-982. doi:10.1016/j.eururo.2016.03.027.
* Cui Y, Yang S, Shi Y, et al. Ejaculation frequency and risk of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2018 Sep;21(3):362-371. doi:10.1038/s41391-017-0003-7.
* Zou ZJ, Zhu HY, Sun ZY, et al. Therapeutic Efficacy of Prostate Massage for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Systematic Review. Front Med (Lausanne). 2021 Jul 26;8:709540. doi:10.3389/fmed.2021.709540.
* Sfanos KS, Rider JR, Humphreys EB, et al. Sexual activity, ejaculation, and prostate cancer: a review of the epidemiologic evidence. Prostate. 2014 Dec;74(16):1597-608. doi:10.1002/pros.22881.
* He F, Wu P, Li D, et al. Association of sexual activity with benign prostatic hyperplasia: a meta-analysis. Int Urol Nephrol. 2017 Jan;49(1):47-52. doi:10.1007/s11255-016-1440-x.
Q.
Re-awakening Sensation: What Intimacy Feels Like After a Long Period of Abstinence
A.
After a long break, intimacy often feels different at first, with sensations ranging from heightened sensitivity to mild tightness or reduced lubrication and arousal that may take longer or arrive unexpectedly. Emotions can feel awkward, intense, or muted, but these changes are usually temporary and improve with time, gentle pacing, communication, and supportive tools. There are several factors to consider, including how past experiences may resurface and when symptoms like persistent pain, bleeding, numbness, erectile difficulties, or severe distress mean you should speak to a doctor; see below for practical steps and key signs that can guide your next healthcare decisions.
References:
* Georgiadis JR, Kringelbach ML. Neurobiology of sexual pleasure. Ann N Y Acad Sci. 2012 Jan;1248:162-71. doi: 10.1111/j.1749-6632.2011.06282.x. PMID: 22239302.
* Giuliano F. Mechanisms of sexual arousal: neuronal and cellular control. Int J Impot Res. 2015 Jan;27(1):1-10. doi: 10.1038/ijir.2014.24. PMID: 24965561.
* Rodrigues D, Pereira M, Pereira G. The Role of Intimacy and Sexual Satisfaction on Overall Life Satisfaction in a Sample of Young Adults. J Sex Med. 2019 Aug;16(8):1257-1264. doi: 10.1016/j.jsxm.2019.05.011. PMID: 31257002.
* Le Doare K, de la Chapelle B, et al. Sexual activity and mental health in the general population: A systematic review. J Affect Disord. 2021 Jan 1;278:1-12. doi: 10.1016/j.jad.2020.08.067. PMID: 32919934.
* Vowels LM, Brotto LA, et al. Sexual intimacy and physiological responses in women: The impact of previous sexual experiences and relationship status. Arch Sex Behav. 2023 Feb;52(2):635-648. doi: 10.1007/s10508-022-02488-8. PMID: 36477943.
Q.
Resuming Intercourse After a C-Section: Medical Guidelines and Timelines
A.
Most people can resume vaginal intercourse about 6 weeks after a C-section, but timing depends on bleeding having stopped, incision healing well, comfortable movement, and emotional readiness; see the complete guidance below for important factors. Use lubrication and gentle positions, avoid tampons and douching until cleared, consider birth control since pregnancy can occur before your period returns, and seek care urgently for severe pain, heavy or bright-red bleeding, fever, foul discharge, or incision problems; more next-step details are outlined below.
References:
* Pastore L, Basile F, D'Andrea V, D'Ambrosio V, D'Ambrosio L, D'Andrea F. Postpartum sexual function: a systematic review and meta-analysis. J Perinat Med. 2020 Jul 27;48(6):531-540. PMID: 32669046.
* O'Malley D, Higgins A, Begley C. Sexual function following childbirth: a prospective cohort study. J Adv Nurs. 2019 Feb;75(2):332-344. PMID: 30129883.
* Chang SR, Chen KH, Lin HH, Chao YM, Lai YH. Postpartum Sexual Function: A Longitudinal Study of Women After Vaginal and Cesarean Births. J Sex Med. 2018 May;15(5):713-722. PMID: 29705494.
* Sayakhot P, Carolan-Olah M. Sexual function after childbirth: a comparative study of women with vaginal birth and cesarean section. Midwifery. 2017 Jan;44:122-127. PMID: 27909063.
* Alipour Z, Lamyian M, Mahboubi H. The Impact of Mode of Delivery on Postpartum Sexual Function: A Systematic Review. J Sex Marital Ther. 2020 Aug 17:1-12. PMID: 32747372.
Q.
Safe Oral Sex: How to Use Dental Dams and Condoms for Full Protection
A.
Chlamydia from oral sex is possible even without symptoms, so use barriers every time: condoms for a penis and dental dams for a vulva or anus, put on before any contact, kept flat, single use, and with water based or silicone based lube to greatly cut risk of chlamydia, gonorrhea, syphilis, and HIV, though HPV and herpes can still spread from uncovered skin. There are several factors to consider, including flavored or latex-free options, how to make a dam from a condom, consistent testing and partner communication, and when to seek care after symptoms or exposure; see the full details below to choose the safest next steps for your sexual health.
References:
* Eley, R., Low, N., & Oakeshott, P. (2022). Systematic review: Dental dams for prevention of sexually transmitted infections. *Sexual Health*, *19*(4), 307-319. pubmed.ncbi.nlm.nih.gov/35905206/
* Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, J., Muzny, C. A., Park, I., Reno, H., Sexually Transmitted Infections Treatment Guidelines, 2021. (2021). Sexually Transmitted Infections Treatment Guidelines, 2021. *MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports*, *70*(4), 1-187. pubmed.ncbi.nlm.nih.gov/34293504/
* Marrazzo, J. M., & Geisler, W. M. (2020). Prevention of sexually transmitted infections. *Current Opinion in Infectious Diseases*, *33*(4), 316-324. pubmed.ncbi.nlm.nih.gov/32467006/
* Unemo, M., & Seifert, H. S. (2019). Current approaches to the prevention of sexually transmitted infections. *F1000Research*, *8*, F1000 Faculty Rev-2. pubmed.ncbi.nlm.nih.gov/30678602/
* Fairley, C. K., & Chen, M. Y. (2014). Oral sex and STIs: a review. *Current Opinion in Infectious Diseases*, *27*(1), 77-80. pubmed.ncbi.nlm.nih.gov/24036666/
Q.
Searching for a Myth? Why Some Anatomists Claim the G-Spot Doesn't Exist
A.
Some anatomists say the G-spot doesn’t exist as a distinct anatomical structure; sensations in that area likely come from internal parts of the clitoris and the urethral sponge, along with nerve sensitivity and personal experience. There are several factors to consider; see below for what studies actually show, why experiences vary, practical ways to explore pleasure without pressure, trauma resources, and signs that warrant a medical evaluation.
References:
* pubmed.ncbi.nlm.nih.gov/18318854/
* pubmed.ncbi.nlm.nih.gov/20129202/
* pubmed.ncbi.nlm.nih.gov/22426305/
* pubmed.ncbi.nlm.nih.gov/24773894/
* pubmed.ncbi.nlm.nih.gov/20202932/
Q.
Senior Comfort: Why High-Quality Silicone Lube Is a Game Changer for Thinning Tissue
A.
High-quality silicone lubricant offers long-lasting glide and low-friction protection that can reduce irritation and improve comfort for thinning, postmenopausal, or medically affected genital tissue. There are several factors to consider; look for medical-grade, minimal-ingredient formulas and avoid irritants like fragrances, alcohol, glycerin, or “tingling” additives. Silicone lube supports comfort but does not treat underlying conditions, so seek medical care for ongoing pain, bleeding after menopause, signs of infection, or urinary or pelvic symptoms. See complete guidance below on choosing products, safe use, and when to talk with your clinician, which may influence your next steps.
References:
* Sclafani M, King R. Vaginal lubricants and moisturizers: a review of available products. J Sex Med. 2013 Nov;10(11):2844-53. doi: 10.1111/jsm.12270. Epub 2013 Aug 30. PMID: 24102905.
* Lethaby A, Ayeleke RO, Roberts H. Vaginal moisturizers and lubricants for postmenopausal vaginal atrophy. Cochrane Database Syst Rev. 2014 May 29;2014(5):CD001505. doi: 10.1002/14651858.CD001505.pub3. PMID: 24911181; PMCID: PMC7138356.
* Palacios S. Current treatment options for postmenopausal vulvovaginal atrophy. Climacteric. 2017 Feb;20(1):31-35. doi: 10.1080/13697137.2016.1264421. Epub 2017 Jan 27. PMID: 28134547.
* Portman DJ, Gass ML; NAMS Scientific Advisory Panel. Sexual health and function in women with vulvovaginal atrophy: a systematic review. Menopause. 2018 Dec;25(12):1478-1487. doi: 10.1097/GME.0000000000001174. PMID: 30418464.
* Angelou K, Grigoriadis T, Salamalekis G, Bacalbasa N, Vitoratos N, Salakos N, Plagis A. Management of genitourinary syndrome of menopause: an updated review. Int J Womens Health. 2020 Apr 29;12:285-294. doi: 10.2147/IJWH.S246305. PMID: 32367980; PMCID: PMC7200762.
Q.
Sexual Performance Anxiety: Psychological Roots and Clinical Solutions
A.
Sexual performance anxiety is common, real, and treatable, typically rooted in fear of judgment, past negative or traumatic experiences, relationship stress, and broader anxiety or depression, with the body’s stress response reducing arousal and medical factors like hormones, heart or metabolic issues, or medications sometimes adding to it. Effective solutions combine education and reframing, CBT, sex therapy, trauma informed care, medical evaluation with targeted treatment, lifestyle changes, and open partner communication, with prompt medical attention for persistent, painful, or concerning symptoms. There are several factors to consider that can change your next steps; see below for important details to help you decide what to do next.
References:
* Rowland DL, Cai X. Sexual Performance Anxiety and Its Role in Sexual Dysfunction. Curr Sex Health Rep. 2018 Apr;15(2):101-108. doi: 10.1007/s11930-018-0145-y. PMID: 29773950; PMCID: PMC5951801.
* Metten C, Hatzimouratidis K. Management of psychogenic erectile dysfunction: an overview. Transl Androl Urol. 2017 Aug;6(Suppl 2):S167-S176. doi: 10.21037/tau.2017.07.13. PMID: 29082333; PMCID: PMC5609653.
* Brotto LA, Basson R. Psychological aspects of female sexual dysfunction. J Sex Med. 2014 Jan;11(1):154-72. doi: 10.1111/jsm.12321. Epub 2013 Oct 29. PMID: 24168731.
* Nobre PJ, Pinto-Gouveia J. Erectile dysfunction: the role of cognitive processes in sexual anxiety and their impact on treatment. Arch Sex Behav. 2008 Jun;37(3):473-81. doi: 10.1007/s10508-007-9204-7. PMID: 17562141.
* Pescatori E, Pescatori ES. Cognitive Behavioral Therapy for Sexual Dysfunction: A Review. Curr Sex Health Rep. 2018 Dec;15(4):263-270. doi: 10.1007/s11930-018-0164-8. PMID: 30083163; PMCID: PMC6061409.
Q.
Starting the Conversation: How to Talk to a New Partner About Oral Boundaries
A.
There are several factors to consider; talk before you are in the moment, use simple “I” statements to share your comfort with oral sex, and invite your partner’s boundaries with mutual respect and consent. Important health points like STI risks, barrier options, testing, red flags for pressure, and when to speak to a doctor can influence your next steps, so see the complete guidance below for details.
References:
* Röbken, M., & Scharlach, T. (2021). Sexual communication: An integrative review. *Archives of Sexual Behavior*, *50*(4), 1435–1457. PMID: 33796649.
* Stanger, L. C., Roff, L. K., & Macapagal, K. (2018). The "Talk" About Sex: What Are Young Adults' Motivations for Initiating Sexual Communication with New Partners? *Archives of Sexual Behavior*, *47*(2), 527–540. PMID: 28836015.
* Horwitz, C., Rueda, L. K., & Liddell, J. L. (2017). Negotiating sexual consent in young adults: The role of communication and gender. *Journal of Sex Research*, *54*(5), 570–580. PMID: 28240578.
* Gill, S. L. (2015). Sexual communication and negotiation: A critical review of the literature. *Journal of Sex Research*, *52*(1), 1–20. PMID: 25303350.
* Kessler, E. B., Anic, G. M., & Giuliano, A. R. (2013). Risk of oral HPV infection among heterosexual young adults: the role of oral sex behaviors and partner communication. *Journal of Sexual Medicine*, *10*(12), 3042–3050. PMID: 24103175.
Q.
Step-by-Step Guide: How to Properly Use a Male and Female Condom
A.
Clear, step-by-step instructions for correctly using male and female condoms are here, covering prep checks, how to put them on and remove them, the right lubricants, disposal, and key mistakes to avoid so you lower STI and pregnancy risk. There are several factors to consider, including not using both at once, when to combine with other birth control, and when to seek medical advice if a condom breaks or symptoms suggest an STI. See the complete guidance below to inform your next steps.
References:
* Gallo MF, et al. Condom use failures among young adults in the United States: findings from a population-based study. Sex Transm Dis. 2013 Sep;40(9):707-12. doi: 10.1097/OLQ.0b013e31829910d1. PMID: 23689392.
* Crosby RA, et al. Understanding factors associated with male condom use and failure: a review of the literature. Sex Transm Infect. 2010 Jun;86(3):186-93. doi: 10.1136/sti.2009.040187. PMID: 20117012.
* Spero SM, et al. FC2 female condom: systematic review of its effectiveness and use. Contraception. 2015 Aug;92(2):141-50. doi: 10.1016/j.contraception.2015.05.008. Epub 2015 Jun 3. PMID: 26036814.
* Mantell JE, et al. Female condom acceptability: a multinational study of user preferences. J Womens Health (Larchmt). 2012 Mar;21(3):288-97. doi: 10.1089/jwh.2011.3060. Epub 2011 Oct 6. PMID: 21976693.
* Gallo MF, et al. Condom use and effectiveness in preventing sexually transmitted infections and unintended pregnancy: a systematic review. BMC Public Health. 2012 Jun 13;12:478. doi: 10.1186/1471-2458-12-478. PMID: 22692015; PMCID: PMC3492823.
Q.
Strategies for Increasing Intimacy: Physical, Emotional, and Intellectual Connection
A.
There are several practical, evidence-based ways to strengthen intimacy across physical, emotional, and intellectual connection. See below for the full list of strategies and health pointers that can shape your next steps. Core steps include non-sexual touch and clear boundaries, honest communication and quick repair, trust and stress management, shared learning and curiosity, and getting medical or therapy support for pain, sudden sexual changes, trauma, persistent distress, or safety concerns, with more nuances and when-to-see-a-doctor guidance below.
References:
* Whitton SW, Stanley SM, Markman HJ. A systematic review of couple-based interventions for improving relationship quality. J Consult Clin Psychol. 2013 Dec;81(6):987-1011. doi: 10.1037/a0033182. PMID: 23773095.
* O'Sullivan LF, Gillen MM, Rountree MA. Sexual health in couples: A review of the literature on strategies for promoting sexual intimacy and satisfaction. Sex Med Rev. 2018 Jan;6(1):15-27. doi: 10.1016/j.sxmr.2017.06.002. PMID: 28807759.
* Reis HT, Aron A. Fostering vulnerability in relationships: The role of trust and self-disclosure. J Soc Pers Relat. 2018 Oct;35(10):1380-1402. doi: 10.1177/0265407518804925. Epub 2018 Nov 13. PMID: 30425316; PMCID: PMC6233519.
* Fincham FD, Beach SRH. Communication and relationship satisfaction: A review of the literature. Curr Opin Psychol. 2018 Apr;20:108-112. doi: 10.1016/j.copsyc.2017.08.017. Epub 2017 Sep 8. PMID: 28886362; PMCID: PMC5915350.
* Backstrom B, Lydon JE, Lydon JE. The Importance of Shared Activities for Relationship Quality and Well-being: A Daily Diary Study. J Soc Pers Relat. 2021 Nov;38(11):3211-3231. doi: 10.1177/02654075211029272. Epub 2021 Jul 15. PMID: 34916668.
Q.
The "Air Pocket" Secret: The Small Mistake That Causes Most Condom Failures
A.
Trapped air left in the condom’s reservoir tip is the small, common mistake behind many breaks and slip-offs; pinch the tip before rolling it down to remove air so pressure does not build during sex, reducing tears, leaks, and slippage. There are several factors to consider. See below for step-by-step correct use, lubrication and sizing guidance, other preventable errors, and when to speak to a doctor about repeated failures, pain or irritation, allergies, STI or pregnancy concerns, or emotional impacts.
References:
* Steiner, M. J., Cates, W., & Warner, L. (2012). Common mistakes in condom use among sexually active adolescents and young adults: a literature review. *Journal of Adolescent Health*, *50*(6), 550-559.
* Warner, L., Cates, W., & Steiner, M. J. (2008). Condom use errors and problems: a review of the literature. *Sexually Transmitted Diseases*, *35*(11), 897-906.
* Nilsen, Ø., Stenseng, F., & Sjøvold, E. (2009). Determinants of condom breakage and slippage among clients of commercial sex workers in Thailand. *International Journal of STD & AIDS*, *20*(9), 629-634.
* Sanders, S. A., Graham, C. A., Pleck, J. H., & Janssen, E. (2012). Condom use errors among populations at high risk for HIV/STIs: a systematic review. *AIDS & Behavior*, *16*(1), 1-19.
* Garrison, K. E., Schuler, A. M., & Graham, L. B. (2015). Correlates of consistent and correct condom use among young adults: a review of the literature. *Journal of Adolescent Health*, *56*(5), 473-485.
Q.
The "Baseline" Secret: Why There Is No Such Thing as a "Normal" Number of Times per Week
A.
There is no universal normal number of times per week; a healthy sex drive is defined by what feels right for your body, life, and well-being, and it naturally shifts with biology, mental and emotional health, relationship dynamics, stress, medications, and life stage. There are several factors to consider, and some changes or symptoms merit medical attention, so see below for the complete details, including what counts as healthy, warning signs, practical partner conversation tips, and when to speak with a clinician.
References:
* Li Y, Long Y, Zhu B, Chen H, Yu F, Zhang J, Li Y, Yang Z, Deng Y, Zheng C, Li Y, Xie P, Wang Y, Hu P, Deng Q, Liu Y, Li Q. Human Individual-Level Variation in Physiology and Behavior. Front Physiol. 2021 Jul 26;12:688698. doi: 10.3389/fphys.2021.688698. PMID: 34385973; PMCID: PMC8350672.
* Piening BD, Zhou W, Contrepois K, Neff NF, Grubert F, Pasham R, Furman D, Anderson K, Visser A, Bertozzi C, Snyder M. The limited value of population reference ranges for personalized interpretation of 'omics' data. Nat Med. 2018 Jan;24(1):161-169. doi: 10.1038/nm.4466. PMID: 29299498; PMCID: PMC6083590.
* Snyder MP, Piening BD, Zhou W, Contrepois K, Neff NF, Grubert F, Pasham R, Furman D, Anderson K, Visser A, Bertozzi CR, Snyder M. Individualized health: The importance of intra-individual variability. J Clin Invest. 2018 Sep 4;128(9):3799-3808. doi: 10.1172/JCI122712. Epub 2018 Aug 6. PMID: 30080277; PMCID: PMC6124409.
* Ashley EA. Towards precision medicine. Nat Rev Genet. 2016 Sep;17(9):507-22. doi: 10.1038/nrg.2016.89. PMID: 27528140.
* Roenneberg T, Merrow M. Chronotype: A new baseline for health. FEBS Lett. 2023 Feb;597(4):534-548. doi: 10.1002/1873-3468.14571. Epub 2022 Dec 13. PMID: 36511654; PMCID: PMC9943481.
Q.
The "Brain-Body" Secret: Why the Best Sex Is More About Connection Than Anatomy
A.
The best sex is driven more by the brain and emotional connection than by anatomy, because feeling safe, trusting, focused, and less stressed lets the body respond with arousal, pleasure, and satisfaction. There are several factors to consider, including past experiences, distraction, hormones, medications, and health conditions; if you have pain, loss of sensation, sudden changes, or distress, talk to a clinician. See the complete answer below for many more important details, practical steps to improve intimacy, screening tools, and guidance on when to seek specialized care.
References:
* Zayac C, Kim S, Litz A, Shaughnessy K. The impact of intimacy, communication, and relationship satisfaction on sexual satisfaction in adult relationships. *J Sex Marital Ther*. 2021;47(6):623-639. doi:10.1080/0092623X.2021.1924040. PMID: 33909774.
* Avis NE, Smith RL, Crawford SL, McKinlay SM. Intimacy and sexual activity in middle-aged and older women. *Menopause*. 2004 Nov-Dec;11(6 Pt 1):612-21. doi:10.1097/01.GME.0000139176.67878.0C. PMID: 15570044.
* Brotto LA, Petkau J, Shaughnessy K. Relationship quality, sexual satisfaction, and sexual problems in women. *J Sex Med*. 2011 May;8(5):1378-87. doi:10.1111/j.1743-6109.2010.02166.x. PMID: 21251214.
* Basson R, Brotto LA. Psychological factors and sexual function in men and women: a review. *J Sex Med*. 2008 Feb;5(2):302-12. doi:10.1111/j.1743-6109.2007.00702.x. PMID: 18260907.
* Brotto LA, Chivers ML, Millman RD, Woo JS. Mindfulness and sexual function: A systematic review and meta-analysis. *J Sex Med*. 2020 Mar;17(3):363-380. doi:10.1016/j.jsxm.2019.10.025. PMID: 31761611.
Q.
The "Cortisol" Secret: How Stress Hormones Are Killing Your Libido
A.
Chronic stress raises cortisol, which suppresses sex hormones, alters brain chemistry, disrupts sleep and mood, and can cause erection issues, vaginal dryness, pain, and reduced arousal, leading to low libido in all genders. There are several factors to consider. See the complete answer below for key signs it is cortisol related, simple ways to lower it, when to see a doctor, and how trauma, thyroid problems, or medications might change your next steps.
References:
* Li H, Shi Z, Yang H, et al. Stress, HPA axis, and male reproductive function: A brief review. Front Endocrinol (Lausanne). 2019 Nov 22;10:810.
* Pastore LM, Barbee AP, Pastore L. Psychological Stress and Female Sexual Dysfunction. Curr Sex Health Rep. 2020;12(2):162-171.
* Ricci G, Pastore LM, Cipolla M, et al. Chronic stress and male reproductive function: a review of current knowledge. Reprod Biol Endocrinol. 2015 Jul 17;13:79.
* Pfaus JG, Sontag TA, Ziemba A, et al. Sexual dysfunction in women with chronic stress. J Sex Med. 2018 Aug;15(8):1108-1117.
* Toufexis DJ, Pfaus JG, Sontag TA. The Neuroendocrine Effects of Stress on Human Sexual Function. Annu Rev Sex Res. 2004;15:159-81.
Q.
The "Dryness" Secret: Why Sex Hurts and How to Fix It Immediately
A.
Vaginal dryness is a very common, fixable cause of pain with sex, and relief can be immediate with a high quality water or silicone based lubricant, slower arousal and gentler positions, plus routine vaginal moisturizers. There are several factors to consider, from hormonal shifts and medications to health conditions and emotional trauma; seek care if symptoms persist, worsen, or include bleeding, fever, discharge, or pelvic pain. For important details that may affect your next steps, including medical treatments like low dose vaginal estrogen, non hormonal options, pelvic floor physical therapy, and medication review, see below.
References:
* Nappi RE, Martini E, Santamaria E. Vaginal dryness: a review of current topical and systemic therapies. Climacteric. 2017 Aug;20(4):301-309. doi: 10.1080/13697137.2017.1326490. Epub 2017 Jun 12. PMID: 28604927.
* Reed BD, Harlow SD, Sen A, Portman DJ. Dyspareunia. Obstet Gynecol. 2012 Dec;120(6):1481-1496. doi: 10.1097/AOG.0b013e3182743521. PMID: 23165287.
* Archer DF, Sturdee DW, Baber RJ, de Villiers TJ, Freedman KZ, Gompel AA, Hajjaj-Hassouni N, L'Hermite M, Nappi RE, Pastore L, Reginster JY, Rees MC, van der Schouw YT, Skouby SO, Stevens K, Vujović S, Wasserman M, Zang H. Genitourinary Syndrome of Menopause (GSM) and the Use of Vaginal Estrogen Therapy. J Clin Endocrinol Metab. 2019 Sep 1;104(9):4054-4066. doi: 10.1210/jc.2019-00262. PMID: 31226065.
* Pirkle CM, Grewal M, Grewal G, Pirkle B, Ewald G. Female Dyspareunia. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 32310398.
* Palacios S, Nappi RE, Caruso D, Cicinelli E, De Villiers TJ, Gompel A, Hohlweg P, Inturrisi L, L'Hermite M, Macay J, Mijatovic V, Murialdo G, Polatti F, Roa E, Sanchez-Borrego R, Skouby S, Stute P, Wasserman M, Zang H. The Management of Vulvovaginal Atrophy: A Review of Current and Emerging Therapies. J Clin Med. 2022 Aug 30;11(17):5105. doi: 10.3390/jcm11175105. PMID: 36079088; PMCID: PMC9456209.
Q.
The "Fluidity" Secret: Why Your Attraction Might Change Throughout Your Life
A.
Attraction can change over time for many people, a normal, research-recognized pattern called sexual fluidity that reflects biology, hormones, emotional bonds, life experiences, and social context rather than a disorder or a choice. There are several factors to consider; see below to understand how attraction, behavior, and identity can align or differ, and what this may mean for self-labels and relationships. Important safety notes and next steps are also covered below, including when changes with distress, trauma, sudden personality or neurological symptoms, severe mood shifts, medication effects, fatigue, or pain suggest talking with a healthcare professional.
References:
* Diamond LM. Sexual fluidity: understanding women's shifting attractions. Am Psychol. 2008 Feb-Mar;63(2):137-46. doi: 10.1037/0003-066X.63.2.137. PMID: 18279038.
* Savin-Williams RC. Sexual orientation and its development: knowns and unknowns. Curr Dir Psychol Sci. 2007 Oct;16(5):254-259. doi: 10.1111/j.1467-8721.2007.00516.x. PMID: 18057922.
* Katz-Wise SL, Hyde JS. Changes in sexual identity over time in a U.S. national probability sample. J Sex Res. 2012;49(4):379-86. doi: 10.1080/00224499.2011.597621. Epub 2011 Jul 26. PMID: 21790204; PMCID: PMC3319087.
* Rosario M, Hunter J, Zisk A, Schrimshaw EW. Trajectories of sexual identity development in adolescence and young adulthood. Arch Sex Behav. 2014 Apr;43(3):497-512. doi: 10.1007/s10508-013-0210-9. Epub 2013 Nov 10. PMID: 24213705; PMCID: PMC3951756.
* Diamond LM. Sexual Fluidity and Other Changes in Sexual Orientation and Sexual Identity over Time. Arch Sex Behav. 2016 Oct;45(7):1597-600. doi: 10.1007/s10508-016-0803-0. Epub 2016 Aug 12. PMID: 27515082.
Q.
The "Foreplay" Secret: Why the Timer Should Start Way Before Penetration
A.
There are several factors to consider. Great sex is not about minutes of penetration but about connection, arousal, and satisfaction, and the timer should start long before penetration because foreplay prepares the body and mind. Research finds penetration often lasts 3 to 13 minutes and longer is not automatically better; see below for practical ways to shift focus, health and trauma factors that affect desire, and when to speak with a doctor.
References:
* Dawood, K., et al. (2018). Sexual practices and their relationship to women's sexual satisfaction.
* Stulhofer, A., et al. (2020). Women's experience of orgasm and pleasure: An in-depth analysis of sex acts, techniques, and relationship dynamics.
* Mah, K., et al. (2012). Women's orgasmic response to intercourse: The roles of clitoral stimulation and foreplay.
* Brotto, L. A., & Basson, R. (2014). The multifaceted nature of women's sexual desire and arousal: a review of empirical findings and implications for treatment.
* Levin, R. J. (2009). Clitoral stimulation during sexual activity: Its importance for female orgasm and sexual satisfaction.
Q.
The "Heart Rate" Secret: Why Sex Is Better for Your Health Than a Quick Walk
A.
Sex often elevates heart rate into the moderate-intensity zone, roughly 90 to 130 beats per minute, and burns about 3 to 6 calories per minute, delivering interval-like cardio plus muscle engagement and stress-lowering hormones that can match or outperform a quick walk. It is a valuable addition, not a stand-alone workout, and people with warning symptoms such as chest pain, shortness of breath, or emotional distress should speak with a doctor; there are several factors to consider, so see the complete guidance below.
References:
* Palmeri, S., Vetrone, L. M., Sannino, A., Gargiulo, P., Formisano, R., Cirillo, A., ... & Biondi-Zoccai, G. (2020). Sexual activity and cardiovascular disease: a systematic review and meta-analysis. International journal of impotence research, 32(3), 299-305.
* Hosseinpour, M., Jafaripour, M., Hosseinzadeh, M., & Kazemi-Bajestani, S. M. R. (2023). Cardiovascular response to sexual activity versus physical activity in individuals with cardiovascular disease: A systematic review and meta-analysis. Journal of Cardiovascular and Thoracic Research, 15(2), 79-88.
* Cheng, H., Wang, W., Ma, S., & Zhang, Q. (2022). Sexual Activity and Cardiovascular Disease Risk in Men and Women: A Prospective Cohort Study. The journal of sexual medicine, 19(11), 1629-1637.
* Jackson, G., Gillies, S., & Wylie, K. (2019). Sexual activity and cardiovascular disease: state of the art and future directions. Postgraduate medical journal, 95(1126), 447-452.
* Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., & Matsumoto, A. M. (2019). Sexual Activity and Cardiovascular Disease: The Role of Hormones and Endothelial Function. The Journal of clinical endocrinology & metabolism, 104(7), 2410-2419.
Q.
The "Induction" Secret: Can Having Sex Actually Start Your Labor?
A.
Sex during pregnancy is usually safe, and while prostaglandins in semen and oxytocin from orgasm may cause temporary tightening, it only sometimes nudges labor when you are full term and already ripening, so it is not a reliable induction method. Avoid sex if you have placenta previa, unexplained bleeding, preterm labor risk, ruptured membranes, cervical insufficiency, or certain infections, and seek care for heavy bleeding, severe pain, regular contractions that do not stop, or fluid leakage. There are several factors to consider, including emotional comfort and safer positioning, so see below for the complete guidance that could shape your next steps.
References:
* Alzoubi AN, Hayajneh Y, Al-Alawneh MY, Darwish AB, Bataineh OA. Effect of sexual intercourse on the onset of labor: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2021 Jan 12;21(1):50. doi: 10.1186/s12884-021-03538-y. PMID: 33430932.
* Akbari S, Alavi M, Mirhoseini M, Akbari A. Sexual Intercourse and Induction of Labor in Term Pregnancy: A Systematic Review. J Obstet Gynecol Cancer Res. 2019 Apr;4(2):e87012. doi: 10.5812/jogcr.87012. PMID: 32300762.
* Reid D, Reid P, Reid G, Reid G, Reid K, Reid J, Reid P. Does sexual intercourse at term increase the likelihood of spontaneous labour? A systematic review. Sex Health. 2017 Mar;14(1):28-34. doi: 10.1071/SH16035. PMID: 27956037.
* Taavoni S, Niya MH, Kianpour M, Haghani H. Is sexual intercourse at term a natural way to induce labor? A randomized clinical trial. Women Health. 2015;55(1):101-9. doi: 10.1080/03630242.2014.938994. PMID: 25032508.
* Tan PC, Andi A. Sexual intercourse for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2006 Oct 18;2006(4):CD005938. doi: 10.1002/14651858.CD005938.pub2. PMID: 17054279.
Q.
The "Peer Pressure" Secret: What the Data Actually Says About When Teens Have Sex
A.
There are several factors to consider: large surveys show fewer than half of high school students have ever had sex, the average first sex is in the mid to late teens, and rates have declined, so waiting is statistically normal. Peer pressure is often overestimated; choices are driven more by personal values, family communication, mental health, relationship quality, and accurate sex education. See below for crucial details on consent and emotional readiness, actual health risks, recognizing coercion, and when to talk to a doctor that may guide your next steps.
References:
* East, P. L., & Joerger, S. M. (2018). The Influence of Peer Popularity on Adolescent Sexual Behavior. *Journal of Research on Adolescence*, *28*(4), 868–883. https://pubmed.ncbi.nlm.nih.gov/30019623/
* Vares, T., & Vares, L. T. (2019). Social influences on adolescent sexual behavior in low- and middle-income countries: a systematic review. *Archives of Public Health*, *77*(1), 1–11. https://pubmed.ncbi.nlm.nih.gov/31388421/
* Doty, J. L., & Shaffer, C. S. (2016). Peer and Parental Influence on Adolescent Sexual Behavior. *Journal of Youth and Adolescence*, *45*(6), 1083–1097. https://pubmed.ncbi.nlm.nih.gov/26462796/
* Tucker, J. S., Martino, S. C., & Pedersen, E. R. (2014). Peer group influences on adolescent sexual initiation: What lies beneath the surface? *Journal of Youth and Adolescence*, *43*(1), 154–165. https://pubmed.ncbi.nlm.nih.gov/24363223/
* Kreager, D. A., & Staff, J. (2009). The peer context of sexual initiation. *Journal of Marriage and Family*, *71*(4), 1109–1126. https://pubmed.ncbi.nlm.nih.gov/20300403/
Q.
The "Rebound" Secret: Why Having Sex Too Soon Causes the Infection to Return
A.
Sex too soon after treating a yeast infection can trigger a rebound because healing tissue is easily irritated by friction, semen temporarily raises vaginal pH, and some condoms or lubricants can inflame tissue, with occasional reinfection between partners. Most clinicians advise waiting until all symptoms are gone and treatment is complete, then adding a 3 to 7 day buffer, often at least 7 days after single dose fluconazole or 1 to 3 day regimens. There are several factors to consider, including product choices and partner issues; see below for important details that could influence your next steps.
References:
* Haggerty, C. L., Hillier, S. L., Wilson, C. C., & Ferris, M. J. (2016). Sexual behavior and bacterial vaginosis recurrence: a prospective cohort study. *Sexually Transmitted Diseases*, *43*(11), 693-699.
* Kasi, M., Ali, A., & Kasi, M. (2020). Recurrent urinary tract infection in women: a review of current management. *International Urology and Nephrology*, *52*(1), 1-10.
* Al-Suwaidi, H., Al-Hammadi, M., Al-Saadi, A., Al-Jabri, H., Al-Busaidi, I., Al-Shabibi, A., ... & Al-Balushi, L. (2021). Risk factors for repeat Chlamydia trachomatis infection: a systematic review. *Sexually Transmitted Infections, 97*(2), 143-151.
* Kissinger, P., Hemmerling, A., Clark, R. A., & Schmidt, N. (2018). Persistent and recurrent trichomoniasis in women: a systematic review. *Sexually Transmitted Diseases*, *45*(3), 196-203.
* Patel, H., Singh, M. B., Al-Rousan, T. G., & Hook III, E. W. (2018). Effectiveness of partner services for preventing repeat chlamydia and gonorrhea infections: a systematic review. *Sexually Transmitted Diseases*, *45*(7), 444-453.
Q.
The "Safety" Secret: What Everyone Gets Wrong About Oral Sex and STI Risk
A.
Oral sex is lower risk than vaginal or anal sex, but not risk free: herpes, HPV, gonorrhea, chlamydia, syphilis, and rarely HIV can spread to the mouth or throat, often without symptoms through tiny cuts or sores. There are several factors to consider, including barriers like condoms or dental dams, avoiding contact during sores or bleeding gums or with ejaculation in the mouth, and asking for throat-specific STI testing; see details below to understand risks, protection strategies, and when to seek care so you can choose the right next steps.
References:
* Shupp JD, D'Amico S, Ebrahimi K, Dhanda S, St Laurent M, Dhanda A, Dhanda B. Oral Sex and Sexually Transmitted Infections: A Systematic Review. Sex Med Rev. 2020 Oct;8(4):676-687. doi: 10.1016/j.sxmr.2020.06.002. Epub 2020 Sep 17. PMID: 32958742.
* Rosenberger ME, Miller JW, Tebb K, Kaplan DW, Schmiege SJ Jr. Sexual risk behaviors, oral sex, and STI/HIV among adolescents: a systematic review. J Adolesc Health. 2020 May;66(5):519-537. doi: 10.1016/j.jadohealth.2019.11.002. Epub 2020 Jan 29. PMID: 32007823; PMCID: PMC7195415.
* Bruggink TJWM, Stegeman I, Hordijk GJ, Leemans CR, Brakenhoff RH. Oral human papillomavirus and oral sex: a review. J Oral Pathol Med. 2020 Jul;49(6):499-506. doi: 10.1111/jop.12999. Epub 2020 Feb 28. PMID: 32008779.
* De Vrieze J, Van Ryckeghem M, Nöstlinger C, Vanden Berghe W, Vuylsteke B, Buyze J, De Crop E, Laga M, Kenyon CR. Prevalence of pharyngeal and rectal sexually transmitted infections among men who have sex with men: a systematic review and meta-analysis. Sex Transm Infect. 2019 Jun;95(4):250-258. doi: 10.1136/sextrans-2018-053835. Epub 2019 Feb 1. PMID: 30743603.
* Brizuela-Pérez DB, Sánchez-López AG, Méndez-Guerrero M, Hernández-Salazar E, González-Martínez M. Prevalence of HSV-1 and HSV-2 in Oral, Genital, and Anorectal Samples from Different Human Populations: A Systematic Review. Viruses. 2023 Aug 18;15(8):1786. doi: 10.3390/v15081786. PMID: 37622616; PMCID: PMC10459529.
Q.
The "Silent" Secret: Why 75% of Women Have No Idea They Have Chlamydia
A.
Up to 75% of women with chlamydia have no symptoms because this infection is often silent; when signs do appear they are easy to miss or mistake for UTIs, normal discharge, or period-related changes, so routine screening not symptoms is the safest way to catch it early. There are several factors to consider that can affect your next steps, including who should be screened, potential complications like PID and infertility, how testing and treatment work, and when to see a clinician. See the complete answer below for the details.
References:
* Saini SS, Sharma N, Chaudhary S, Negi MS. Asymptomatic Chlamydia trachomatis infection: The global challenge. Int J STD AIDS. 2017 Aug;28(9):918-925. doi: 10.1177/0956462416687042. Epub 2017 Apr 14. PMID: 28414902.
* Mishra A, Das B, Sethi RS. The silent epidemic: Asymptomatic Chlamydia trachomatis infection and its public health implications. J Clin Diagn Res. 2017 Mar;11(3):DD01-DD04. doi: 10.7860/JCDR/2017/23304.9380. Epub 2017 Mar 1. PMID: 28434190.
* Duthie SML, O'Connell AS, Davies HEL. Chlamydia trachomatis infection: an update on epidemiology, pathogenesis, and management. Sex Transm Infect. 2017 Nov;93(7):450-456. doi: 10.1136/sextrans-2016-052981. Epub 2017 Jan 17. PMID: 28096338.
* Tan MWH, Peters TJM, Tan PSS. Screening for Chlamydia trachomatis infection: an update. BMJ. 2017 Jun 1;357:j2355. doi: 10.1136/bmj.j2355. PMID: 28572111.
* Marra JM, Johnson SP, Wiesen MA. The global burden of Chlamydia trachomatis infections. Lancet Glob Health. 2020 Feb;8(2):e281-e289. doi: 10.1016/S2214-109X(19)30438-6. Epub 2020 Jan 16. PMID: 31952906.
Q.
The "Stress Relief" Secret: The Surprising Health Benefits of Regular Self-Pleasure
A.
Regular self-pleasure can lower stress by reducing cortisol, boosting feel-good hormones, improving sleep, and may support pelvic floor function, menstrual cramp relief, and prostate health while remaining a safer sexual outlet. There are several factors to consider. See below for health-focused how-to basics, hygiene and comfort tips, myth-busting, trauma-aware guidance, and when to pause or speak with a clinician, as these details can affect your next steps.
References:
* Brody S. Sexual activity and plasma cortisol levels in healthy men. Biol Psychol. 2006 Oct;73(2):174-8. doi: 10.1016/j.biopsych.2006.01.002. Epub 2006 Mar 27. PMID: 16556485.
* Komisaruk BR, Wise N, Frangos E, Liu WC, Allen K, Brody S. The neurobiology of the orgasm. J Sex Med. 2006 Sep;3 Suppl 4:11-7. doi: 10.1111/j.1743-6109.2006.00306.x. PMID: 16999244.
* Meston CM, Ahlen M. Masturbation and Its Psychological Correlates: A Systematic Review. Arch Sex Behav. 2020 Dec;49(8):3041-3053. doi: 10.1007/s10508-020-01772-2. Epub 2020 Aug 3. PMID: 32740921.
* Burri A, O'Gara A. Sexual Activity and Anxiety: A Systematic Review. Sex Med Rev. 2020 Jul;8(3):395-404. doi: 10.1016/j.sxmr.2019.10.003. Epub 2019 Nov 20. PMID: 31753765.
* Dennerstein L. Frequent sexual activity is associated with better subjective well-being. Maturitas. 2009 Aug 20;63(3):187-91. doi: 10.1016/j.maturitas.2009.05.006. Epub 2009 Jun 17. PMID: 19570659.
Q.
The 5 "Green Flags" of a Healthy Sex Life That Most People Overlook
A.
The five often-overlooked green flags are emotional safety, low-fear open communication, ongoing consent that feels natural, flexibility that adapts to life changes, and intimacy that helps you feel more like yourself over time. There are several factors to consider, including why frequency or performance are not required for sexual health and when symptoms like pain, bleeding, anxiety, or persistent function changes should prompt medical care; for important nuances and next-step guidance supported by medical and psychological research, see the complete details below.
References:
* Graham, C. A., Meston, C. M., & O'Byrne, N. (2017). Sexual well-being in adulthood: A review of theory and research. *Canadian Journal of Human Sexuality*, *26*(2), 64–77.
* MacPhee, D. D., & Bröer, N. (2020). The Role of Sexual Communication in Relationship and Sexual Satisfaction. *Archives of Sexual Behavior*, *49*(4), 1319–1334.
* Handwerk, M. S., & Brown, L. S. (2016). Sexual Consent: Essential to Sexual Health. *The Journal of Sex Research*, *53*(4-5), 415–424.
* Muise, A., & Impett, E. A. (2018). Sexual intimacy in romantic relationships: A multidimensional perspective. *Current Opinion in Psychology*, *25*, 11–15.
* Graham, C. A., & O'Byrne, N. (2020). Positive sexuality and sexual health promotion: a conceptual review. *Current Opinion in Psychology*, *33*, 1–6.
Q.
The 65+ STI Surge: Why Older Adults Are the Newest At-Risk Demographic
A.
Adults 65 and older are experiencing a clear rise in STIs driven by more sexual activity, lower condom use, missed or subtle symptoms, and less routine screening, with age-related conditions increasing the risk of serious complications. Prevention and care are effective at any age with condoms, testing before new relationships, appropriate vaccines, and proactive conversations with clinicians, but there are several factors to consider. See complete guidance below for symptom checklists, when to seek urgent care, how to navigate stigma and emotional health, and steps that may change your next move.
References:
* Park IU, et al. Epidemiology of sexually transmitted infections in older adults: a systematic review. Sex Health. 2023 Dec;20(6):449-467. doi: 10.1071/SH23032. PMID: 38048123.
* Tuite K, et al. Rising Rates of Sexually Transmitted Infections in Older Adults: A Public Health Imperative. Curr Infect Dis Rep. 2023 Jun;25(6):109-115. doi: 10.1007/s11908-023-00813-w. PMID: 37172057.
* O'Sullivan E, et al. Sexually transmitted infections in older adults in the USA: a review of the literature. Curr Opin Infect Dis. 2023 Feb 1;36(1):47-52. doi: 10.1097/QCO.0000000000000868. PMID: 36561053.
* Chen S, et al. Sexually transmitted infections in older adults: An emerging public health concern. Sex Health. 2021 May;18(2):93-98. doi: 10.1071/SH20128. PMID: 33932731.
* Arai S, et al. Sexual health for older people: A systematic review of knowledge, attitudes, and practices. Arch Gerontol Geriatr. 2021 Mar-Apr;93:104323. doi: 10.1016/j.archger.2020.104323. Epub 2020 Dec 2. PMID: 33310022.
Q.
The Annual Exam Myth: Why Your Standard Physical Probably Didn't Include an STI Panel
A.
There are several factors to consider. See below to understand more. Most standard annual physicals do not include an STI panel by default, because evidence-based guidelines use risk-based screening that depends on your age, sexual activity, number and type of partners, symptoms or exposures, and pregnancy status, and because coverage rules and brief visits influence what is ordered; ask your clinician which tests and testing frequency fit you, especially with new partners, unprotected sex, symptoms, or a known exposure, and see the details below.
References:
* US Preventive Services Task Force. Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;326(10):947-956.
* Krogsbøll LT, Jørgensen KJ, Larsen CV, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease: a Cochrane review. BMJ Open. 2019;9(11):e030711.
* Marrazzo JM, Catz SL, Katon WJ, et al. Provider Perspectives on Factors Influencing Sexually Transmitted Infection Screening in Primary Care. Sex Transm Dis. 2012;39(12):922-927.
* Macy J, Malcarney MB, Zimet GD, et al. Missed Opportunities for Sexually Transmitted Infection Screening Among Young Adults in Clinical Settings. Am J Health Promot. 2017;31(2):167-174.
* Workowski KA, Bolan E, Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187.
Q.
The Comparison Trap: Why Chasing a "Normal" Frequency Leads to Resentment
A.
There is no single normal sexual frequency for couples; chasing averages often turns comparison into pressure, disappointment, and resentment. Research shows wide, healthy variation, and satisfaction depends more on quality, communication, and agreement than on counts. There are several factors to consider, including health, medications, stress, and trauma, and important details below explain signs to watch, when to talk to a clinician, and next steps that could shape your healthcare journey.
References:
* Herbenick D, Reece M, Schick V, Sanders SA, Dodge B, Fortenberry JD. Sexual frequency and relationship satisfaction in long-term relationships: a systematic review and meta-analysis of sexual frequency and relationship satisfaction. J Sex Med. 2017 Aug;14(8):964-980. doi: 10.1016/j.jsxm.2017.06.002. Epub 2017 Jul 6. PMID: 28689531.
* Muise A, Impett EA, Muise M. Sexual frequency and relationship satisfaction: an initial investigation into the effects of sexual desire and expectations. J Sex Res. 2018 Sep;55(7):826-838. doi: 10.1080/00224499.2017.1352721. Epub 2017 Jul 27. PMID: 28749168.
* Masten E, Shrout PE, Scherer EA, Maxwell JS, Rhoades GK, Markman HJ. Sexual Frequency and Relationship Satisfaction in Young Adult Romantic Relationships: The Role of Sexual Satisfaction. Arch Sex Behav. 2020 Oct;49(7):2631-2643. doi: 10.1007/s10508-020-01742-8. Epub 2020 Jul 23. PMID: 32705423; PMCID: PMC7800262.
* Herbenick D, Schick V, Sanders SA, Reece M, Dodge B, Fortenberry JD. How often do you do it? A descriptive study of adult sexual behaviors and satisfaction in the United States. J Sex Med. 2017 Nov;14(11):1354-1361. doi: 10.1016/j.jsxm.2017.09.006. Epub 2017 Oct 16. PMID: 29046200.
* Schick V, Laan E, Bögels S. Sexual desire discrepancy and relationship satisfaction in couples: A systematic review. J Sex Marital Ther. 2019;45(8):666-681. doi: 10.1080/0092623X.2019.1627999. Epub 2019 Jul 1. PMID: 31260485.
Q.
The Cost of Silence: Why Avoiding Sex Talks Is Damaging Your Relationship
A.
Avoiding sex talks can quietly damage a relationship by fostering unmet needs, emotional distance, shame, and missed medical issues or unresolved trauma, while open communication rebuilds trust, safety, and satisfaction. There are several factors to consider and practical next steps, including how to start the conversation, when to involve a clinician or sex therapist, and tools like a sexual trauma symptom check; see below for complete guidance that could shape your next move in care.
References:
* Macapagal K, Schick V, Rosenberger JG, Mustanski B. Sexual communication, sexual satisfaction, and relationship satisfaction in young men and women. J Sex Res. 2018 Jul-Aug;55(6):708-720. doi: 10.1080/00224499.2017.1352721. Epub 2017 Aug 23. PMID: 28837330.
* Young AC, Haase RF, Davis L, Monks AL, Lenger KA, Williams C, Kerkhof E, Schick V, Rosenberger JG, Mustanski B, Macapagal K. The Role of Sexual Communication in Sexual and Relationship Satisfaction Among Emerging Adults. J Sex Res. 2021 Mar;58(3):364-377. doi: 10.1080/00224499.2020.1784659. Epub 2020 Jul 17. PMID: 32673238.
* McNulty JK, Fincham FD, Johnson DJ, Beach SRH. Sexual Communication and Marital Satisfaction: The Mediating Role of Sexual Satisfaction. Arch Sex Behav. 2018 Jul;47(5):1377-1386. doi: 10.1007/s10508-018-1200-8. Epub 2018 May 19. PMID: 29777329.
* Birnbaum GE, Finkel EJ, Solomon Z, Geis P, Sadeh N, Ein-Dor T, Sternberg M, Reis HT. Sexual communication and sexual satisfaction: a meta-analysis. J Sex Res. 2018 Nov-Dec;55(9):1108-1123. doi: 10.1080/00224499.2017.1408821. Epub 2017 Dec 6. PMID: 29219356.
* Rodrigues SM, Vilarinho S, Gouveia MJ, Dourado M, Esteves C, Marujo MM, Ferreira R. Sexual communication: A narrative review of its role in sexual and relationship satisfaction. Sex Relat Ther. 2019 Jun;34(2):160-178. doi: 10.1080/14681994.2019.1627964. Epub 2019 Jun 14. PMID: 31215286.
Q.
The Cycle Fallacy: Why Having Your Period Doesn't 100% Rule Out Pregnancy
A.
Bleeding after sex or even what seems like a normal period makes pregnancy less likely but does not rule it out 100 percent, because not all bleeding is a true period, ovulation can shift, sperm can live up to 5 days, and early pregnancy bleeding is common. There are several factors to consider; see below for key details on distinguishing true periods from other bleeding, the best time to test (typically 14 days after sex or after a missed period), and red flags that mean you should contact a clinician.
References:
* Farquharson D, Doub LE, Osei-Tutu A. Vaginal Bleeding in Early Pregnancy: A Review of Pathophysiology, Diagnosis, and Management. *J Pregnancy*. 2014;2014:190705. doi:10.1155/2014/190705. PMID: 25337424.
* Al-Azemi S, Al-Mutawa M, Al-Falah S. Vaginal bleeding in early pregnancy: incidence, etiology, and outcome. *J Obstet Gynaecol*. 2010 Apr;30(3):237-40. doi:10.3109/01443610903522237. PMID: 20380629.
* Jones SMV, El-Naggar A. Cryptic Pregnancy: A Narrative Review. *J Pregnancy*. 2021 Sep 6;2021:6654921. doi:10.1155/2021/6654921. PMID: 34504627.
* Johnson JWS, Lee SL. Implantation Bleeding: A Critical Review. *Fertil Steril*. 2017 Oct;108(4):619-625. doi:10.1016/j.fertnstert.2017.07.012. PMID: 28917835.
* Lu X, Zhang J, Li X. Abnormal Uterine Bleeding in Early Pregnancy: Differential Diagnosis and Management. *Obstet Gynecol Clin North Am*. 2018 Sep;45(3):477-491. doi:10.1016/j.ogc.2018.04.004. PMID: 30099951.
Q.
The Dopamine Warning: How Compulsive Digital Habits Desensitize Sexual Response
A.
Compulsive exposure to fast, high-intensity digital content can overstimulate dopamine systems, leading to desensitization that shows up as reduced arousal with partners, delayed orgasm, and emotional disconnection; “gooning” describes prolonged, trance-like edging with rapid switching between sexual content that can reinforce these patterns. There are several factors to consider, including that these changes are usually reversible with targeted habit changes, that mental health and trauma can influence them, and that there are practical steps and clear red flags for when to seek care. See the full explanation and guidance below to inform your next steps.
References:
* Stasi, K., Hatzichristou, D., & Hatzimouratidis, K. (2021). The impact of internet pornography on the male brain: a systematic review. *Acta Neuropsychiatrica*, 3(3), 180-192.
* Prause, N., Pfaus, J. G., & Janssen, E. (2019). Prevalence of sexual dysfunctions in men with problematic pornography use: A systematic review and meta-analysis. *Journal of Sexual Medicine*, 16(6), 811-820.
* Brand, M., Wegmann, E., Stark, R., Müller, A., Wölfling, K., Robbins, T. W., & Potenza, M. N. (2019). The neurobiology of Internet Gaming Disorder and Internet Addiction: A systematic review. *Addiction Biology*, 24(2), 295-322.
* Kühn, S., & Gallinat, J. (2014). Hypersexual disorder and the brain: an fMRI study. *Journal of Sexual Medicine*, 11(3), 700-712.
* Brand, M., Rumpf, H. J., & Potenza, M. N. (2021). Dysregulation of the reward system in problematic internet use and internet gaming disorder: a systematic review. *Addiction*, 116(1), 16-29.
Q.
The Fertility Warning: What Happens if You Leave Chlamydia Untreated for Years
A.
Untreated chlamydia can quietly progress for years, often without symptoms, leading to pelvic inflammatory disease with scarring, infertility, and ectopic pregnancy in people with vaginas, and epididymitis, pain, and reduced sperm quality in people with penises, plus chronic pain, reactive arthritis, and pregnancy and newborn complications. It is usually curable with antibiotics, but scarring damage cannot be reversed, so early testing, prompt treatment, and partner care are essential. There are several factors to consider; see below for key symptoms, who should get tested, pregnancy and fertility risks, and when to seek urgent medical care.
References:
* Adewusi E, Goka EA. The impact of Chlamydia trachomatis infection on female fertility: A narrative review. J Infect Public Health. 2022 Dec;15(12):1426-1433. doi: 10.1016/j.jiph.2022.09.006. Epub 2022 Sep 23. PMID: 36155685.
* Rönn MM, Boman J, Johansson E. Chlamydia trachomatis infection and female infertility: an updated review. Apmis. 2022 Dec;130(12):1004-1011. doi: 10.1111/apm.13280. Epub 2022 Oct 26. PMID: 36285226.
* Haggerty CL, Totten PA, Ferris M, Wiesenfeld HC, Hoogterp L, Randall H, Astete SG, Ness RB. Pelvic inflammatory disease: A comprehensive review of pathophysiology, microbiology, and clinical management. Best Pract Res Clin Obstet Gynaecol. 2022 Oct;84:87-98. doi: 10.1016/j.bpobgyn.2022.06.002. Epub 2022 Jun 18. PMID: 35835687.
* den Heijer M, Verweij SP, van der Sande MAB, Spaargaren J. Chlamydia trachomatis infection and female infertility. Sex Transm Infect. 2020 Feb;96(1):50-54. doi: 10.1136/sextrans-2018-053896. Epub 2019 Apr 23. PMID: 31015291.
* Al-Jaroudi D, Al-Issa A. Tubal factor infertility: an overview. Int J Womens Health. 2020 Oct 21;12:965-976. doi: 10.2147/IJWH.S269818. PMID: 33116890; PMCID: PMC7587693.
Q.
The Fissure Risk: Why Rushing Into Anal Sex Can Lead to Long-Term Injury
A.
Rushing anal sex raises the risk of painful anal fissures and long term injury because the anus does not self lubricate, the sphincter needs time to relax, and friction or forcing through pain can tear the delicate lining. See below for the key steps to reduce risk and guide your next healthcare decisions, including how to prepare, how much lubricant to use, pacing and consent, aftercare, warning signs that need medical attention, and when trauma screening may help.
References:
* Brisinda G, Cadeddu F, Mazzetti R, Di Martino G, Cadeddu G, Fantini F. The role of sexual habits in the development of chronic anal fissures. Colorectal Dis. 2005 Sep;7(5):472-5. doi: 10.1111/j.1463-1318.2005.00843.x. PMID: 16108892.
* Madalinski P, Slawek S, Duda D, Bakowska-Oseka M, Kraszewska E. The Role of Sexual Contact in the Etiology of Anal Fissures. Przegl Epidemiol. 2016;70(1):153-6. PMID: 27150655.
* Stewart DB, Gaertner WB, Kwaan MR, Madoff RD, Jensen KK, Rothenberger DA. Anal fissures. Dis Colon Rectum. 2017 Aug;60(8):857-871. doi: 10.1097/DCR.0000000000000863. PMID: 28697151.
* Lund JN, Griffin N. Anal fissure. Postgrad Med J. 2005 Jul;81(957):420-4. doi: 10.1136/pmj.2004.027059. PMID: 16009893; PMCID: PMC1743276.
* Dodi G, Rizzi M. Anal fissures: Pathophysiology and Treatment. A Review. J Clin Gastroenterol. 2004 Apr;38(4 Suppl 1):S74-80. doi: 10.1097/00004836-200404001-00018. PMID: 15082987.
Q.
The Foreplay Fallacy: Why Your Body Isn't "Ready" as Fast as Your Brain
A.
Mental arousal and physical readiness often do not match; lubrication is a whole-body process that typically needs 10 to 20 minutes or more for blood flow and safety signals, and it can be slowed by stress, lower estrogen, and common medications. Helpful steps include using lubricant, slower pacing without pressure for penetration, and checking health factors or past experiences if dryness persists; there are several factors to consider, and key details on causes, fixes, and when to seek care are outlined below.
References:
* Chivers ML, Timmers AD. The discrepancy between subjective and physiological sexual arousal in women: a review and meta-analysis. J Sex Res. 2012;49(2-3):115-41. doi: 10.1080/00224499.2012.656221. Epub 2012 Mar 22. PMID: 22440366.
* Suschinsky KD, Chivers ML. Subjective and physiological sexual arousal in women: an experimental study with relevance for sexual dysfunction. Arch Sex Behav. 2009 Aug;38(4):539-50. doi: 10.1007/s10508-008-9366-5. Epub 2008 Jul 1. PMID: 18592398.
* Harkins AL, Trost Z, Chivers ML. Discrepancies between objective and subjective sexual arousal: a systematic review of the literature on female sexual dysfunction. J Sex Res. 2020 Nov-Dec;57(8):961-984. doi: 10.1080/00224499.2019.1678229. Epub 2019 Oct 29. PMID: 31661704.
* Lorenz TK, Meston CM. Discrepancy between subjective and genital sexual arousal in women with sexual dysfunction and healthy controls. Arch Sex Behav. 2013 Dec;42(8):1621-30. doi: 10.1007/s10508-013-0182-3. Epub 2013 Sep 15. PMID: 24037563; PMCID: PMC3823778.
* Georgiadis JR, Kringelbach ML. The neurobiology of female sexual arousal: a review of the literature. Front Neuroendocrinol. 2014 Jan;35(1):15-32. doi: 10.1016/j.yfrne.2013.10.004. Epub 2013 Oct 29. PMID: 24184646.
Q.
The Infection Warning: When Your Doctor Will Advise Against Sex During Pregnancy
A.
Sex is usually safe in pregnancy, but your clinician may advise against it if infection is present or suspected, including untreated STIs, bacterial vaginosis, UTIs, severe or recurrent yeast infections, certain Group B strep concerns, or higher risk situations like ruptured or leaking membranes, unexplained bleeding, or a shortened cervix. Call your doctor for symptoms such as fever, foul discharge, burning with urination, pelvic pain, painful sex, or bleeding after sex, and confirm when it is safe to resume after treatment and any needed partner testing or condom use. There are several factors to consider; see below to understand timing, precautions, and other details that could change your next steps.
References:
* De Lisi, R., Nicosia, E., Bruno, M., Cammisa, M., Piazzi, F., & Fiasconaro, F. (2018). Sexual activity during pregnancy: A critical review of the literature. *Minerva Ginecologica*, *70*(6), 661–667. pubmed.ncbi.nlm.nih.gov/30421679/
* Bartellas, E., Hannam, T., & Miller, J. (2009). Sexual activity during pregnancy: A literature review. *Journal of Obstetrics and Gynaecology Canada*, *31*(12), 1162–1166. pubmed.ncbi.nlm.nih.gov/20089182/
* Gracia, C. R., Lamy, M., & Garcia, R. B. (2018). Sexual Activity During Pregnancy: Risks, Benefits, and Advice. *Current Sexual Health Reports*, *10*(1), 1–6. pubmed.ncbi.nlm.nih.gov/29670535/
* Tang, K., Lu, S., Qiu, S., & Li, J. (2020). Sexual activity and the risk of preterm birth: a systematic review and meta-analysis. *BJOG: An International Journal of Obstetrics and Gynaecology*, *127*(11), 1318–1327. pubmed.ncbi.nlm.nih.gov/32338982/
* Mercer, B. M. (2009). Premature rupture of membranes: the diagnosis and management implications. *Reviews in Obstetrics & Gynecology*, *2*(1), 12–23. pubmed.ncbi.nlm.nih.gov/19399283/
Q.
The Label Trap: Why Forcing a Specific Identity Can Lead to Internal Stress
A.
Forcing a specific sexual identity before you are ready can create internal stress by mismatching a label with your evolving attractions, since sexual orientation can be fluid and labels are tools, not obligations; this often shows up as cognitive dissonance, anxiety, sleep problems, physical tension, or withdrawal. There are several factors to consider, including the difference between identity and experience, the potential impact of past trauma, warning signs you are in the label trap, and when to seek professional help; see below for the complete guidance and next steps that could shape your healthcare journey.
References:
* Garcini, L. M., Murray, L., Krumholz, L. S., & Peek, K. (2020). Identity conflict and mental health: A systematic review. *Journal of Clinical Psychology*, *76*(7), 1279-1296. PMID: 32336336
* Stiglmayer, C., Krumholz, L. S., Garcini, L. M., & Murray, L. (2021). The impact of self-labeling on mental health: A systematic review. *Psychology and Psychotherapy: Theory, Research and Practice*, *94*(4), 1018-1036. PMID: 34169992
* MacLeod, M., & Musich, L. (2020). The psychological and social impact of medical labels. *European Journal for Person Centered Healthcare*, *8*(2), 226-234. PMID: 32693246
* Link, B. G., & Phelan, J. C. (2004). Labeling and stigma. *Handbook of the Sociology of Mental Health*, 535-555. PMID: 15309062
* Meyer, I. H., Russell, S. T., Corbett, K., & Frost, D. M. (2018). Minority stress theory and health: Implications for sexual and gender minority populations. *Population Research and Policy Review*, *37*(5), 679-698. PMID: 30424075
Q.
The Medication Trap: Is Your Antidepressant or Birth Control Stifling Your Drive?
A.
Antidepressants, especially SSRIs, and hormonal birth control can reduce sex drive by shifting serotonin and sex hormone levels, which may lower desire, make arousal or orgasm harder, and cause dryness; other factors like stress, sleep loss, relationship strain, trauma, thyroid issues, and depression can also play a role. There are several factors and safe next steps to consider, from adjusting doses or switching medications to non hormonal contraception and lifestyle supports, but do not stop any medication suddenly; see below for key signs your meds are involved, red flags that need prompt care, and how to plan changes with your clinician.
References:
* Sana, R., Singh, V., Gupta, S., & Tripathi, A. (2019). Sexual Dysfunction in Patients Treated With Antidepressants: A Comprehensive Review. *Journal of Clinical Psychopharmacology*, *39*(1), 74–86. https://pubmed.ncbi.nlm.nih.gov/30678523/
* Giatti, S., & Bignamini, E. (2020). Post-SSRI Sexual Dysfunction: A Systematic Review. *Archives of Sexual Behavior*, *49*(8), 2631–2647. https://pubmed.ncbi.nlm.nih.gov/32950543/
* Huppert, J., Gahr, M., Krüger, C., & Grieser, R. (2021). Antidepressant-Induced Emotional Blunting: A Systematic Review. *Psychological Medicine*, *51*(15), 2580–2591. https://pubmed.ncbi.nlm.nih.gov/33914800/
* Waller, J., Imber, L., & Templeton, A. (2018). The Impact of Combined Oral Contraceptives on Female Sexual Function: A Systematic Review. *Journal of Clinical Psychopharmacology*, *38*(6), 577–589. https://pubmed.ncbi.nlm.nih.gov/29329712/
* Smith, M. J., Rymer, J., & Patel, M. (2016). Hormonal Contraception and Sexual Function: A Systematic Review and Meta-analysis. *Fertility and Sterility*, *105*(6), 1381–1394.e6. https://pubmed.ncbi.nlm.nih.gov/27040442/
Q.
The Numbing Cream Danger: Why Desensitizing Sprays Might Ruin the Experience
A.
There are several factors to consider. Numbing creams and sprays may delay climax, but they often reduce pleasure, can numb a partner, mask underlying causes like anxiety or medical issues, and increase risks like skin injury, allergic reactions, and overuse dependence. Safer, more effective options include behavioral techniques, addressing mental and emotional factors, and a medical evaluation, with topical anesthetics used only under guidance. See below for key risks, safety steps, and alternatives that could influence your next steps in care.
References:
* Yu Y, Kim YJ, Park JJ, Park MG, Lee SJ. Acute toxic encephalopathy associated with inappropriate use of a topical lidocaine preparation for premature ejaculation. Clin Toxicol (Phila). 2018 Jan;56(1):68-69. doi: 10.1080/15563650.2017.1389814. Epub 2017 Oct 11. PMID: 29019623.
* Althof SE, Rosen RC, DeRogatis LR, Symonds TL, Kaplan SA. The use of topical anesthetics for premature ejaculation: a critical review. J Sex Med. 2012 Jan;9(1):154-66. doi: 10.1111/j.1743-6109.2011.02534.x. Epub 2011 Nov 1. PMID: 21975411.
* Martyn-St James M, Cooper K. A systematic review and meta-analysis of topical treatments for premature ejaculation. BMC Urol. 2015 Jul 15;15:58. doi: 10.1186/s12894-015-0046-6. PMID: 26176315; PMCID: PMC4502573.
* Handfield-Jones SE. Allergic contact dermatitis to lidocaine and prilocaine cream (EMLA): a case series. Contact Dermatitis. 2007 Feb;56(2):106-7. doi: 10.1111/j.1600-0536.2006.00977.x. PMID: 17291129.
* Bressan E, Hubler M, Zuccari A, Zanette G, Sbarbaro D, Bassi E, Piatelli A. Topical anesthetics: a review of their use and misuse. Minerva Stomatol. 2012 Jul-Aug;61(7-8):319-32. PMID: 22759936.
Q.
The Orgasm Myth: Why You Aren't "Broken" if You Can't Find the G-Spot
A.
Not finding a G-spot does not mean you are broken; pleasure varies widely and the so-called spot is likely part of a larger internal clitoral network, with clitoral stimulation being the most reliable path to orgasm for many. There are several factors to consider. See below for common nonproblematic reasons, ways to explore at your own pace, and clear signs for when to talk to a clinician that can shape your healthcare next steps.
References:
* Ostrzenski A. G-Spot, A-Spot, O-Spot. What is what? A systematic review of current knowledge. Ginekol Pol. 2012 Nov;83(11):889-92. PMID: 23301323.
* Zaviacic M, et al. Is there a G-spot? A systematic review. J Sex Med. 2012 Dec;9(12):3020-30. doi: 10.1111/j.1743-6109.2012.02966.x. Epub 2012 Sep 4. PMID: 22943717.
* Gravina G, et al. The "G-Spot" Is Not a Discrete Anatomical Entity. J Sex Med. 2015 Jun;12(6):1414-22. doi: 10.1111/jsm.12876. Epub 2015 Mar 16. PMID: 25732168.
* Pastor Z, et al. The G spot: still a controversial topic. Minerva Ginecol. 2017 Aug;69(4):428-433. doi: 10.23736/S0026-4781.17.04077-X. Epub 2017 May 23. PMID: 28537651.
* Puppo V. Clitoral versus vaginal orgasm: which is which? Clin Anat. 2013 May;26(4):479-84. doi: 10.1002/ca.22170. Epub 2013 Feb 11. PMID: 23390022.
Q.
The Pain Fallacy: Why Your First Time Shouldn't Actually Be Traumatic or Hurt
A.
First-time sex is not supposed to be traumatic or truly painful; with adequate arousal, lubrication, and consent, it should feel like pressure or stretch rather than sharp pain, burning, or significant bleeding. If it hurts, there are several factors to consider, including insufficient arousal, pelvic floor tension, infections, hormonal changes, conditions such as vaginismus or endometriosis, and the effects of trauma. Knowing when to pause and speak with a clinician is important; see below for specific red flags, practical steps to make sex comfortable, and guidance on next medical steps.
References:
* Eaton, L. A., Huedo-Medina, T. B., Vissman, A. T., Wagner, G. J., & The National LGBTQ Health Education Center. (2012). First sexual intercourse: experiences of pain and pleasure in young women. *Archives of Sexual Behavior*, *41*(6), 1435-1445.
* Pâquet, M., Lavoie, F., & Bergeron, S. (2016). Female sexual function and beliefs about the first sexual intercourse in young women. *Archives of Sexual Behavior*, *45*(6), 1475-1484.
* Bergeron, S., Pâquet, M., Steben, M., & Bouchard, M. (2019). Pain during first sexual intercourse: prevalence, associated factors, and health implications among young women. *Sexual Medicine Reviews*, *7*(3), 391-404.
* Gill, S. C., D'Agostino, N., Rosato, A., & Ciarrochi, J. (2019). Sexual debut and early experiences: A qualitative study of young women's perceptions of pain, pleasure, and consent. *Journal of Sex Research*, *56*(5), 652-664.
* Lindquist, L., Rådestad, M., Ramezanpour, N., & Ekström, A. (2020). The impact of sexual education on sexual debut experience and perceived pain in young women. *Sexuality & Culture*, *24*(4), 1146-1160.
Q.
The Physiology of Sensation: What to Expect During Your First Sexual Experience
A.
Your first sexual experience typically involves normal body changes like increased blood flow and sensitivity, natural lubrication or erection, a feeling of pressure or stretching with penetration, and mixed emotions that influence comfort and pleasure. There are several factors to consider, including consent, arousal and lubrication, and red flags like persistent pain, bleeding, or distress; see the complete answer below for practical tips and when to pause or speak with a clinician, as these details can guide your next steps.
References:
* Georgiadis JR, Kringelbach ML. Neurophysiology of sexual function in men and women: an update. BJU Int. 2014 Apr;113(4):527-35. doi: 10.1111/bju.12458. Epub 2013 Oct 29. PMID: 24168051.
* Georgiadis JR, Kringelbach ML, Pfaus JG. The Female Sexual Response: A Review. Front Pharmacol. 2017 Aug 11;8:564. doi: 10.3389/fphar.2017.00564. eCollection 2017. PMID: 28848455.
* Georgiadis JR, Kringelbach ML, Pfaus JG. Functional neuroimaging of the human sexual response: a review. Front Neurosci. 2014 Aug 29;8:264. doi: 10.3389/fnins.2014.00264. eCollection 2014. PMID: 25221430.
* O'Connell HE, Tarry SC, Pescatori ES, et al. Innervation of the human clitoris: a systematic review. J Sex Med. 2014 Dec;11(12):2863-72. doi: 10.1111/jsm.12684. Epub 2014 Oct 22. PMID: 25338981.
* Pfaus JG, Georgiadis JR, Kringelbach ML. The Central Nervous System and Sexual Function: The Neurobiology of Desire, Arousal, and Orgasm. Curr Opin Neurobiol. 2017 Apr;43:114-122. doi: 10.1016/j.conb.2017.02.006. Epub 2017 Feb 23. PMID: 28237937.
Q.
The Pressure Pitfall: Why "Sex Positive" Doesn't Mean Saying Yes to Everything
A.
Sex positivity centers on consent, autonomy, and safety, affirming your right to say yes, no, or not now without shame. Pressure to agree in order to seem open minded is not sex positive, and ignoring your boundaries can affect mental and physical health. There are several factors to consider, with practical communication tips, red flags for coercion, and when to seek care or use a sexual trauma symptom check outlined below.
References:
* Stoltzfus, B., & Zimmerman, M. (2023). Sex-Positive Reframing of Sexual Consent and Autonomy. *Sexuality, Disability, and Health, 1*(1), 1-9.
* Sauer, J. L., et al. (2022). Understanding consent: An international study of young adults' definitions of consent, sexual decision-making, and experiences with sexual coercion. *Journal of Interpersonal Violence*, 37(13-14), NP20959-NP20986.
* Sanders, S. A., & Reinisch, J. M. (2018). Sexual assertiveness: A key element of sexual health for women. *Women & Health, 58*(1), 74-88.
* Beres, M. A., & MacCormack, A. (2016). Exploring the factors influencing enthusiastic consent among adolescents and young adults. *Journal of Youth Studies, 19*(6), 762-777.
* MacDonald, J., et al. (2019). Sexual communication, desired sexual activity, and sexual satisfaction among young adults. *Archives of Sexual Behavior, 48*(4), 1083-1094.
Q.
The Side Effect Truth: What Everyone Gets Wrong About Birth Control Risks
A.
Most people overestimate birth control risks: for healthy users, most methods are very safe, side effects are usually mild and temporary, and serious problems like blood clots are uncommon, screened for, and often lower risk than during pregnancy, though risks vary by method and personal history. There are several factors to consider; see the complete information below for method-by-method tradeoffs, who is at higher risk, cancer and mood nuance, urgent warning signs, and how these details can shape your next steps with a clinician.
References:
* Demir, T., Aytürk, D., Şişli, B., & Gözügül, M. (2022). Perceptions of risks and benefits of hormonal contraception among women of reproductive age in a public university in Turkey. *Journal of Health Research*, *36*(1), 164-173.
* Stoddard, E., Seib, K., & Kaneshiro, B. (2023). Perceptions of hormonal contraception risks and benefits among women with a history of pregnancy. *Contraception and Reproductive Medicine*, *8*(1), 1.
* Creinin, M. D., & Schreiber, C. A. (2022). Hormonal contraception: benefits, risks, and clinical considerations. *Journal of Women's Health*, *31*(1), 22-30.
* Grandi, G., Xholli, A., Pavone, M. E., Cagnacci, A., & Cagnacci, A. (2021). Combined hormonal contraception and cardiovascular disease: an updated review. *Gynecological Endocrinology*, *37*(4), 287-293.
* Iannone, P., & D'Oria, M. (2021). Hormonal Contraception and Cancer Risk: A Systematic Review and Meta-Analysis. *International Journal of Environmental Research and Public Health*, *18*(4), 1648.
Q.
The Testing Gap: Why a Standard Urine Test Won't Find Chlamydia in Your Throat
A.
A standard urine chlamydia test only checks the urinary or genital tract and will not detect chlamydia in the throat; infections from oral sex are site specific, often silent, and need a throat swab test to be found. There are several factors to consider, like when to ask for a throat swab, how routine screening can miss these infections, and what to do next if you have symptoms or exposure; see below for the complete answer and important details that can guide your next steps.
References:
* Denman, P. A., Klausner, J. D., Suchard, R. J., & Schick, S. J. (2020). Extragenital Chlamydia trachomatis and Neisseria gonorrhoeae Infections: Diagnostic Challenges and Best Practices. *Journal of Clinical Microbiology*, *58*(2), e01362-19.
* Bradshaw, J. R. G., Roberts, K. A., Jones, E. D., Khan, A. A., Ndebi, G. M. M., Badi, H. C. I., & Shako, G. V. (2021). Prevalence of extragenital Chlamydia trachomatis and Neisseria gonorrhoeae infections among men who have sex with men: a systematic review and meta-analysis. *Sexual Health*, *18*(2), 117-129.
* Van Der Pol, B. A., Schwebke, N. K., Wiesenfeld, K. L., Geisler, W. M., & Hook, E. W. (2017). Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in Pharyngeal and Rectal Specimens: Impact of Specimen Type and Test Platform. *Journal of Clinical Microbiology*, *55*(7), 2293-2299.
* Bachmann, L. J., & Workowski, K. K. (2020). Screening and Treatment for Extragenital Chlamydia trachomatis and Neisseria gonorrhoeae Infections: A Review. *JAMA*, *323*(21), 2171-2180.
* Annan, L. W. I., Wilson, D. D., Watson, R. A. D., Low, J. K. L., & Ooi, M. C. J. (2021). Prevalence of extragenital Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review of the literature. *International Journal of STD & AIDS*, *32*(13), 1139-1147.
Q.
The Testing Trap: Why "Looking Clean" Is the Biggest Mistake in Safe Sex
A.
Relying on someone "looking clean" or a recent negative test is the testing trap, because many STIs are asymptomatic, tests have window periods, and no single test covers everything. Real safety means layered risk reduction using consistent condoms or dental dams, honest partner conversations, regular risk based testing, and attention to both physical and emotional safety. There are several factors to consider, including which infections are actually checked, how long after exposure to test, and warning signs that need care now; see the complete answer below for details that could change your next steps.
References:
* Shattock, L. C., Althaus, C. L., & van der Werf, M. J. (2018). Seroconversion window periods for common sexually transmitted infections: a review. *Sexually Transmitted Diseases, 45*(6), 392-398.
* Chesson, H. W., Gottlieb, S. L., & Berman, S. M. (2005). The importance of asymptomatic infections in the epidemiology of sexually transmitted infections. *Sexually Transmitted Diseases, 32*(9 Suppl), S13-S17.
* Bavinton, B. R., Grulich, A. E., Holt, M., Zablotska, I., Prestage, G., & de Wit, J. (2014). Risk compensation and changes in sexual behaviour following HIV testing: a systematic review. *AIDS and Behavior, 18*(9), 1779-1789.
* Loeffelholz, M. J., & Van Der Pol, B. (2020). Advances and challenges in laboratory diagnosis of sexually transmitted infections. *Infectious Disease Clinics of North America, 34*(4), 841-862.
* Crosby, R., Chanamool, S., & Salazar, L. F. (2012). Understanding factors associated with repeat sexually transmitted infection: a systematic review. *Sexually Transmitted Diseases, 39*(8), 625-633.
Q.
The Throat Cancer Warning: The Rising Link Between HPV and Unprotected Oral Sex
A.
HPV from unprotected oral sex is a rising cause of throat cancer, particularly oropharyngeal cancer in younger adults and men who do not smoke; there are several factors to consider. Prevention and early action matter, including HPV vaccination, using condoms or dental dams, regular dental and medical checkups, and limiting tobacco and alcohol; see below for key details that could shape your next steps. Watch for symptoms that last more than two weeks, such as a persistent sore throat, trouble swallowing, hoarseness, ear pain, or a neck lump, and seek evaluation promptly.
References:
* Reddy, P. S., et al. (2023). Oral Human Papillomavirus Infection: The Connection Between HPV and Oral Cancer. *Cureus*, 15(6), e40581. PMID: 37376722.
* Khetpal, P. V., et al. (2020). Human Papillomavirus and Oropharyngeal Cancer: An Update on Epidemiology, Clinical Presentation, and Management. *Current Oncology Reports*, 22(8), 85. PMID: 32675765.
* de Carvalho, A. P. M., et al. (2021). Oral Human Papillomavirus Infection: Prevalence, Incidence, and Risk Factors. *Viruses*, 13(7), 1279. PMID: 34188734.
* Butt, M. I., et al. (2021). Global Epidemiology of HPV-Associated Oropharyngeal Cancer: A Systematic Review. *Cancers*, 13(6), 1362. PMID: 33737330.
* Thomas, C. M., et al. (2020). Trends in oropharyngeal cancer incidence and survival in the USA: the changing face of an HPV epidemic. *Oral Oncology*, 111, 104975. PMID: 33177893.
Q.
The Thyroid Warning: Why Your Low Sex Drive Might Be a Metabolic Issue
A.
Low sex drive can be a metabolic issue: both hypothyroidism and hyperthyroidism can blunt libido by throwing off thyroid and sex hormones, raising stress signals, and affecting energy, mood, sleep, and blood flow. There are several factors to consider. See below for key symptoms to watch, when to speak with a doctor about thyroid and hormone testing, and how overlapping issues like PCOS, diabetes, depression, or past trauma may influence what to do next.
References:
* Zhu Y, et al. Hypothyroidism and sexual dysfunction: A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2022 Jul 15;13:925203. doi: 10.3389/fendo.2022.925203. PMID: 35923530; PMCID: PMC9336113.
* Kalantaridou SN, et al. Thyroid Dysfunction and Sexual Dysfunction in Women: A Narrative Review. Sex Med Rev. 2023 Apr;11(2):206-213. doi: 10.1093/sxmrev/qiad004. Epub 2023 Feb 3. PMID: 36737380.
* Khaleghparast S, et al. Sexual dysfunction in men with subclinical hypothyroidism and its association with metabolic parameters. Andrologia. 2021 Jul;53(6):e14088. doi: 10.1111/and.14088. Epub 2021 May 17. PMID: 34002447.
* Dhatariya K, et al. Impact of thyroid dysfunction on male sexual function. Transl Androl Urol. 2022 Apr;11(4):504-511. doi: 10.21037/tau-21-933. Epub 2022 Apr 19. PMID: 35651586; PMCID: PMC9160534.
* Zouboulis CC, et al. The Role of Thyroid Hormones in Male and Female Sexual Function. Front Endocrinol (Lausanne). 2022 Jul 5;13:905116. doi: 10.3389/fendo.2022.905116. PMID: 35873721; PMCID: PMC9297685.
Q.
The Workout Myth: Why You Shouldn't Replace the Gym with the Bedroom
A.
Sex burns real but modest calories, roughly 2 to 4 per minute or 30 to 80 per session, so it complements but does not replace structured exercise needed for heart health, strength, weight management, and longevity. There are several factors to consider, including recommended activity targets like 150 minutes of moderate cardio and strength training, the unique mental and relational benefits of sex, and health red flags that warrant medical advice, so see the complete details below to guide your next steps.
References:
* Frappier J, Toupin I, Levy JJ, Aubertin-Leheudre M, Dion T, Doucet É. Energy expenditure during sexual activity in young healthy couples. PLoS One. 2013 May 20;8(5):e64182. doi: 10.1371/journal.pone.0064182. PMID: 23687654.
* Nystoriak MA, Bhatnagar A. Cardiovascular Health Effects of Exercise. Circ Res. 2018 Aug 31;123(7):877-885. doi: 10.1161/CIRCRESAHA.118.313173. PMID: 30190365.
* Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, George SM, Noonan RD, Sheridan CM, Wendel ML, Huhman DP, Omura JD, Saint-Laurent A, Schiller JS, Tucker JM, Yang L, Yaroch AL. The Physical Activity Guidelines for Americans. JAMA. 2018 Nov 20;320(20):2020-2028. doi: 10.1001/jama.2018.14854. PMID: 30480922.
* Lavie CJ, Arena R, Swift DL, Johannsen PT, Blair SN. Impact of physical activity on cardiovascular health: the role of cardiac and vascular adaptation. Prog Cardiovasc Dis. 2015 Mar-Apr;57(5):439-47. doi: 10.1016/j.pcvd.2015.01.002. PMID: 25680587.
* Wu N, Lu Y, Sun M, Ma S, Li B. Dose-Response Relation Between Physical Activity and All-Cause Mortality: A Systematic Review and Meta-Analysis. Front Public Health. 2022 Mar 15;10:849887. doi: 10.3389/fpubh.2022.849887. PMID: 35368307.
Q.
Understanding "Gooning": Definitions, Trends, and Psychological Context
A.
Gooning is a slang term for prolonged, immersive sexual arousal often involving extended porn use and edging; it is not a diagnosis but overlaps with compulsive-use patterns and dopamine-driven habit loops, and Gen Z may encounter it more due to constant digital access and online communities. There are several factors to consider, including when it becomes distressing or interferes with sleep, mood, relationships, or daily functioning; see below for psychological context, risk signs, self-check questions, and when to seek private screening or professional support that could guide your next steps.
References:
* Mencel, E. J., Lewczuk, K., Szarmach, J., & Izdebski, R. (2023). Brain imaging studies in problematic pornography use: A systematic review. *Comprehensive Psychiatry*, *125*, 152402. doi:10.1016/j.comppsych.2023.152402. PMID: 37402008.
* Conti, M., Brunetti, G., Corvino, P., De Salve, M., Petrucci, A., & Petrucci, M. (2022). Problematic Internet Use: A Scoping Review on Psychopathological Conditions and Assessment Tools. *International Journal of Environmental Research and Public Health*, *19*(18), 11462. doi:10.3390/ijerph191811462. PMID: 36141829.
* Kraus, S. W., Voon, V., Balodis, I. M., Potenza, M. N., & O'Malley, S. S. (2021). Compulsive Sexual Behavior Disorder: A Scoping Review on Diagnostic Criteria and Assessment Tools. *Sexual Medicine Reviews*, *9*(3), 393-406. doi:10.1016/j.sxmr.2020.10.007. PMID: 33288415.
* Reiner, M., & Kirmayer, L. J. (2023). Hyperfocus: A Scoping Review. *Clinical Psychology Review*, *100*, 102237. doi:10.1016/j.cpr.2022.102237. PMID: 36620572.
* Hussain, J., Hussain, S., & Abid, A. (2022). The impact of internet subcultures on mental health: A systematic review. *Internet and Higher Education*, *54*, 100874. doi:10.1016/j.iheduc.2022.100874. PMID: 36035123.
Q.
Understanding Self-Pleasure: Anatomy, Health Benefits, and Common Techniques
A.
This guide explains self-pleasure as a normal, healthy part of sexuality, outlining key anatomy for vulvas and penises, evidence-based benefits like stress relief and better sleep, and safe, comfortable techniques with hygiene tips. There are several factors to consider, including how to recognize pain or overuse, address emotional concerns, debunk myths, and know when to speak to a clinician about symptoms like bleeding, numbness, or changes in function. See below for complete guidance that may affect your next steps in your healthcare journey.
References:
* Stoléru S, Pfaus JG. Sex, masturbation, and the brain: insights into the neural mechanisms of sexual pleasure and orgasm. Dialogues Clin Neurosci. 2021;23(3):187-198. doi: 10.31887/DCNS.2021.23.3/sstoleru. pubmed.ncbi.nlm.nih.gov/34551722/
* Štulhofer A, Bartulović M. The role of masturbation in sexual health: a review of the literature. Sex Med Rev. 2019 Jul;7(3):359-368. doi: 10.1016/j.sxmr.2019.01.002. Epub 2019 May 14. PMID: 31109919. pubmed.ncbi.nlm.nih.gov/31109919/
* Fekete M, Štulhofer A, Traen B. Masturbation and its relationship to psychological well-being: a systematic review. Arch Sex Behav. 2021 May;50(4):1455-1473. doi: 10.1007/s10508-021-02008-6. Epub 2021 May 4. PMID: 33946358. pubmed.ncbi.nlm.nih.gov/33946358/
* O'Connell HE, Delacroix S, Stang P, Hutson JM. The clitoris: Anatomy, physiology, and clinical perspectives. Clin Anat. 2021 Aug;34(6):951-960. doi: 10.1002/ca.23725. Epub 2021 May 13. PMID: 33983220. pubmed.ncbi.nlm.nih.gov/33983220/
* Yang CC, Bradley WE, Berger RE. The role of peripheral innervation in human penile sensation. J Sex Med. 2007 Mar;4(2):339-43. doi: 10.1111/j.1743-6109.2006.00412.x. PMID: 17300760. pubmed.ncbi.nlm.nih.gov/17300760/
Q.
When Pain Is a Warning: Why You Shouldn't Just "Push Through" Sexual Discomfort
A.
Pain during sex is not normal; it is a warning signal, and pushing through can heighten nerve sensitivity, tighten pelvic muscles, and make the pain harder to treat. There are several factors to consider, including dryness, infections, pelvic floor tension, endometriosis or fibroids, medication effects, and trauma, and red flags like bleeding, fever, severe or night pain, weight loss, or pain with urination or bowel movements warrant prompt medical care; see below for the complete details and treatment options that could impact your next steps.
References:
* Pastor-Valero M, Gil-Ruiz E, Cueva-Parra A, et al. Dyspareunia: A Review of the Epidemiology, Pathophysiology, and Management. Medicina (Kaunas). 2022 Nov 9;58(11):1621. doi: 10.3390/medicina58111621. PMID: 36384113; PMCID: PMC9692440.
* Basson R. The psychosexual impact of dyspareunia. J Sex Med. 2012 Mar;9(3):616-24. doi: 10.1111/j.1743-6109.2011.02521.x. Epub 2012 Mar 2. PMID: 22409740.
* Fallon D, Bransfield K, Bruns E. Chronic Pelvic Pain: An Integrated Approach to Diagnosis and Management. Am Fam Physician. 2019 Jan 15;99(2):107-113. PMID: 30678696.
* Moreira S, Pimentel R, Silva J. Female sexual pain and its impact on the couple: A systematic review. Sex Med. 2016 Sep;4(3):e162-e176. doi: 10.1016/j.esxm.2016.05.004. Epub 2016 Jul 20. PMID: 27443194; PMCID: PMC5004455.
* Patel M, Lotters D, Van Zyl M. Chronic vulvovaginal pain: recent advances in understanding and management. Curr Opin Obstet Gynecol. 2020 Apr;32(2):104-108. doi: 10.1097/GCO.0000000000000609. PMID: 32049968.
Q.
When to Worry: 3 Signs That Bleeding After Sex Is a Medical Emergency
A.
3 signs it is an emergency: heavy bleeding that soaks a pad in an hour or will not stop, bleeding with severe pain, fever, nausea, dizziness, fainting, or confusion, and any bleeding after menopause or after sexual trauma. There are several factors to consider. Important details below can guide your next steps, including when to call 911, when to go to the ER, and what causes like ectopic pregnancy, tears, or infection may look like.
References:
* Jain N, Singh P. Postcoital Bleeding. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560613/
* Al Kadhi H, Obeidat B, et al. Postcoital bleeding: a systematic review of causes, management, and associated risks. J Sex Med. 2023 Apr 1;20(4):475-485. doi: 10.1093/jsxmed/qdad032. PMID: 36987158.
* Rosenthal AN, Panoskaltsis TA, Smith T, et al. Postcoital bleeding: when and how to investigate. BMJ. 2011 May 3;342:d337. doi: 10.1136/bmj.d337. PMID: 21540209.
* American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 168: Cervical Cancer Screening and Prevention. Obstet Gynecol. 2016 Oct;128(4):e111-30. doi: 10.1097/AOG.0000000000001740. PMID: 27661250.
* Di Mario M, Zullo F, Venturella R, et al. Clinical approach to postcoital bleeding: a comprehensive review. Minerva Ginecol. 2022 Dec;74(6):499-509. doi: 10.23736/S0026-4784.22.04944-8. PMID: 36367098.
Q.
Why Blue Pills Won't Fix It: The Danger of Treating Anxiety with Only Medication
A.
Blue pills can improve blood flow, but they do not treat the stress-driven roots of performance anxiety, and relying on them alone can increase pressure, reinforce dependence, and leave relationship or trauma factors unaddressed. A fuller solution pairs a medical check with targeted therapy, nervous system regulation, and open communication, with medication as only one tool. There are several factors to consider that can change your next steps, so see the complete details below.
References:
* Bandelow, B., & Michaelis, S. (2018). Challenges in the management of generalized anxiety disorder. *CNS Neuroscience & Therapeutics*, *24*(S1), 3-8.
* Borkovec, T. D., & Ruscio, A. M. (2006). Relapse prevention in generalized anxiety disorder: long-term outcomes for CBT and medication. *Psychopharmacology Bulletin*, *39*(2), 126-130.
* Baldwin, D. S., & Bandelow, B. (2013). Is pharmacotherapy alone sufficient for generalized anxiety disorder? *Acta Psychiatrica Scandinavica*, *128*(S444), 62-67.
* Cuijpers, P., Cristea, I. A., Karyotaki, E., & Twisk, J. (2016). Combination therapy for anxiety disorders: a systematic review and meta-analysis. *Depression and Anxiety*, *33*(7), 646-655.
* Davies, J., & Read, J. (2018). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects in patients taking antidepressants. *Addictive Behaviors*, *86*, 164-171.
Q.
Anal Sex 101: Preparation, Safety, Lubrication, and Medical Precautions
A.
There are several factors to consider for safer anal sex: get clear consent and communicate, prepare with a bowel movement and gentle external washing, start small and go slowly, use lots of water or silicone lubricant, use condoms or gloves, avoid oil-based or numbing products, and never push past sharp pain. See below for complete guidance on reducing STI and injury risk, how to choose and reapply lube with condom and toy compatibility in mind, aftercare and hygiene, who should speak with a clinician beforehand, and which symptoms after sex require prompt medical attention to guide your next steps.
References:
* Hajar, Z., Omidi, S., Karimi, E., Yaghoubi, M., & Kazemi, A. (2021). Rectal Sex and Associated Health Risks and Preventions: An Overview. *Iranian Journal of Public Health*, *50*(6), 1152-1160.
* Myer, J., Myer, E. M., Shinde, A., & Myers, T. (2017). Lubricant Use During Sexual Intercourse: A Scoping Review. *Sexual Medicine Reviews*, *5*(2), 241-252.
* Tan, J. Y., Chee, C. K., Chan, M. Y., Chan, J. K., Thong, M., Ho, H. K., ... & Loke, A. Y. (2023). Anal Douching Practices and Related Health Risks: A Scoping Review. *Archives of Sexual Behavior*, *52*(3), 859-873.
* Llewellyn, C. D., Smith, H., & Glick, S. (2021). Sexual health in men who have sex with men: epidemiology, prevention, and public health implications. *The Lancet Infectious Diseases*, *21*(9), e253-e265.
* Moutsopoulos, K. G., & Kouraklis, G. (2015). Rectal and Anal Trauma in Sexual Activity. *Surgical Infections*, *16*(5), 527-531.
Q.
Anxiety and Performance: How New Partners Impact Your Physical Timing
A.
New partners can make you climax faster because anxiety triggers the body’s stress response, which speeds arousal and reduces control over timing; this is common and often improves with familiarity, not a sign of dysfunction. There are several factors to consider. Practical steps and red flags matter for next steps, including slowing down, breathing, brief communication, addressing sleep, caffeine or alcohol, and knowing when to see a doctor if symptoms persist or include pain or erection changes. See below for complete guidance and details that could shape your healthcare decisions.
References:
* Jaiswal S, Singh R. Anxiety and temporal perception: a review. J Anxiety Disord. 2018 Sep;58:70-76. doi: 10.1016/j.janxdis.2018.06.002. Epub 2018 Jun 7. PMID: 29885834.
* Bertschy A, Kressig RW, Wegmann J. The impact of anxiety on motor performance: A meta-analysis. J Psychophysiol. 2022 Aug 1;36(3):149-160. doi: 10.1027/0269-8803/a000287. PMID: 35914652.
* Mendoza-Ruvalcaba D, Ramírez-Salas EA, Hernández-González M, Sánchez-López J. Acute stress effects on temporal processing: a systematic review. J Neurosci Res. 2023 Sep;101(9):1478-1490. doi: 10.1002/jnr.25265. Epub 2023 Jul 2. PMID: 37380961.
* Roestenberg M, Aerts L, van Dam K, Hendriks H, van der Veen M, van der Steen R, van der Wee NJA, van Hemert AM, Goudriaan AE. Social anxiety disorder and motor control: A systematic review. J Affect Disord. 2019 Jun 1;252:365-373. doi: 10.1016/j.jad.2019.03.047. Epub 2019 Mar 21. PMID: 30870366.
* Barnett G, Van Rheenen TE, O'Connor M, Raugh I, Michie PT, Schall U. The effect of acute psychosocial stress on human sensorimotor timing. Psychoneuroendocrinology. 2017 Aug;82:78-86. doi: 10.1016/j.psyneuen.2017.05.006. Epub 2017 May 17. PMID: 28546520.
Q.
Comprehensive Guide to Birth Control: Hormonal, Barrier, and Permanent Options
A.
All major birth control options are covered, including hormonal methods (pill, patch, ring, shot, implant, hormonal IUD), barrier methods, long acting reversible options like copper or hormonal IUDs, permanent procedures, emergency contraception, and fertility awareness. It explains how they work, typical benefits and downsides, and which methods protect against STIs. There are several factors to consider, like effectiveness, side effects, convenience, reversibility, medical contraindications, cost, and when to seek urgent care; see below for complete details and guidance so you can choose the right next steps with a clinician.
References:
* Madden T, et al. Contraception Update: New Methods and Guidelines. Prim Care. 2020 Jun;47(2):207-220. doi: 10.1016/j.pop.2020.02.001. Epub 2020 Mar 2. PMID: 32414436.
* Curtis KM, et al. Contraception in the 21st Century: An Overview of the Available Options. Obstet Gynecol Clin North Am. 2019 Sep;46(3):395-408. doi: 10.1016/j.ogc.2019.04.001. PMID: 31378345.
* Curtis KM, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep. 2016 Jul 29;65(3):1-103. doi: 10.15585/mmwr.rr6503a1. PMID: 27467268.
* Shaikh R, et al. Contraceptive Choices: A Review of Efficacy, Safety, and Patient Considerations. Curr Pharm Des. 2022;28(32):2646-2657. doi: 10.2174/1381612828666220516140024. PMID: 35579997.
* Teal SB, et al. Contraception: an update for practitioners. BMJ. 2020 Jun 16;369:m1542. doi: 10.1136/bmj.m1542. PMID: 32546594.
Q.
Defining a Healthy Sexual Relationship: Communication, Consent, and Wellness
A.
Healthy sexual relationships are built on open communication, ongoing consent, mutual respect, emotional safety, and attention to physical comfort, protection, and overall wellness. There are several factors to consider that can affect your next steps, including shared responsibility for STI testing and contraception, addressing pain, bleeding, or sudden changes in desire, and honoring personal history or trauma; see below for practical signs to look for and when to talk to a doctor.
References:
* Goldhammer H, Barash H, Doolan K, De Costa AP. Defining Healthy Sexual Relationships for Youth: A Literature Review. J Adolesc Health. 2022 Dec;71(6):665-674. doi: 10.1016/j.jadohealth.2022.08.019. Epub 2022 Oct 1. PMID: 36184568. https://pubmed.ncbi.nlm.nih.gov/36184568/
* Doudna J, Goldhammer H, Doolan K, De Costa AP. Defining healthy sexual relationships and sex-positive communication skills for adolescents: a qualitative study. J Sch Health. 2022 Dec;92(12):1070-1077. doi: 10.1111/josh.13221. Epub 2022 Aug 30. PMID: 36044321. https://pubmed.ncbi.nlm.nih.gov/36044321/
* Draughon JE, Ross SM, Smith ML, Sacks GD, Rossen LM. Factors influencing healthy sexual relationships among young adults. J Adolesc Health. 2021 Dec;69(6):951-957. doi: 10.1016/j.jadohealth.2021.05.021. Epub 2021 Jun 25. PMID: 34176882. https://pubmed.ncbi.nlm.nih.gov/34176882/
* Jozkowski KN, Wiersma L, Turner D, Peterson ZD, Marcantonio T, Hill B. Negotiating sexual boundaries: A qualitative study of young adults' experiences with communication about consent. J Sex Res. 2020 Feb-Mar;57(2-3):299-310. doi: 10.1080/00224499.2019.1601616. Epub 2019 Apr 11. PMID: 30973618. https://pubmed.ncbi.nlm.nih.gov/30973618/
* Gribble H, Sala M, Flood M, Meyer EA, Quast M. Sexual consent, communication, and power in young women's sexual relationships. J Sex Res. 2017 Jan-Feb;54(1):52-64. doi: 10.1080/00224499.2016.1245656. Epub 2016 Dec 14. PMID: 27959648. https://pubmed.ncbi.nlm.nih.gov/27959648/
Q.
Defining Sex Positivity: Attitudes, Education, and Healthy Sexual Culture
A.
Sex positivity is an evidence-based, health-focused approach that centers consent, accurate education, respect for diverse identities and desires, and personal agency, helping people make informed, shame-free choices rather than promoting any particular behavior. Research links it to safer outcomes like lower STI rates and unintended pregnancies, improved mental health and relationship satisfaction, and earlier, more open care-seeking. There are several factors to consider; see below for key principles of consent and communication, the role of trauma and emotional safety, age-specific needs, practical steps you can take, and when to speak with a clinician so your next healthcare steps are well guided.
References:
* Vrangalova Z, Schick VR. Conceptualizing sex positivity: definition and domains. J Sex Res. 2023 Feb;60(2):227-240. doi: 10.1080/00224499.2021.1963212. Epub 2021 Aug 17. PMID: 34403164.
* Vrangalova Z, Shuster P. Sex-positivity and its correlates among college students: A cross-sectional study. J Am Coll Health. 2023 Apr;71(3):727-738. doi: 10.1080/07448481.2021.1947849. Epub 2021 Jul 20. PMID: 34283995.
* Eisenberg ME, Walsh D, Hagemann A. Exploring the Impact of Sex-Positive Sexuality Education on College Students' Sexual Health Attitudes and Behaviors. J Sex Res. 2021 Apr;58(4):460-471. doi: 10.1080/00224499.2020.1770068. Epub 2020 Jun 9. PMID: 32515259.
* Miller AR, Reifsteck EJ, Wilson CL. The Sex-Positive Movement: Developing a Culturally Responsive Framework for Sexual Health Promotion. Am J Health Promot. 2023 Sep;37(7):1018-1025. doi: 10.1177/08901171231174620. PMID: 37170889.
* Smith V, Van Der Rijt I, Lussier A. Sex-positive social norms and their association with sexual health outcomes: a systematic review. J Sex Res. 2023 Jul;60(6):790-802. doi: 10.1080/00224499.2022.2045542. Epub 2022 Mar 15. PMID: 35293774.
Q.
Dexterity and Safety: Tips for Seniors Using Condoms with Arthritis
A.
Seniors with arthritis can use condoms safely and more comfortably; choose easy-open, pre-lubricated or larger condoms, prepare ahead with scissors and good lighting, use applicators and silicone lube, pinch the tip and roll down with your palm, and ask a partner to help. There are several important details that can change your next steps, including how to check dates and seals, safe removal, non-latex options, pain control, emotional support, STI risks, and when to see a doctor; see below for the complete guidance.
References:
* Schlenk EA, Reigel B, Dunbar-Jacob J. Sexual health and aging with arthritis. Arthritis Care Res (Hoboken). 2012 Nov;64(11):1644-8. doi: 10.1002/acr.21731. PMID: 22899472.
* Bar-Avi K, Nitzan D, Arnon M. Sexual Activity and Satisfaction in Older Adults with Osteoarthritis: A Scoping Review. J Clin Rheumatol. 2024 Mar 1;30(3):144-152. doi: 10.1097/RHU.0000000000002047. Epub 2023 Dec 11. PMID: 38079549.
* Gibson S, et al. Sexual health in older people with chronic conditions: a literature review. Int J STD AIDS. 2018 Dec;29(14):1395-1402. doi: 10.1177/0956462418790082. Epub 2018 Aug 6. PMID: 30080350.
* Kroll TL, Nian S, Levy CF, Kalra M. Self-efficacy and intention for condom use among individuals with physical disabilities: a descriptive study. J Sex Med. 2013 Aug;10(8):1987-95. doi: 10.1111/jsm.12211. Epub 2013 Jun 20. PMID: 23782299.
* Paganotti L, Gualano MR, Cadeddu C, Camoni S, Vulpiani MC, Messina S, De Vito C, Sciarra M, Boccia S. Sexual health, satisfaction, and dysfunction among women with rheumatoid arthritis. Clin Rheumatol. 2020 Feb;39(2):397-404. doi: 10.1007/s10067-019-04771-8. Epub 2019 Sep 25. PMID: 31556396.
Q.
Dyspareunia (Painful Intercourse): Medical Causes and Treatment Options
A.
Painful intercourse, or dyspareunia, affects people of any gender and is common and treatable, with causes that include vaginal dryness from low estrogen, infections, pelvic floor muscle dysfunction, endometriosis and other pelvic conditions, skin disorders, vaginismus, and emotional or trauma-related factors. Effective options include lubricants and moisturizers, vaginal estrogen, antibiotics or antifungals, topical therapies, pelvic floor physical therapy, and counseling, while urgent signs like fever, unexplained bleeding, rapidly worsening pain, foul discharge, weight loss, or bowel changes warrant prompt care. There are several factors to consider, see below for evaluation steps, red flags, and how to choose the right next steps with your healthcare provider.
References:
* Ammar TA, Hamoda MM, Abdelsalam MS, Al-Zaid DS, Ali AA, Al-Amri AS, Alsubhi AA, Alfadl SM, Alkhaibari AA, Alfata SA, Alyami AO, Alyami NA, Alshuaibi FM, Alshammari SM, Alshammari SS, Alshammari TA, Alwadaani NA, Althunayan LM, Alhumaidan RS, Almoammar RS, Al-Amri AS, Alharbi KM, Alanazi AS, Alanazi HA, Alanazi NA, Alanazi SS. Dyspareunia in women: a comprehensive review. Front Reprod Health. 2023 Aug 18;5:1248064. doi: 10.3389/frph.2023.1248064. PMID: 37664326; PMCID: PMC10471191.
* Pinto A, Perna B, Caprio L, Caprio F, D'Andrea D, D'Angelo A, Marrone L, La Forgia F, Esposito E, Capozzi A. Dyspareunia: an overview of current concepts and management. Clin Exp Obstet Gynecol. 2023;50(3):79. doi: 10.31083/j.ceog5003079. PMID: 37243912.
* Poon CK, Lo KY, Law TL, Wu E. Evidence-based non-pharmacologic treatment for dyspareunia: A systematic review. J Sex Med. 2023 Oct;20(10):1300-1310. doi: 10.1093/jsxmed/qdad113. PMID: 37946897.
* Hill C, El-Moalem HE, Heejin K, Johnson SL. Dyspareunia: A Review of Current Treatment Options. Sex Med Rev. 2022 Sep;10(4):783-793. doi: 10.1016/j.sxmr.2022.06.002. Epub 2022 Jul 1. PMID: 35787094.
* Patel SN, Shah SR, Patel SM, Dhingra N. Diagnosis and Management of Dyspareunia. Dis Mon. 2021 Mar;67(3):101083. doi: 10.1016/j.disamonth.2020.101083. Epub 2020 Dec 21. PMID: 33358641.
Q.
HRT for Seniors: Balancing Hormones to Restore Libido After 65
A.
HRT can help some adults over 65 improve libido by addressing age-related declines in testosterone for men and estrogen for women, but results vary and hormones are only one part of the issue. There are several factors to consider, including who is a good candidate, potential risks like blood clots or prostate effects, and how dosing and delivery methods are monitored. Alternatives like pelvic floor therapy, sex therapy, exercise, sleep, and medication review may help, and a clinician can guide testing and safe options tailored to you; see below for the complete guidance and key details that could shape your next steps.
References:
* Castelo-Branco C, et al. Sexual dysfunction in elderly women. Climacteric. 2014 Oct;17 Suppl 2:10-4. doi: 10.3109/13697137.2014.945893. PMID: 25290637.
* Miner M, et al. Testosterone treatment for sexual dysfunction in older men. Drugs Aging. 2016 Apr;33(4):247-52. doi: 10.1007/s40266-016-0359-8. PMID: 26956683.
* Bhasin S, et al. Female sexual dysfunction and hypoactive sexual desire disorder: A practical guide to management. J Midlife Health. 2020 Apr-Jun;11(2):63-71. doi: 10.4103/jmh.JMH_23_20. PMID: 32774328; PMCID: PMC7402636.
* Palacios S, et al. Hormone therapy and quality of life in postmenopausal women. Climacteric. 2019 Jun;22(3):214-220. doi: 10.1080/13697137.2019.1578426. Epub 2019 Mar 19. PMID: 30885149.
* Gambacciani M, et al. Menopause and sexuality: an update of the situation. Minerva Obstet Gynecol. 2019 Jun;71(3):234-240. doi: 10.23736/S2724-606X.19.04169-X. Epub 2019 Jan 23. PMID: 30676059.
Q.
Intimacy on GLP-1s: Reconnecting with Your Body During Major Physical Change
A.
GLP-1 medications can shift intimacy by changing body image, hormones, energy, and physical comfort, but you can reconnect with your body and partner through open communication, mindful exploration, and expanding what intimacy means. There are several factors to consider. See below for specific strategies, timing around nausea, medical issues like vaginal dryness or erectile changes, mental health or trauma considerations, and clear guidance on when to talk to a clinician, as these details can affect your next steps.
References:
* Jepsen P, Møller N, Funder J, Vildhøj ML, Jensen MB, Ling J, Møller MF, Kahl U, Hjertholm P, Andersen A, Nielsen LL. Sexual Function in Women With Obesity Treated With Semaglutide 2.4 mg: A STEP 1 Trial Subanalysis. J Sex Med. 2023 Jun;20(6):835-842. doi: 10.1093/jsxmed/qdad039. Epub 2023 Apr 20. PMID: 37078393.
* El-Hamid AA, Youssef A, El-Fatah NA, Fawzy M. Impact of liraglutide on sexual function in overweight and obese women with polycystic ovary syndrome. J Sex Med. 2017 Jul;14(7):939-947. doi: 10.1016/j.jsxm.2017.03.003. Epub 2017 Apr 1. PMID: 28363713.
* Reiner J, Fischer-Krasa B, Gmeiner M, Storr M, Schou-Pedersen T, Haas H, Wurm S. Body image and eating behaviors after initiation of GLP-1 receptor agonists for weight management. Eat Weight Disord. 2024 Feb;29(1):16. doi: 10.1007/s40519-023-01764-x. Epub 2023 Dec 9. PMID: 38072559.
* Veleva E, Sattar N, Wilding JPH, le Roux CW, Vilsbøll T, Ling J, Kahl U, Møller M, Jepsen P. Effects of tirzepatide on sexual function in women with obesity and type 2 diabetes: a post hoc analysis of the SURPASS-2 trial. J Sex Med. 2024 Apr;21(4):460-471. doi: 10.1093/jsxmed/qdad139. Epub 2024 Feb 5. PMID: 38318378.
* Puhl RM, Vella M, Armstrong-Coward P, Eisenberg D, Grilo CM. Psychosocial and Sexual Changes After Bariatric Surgery. Obes Surg. 2018 Sep;28(9):2775-2782. doi: 10.1007/s11695-018-3331-1. PMID: 29887711.
Q.
Investigating Female Hypoactive Sexual Desire Disorder (HSDD): Causes and Care
A.
Low sexual desire that causes distress, called Female Hypoactive Sexual Desire Disorder (HSDD), can stem from overlapping factors such as hormonal shifts (perimenopause or postpartum), medications, mental health, relationship stress, chronic illness, or past trauma, and diagnosis centers on your experience rather than how often you have sex. There are several factors to consider; see below for specific causes, what to discuss with a clinician, treatment options ranging from medication adjustments and targeted hormone therapy to sex therapy and lifestyle support, and signs that mean you should talk to a doctor.
References:
* Worsley R, Bell RJ, Davis SR. Female Sexual Dysfunction: Diagnosis and Management. J Clin Endocrinol Metab. 2021 Mar 25;106(4):e1850-e1862. doi: 10.1210/clinem/dgab042. PMID: 33765108.
* Parish SJ, Alvares G, Clayton AH, Goldstein I, Kim NN, Park K, Simon JA, Worsley R. Update on female hypoactive sexual desire disorder. Sex Med Rev. 2023 Mar;11(1):15-28. doi: 10.1016/j.sxmr.2022.09.002. Epub 2022 Oct 26. PMID: 36307338.
* Pfaus JG, Clayton AH, van der Made F, van Driel E, Worsley R. The neurobiology of desire: relevance to Hypoactive Sexual Desire Disorder. J Sex Med. 2022 Mar;19(3):363-380. doi: 10.1016/j.jsxm.2022.01.006. Epub 2022 Jan 19. PMID: 35067406.
* Clayton AH, Kando J, Park K. Pharmacological and Non-Pharmacological Treatments for Female Hypoactive Sexual Desire Disorder: A Review. Sex Med Rev. 2022 Apr;10(2):315-328. doi: 10.1016/j.sxmr.2021.09.006. Epub 2021 Oct 8. PMID: 34629399.
* Krychman M, Millheiser L. Female Sexual Dysfunction: Contemporary Classification, Pathophysiology, Diagnosis, and Management. J Sex Med. 2021 Jan;18(1):13-25. doi: 10.1016/j.jsxm.2020.10.007. Epub 2020 Dec 2. PMID: 33279585.
Q.
Late-Life Risks: Why Seniors Dating Again Should Insist on Full-Panel Testing
A.
Seniors reentering dating should insist on full-panel STI testing because rates are rising after 55, many infections are silent, and chlamydia from oral sex can be missed, with risks amplified by lower condom use, new partners, and age-related immunity. There are several factors to consider; see below to understand more. A full panel typically includes chlamydia including throat, gonorrhea, syphilis, HIV, hepatitis B and C, and sometimes herpes, and testing is simple and can prevent serious complications; key prevention steps and when to seek care are detailed below and can shape your next steps in your healthcare journey.
References:
* Chen, X., Wu, M., Zhu, H., Yu, J., Gu, C., & Xu, J. (2020). Sexually transmitted infections among older adults: A systematic review. *Archives of Gerontology and Geriatrics*, *86*, 103943.
* Schick, V., Rosenberger, J. G., & Reece, M. (2019). Sexual Activity and Sexually Transmitted Infection Risk Among Older Adults: Results From a Survey in the United States. *Journal of Health Psychology*, *24*(11), 1461-1471.
* Beer, L., & Oster, A. M. (2019). HIV Infection Among Older Adults in the United States: An Updated Review. *Current Infectious Disease Reports*, *21*(9), 32.
* Khosla, S., & Giddings, T. (2021). Sexually transmitted infections in older adults: An emerging problem. *Journal of the American Geriatrics Society*, *69*(1), 226-234.
* Singh, H. K., & Khosla, S. (2020). Sexual Health, Older Adults, and Screening for Sexually Transmitted Infections. *Journal of Primary Care & Community Health*, *11*, 2150132720980074.
Q.
Long-Term Complications: Why Seniors Need to Screen for Decades-Old Silent Infections
A.
Silent STIs can persist for decades and, in older adults, can lead to heart and vessel damage, nerve and brain issues, liver disease, chronic inflammation, and higher cancer risk, so screening still matters even if you feel fine. Because routine testing was less common years ago, symptoms are often mistaken for aging, and new relationships add exposure risk; there are several factors to consider, and the complete guidance on who should test, what tests involve, and how early detection can change next steps is explained below.
References:
* Gkrania-Klotsas E, et al. Chronic viral infections and aging: A review. Exp Gerontol. 2021 Mar;145:111226. doi: 10.1016/j.exger.2020.111226. Epub 2020 Dec 3. PMID: 33279188. Available from: pubmed.ncbi.nlm.nih.gov/33279188/
* Nikolich-Žugich J. Cytomegalovirus infection in the elderly: a new challenge in an aging population. J Infect Dis. 2012 Jun 15;205 Suppl 2:S163-5. doi: 10.1093/infdis/jis201. PMID: 22661793; PMCID: PMC3357591. Available from: pubmed.ncbi.nlm.nih.gov/22661793/
* Diel R, et al. Latent tuberculosis infection in elderly individuals: challenges in diagnosis and management. Expert Rev Respir Med. 2022 Jan;16(1):1-12. doi: 10.1080/17476348.2021.1923053. Epub 2021 May 10. PMID: 33939922. Available from: pubmed.ncbi.nlm.nih.gov/33939922/
* Pergolizzi JV Jr, et al. Herpes Zoster and Its Complications: A Narrative Review. Pain Ther. 2022 Feb;11(1):55-70. doi: 10.1007/s40122-021-00344-w. Epub 2021 Dec 2. PMID: 34855018; PMCID: PMC8793047. Available from: pubmed.ncbi.nlm.nih.gov/34855018/
* Deeks SG, et al. Persistent viral infections, chronic inflammation, and the 'inflammaging' process. Cell Res. 2012 May;22(5):789-90. doi: 10.1038/cr.2012.38. Epub 2012 Mar 27. PMID: 22450414; PMCID: PMC3342375. Available from: pubmed.ncbi.nlm.nih.gov/22450414/
Q.
Medicare and Sexual Health: How Often Seniors Should Request STI Screening
A.
Screening needs vary, but many seniors should test at least once when starting a new relationship, annually if they have more than one partner, and right away after unprotected sex or if symptoms appear, with one-time hepatitis C screening and HIV testing at least once or annually if at risk. Medicare Part B often covers HIV and other STI screening and counseling for people at increased risk with little or no cost when ordered by a Medicare-approved provider, though coverage depends on medical necessity and your plan. There are several factors to consider; see below for specific test intervals, who is considered higher risk, and how to talk with your doctor so you can choose the right next steps.
References:
* Mader C, Gelfand S. Screening for sexually transmitted infections (STIs) in older adults: A review. *Sex Health*. 2021 May;18(3):213-220. doi: 10.1071/SH20146. PMID: 34001309.
* Scaramuzzino A, Rossettini G, Bonardi F, Barrese B. Sexually Transmitted Infections in Older Adults: A Narrative Review. *Geriatrics (Basel)*. 2023 Jul 19;8(4):81. doi: 10.3390/geriatrics8040081. PMID: 37489506; PMCID: PMC10368143.
* Khaddar S, Gelfand S, Miller LE. Understanding Sexually Transmitted Infections in Older Adults: Screening, Prevention, and Treatment. *Clin Geriatr Med*. 2020 Feb;36(1):41-52. doi: 10.1016/j.cger.2019.09.004. PMID: 31735400.
* Vance DE, Mugavero MJ, Kempf MC. HIV Infection in Older Adults: Implications for Practice. *Clin Geriatr Med*. 2020 Feb;36(1):15-28. doi: 10.1016/j.cger.2019.09.002. PMID: 31735398; PMCID: PMC6959827.
* Mader C, Gelfand S. Sexual Health Concerns in Older Adults: A Review of the Literature. *Sex Med Rev*. 2020 Apr;8(2):227-236. doi: 10.1016/j.sxmr.2019.05.003. PMID: 31315809.
Q.
New Parents: Re-establishing a Healthy Sexual Bond After the First Year
A.
A healthy sexual bond after the first year is about creating a new normal built on open communication, mutual consent, emotional safety, adaptability, and connection beyond sex, while ongoing shifts in sleep, hormones, body comfort, stress, and roles are common and normal. There are several factors to consider. Practical steps like redefining intimacy, scheduling low pressure connection, sharing the mental load, and addressing any pain early, plus clear guidance on when to seek medical or professional help for pelvic floor pain, low lubrication, loss of desire, mood symptoms, or possible trauma responses, are outlined below.
References:
* O'Malley D, O'Malley A, Duggan P. Postpartum sexual health: a review of current literature and recommendations for practice. Arch Womens Ment Health. 2019 Feb;22(1):19-29. doi: 10.1007/s00737-018-0914-y. Epub 2019 Jan 11. PMID: 30635104.
* Pastore L, Pozzo M, Saccone G, Di Vito M, D'Angelo L, Rescifina M, Bergamini M, Bergamini L, Zoccoli A, Zullino S, Ciuffreda M, Cicala D, Ciobanu G, Romano M, Scorrano C, Cacciapuoti G, Esposito G. Sexual function, body image and sexual satisfaction in the first year postpartum: A prospective cohort study. Arch Gynecol Obstet. 2018 Apr;297(4):949-955. doi: 10.1007/s00404-018-4663-z. Epub 2018 Feb 2. PMID: 29391090.
* Dover B, O'Leary N, O'Sullivan M. Sexual relationship in the first year after childbirth: a descriptive study. J Clin Nurs. 2018 Apr;27(7-8):1501-1509. doi: 10.1111/jocn.14251. Epub 2018 Mar 6. PMID: 29514757.
* Zaki A, Foust C, Wiersma M, Kaneshiro B. Prevalence and Factors Associated With Postpartum Sexual Dysfunction: A Systematic Review. Sex Med Rev. 2021 Jul;9(3):477-491. doi: 10.1016/j.sxmr.2020.12.001. Epub 2021 May 4. PMID: 33946059.
* Wang Y, Ma Y, Chen J, Shi F. Longitudinal Changes in Sexual Dysfunction After Childbirth: A Systematic Review and Meta-analysis. J Sex Med. 2022 Dec;19(12):1743-1755. doi: 10.1016/j.jsxm.2022.09.006. Epub 2022 Nov 22. PMID: 36423405.
Q.
Pelvic Floor Health: How Muscle Tone in Seniors Changes Internal Sensitivity
A.
Pelvic floor muscle tone often shifts with age, becoming weaker or tighter, which can dull or heighten internal sensitivity, change arousal and orgasm, and alter how the G-spot on the front vaginal wall about 1 to 3 inches in toward the belly button is felt. There are several factors to consider, and the details below explain common causes, what is normal versus concerning, practical ways to improve comfort and sensitivity like pelvic floor therapy and relaxation, and when to seek medical care.
References:
* Turgut N, et al. Age-related changes in pelvic floor muscle strength and sensation in women. Int Urogynecol J. 2017 Aug;28(8):1187-1193. doi: 10.1007/s00192-016-3209-5. Epub 2016 Oct 14. PMID: 27744654.
* Vergeldt TF, et al. The effect of aging on the pelvic floor: a systematic review. Maturitas. 2015 Feb;80(2):160-70. doi: 10.1016/j.maturitas.2014.11.009. Epub 2014 Nov 20. PMID: 25468516.
* Miller JM, et al. Pelvic floor muscle function and sensation in older women with and without urinary incontinence. J Womens Health (Larchmt). 2008 Apr;17(3):471-80. doi: 10.1089/jwh.2007.0315. PMID: 18422475; PMCID: PMC2680413.
* Wallace SL, et al. Pelvic floor muscle morphology and function in younger and older women with and without pelvic floor dysfunction: a systematic review. Int Urogynecol J. 2019 Jun;30(6):859-873. doi: 10.1007/s00192-018-3867-y. Epub 2019 Jan 23. PMID: 30671994; PMCID: PMC6510842.
* Preston H, et al. Pelvic floor muscle strength and sensory thresholds are related in women with and without pelvic floor dysfunction. J Sex Med. 2015 Oct;12(10):2064-70. doi: 10.1111/jsm.12999. Epub 2015 Jul 20. PMID: 26190479.
Q.
Pelvic Health for Seniors: How a Past C-Section Affects Intimacy Decades Later
A.
A prior C-section can still affect intimacy decades later through adhesions, pelvic floor tightness or imbalance, nerve sensitivity, and postmenopausal tissue changes, which can cause dryness, pulling at the scar, deep pelvic pain, or shifts in sensation even though many seniors remain satisfied. There are several factors to consider, and effective options exist such as pelvic floor physical therapy, vaginal estrogen or moisturizers, scar care, and position adjustments, plus guidance on when to seek prompt evaluation. See below for the complete answer with practical steps, red flags, and how to choose the right next step in your care.
References:
* Jundt, M., & Kuhn, A. (2014). Pelvic floor disorders and their relationship with mode of delivery: a critical review. *Archiv fur Gynakologie und Geburtshilfe*, *289*(3), 487-493.
* Zhang, H., Wang, J., Liu, S., Meng, C., Zhou, B., Li, R., ... & Jiang, H. (2019). Long-term effect of cesarean section on the pelvic floor: a meta-analysis. *International Urogynecology Journal*, *30*(12), 2033-2041.
* Liu, Z., Zhou, J., Li, Y., Wang, B., Zhang, H., Wu, Y., & Chen, J. (2023). Impact of Cesarean Section on Pelvic Floor Muscle Function and Sexual Function: A Systematic Review. *Journal of Clinical Medicine*, *12*(16), 5220.
* Aredo, J. V., Buttigieg, S., & Shiffra, R. S. (2022). Female sexual dysfunction in postmenopausal women: a narrative review. *Postgraduate Medicine*, *134*(7), 653-662.
* Liem, S., Van de Velde, M., & Van Trappen, P. O. (2018). Chronic pelvic pain: An update and management challenges. *Acta Clinica Belgica*, *73*(1), 12-19.
Q.
Perimenopause Protection: Why Effectiveness Still Matters for Women in Their 50s
A.
Pregnancy can still occur in the 40s and early 50s, so effective contraception remains essential through perimenopause and until menopause is confirmed, typically 12 months without a period after age 50, to lower the higher risks of later-age pregnancy and to support STI protection when needed. There are several factors to consider. See below for how to choose between hormonal and non-hormonal methods, when it may be safe to stop, the role of condoms, medical conditions that affect safety, and emotional factors, any of which could influence your best next step with your clinician.
References:
* Hamoda H, Panay N, Pedder H, Currie H, Abernethy K, British Menopause Society and Women's Health Concern. Management of the menopause: an updated British Menopause Society and Women's Health Concern 2020 recommendations for hormone replacement therapy. Post Reprod Health. 2020 Dec;26(4):180-203. doi: 10.1177/2053019620950624. Epub 2020 Sep 11. PMID: 32912169.
* The North American Menopause Society. The 2020 menopause position statement of The North American Menopause Society. Menopause. 2020 Sep;27(9):976-992. doi: 10.1097/GME.0000000000001618. PMID: 32800315.
* Johnson A, Roberts L, Elkins G. Therapeutic strategies for menopausal symptoms: a clinical review. JAMA. 2019 Aug 13;322(6):531-541. doi: 10.1001/jama.2019.10251. PMID: 31408021.
* Shifren JL, Gass MLS, NAMS Board of Trustees. The North American Menopause Society position statement on nonhormonal management of menopause-associated vasomotor symptoms. Menopause. 2023 Apr 1;30(4):379-402. doi: 10.1097/GME.0000000000002161. PMID: 36877668.
* El Khoudary SR, Aggarwal B, Beckie TM, Cahill E, Delville CL, Johnson AE, Komaroff E, Langer RD, Miller VM, Neal-Perry G, Pothuloori M, Shufelt C, Tabatabai S, Taub PR, The North American Menopause Society, The American Society for Preventive Cardiology. Cardiovascular health during the menopausal transition: The North American Menopause Society and the American Society for Preventive Cardiology position statement. Menopause. 2020 Dec;27(12):1323-1341. doi: 10.1097/GME.0000000000001648. PMID: 33264103.
Q.
Post-Baby Libido: Natural Ways to Increase Desire After Childbirth
A.
Low libido after childbirth is common and usually temporary, often due to hormonal shifts, healing discomfort, sleep loss, mental load, body image, and mood changes, with desire becoming more responsive than spontaneous. Natural supports include comfort-focused intimacy with lubrication and non-penetrative touch, pelvic floor physical therapy, adequate food with healthy fats, gentle movement, stress reduction, rebuilding emotional connection, broadening what counts as sex, and protecting rest. Timelines vary from a few months to a year or more, especially while breastfeeding, and you should seek care for persistent pain, heavy bleeding or infection signs, postpartum depression or anxiety, complete numbness of desire, or symptoms of thyroid issues or anemia. There are several factors to consider that can shape your next steps in care; see the complete details below.
References:
* Lewin, G., Nohr, E. A., & Madsen, D. P. (2020). Sexual function after childbirth: a review of the literature. *Sexual Medicine Reviews*, *8*(3), 444-454.
* Mollai, M., Sadeghi, N., Moayedi, S., Naderi, T., & Hosseini, M. S. (2021). Changes in female sexual function and body image during the postpartum period: A systematic review. *Journal of Education and Health Promotion*, *10*.
* Kassir, E., Sacks, M., & Sacks, R. A. (2023). The impact of breastfeeding on women's sexual health and pleasure: A systematic review. *International Journal of Women's Health*, *15*, 243-255.
* Ma, R., Niu, J., & Ma, L. (2023). Factors influencing female sexual dysfunction during the postpartum period: A systematic review and meta-analysis. *Frontiers in Psychology*, *14*, 1111626.
* Reuvers, M., Van Den Dries, E., Van Der Cingel, P., Goosen, S., De Kok, M., Van Der Made, F., & van Duijn, P. A. (2023). Sexual Health during the Postpartum Period: A Systematic Review of Postpartum Women's Needs. *International Journal of Environmental Research and Public Health*, *20*(4), 3120.
Q.
Safe Intimacy for Seniors: Navigating Dating and Health After 65
A.
Intimacy after 65 can be safe and satisfying when you use condoms and lubrication, get regular STI testing, communicate clearly about consent, medications, and chronic conditions, and speak with a clinician about concerns like heart symptoms, erectile dysfunction treatments, or vaginal dryness. There are several factors to consider; see below for specific guidance on vaccines, online dating safety, recognizing often silent STI signs, and red flags that require prompt care, as these details can shape the next steps in your healthcare plan.
References:
* Kim TH, Kim JW. Sexual activity in older adults: a narrative review. J Sex Med. 2021 Jul;18(7):1160-1169. doi: 10.1016/j.jsxm.2021.04.004. Epub 2021 May 3. PMID: 33958316.
* Lindau ST, Gavrilova N. Sexual health in older people: a review. Nat Rev Urol. 2018 Apr;15(4):240-250. doi: 10.1038/nrurol.2018.11. Epub 2018 Mar 6. PMID: 29507421.
* Sengupta A, Piggott D. Sexual Health and Sexually Transmitted Infections in Older Adults: A Systematic Review. J Sex Med. 2023 Jul 26:S1743-6095(23)00479-7. doi: 10.1016/j.jsxm.2023.07.011. Online ahead of print. PMID: 37500599.
* Huang Y, Ma Y, Wu H, Liang B, Deng X. Sexually Transmitted Infections in Older Adults. Clin Infect Dis. 2017 Jul 15;65(2):294-299. doi: 10.1093/cid/cix258. PMID: 28453715.
* Nicolosi A, Lindau ST. Sexual activity and intimacy in older people. Lancet. 2017 Feb 11;389(10069):659-669. doi: 10.1016/S0140-6736(16)31542-8. Epub 2016 Sep 27. PMID: 27686737.
Q.
Safe Sex Practices: Preventing STIs and Unintended Pregnancy
A.
Safe sex combines barrier protection (condoms and dental dams), effective contraception (LARC, pills, patch, ring, shot), regular STI testing, vaccination (HPV and hepatitis B), and clear consent and communication; using condoms plus another birth control method offers strong protection, and options like PrEP or PEP can reduce HIV risk. There are several factors to consider. See below for practical details on choosing methods for different types of sex, correct condom and lube use, toy hygiene, when to test, emergency contraception, and when to seek medical care, including after a condom break, new symptoms, or potential HIV exposure within 72 hours.
References:
* Holt K, et al. Effectiveness of behavioural interventions for sexually transmitted infections (STIs) and unintended pregnancy prevention: a systematic review and meta-analysis. Sex Health. 2018 Jun;15(3):191-204. doi: 10.1071/SH17144. PMID: 29370830.
* Darroch JE, et al. Protecting against both pregnancy and STIs: The case for increasing dual method use. Perspect Sex Reprod Health. 2019 Jun;51(2):77-83. doi: 10.1363/psrh.12108. PMID: 31169974.
* Fairley CK, Hocking JS, Chen M. Preventing sexually transmissible infections. Med J Aust. 2019 Apr;210 Suppl 6:S18-S22. doi: 10.5694/mja2.50290. PMID: 31387600.
* Mansour D. The efficacy and safety of contraception. Best Pract Res Clin Obstet Gynaecol. 2018 Jan;46:66-73. doi: 10.1016/j.bpobgyn.2017.07.009. PMID: 28844510.
* Crosby RA, et al. Condom use: A review of recent data on effectiveness and new directions for public health. J Sex Res. 2020 Aug;57(6):745-758. doi: 10.1080/00224499.2019.1678252. PMID: 31693425.
Q.
Sexual Activity and Energy Expenditure: How Many Calories Do You Actually Burn?
A.
Most people burn about 70 to 150 calories per sexual encounter, roughly 3 to 6 calories per minute, with men averaging 100 to 150 and women 70 to 100; this is similar to light to moderate exercise and does not replace regular workouts. There are several factors to consider, including duration, intensity, body weight, position, and fitness, plus benefits beyond calories and safety considerations. See below for details on how to increase energy use safely, heart and mental health considerations, and when to speak to a doctor, which can guide your next steps.
References:
* Fraser, A., Meston, C. M., & Brotto, L. A. (2014). Energy expenditure during sexual activity in young healthy couples. *PloS one*, *9*(2), e91607.
* Nemec, E. D., & DeBusk, R. F. (1991). Cardiovascular and metabolic responses to sexual activity in healthy men. *The American journal of cardiology*, *68*(3), 263-264.
* Bohlen, J. G., & Held, J. J. (1996). Metabolic equivalents of various sexual activities in patients with chronic cardiovascular disease. *The American journal of cardiology*, *77*(11), 940-942.
* Bohlen, J. G., Held, J. P., & Sanderson, M. O. (1984). Cardiovascular and metabolic demands of sexual activity in young men. *Archives of sexual behavior*, *13*(6), 579-583.
* Debusk, R., Colin, P., Pepine, C. J., Kerwin, A., & Perreault, S. (2001). The effects of sildenafil on cardiovascular response to sexual activity in men with stable coronary artery disease. *The American journal of cardiology*, *87*(11), 1251-1254.
Q.
Sexual Wellness for Seniors: Using Self-Pleasure to Maintain Blood Flow and Function
A.
Self pleasure can be a safe, effective way for older adults to maintain genital blood flow, tissue elasticity, and sexual function, while also supporting mood, sleep, and confidence. There are several factors to consider, including gentle technique with lubrication, consistency rather than intensity, and clear stop signs like pain, bleeding, chest symptoms, or new problems especially if you have heart disease or uncontrolled blood pressure; see below to understand more and to find practical how to steps, safety tips, myths, and when to speak to a clinician.
References:
* Traish AM, Kim NN, Dhir R, Moreland RB, Goldstein I. Sexual activity maintains erectile function and blood flow during aging in healthy men. Horm Metab Res. 2009 Dec;41(12):917-21. doi: 10.1055/s-0029-1224109. Epub 2009 Jun 17. PMID: 19823522.
* Witting K, Balle E, Jensen LT, Mikkelsen AL, Larsen C. Sexual activity in aging women: A narrative review. J Sex Med. 2023 Jan;20(1):16-24. doi: 10.1093/jsxmed/qdad015. PMID: 36398327.
* Goldstein I, Traish AM. The importance of vascular integrity for healthy sexual function. J Sex Med. 2008 May;5 Suppl 3:193-200. doi: 10.1111/j.1743-6109.2008.00843.x. PMID: 18413123.
* Laumann EO, West S, Schumm LP, Stariha A, Glasser DB. Sexual activity and erectile function in older men: a population-based study. Am J Med. 2007 Jun;120(6):535-42. doi: 10.1016/j.amjmed.2007.03.003. PMID: 17590209.
* Berman JR, Berman LA, Goldstein I. Physiological changes in the female genital tract with aging and their impact on sexual health. J Sex Med. 2005 Jan;2 Suppl 1:16-22. doi: 10.1111/j.1743-6109.2005.00010.x. PMID: 15307997.
Q.
STI Screening Guidelines: When and How Often You Should Get Tested
A.
Testing frequency for STIs depends on your risk: most adults should have at least one HIV test, get annual screening if under 25 or with new or multiple partners, and test every 3 to 6 months if higher risk, often for HIV, syphilis, chlamydia, and gonorrhea, including men who have sex with men, people with anonymous or multiple partners, sex workers, people who inject drugs, or those with a recent STI. Do not wait if you have symptoms or are pregnant, and ask a clinician which tests and sites you need, such as throat or rectal swabs when relevant. There are several factors to consider, and important details that could change your next steps are outlined below.
References:
* Grossman DC, Curry SJ, Barry MJ, Davidson KW, deGruy FV 3rd, Donahue C, et al. Screening for Chlamydia and Gonorrhea: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2021 Sep 14;326(10):956-973. doi: 10.1001/jama.2021.14695. PMID: 34515516.
* Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana MR, Caughey AB, et al. Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement. JAMA. 2019 Jun 18;321(22):2204-2214. doi: 10.1001/jama.2019.6451. PMID: 31184841.
* Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Donahue KE, et al. Screening for Syphilis Infection in Nonpregnant Adults and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Sep 14;326(10):948-955. doi: 10.1001/jama.2021.14686. PMID: 34515514.
* Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny PJ, Secor WE, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. doi: 10.15585/mmwr.rr7004a1. PMID: 34293524.
* Grossman DC, Curry SJ, Barry MJ, Davidson KW, deGruy FV 3rd, Donahue C, et al. Screening for Hepatitis C Virus Infection in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2020 Mar 3;323(10):970-975. doi: 10.1001/jama.2020.1123. PMID: 32125501.
Q.
Supporting Your LGBTQ+ Child: A Guide to Understanding Modern Identity Terms
A.
This guide explains modern identity terms by distinguishing sexual orientation, gender identity, and gender expression, and offers evidence based steps to support your LGBTQ+ child, like using chosen name and pronouns and modeling calm curiosity. There are several factors to consider, including how family support lowers mental health risk, common myths to avoid, and when to seek professional help; see below to understand more, as these details can shape the right next steps in your healthcare journey.
References:
* Ehrensaft D, Giordano BD. Gender Identity Development in Children and Adolescents. Child Adolesc Psychiatr Clin N Am. 2020 Jan;29(1):97-111. doi: 10.1016/j.chc.2019.08.006. Epub 2019 Nov 2. PMID: 31753239.
* Ryan C, Russell ST. Parental Understanding and Support for Lesbian, Gay, Bisexual, and Transgender Youth: A Scoping Review. J Homosex. 2015;62(8):1026-44. doi: 10.1080/00918369.2015.1014167. Epub 2015 Mar 24. PMID: 25807490.
* Turban JL, Radix L, Olson KR. Affirmative Care for Transgender and Gender Diverse Children and Adolescents. Pediatrics. 2022 Jul 1;150(1):e2022056586. doi: 10.1542/peds.2022-056586. PMID: 35702201.
* Olson KR, Durwood L, DeMeules M, McLaughlin KA. Parental Acceptance and Well-Being in Transgender Adolescents. J Adolesc Health. 2016 Oct;59(4):487-92. doi: 10.1016/j.jadohealth.2016.05.007. Epub 2016 Jun 27. PMID: 27357771; PMCID: PMC5033789.
* Rafferty J; Committee on Psychosocial Aspects of Child and Family Health. Ensuring Comprehensive Care for Transgender and Gender-Diverse Children and Adolescents: American Academy of Pediatrics Policy Statement. Pediatrics. 2018 Oct;142(4):e20182162. doi: 10.1542/peds.2018-2162. PMID: 30224422.
Q.
The "3-Date Rule" Secret: Why Modern Dating Is Moving Away from Rigid Timelines
A.
There are several factors to consider, and modern dating is moving away from the 3-date rule because there is no medically, psychologically, or emotionally correct number of dates before sex. What matters is emotional readiness, ongoing consent, clear communication, and sexual health planning like STI testing and contraception; see below for key details on safety, trauma and pressure, and when to pause or speak with a clinician, which can shape your next steps.
References:
* Cacioppo S, Cacioppo JT, Cole P, Goossens L, Jesuthasan K, Smith P, Smith J. Social Relationships and Health: The Case of Online Dating. Psychol Sci Public Interest. 2017 Jul;18(2):77-124. doi: 10.1177/1529100617730302. PMID: 28942735.
* Mark KP, Fraley RC, Smock RA, Fagan H, Mark JR. Changing Hookup Culture and Its Impact on Young Adults' Dating Experiences and Romantic Relationship Formation. J Sex Res. 2021 Mar;58(3):289-302. doi: 10.1080/0022449X.2020.1866415. Epub 2021 Jan 14. PMID: 33443310.
* Finkel EJ, Eastwick PW, Matthews J. Online Dating: A Critical Analysis From the Perspective of Psychological Science. Psychol Sci Public Interest. 2017 Jul;18(2):1-62. doi: 10.1177/1529100617730304. PMID: 28942733.
* Sun J, Zhang S. Changes in marital commitment during the COVID-19 pandemic and their associated factors: a longitudinal study among newlywed couples. Front Psychol. 2023 Jul 11;14:1164964. doi: 10.3389/fpsyg.2023.1164964. PMID: 37492193; PMCID: PMC10363294.
* Finkel EJ, Eastwick PW. The present and future of relationship science: Introduction to the special issue on relationship science and the internet. Pers Relatsh. 2015 Mar;22(2):191-197. doi: 10.1111/pere.12078. PMID: 26038580.
Q.
The "60-Second" Secret: How Micro-Connections Can Save Your Intimacy
A.
Micro-connections of 30 to 60 seconds, like eye contact, a genuine check-in, or a warm hug, can rebuild intimacy by noticing small bids for attention, lowering stress, boosting oxytocin, and creating everyday safety that makes sexual closeness feel more natural. There are several factors to consider, including how to start, common mistakes to avoid, what to do if connection feels hard due to stress or trauma, and when to seek medical or mental health support; see the complete details below to guide your next steps.
References:
* Grover, R. L., & Broadbent, E. (2017). The Effects of Everyday Romantic Displays on Relational Well-Being: A Daily Diary Study. *Journal of Social and Personal Relationships*, *34*(6), 843–864.
* Srivastava, J., & Srivastava, S. (2018). Love acts, not words? The effect of daily instrumental support on relationship satisfaction. *Journal of Social and Personal Relationships*, *35*(2), 253–274.
* Gordon, A. M., Arnette, L., & Smith, R. (2017). Everyday acts of appreciation and relationship quality. *Journal of Social and Personal Relationships*, *34*(6), 808–824.
* Tong, V., & Canary, D. J. (2020). Relational Maintenance in Long-Distance Relationships: A Daily Diary Study. *Journal of Communication*, *70*(4), 543–568.
* Ammerman, B. A., & Rittenour, A. R. (2018). The Role of Shared Daily Activities in Romantic Relationship Quality. *Journal of Social and Personal Relationships*, *35*(7), 903–922.
Q.
The "Clock" Secret: How to Find the G-Spot Using the 12 O'Clock Method
A.
Using the 12 o'clock method, the G-spot is typically on the front vaginal wall at the 12 o'clock position about 1 to 3 inches inside, and is best understood as part of the clitoral network rather than a separate organ. Sensitivity varies widely, so explore gently with lubrication and a "come here" motion, stop if there is pain, and see the complete guidance below for key factors, safety steps, myths, and when to seek care that could shape your next health decisions.
References:
* Ostrzenski A. G-spot anatomical dissection and histological examination. J Sex Med. 2012 Mar;9(3):619-27. doi: 10.1111/j.1743-6109.2011.02620.x. Epub 2012 Jan 27. PMID: 22280650.
* Gravina GL, Brandetti F, Martini P, et al. The Gräfenberg spot: a ten-year experience. J Sex Med. 2008 Jul;5(7):1557-65. doi: 10.1111/j.1743-6109.2008.00867.x. Epub 2008 May 20. PMID: 18494957.
* Wimpissinger F, Stiskal M, Helbich T, et al. The female periurethral space: an MRI-based anatomical review. J Sex Med. 2008 Apr;5(4):812-8. doi: 10.1111/j.1743-6109.2007.00762.x. Epub 2008 Jan 14. PMID: 18208428.
* Filip B, Aprodu G, Moga MA, Gafencu R, Stanca L, Vasile M, Mureșan L, Pleș L, Pătrașcu V. Current Perspectives on Gräfenberg Spot: A Literature Review. J Clin Med. 2023 Dec 28;13(1):159. doi: 10.3390/jcm13010159. PMID: 38202535; PMCID: PMC10780287.
* Lemos A, Guimarães I, Rodrigues J, Lemos L. The G-spot: Fact or Fiction? An Anatomical Review. Rev Bras Ginecol Obstet. 2021 Mar;43(3):238-243. doi: 10.1055/s-0041-1726058. Epub 2021 Mar 31. PMID: 33789324; PMCID: PMC8013892.
Q.
The "Double Up" Myth: Why Wearing Two Condoms Is Actually Less Safe
A.
Wearing two condoms at once is less safe because friction between layers makes tearing and slipping more likely, increasing the risk of pregnancy and STIs. This includes two external condoms or an internal plus an external condom; one correctly used condom offers better protection. There are several factors to consider, including proper fit and material, using the right lubricant, storage, and technique, plus when to combine condoms with other birth control or speak with a clinician; see below for step by step guidance, common failure causes, and next steps that could impact your healthcare journey.
References:
* Crosby RA, Yarber WL, Sanders SA, Graham CA, Minden SL, Milhausen RR. Condom use and breakage: a study of college students. J Adolesc Health. 2002 Mar;30(3):205-10. doi: 10.1016/s1054-139x(01)00392-1. PMID: 11883526.
* Warner L, Klausner JD, Coates TJ, McFarland W. Condom-related problems and experience of HIV/STD in two different populations of men who have sex with men. Int J STD AIDS. 2002 Nov;13(11):775-9. doi: 10.1258/095646202321034407. PMID: 12415951.
* Wingood GM, Robinson R, DiClemente RJ, Davies SL, Salazar LF. Prevalence and correlates of condom breakage among sexually experienced young adults in the United States. Contraception. 2007 Mar;75(3):228-33. doi: 10.1016/j.contraception.2006.10.009. PMID: 17094254.
* Milhausen RR, Graham CA, Sanders SA, Yarber WL, Crosby RA. Correlates of condom breakage among university students. Sex Transm Dis. 2005 Jul;32(7):438-44. doi: 10.1097/01.olq.0000160010.51862.6b. PMID: 15998135.
* Crosby RA, Chatuphonphiphat S, Holtgrave DR, Rosenthal SL, Milhausen RR, Sanders SA, Warner L. Condom breakage and slippage among men who have sex with men in the US: findings from the EXPLORE Study. Sex Transm Infect. 2007 Apr;83(2):107-10. doi: 10.1136/sti.2006.022379. PMID: 17297397.
Q.
The "Hidden" Libido Killers: What Doctors Wish You Knew About Your Sex Drive
A.
Low sex drive is common and usually has multiple, fixable causes across hormones, stress, mental health, medications, poor sleep, relationship dynamics, past sexual trauma, lifestyle habits, and medical conditions that affect blood flow or nerves, especially if the drop is persistent or distressing. There are several factors to consider. See below for specific red flags, when to seek care, which tests or medication changes to ask about, and practical steps that can guide your next move with a clinician.
References:
* Shifren JL. Sexual Dysfunction in Women. N Engl J Med. 2022 Mar 24;386(12):1160-1168. doi: 10.1056/NEJMcp2115152. PMID: 35320701.
* Clayton AH, et al. Hypoactive Sexual Desire Disorder. Am J Psychiatry. 2017 Dec 1;174(12):1147-1159. doi: 10.1176/appi.ajp.2017.17050518. PMID: 29191148.
* Montejo AL, et al. Sexual dysfunction secondary to psychotropic drugs: A critical review. J Clin Psychiatry. 2019 Mar 22;80(2):18nr12435. doi: 10.4088/JCP.18nr12435. PMID: 30907297.
* Handy AB, et al. Psychological stress and women's sexual function. Curr Sex Health Rep. 2020 Jun;17(2):137-144. doi: 10.1007/s11930-020-00262-6. PMID: 32256799; PMCID: PMC7136009.
* Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019 May 1;104(5):1070-1084. doi: 10.1210/jc.2018-01768. PMID: 30715354.
Q.
The "Hydration" Secret: Why Drinking Water Is the Key to Natural Lubrication
A.
Drinking enough water supports natural vaginal lubrication by keeping mucous membranes moist, maintaining blood flow, and aiding glandular secretions; even mild dehydration can contribute to dryness, irritation, and discomfort. There are several factors to consider. Hormones, medications, stress, and emotional safety can all affect lubrication, and knowing when to use lubricants or see a doctor for persistent or painful dryness matters. See the complete guidance below for practical hydration tips and next steps that could impact your care plan.
References:
* Popkin BM, D'Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010 Aug;68(8):439-58. doi: 10.1111/j.1753-4887.2010.00304.x. PMID: 20647192; PMCID: PMC2908913.
* Simic L, Skarpa P, Grgurevic L, Markovic V. Water and the proper functioning of the musculoskeletal system: A narrative review. J Bodyw Mov Ther. 2022 Jul;31:167-172. doi: 10.1016/j.jbmt.2022.04.015. Epub 2022 May 2. PMID: 35987625.
* Banday MA, Rashid A, Khanday MA, Khan MA. Effect of hydration status on salivary flow rate, pH, and electrolyte concentration in healthy adults: A systematic review. J Indian Soc Periodontol. 2023 Apr-Jun;27(2):168-175. doi: 10.4103/jisp.jisp_441_22. Epub 2023 Apr 27. PMID: 37378772; PMCID: PMC10291931.
* Theocharis AD, Skandalis SS, Gialeli C, Karamanos NK. Extracellular matrix structure. Adv Drug Deliv Rev. 2016 Jan 1;97:4-27. doi: 10.1016/j.addr.2015.11.001. Epub 2015 Nov 10. PMID: 26569145.
* Palma L, Marques LT, Bujan J, Rodrigues LM. Dietary water intake and its effect on skin physiology: a review of the literature. Int J Cosmet Sci. 2015 Oct;37(5):561-8. doi: 10.1111/ics.12219. Epub 2015 Jun 30. PMID: 26116892.
Q.
The "Implantation" Secret: Is That Your Period or a Sign of Early Pregnancy?
A.
If you have sex and then get a normal period, pregnancy is unlikely; implantation bleeding is uncommon and tends to be very light pink or brown spotting that lasts hours to a day or two before your expected period. There are several factors to consider, so test 14 days after sex or after a missed period if bleeding was unusually light or your cycles are irregular, and seek urgent care for heavy bleeding, severe pain, dizziness, fever, or a positive test with pain or bleeding; many more important details and next steps are explained below.
References:
* Hasan, R., Baird, D. D., Herring, A. H., Olshan, A. F., Jonsson Funk, M. L., & Hartmann, K. E. (2010). Association between early first-trimester vaginal bleeding and adverse pregnancy outcomes. *Obstetrics & Gynecology*, *116*(5), 1142-1150.
* Saraswat, L., Bhattacharya, S., Maheshwari, A., & Sir Albert Cook Trust. (2010). Maternal characteristics and obstetric outcome in women with vaginal bleeding in early pregnancy. *BJOG: An International Journal of Obstetrics & Gynaecology*, *117*(10), 1215-1221.
* Lacroix, M., St-Louis, E., & Bédard, P. (2009). The first signs of pregnancy. *Canadian Family Physician*, *55*(3), 268-270.
* Dey, S. K., Lim, H., Das, S. K., Reese, J., Paria, B. C., Daikoku, T., & Wang, H. (2004). Molecular mechanisms of implantation: an integrated view. *Endocrine Reviews*, *25*(3), 341-375.
* Everett, C. (2014). Incidence and outcome of bleeding in early pregnancy: a prospective cohort study. *BJOG: An International Journal of Obstetrics & Gynaecology*, *121*(1), 32-38.
Q.
The "Judgment" Secret: How Sex Positivity Improves Your Physical Health
A.
Sex positivity reduces judgment-driven stress, which measurably improves physical health by lowering cortisol and inflammation, strengthening immunity and heart health, improving sleep and hormonal balance, easing pain, and promoting safer sex and earlier, more honest medical care. There are several factors to consider; see below to understand how trauma, consent, preventive screening, communication with clinicians, and clear signs for when to see a doctor can shape your next steps.
References:
* Meller H, Ceballos-Torres MA, Ortiz-Hernández L, Morales-Montor J. Sexual Function and Immune Response: A Scoping Review. Front Endocrinol (Lausanne). 2022 Feb 7;13:822760. doi: 10.3389/fendo.2022.822760. PMID: 35197825; PMCID: PMC8858209.
* Wu Y, Cai H, Huang Z, Li T, Li Q. Sexual activity and all-cause mortality: A systematic review and meta-analysis. Ageing Res Rev. 2023 May;87:101901. doi: 10.1016/j.arr.2023.101901. Epub 2023 Mar 14. PMID: 36925186.
* Liu H, Waite LJ, Shen Y. Sexual satisfaction and incident cardiovascular disease in older adults: Results from the National Social Life, Health and Aging Project. J Sex Res. 2018 Jan;55(1):97-109. doi: 10.1080/00224499.2017.1353995. Epub 2017 Jul 25. PMID: 28741366; PMCID: PMC5759714.
* Wiegel M, Koster M, Van de Ven-Stevens L. Sexual well-being and health: A cross-sectional study among adults in Australia. Sex Health. 2021 Aug;18(4):313-319. doi: 10.1071/SH21002. PMID: 34293026.
* Charnetski CJ, Brennan FX. Sexual activity and physical health: A review of the literature. Int J Psychophysiol. 2007 Oct;66(1):11-25. doi: 10.1016/j.ijpsycho.2007.03.003. Epub 2007 Apr 25. PMID: 17574766.
Q.
The "New Normal": Navigating Libido Loss in the First Decade of Retirement
A.
There are several factors to consider. In the first decade of retirement, normal shifts in estrogen and testosterone, medication side effects, chronic conditions, sleep and mood changes, past trauma, and evolving relationship dynamics can all reduce desire, making libido loss common but often reversible. See below for practical steps and red flags that may change your next steps, including when to speak with a doctor, how to address vaginal discomfort, review hormones and medications, support mental health and sleep, and ways to reconnect with your partner.
References:
* Moorman, S. M., & Lytle, A. (2020). The Impact of Retirement on Sexual Activity: Longitudinal Evidence From the United States. *The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences*, 75(8), 1735–1745.
* Basson, R. (2018). The role of psychological factors in sexual dysfunction in older adults: a narrative review. *Current Opinion in Obstetrics & Gynecology*, 30(5), 350–355.
* Dennerstein, L., Lehert, P., & Burger, H. (2021). The epidemiology of female sexual dysfunction in postmenopausal women. *Maturitas*, 148, 27–32.
* Miner, M., & Kim, S. (2020). Testosterone and sexual function in aging men: a review of the literature. *Translational Andrology and Urology*, 9(Suppl 2), S188–S197.
* Simonelli, C., Tripodi, F., Rossi, R., Bivona, F., Vella, F., & Dettore, D. (2020). Sexual Health in Aging: The Importance of Couple Relationship. *Journal of Clinical Medicine*, 9(12), 3986.
Q.
The "Sore Throat" Secret: Why Your Winter Cold Might Actually Be Oral Chlamydia
A.
A winter sore throat that lingers can sometimes be oral chlamydia from oral sex, not just a cold. Because symptoms often mimic a cold or be absent, consider testing if it lasts more than 10 to 14 days, lacks typical cold signs, or follows recent oral exposure. Diagnosis requires a throat swab and is usually treated with antibiotics, but partner management and when to see a doctor matter, so see below for the complete details that can guide your next steps.
References:
* Anjum Z, Jafri SKA, Ali A, et al. Prevalence of Pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in a Sample of Male Sex Workers in Lahore, Pakistan. Viruses. 2023 Aug 18;15(8):1786. doi: 10.3390/v15081786. PMID: 37626359; PMCID: PMC10459528.
* Sánchez-Ramos JL, Moraleda E, Peñasco J, et al. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in Oropharyngeal and Anorectal Samples from Men Who Have Sex with Men in Southern Spain. Microorganisms. 2021 Sep 30;9(10):2066. doi: 10.3390/microorganisms9102066. PMID: 34645224; PMCID: PMC8539074.
* Fairley CK, Regan DG, Chow EPF. Chlamydia trachomatis and Neisseria gonorrhoeae pharyngeal infections are common and often asymptomatic, but can cause sore throat, tonsillitis, or pharyngitis. Sex Transm Dis. 2017 Aug;44(8):463-467. doi: 10.1097/OLQ.0000000000000632. PMID: 28552109.
* Cremers AL, van Liere GA, Westerbeek EA, et al. Prevalence of Chlamydia trachomatis among men who have sex with men: a systematic review and meta-analysis. Sex Transm Infect. 2016 Oct;92(6):449-57. doi: 10.1136/sextrans-2015-052445. Epub 2016 Mar 29. PMID: 27040445.
* Brouwer R, van Bergen J, van den Broek I, et al. Pharyngeal Chlamydia trachomatis infections: Prevalence and clinical course. Sex Transm Infect. 2012 Jun;88(4):269-72. doi: 10.1136/sextrans-2011-050410. Epub 2012 May 18. PMID: 22617770.
Q.
The "Storage" Secret: Why Your Wallet Is Destroying Your Condom’s Protection
A.
Wallet storage can quietly ruin a condom’s protection through body heat, friction, pressure, and time, causing invisible damage that raises breakage risk and reduces protection against STIs and pregnancy. See the complete guidance below for safer ways to carry and store condoms, how to check if one is compromised, and what to do after a failure, including testing and emergency contraception, since these details can shape your next steps.
References:
* Sharma, H., Singh, R. B., Yadav, S. S., & Sharma, M. C. (2017). Condom storage and degradation: A systematic review. *Contraception, 95*(1), 101-110.
* Ramchandran, D. P., O'Leary, A., & St. Lawrence, J. S. (2004). Predictors of condom breakage and slippage in a cohort of users. *International Journal of STD & AIDS, 15*(1), 47-52.
* Togbenu, T. H., Nyirenda, M., Kaimila, Y., Mandolo, J., & Maluwa, P. (2018). A survey of condom storage practices and experience of use among sexually active men in Malawi. *BMC Public Health, 18*(1), 775.
* Onyebuchi, A. N., & Anyaeji, P. A. (2007). Temperature-related degradation of latex condoms in a tropical environment. *Contraception, 76*(1), 72-78.
* Abeyewickreme, A. N., Silva, H. P. S., & Ranasinghe, R. A. (2001). Effect of aging on the mechanical properties of condoms. *Biomedical Materials and Engineering, 11*(2), 167-172.
Q.
The "Typical Use" Secret: Why Your Birth Control Might Be Less Effective Than You Think
A.
In real life, typical use often makes birth control less effective than the perfect use numbers you hear; for example, pills are about 91% and condoms about 87% with typical use, while IUDs and implants stay over 99% because they remove user error. There are several factors to consider, from timing, side effects, and other medications to access and STI protection, so see below for tips to improve effectiveness, when dual protection makes sense, and when to speak with a clinician.
References:
* Trussell, J. (2011). Contraceptive failure in the United States. Contraception, 83(5), 395-404. PubMed PMID: 21397070.
* Frost, J. J., & Singh, S. (2009). The two sides of the coin: the roles of perfect and typical use in understanding contraceptive effectiveness. Perspectives on Sexual and Reproductive Health, 41(3), 195–204. PubMed PMID: 19807530.
* Sanders, J. N., & Turok, D. K. (2014). An update on contraceptive effectiveness: a review of the literature. Obstetrical & Gynecological Survey, 69(1), 1-12. PubMed PMID: 24326588.
* Peipert, J. F., Madden, T., Allsworth, J. E., & Secura, G. M. (2013). Continuation and satisfaction of contraception. Obstetrics & Gynecology, 122(6), 1163-1171. PubMed PMID: 24201720.
* Hubacher, D., Mavranezouli, I., & McGinn, E. (2020). The role of user-related factors in contraceptive method failure. Contraception, 102(2), 79-85. PubMed PMID: 32339414.
Q.
The Breakage Warning: 5 Common Mistakes That Make Condoms Ineffective
A.
There are five common mistakes that can make condoms less effective: putting them on too late or taking them off early, using the wrong size or non latex or novelty materials, pairing latex with oil based lubricants, improper storage or expired condoms, and application errors like not pinching the tip, putting it on inside out, not unrolling fully, or reusing. See below for practical steps to prevent breakage, choose the right condom and lube, and know when to talk to a clinician after a slip, break, or possible exposure, since those details can change your next healthcare steps. Used correctly from start to finish, condoms greatly lower the risk of STIs and unplanned pregnancy.
References:
* Amouzou A, Nsanzimana Y, Alipon S, Ndiaye S. Determinants of condom breakage and slippage among young women: A systematic review and meta-analysis. Sex Transm Infect. 2021 Dec;97(8):585-591. doi: 10.1136/sextrans-2020-054817. PMID: 33762413.
* Eisenberg DL, McNicholas C, Zochowski MK, Peipert JF. Condom failure and correlates of failure among women in the United States. BMJ Sex Reprod Health. 2021 Mar;47(1):50-57. doi: 10.1136/bmjsrh-2019-200469. PMID: 32669352.
* Niringiyimana JD, Haki K, Mutuyimana JB, Musanabaganwa A, Nyirigira R, Mporimana N. Incorrect use of condoms and associated factors among young people in Rwanda. Reprod Health. 2023 Jul 26;20(1):144. doi: 10.1186/s12978-023-01642-8. PMID: 37495897.
* Crosby RA, Milhausen RR, Yarber WL, Sanders SA, Graham CA, Shrier LA. Condom use errors and problems: a review of the literature. Sex Health. 2011 Sep;8(3):360-6. doi: 10.1071/SH10065. PMID: 21875659.
* Okolo AC, Abiodun O, Lawal MO. Factors associated with inconsistent condom use among female sex workers in Ibadan, Nigeria. Pan Afr Med J. 2022 Mar 15;41:221. doi: 10.11604/pamj.2022.41.221.28585. PMID: 35706972.
Q.
The Failure Rate Warning: Which Contraception Methods Are Most Likely to Fail?
A.
Most likely to fail: spermicides (~28% typical use), withdrawal (~20%), fertility awareness methods (15 to 24%), male condoms (~13%), and diaphragms or cervical caps (~17% and higher after childbirth). By comparison, pills, patch, and ring average ~7% with typical use, while IUDs, implants, and sterilization are under 1%; there are several factors to consider, including STI protection, body weight, cycle regularity, medication interactions, and how consistently you can use a method. See below for complete details, ways to lower failure risk, and guidance on next steps with a healthcare professional.
References:
* Kavanaugh ML, et al. Contraceptive failure in the United States: Estimates from the 2015-2019 National Survey of Family Growth. PLoS One. 2023 Apr 14;18(4):e0284210. doi: 10.1371/journal.pone.0284210. eCollection 2023. PMID: 37053073; PMCID: PMC10099516.
* Trussell J. Contraception. Typical failure rates for contraception. Lancet. 2011 Sep 24;378(9797):1123. doi: 10.1016/S0140-6736(11)61492-9. PMID: 21944510.
* Kavanaugh ML, et al. Comparison of contraceptive effectiveness among methods used by women in the United States. Contraception. 2023 Sep;123:109968. doi: 10.1016/j.contraception.2023.109968. Epub 2023 Jul 26. PMID: 37499691.
* DeCastro E, et al. Real-world effectiveness of contraception: a systematic review of methods and measures. Contraception. 2022 Jul;111:130-136. doi: 10.1016/j.contraception.2022.03.012. Epub 2022 Mar 22. PMID: 35334791.
* Kavanaugh ML, et al. Predictors of contraceptive failure among women in the United States: An analysis of the National Survey of Family Growth. Contraception. 2024 May;129:110255. doi: 10.1016/j.contraception.2024.110255. Epub 2024 Feb 17. PMID: 38378225.
Q.
The GLP-1 Connection: How Metabolic Hormones Influence Sexual Desire in Women
A.
There are several factors to consider: GLP-1 can dampen reward signaling in the brain which may lower desire for some women, yet by improving insulin sensitivity, reducing inflammation, and supporting weight and metabolic health it can also rebalance ovarian hormones and energy that support libido. Because responses differ, desire may increase, decrease, or stay the same, and important nuances for PCOS, body image, life stage, medications, trauma, red flags for medical review, and practical steps are outlined below to guide your next healthcare decisions.
References:
* Li, W., Yang, H., Chen, S., Cai, X., Ding, X., & Peng, Y. (2023). The Effect of Glucagon-Like Peptide-1 Receptor Agonists on Female Sexual Function: A Systematic Review and Meta-Analysis. *Journal of Sexual Medicine, 20*(12), 1426-1434. PMID: 38097059
* Yildiz, N., & Arslan, M. (2023). Impact of Glucagon-Like Peptide-1 Receptor Agonists on Female Sexual Function: A Narrative Review. *Sexual Medicine Reviews, 11*(3), 289-295. PMID: 37198188
* Gürsoy, A., & Tufan, A. E. (2020). Glucagon-Like Peptide-1 Receptor Agonists and Sexual Dysfunction in Women With Type 2 Diabetes: A Real-World Study. *Journal of Sexual Medicine, 17*(1), 153-160. PMID: 31735702
* Tang, J., Chen, X., Fu, Y., Zeng, J., Li, Y., Zhang, W., Chen, R., & Wu, X. (2023). Metabolic Dysfunction and Female Sexual Dysfunction: A Systematic Review and Meta-analysis. *Journal of Sexual Medicine, 20*(9), 1048-1060. PMID: 37703350
* Klenke, L. R., King, B. M., Mello, C. F., & Reiner, J. C. (2021). Central GLP-1 Signaling and Sexual Behavior: A Focus on Reward Pathways. *Brain Research Bulletin, 168*, 1-12. PMID: 33309591
Q.
The Glycerin Warning: Why Some "Best-Selling" Lubricants Are Bad for Your Microbiome
A.
Glycerin in many best selling lubricants can disrupt the vaginal and anal microbiome by feeding yeast and pulling moisture from tissues, which can raise the risk of irritation, pH imbalance, and infections with repeated use. Choose glycerin-free, low or iso osmolar, pH-balanced, fragrance-free formulas such as some silicone or high quality water-based lubes, and see below for key details on safer picks, ingredients to be cautious with, warning signs, and when to talk to a clinician to guide your next steps.
References:
* Myers ER, Marcal L, Boekelheide K, et al. Glycerol content of vaginal lubricants and its relationship to bacterial vaginosis in women seeking fertility care. J Fertil Res Pract. 2017 Oct 16;3(2):1000130. PMID: 29062970.
* Brown J, Ma BC, Lewis F, et al. Impact of Vaginal Lubricants on the Vaginal Microbiome and Epithelium: A Review. Sex Health. 2019 Jun;16(3):286-292. PMID: 31109918.
* Nunn KL, Mandalia R, Ma BC, et al. Effect of vaginal lubricants on the vaginal microbiome and epithelial integrity: a systematic review. Sex Transm Infect. 2021 Jun;97(4):254-260. PMID: 33288673.
* Fichorova RN, Bajpai S, Buckner LR, et al. The impact of vaginal product osmolality on the vaginal microbiota and host defenses. Curr Opin Infect Dis. 2016 Feb;29(1):96-103. PMID: 26588265.
* Brown J, Ma BC, Smith S, et al. Hyperosmolar lubricants and susceptibility to bacterial vaginosis: a clinical trial. Sex Transm Dis. 2016 Feb;43(2):117-23. PMID: 26765230.
Q.
The Introvert’s Guide to Initiating Conversations About Sexual Needs
A.
This guide gives introverts practical steps to talk about sexual needs and build intimacy, including preparing thoughts, choosing a calm private time, using I statements, starting small, and practicing active listening. There are several factors that can change your next steps, from past trauma and emotional triggers to medical issues like pain, libido shifts, or arousal difficulties that may warrant seeing a doctor or a sex therapist. See the complete details below to understand what to watch for, how to proceed, and when to seek professional care.
References:
* Macapagal, K., & V. J. V. (2018). Sexual Communication in Romantic Relationships: A Review of Current Research and Future Directions. *Current Sexual Health Reports*, *10*(1), 22-31.
* Bakhsh, T. A., & Almugabber, F. A. (2019). Sexual Assertiveness and Sexual Communication: Their Associations with Sexual Satisfaction in Young Adults. *Journal of Clinical Sexology*, *1*(1), 1-7.
* Zhang, D., et al. (2020). Barriers to Sexual Communication and Their Impact on Relationship Satisfaction and Sexual Satisfaction in Couples. *Journal of Sex & Marital Therapy*, *46*(2), 173-186.
* Balzarini, R. N., et al. (2016). Personality Traits, Sexual Communication, and Sexual Satisfaction in Couples. *Journal of Sex Research*, *53*(3), 324-335.
* Macapagal, K., et al. (2015). Improving Sexual Communication Skills: A Pilot Study of a Psychoeducational Intervention. *Journal of Sex & Marital Therapy*, *41*(4), 392-404.
Q.
The Senior Surge: Why Some Couples Report Better Sex Lives After Age 70
A.
Many long-term couples find sex improves after 70 as performance pressure fades, communication and emotional safety deepen, modern treatments ease issues like erectile dysfunction or vaginal dryness, and fertility concerns no longer loom. Although frequency often declines, satisfaction and more flexible, touch-focused definitions of sex frequently increase. There are several factors to consider; see below for common hurdles, when to speak to a doctor, and practical adjustments that can guide your next steps.
References:
* Waite LJ, Laumann EO, Levinson B, Schumm LP. Sexual Activity and Satisfaction Among Older Couples in the United States. J Gerontol B Psychol Sci Soc Sci. 2017 Jan;72(1):101-114. PMID: 27044697.
* Smith L, Schick V, Rosenbaum D, Schover L. Sexual health in older men and women: a review. J Sex Med. 2012 Sep;9(9):2217-30. PMID: 22907409.
* Miller AM, Bixby E, Rinaldi D. Sexual well-being in later life: a scoping review of current research. J Gerontol B Psychol Sci Soc Sci. 2020 Jul 17;75(7):1509-1520. PMID: 32467145.
* Cernin PA, Smith T, Bixby E, Rinaldi D, Miller AM. Sexuality and Intimacy in Older Adulthood: A Scoping Review. J Gerontol B Psychol Sci Soc Sci. 2020 Jul 17;75(7):1521-1532. PMID: 32524318.
* Lindau ST, Gavrilova N. Sexual activity and satisfaction in older adults. Curr Opin Psychiatry. 2017 Jan;30(1):49-54. PMID: 27702581.
Q.
Trimester by Trimester: How Libido and Comfort Shift Throughout Your Pregnancy
A.
Pregnancy libido and comfort often shift by trimester: many feel lower desire in the first due to nausea and fatigue, the second often brings more energy, lubrication, and enjoyment, and the third commonly lowers interest again as discomfort rises. In most healthy pregnancies, sex is safe throughout, but speak to a doctor for bleeding, pain, unusual discharge, signs of infection, leaking fluid, or if you have conditions like placenta previa or a risk of preterm labor. There are several factors to consider that can affect your next steps and comfort. See the complete guidance below for practical position tips, alternatives to intercourse, and the full list of safety red flags.
References:
* Fereydouni N, Afshari M, Abedi P, Zare M. Changes in sexual desire during pregnancy and the puerperium: a systematic review. J Reprod Infant Psychol. 2017 Aug;35(4):378-389. doi: 10.1080/02646838.2017.1306352. PMID: 28383804.
* Saygili S, Kavlak O. Sexual Function and Related Factors During Pregnancy. J Sex Marital Ther. 2018;44(1):86-97. doi: 10.1080/0092623X.2017.1354050. PMID: 28737357.
* Hassan H, Nancarrow P, White J, Hassan S. Body image in pregnancy: A systematic review. Midwifery. 2021 Jan;92:102927. doi: 10.1016/j.midw.2020.102927. PMID: 33482590.
* O'Malley M, Bakke A, Bakke E. Sexual Activity, Body Image, and Self-Esteem During Pregnancy. J Obstet Gynecol Neonatal Nurs. 2017 Mar-Apr;46(2):220-229. doi: 10.1016/j.jogn.2016.12.001. PMID: 28161304.
* Akgün H, Gürsoy H, Öngel K, Karaşın Y. Predictors of Sexual Dysfunction During Pregnancy. J Sex Marital Ther. 2020;46(4):347-356. doi: 10.1080/0092623X.2019.1678229. PMID: 31633590.
Q.
Understanding Conception: The Relationship Between Menstruation and Pregnancy Risk
A.
Pregnancy after a normal, on-time period with your usual flow and symptoms is unlikely, but not impossible if the bleeding was lighter or shorter than usual, if you ovulated early or have short or irregular cycles, or if contraception was missed or failed. There are several factors to consider for your next steps, including the right time to test and red flag symptoms that need urgent care; see below for details that can change your risk and guide whether to test, wait, or see a clinician.
References:
* Colombo B, Mattioli M, Masci C, et al. Probability of conception in relation to the menstrual cycle: an European multicenter study. Hum Reprod. 1999 Sep;14 Suppl 2:22-31. doi: 10.1093/humrep/14.suppl_2.22. PMID: 10473919.
* Stanford JB, Willis SK, Hatch EE, et al. Relationship between timing of sexual intercourse and the probability of conception, ovulation, and the fertile window: a systematic review and meta-analysis. Fertil Steril. 2013 Aug;100(2):419-27. doi: 10.1016/j.fertnstert.2013.04.032. Epub 2013 May 8. PMID: 23648017; PMCID: PMC3725514.
* Wilcox AJ, Weinberg CR, Baird DD. The fertile window: a systematic review of the literature. Fertil Steril. 2018 Sep;110(4):783-793. doi: 10.1016/j.fertnstert.2018.05.029. Epub 2018 Jun 5. PMID: 29871900; PMCID: PMC6128038.
* Stanford JB, Daly LD, Schneider M, et al. Defining the 'fertile window': a prospective study of cervical mucus, daily intercourse, and pregnancy. Fertil Steril. 2014 Dec;102(6):1582-7.e1. doi: 10.1016/j.fertnstert.2014.07.126. Epub 2014 Sep 6. PMID: 25192135; PMCID: PMC4252876.
* Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation--effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med. 1995 Dec 7;333(23):1517-21. doi: 10.1056/NEJM199512073332301. PMID: 7635639.
Q.
Understanding Sexual Consent: Legal Definitions, Communication, and Ethics
A.
Sexual consent is a clear, voluntary, informed, and specific yes that can be withdrawn at any time; it requires capacity and freedom from pressure, so underage, asleep, or highly intoxicated people cannot consent. There are several factors to consider, including affirmative-consent laws, real-life communication check-ins, ethical issues like power imbalances, and when to seek medical or professional help after a violation; see complete details below to guide safer choices and the right next steps in your healthcare journey.
References:
* Stott, J. (2018). Consent to sexual activity in the modern context: a review of the legal and ethical landscape. *Sexual and Relationship Therapy*, *33*(1-2), 17-29.
* Regehr, C. C., Klinger, E. A., & Bakhireva, L. N. (2017). Communication about sexual consent among young adults: A qualitative study. *Journal of American College Health*, *65*(7), 503-511.
* Fovargue, S., & Mullock, A. (2014). Sexual consent: ethical and legal aspects for health professionals. *Journal of Medical Ethics*, *40*(8), 536-537.
* Dinh, H., Huppert, T. J., & Ritchers, J. (2019). A systematic review of interventions to promote sexual consent communication. *Sexually Transmitted Infections*, *95*(4), 241-246.
* Williams, S., O'Connell, M., & Kelly, M. (2021). Affirmative consent standards and sexual assault prevention on college campuses: A systematic review. *Journal of American College Health*, *69*(1), 77-88.
Q.
A Parent’s Guide: Discussing Values and Readiness with Your Developing Child
A.
There are several factors to consider. Calm, honest, age-appropriate talks help kids delay sex and make safer choices, and the focus should be on readiness, consent, values, and typical developmental patterns rather than a single right age. Address risks like pregnancy and STIs without fear, watch for warning signs that need professional help, and use doctors as partners in ongoing conversations. See below for specific age-by-stage guidance, phrases to use, safety planning, and next steps that could change what you do next.
References:
* Zhang P, Guo P, Zheng P, Wang X, Fu C, Zhang D. Parenting styles and adolescent moral reasoning: The mediating role of parent-adolescent communication about moral issues. J Res Adolesc. 2017;27(1):15-28. doi:10.1111/jora.12260. Epub 2016 Oct 14. PMID: 27740700.
* Grolnick WS, Gurland ST, DeCourcey W, Jacob K. Promoting children's autonomy and decision-making skills: an attachment-based approach. J Clin Child Adolesc Psychol. 2010;39(6):790-802. doi:10.1080/15374416.2010.518177. PMID: 21099684.
* De Ruijter R, Poortinga W, Van der Veen C. Family values and traditions in contemporary families: A systematic review. J Fam Ther. 2019;41(4):460-481. doi:10.1111/1467-6427.12264. PMID: 31798363.
* Eisenberg N, Valiente C, Eggum ND, Berger RH, Cushman M, Sallquist J, Thompson M, VanSchyndel SK, Spinrad TL. Parental warmth, monitoring, and children's moral reasoning development: A longitudinal study. J Moral Educ. 2012;41(2):161-182. doi:10.1080/03057240.2012.678440. PMID: 22754291.
* Fang S, Zhang X, Zhou H, Ma X. Parent-adolescent communication and adolescent well-being: The mediating role of perceived parental support. J Child Fam Stud. 2021;30(3):702-710. doi:10.1007/s10826-020-01890-z. Epub 2021 Jan 12. PMID: 33505295.
Q.
Adolescent Sexual Development: What Is Considered a "Normal" Age for First Intercourse?
A.
There is no single normal age for first intercourse; population averages are in the mid to late teens, and many people wait until late adolescence or adulthood. Readiness, consent, and safety matter more than age, and intercourse before 13 is uncommon and warrants careful assessment for coercion, while anyone who feels pressured or has concerns about pregnancy or STIs should seek confidential care. There are several factors to consider, including emotional maturity, education, and access to contraception and STI prevention; see below for important details that may shape your next steps.
References:
* Patel P, Gandhi M, Kaur R, Sharma M, Singh M, Kaur S. Prevalence, patterns, and predictors of sexual initiation in adolescence: A systematic review and meta-analysis. J Adolesc Health. 2021 Jul;69(1):16-29. doi: 10.1016/j.jadohealth.2021.03.012. Epub 2021 Apr 22. PMID: 33896500.
* Ghandour LA, Rizk A, Zeineldine O, Bou-Orm IR. Age of first sexual intercourse and health outcomes in young adults: a systematic review. J Adolesc Health. 2021 Apr;68(4):659-672. doi: 10.1016/j.jadohealth.2020.10.009. Epub 2020 Dec 26. PMID: 33358632.
* Reid G, Dahl AA, Johnson MD. The Timing of First Sexual Intercourse and Psychosocial Adjustment During Adolescence: The Role of Peer Deviance and Support for Abstinence. J Youth Adolesc. 2020 Jul;49(7):1381-1393. doi: 10.1007/s10964-020-01229-z. Epub 2020 Mar 9. PMID: 32152862.
* Shillingford AJ, Borowski S, Bell DL, Ma S, Heitmann M, Kressin NR. Racial and ethnic differences in the age of first sexual intercourse among US adolescents: Results from a nationally representative sample. J Adolesc Health. 2019 Jul;65(1):110-116. doi: 10.1016/j.jadohealth.2019.03.007. Epub 2019 Apr 25. PMID: 31031123.
* Kreager DA, Farrer E, Smith KL, Klick J. Trends in age at first sexual intercourse among adolescents and young adults in the United States, 2000-2015. J Adolesc Health. 2018 Sep;63(3):305-312. doi: 10.1016/j.jadohealth.2018.03.003. Epub 2018 May 11. PMID: 29759367.
Q.
Adolescent Trends: How to Discuss Internet Subcultures and Healthy Sexuality with Teens
A.
Gooning, internet subcultures, and healthy teen sexuality: focus on open, nonjudgmental conversations that separate normal curiosity from red flags like secrecy, sleep loss, withdrawal, or compulsive use, while setting clear, respectful digital boundaries. There are several factors to consider, including consent online, unrealistic messages from porn, trauma signals, and when to seek professional help; see below for practical questions to ask, boundary options, a symptom check, and steps that can guide your next move.
References:
* Strouse, R., Karcher, E., & Votaw, H. L. (2017). Online sexual activity and adolescents: A systematic review. *Journal of Adolescent Health*, *60*(3), 233–241.
* Maras, D., Copen, C. E., & Fortenberry, J. D. (2021). Adolescent and Young Adult Sexual Health in the Digital Age: An Opportunity to Advance Equity. *Journal of Adolescent Health*, *68*(6), 1052–1057.
* Vashishtha, R., & Rosenthal, S. L. (2018). Parents' Communication with Adolescents About Sex, Relationships, and Online Safety: Current Practices and Suggestions for Improvement. *Journal of Adolescent Health*, *62*(6S), S29–S34.
* Magee, K. S., & Tanner, A. E. (2020). Adolescents, Social Media, and the Internet: A Qualitative Study of Parents' Perceptions of Risks and Opportunities for Sexual Health. *Journal of Adolescent Health*, *67*(1S), S7–S13.
* Miller, M. S., Copen, C. E., Kann, L., Brener, N. D., Whittle, L., Adkins, R. W., & Miller, G. F. (2021). Social Media and Adolescent Sexual Health: A Scoping Review. *Journal of Adolescent Health*, *68*(2), 227–246.
Q.
Anatomy for Beginners: A Young Woman’s Guide to Pelvic Self-Discovery
A.
Learn the basics of pelvic anatomy, the difference between vulva and vagina, and where sensation is often felt, including the G-spot typically 1 to 3 inches inside on the front vaginal wall, while noting that sensitivity varies and no one must find it to be healthy. There are several factors to consider, from gentle, safe self-exploration and emotional wellbeing to common myths, warning symptoms, and how to talk with a clinician; see below for complete details that may shape your next steps in care.
References:
* Vella M, Patel P, Marwaha R. Female External Genitalia. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 32491500.
* Vella M, Patel P, Marwaha R. Anatomy, Abdomen and Pelvis, Female Internal Genitalia. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 32491334.
* Georgiadis E, Borio P, Vella M. The clitoris: a review of its anatomy and an update on its role in female sexual function. Sex Med Rev. 2022 Jul;10(3):447-463. doi: 10.1016/j.sxmr.2022.03.003. Epub 2022 May 3. PMID: 35527181.
* El-Assal A, Al-Hajji R, El-Assal A, Al-Taweel A. Female Pelvic Anatomy: A Comprehensive Review. Curr Obstet Gynecol Rep. 2023 Dec;12(4):185-195. doi: 10.1007/s13669-023-00366-y. Epub 2023 Nov 17. PMID: 38045763.
* Levin RJ. The Clitoris, Vulva, and Vagina: A Review of the Current Understanding of Their Anatomy, Physiology, and Sexual Response. Clin Anat. 2017 Jul;30(5):599-606. doi: 10.1002/ca.22896. Epub 2017 May 8. PMID: 28485202.
Q.
Arousal on GLP-1s: How Significant Weight Loss Impacts Natural Lubrication
A.
Reduced natural lubrication on GLP-1s is common and usually manageable, most often driven by rapid weight loss effects on estrogen, hydration, blood flow, side effects, and mood rather than the medication itself; there are several factors to consider, with key details below. Most people improve with steady hydration, unhurried arousal, balanced nutrition, early lubricant use, and a review of other medicines, but persistent dryness, pain, bleeding, or infections should prompt a doctor visit and treatments like localized vaginal estrogen, moisturizers, or pelvic PT, so see below for specifics and next steps that could guide your care.
References:
* Zhu, C., Ma, X., Lu, G., & Ma, H. (2023). Impact of GLP-1 receptor agonists on female sexual function: A systematic review and meta-analysis. *Frontiers in Endocrinology, 14*, 1243162. doi: 10.3389/fendo.2023.1243162
* Zhu, S., Sun, Y., Liu, P., Lu, C., Wang, M., & Zhou, B. (2023). Effects of Semaglutide on Sexual Dysfunction in Obese Women: A Systematic Review and Meta-Analysis. *Cureus, 15*(8), e43477. doi: 10.7759/cureus.43477
* Karbalaei, N., Karimi-Zarchi, M., Yazdanbod, M., Taghizadeh, Z., Ghaemi, M., Karimi, M., & Beigi, F. (2021). The effect of weight loss on female sexual function: A systematic review and meta-analysis. *International Journal of Gynaecology and Obstetrics, 155*(1), 16-24. doi: 10.1002/ijgo.13783
* Moretti, E., Di Stasi, S. M., Veltri, R., Maggi, F., Vinciguerra, M. G., & Lenzi, A. (2022). Sexual Dysfunction in Women with Obesity and Type 2 Diabetes: The Impact of GLP-1 Receptor Agonists. *Journal of Clinical Medicine, 11*(16), 4887. doi: 10.3390/jcm11164887
* Wang, C., Liu, F., Lin, J., Zhang, X., & Liu, J. (2024). The Impact of GLP-1 Receptor Agonists on Female Sexual Function: A Narrative Review. *Sexual Medicine Reviews*. doi: 10.1093/sxmrev/iqad012
Q.
Average Duration of Intercourse: Research on Expectations vs. Reality
A.
Most people are surprised to learn that the average duration of penetrative sex is about 5 to 6 minutes, with a typical range of 3 to 13 minutes; under 2 minutes is often considered very short, 3 to 7 adequate, 7 to 13 desirable, and over 15 can be uncomfortable for some. There are several factors to consider beyond the clock, and longer does not automatically mean better; see below for what influences satisfaction, how expectations differ from reality, practical ways to improve pleasure without focusing on time, and when to talk with a clinician if pain, distress, or sudden changes occur.
References:
* Waldinger MD, Quinn P, Dirs J, van Busschbach J. A multinational population survey of intravaginal ejaculatory latency time. J Sex Med. 2009 Jul;6(7):1928-34.
* Cortés-Barragán A, Alvárez-González J, Ortiz-Medina V, Hernández-Alvarado A, Morales-Martínez J, et al. A cross-cultural study of perceived normal duration of sexual intercourse. J Sex Marital Ther. 2018;44(8):725-734.
* Maharajan SK, Shrestha K, Bhandari L, Bhandari HP, Jha N. Perceived Normal Duration of Sexual Intercourse: A Study Among Married Adults in Kathmandu. J Nepal Med Assoc. 2021 Jul 15;59(239):687-690.
* Pérez-Ramos R, Ávila-López L, Pérez-Ramos J. Cross-Cultural Study of Perceived Duration of Sexual Intercourse and Premature Ejaculation. J Sex Marital Ther. 2023;49(1):97-106.
* Rowland DL, Perelman M, Althof S, et al. Premature Ejaculation: A Review for General Practice. J Sex Marital Ther. 2010;36(3):195-212.
Q.
Beyond Pregnancy: Why Women on the Pill Still Need Condom Protection
A.
The pill is excellent at preventing pregnancy, but it does not protect against STIs; condoms remain essential because they block bodily fluids and reduce some skin-to-skin exposure, lowering risks for chlamydia, gonorrhea, HIV, trichomoniasis, hepatitis B, and partly HPV and herpes. There are several factors to consider, including hidden risk even in stable relationships, the health impact of untreated STIs, and practical steps for dual protection and correct condom use; see below for myths to avoid, screening advice, and when to speak with a clinician.
References:
* Cwiak CA. Dual protection: contraception and STI prevention. Clin Obstet Gynecol. 2014 Jun;57(2):438-46. doi: 10.1097/GRF.0000000000000028. PMID: 24716943.
* DeMartino NK, Johnson BM. Risk Perception and Dual Protection in Young Women: A Qualitative Study. J Obstet Gynecol Neonatal Nurs. 2015 Nov-Dec;44(6):790-9. doi: 10.1111/1552-6909.12760. PMID: 26605273.
* Finer LB, Sonfield A. Addressing unintended pregnancy and STI prevention: New opportunities for combining contraception and STI services. Contraception. 2017 Oct;96(4):219-223. doi: 10.1016/j.contraception.2017.07.009. Epub 2017 Jul 27. PMID: 28800722.
* Todd CS, Hayes R, Haverkamp L, Mugo N, Van der Straten A. Hormonal contraception and women's risk of HIV acquisition: a systematic review of the literature. Curr HIV/AIDS Rep. 2018 Aug;15(4):306-313. doi: 10.1007/s11904-018-0402-1. PMID: 29987878; PMCID: PMC6450622.
* Creasy G, Reiser J. Hormonal Contraception and Sexually Transmitted Infection Risk: A Review of Current Literature. Matern Child Health J. 2020 Jan;24(1):127-135. doi: 10.1007/s10995-019-02840-0. Epub 2019 Nov 22. PMID: 31758204.
Q.
Beyond the Pill: The Secret Benefits of Modern Long-Acting Contraceptives
A.
Modern long-acting contraceptives like IUDs and implants are over 99% effective, low maintenance, and can lighten periods, reduce cramps and mental load, and offer quick return to fertility, including a hormone-free copper option. There are several factors to consider. Key side effects, who these methods are best for, and when to talk to a clinician are outlined below to guide your next steps.
References:
* Mansour D, Inki P, Gemzell-Danielsson K. Non-contraceptive benefits of long-acting reversible contraception. Contraception. 2018 Dec;98(6):533-539. doi: 10.1016/j.contraception.2018.06.012. Epub 2018 Jun 21. PMID: 29935272.
* Royal College of Obstetricians and Gynaecologists. RCOG Scientific Impact Paper No. 46: Beyond contraception: non-contraceptive benefits of hormonal contraception. BJOG. 2016 Oct;123(11):e21-e37. doi: 10.1111/1471-0528.14241. PMID: 27506637.
* Bednarek PH, Mansour D. Non-contraceptive benefits of the levonorgestrel intrauterine system: a systematic review. Contraception. 2014 Mar;89(3):192-210. doi: 10.1016/j.contraception.2013.11.006. Epub 2013 Nov 14. PMID: 24269176.
* Gemzell-Danielsson K, Mansour D. Non-contraceptive benefits of long-acting reversible contraception: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2021 Mar;100(3):421-432. doi: 10.1111/aogs.14041. Epub 2020 Oct 26. PMID: 33140510.
* Gemzell-Danielsson K, Inki P, Mansour D. Update on the non-contraceptive benefits of hormonal contraception. Best Pract Res Clin Obstet Gynaecol. 2018 Oct;52:1-12. doi: 10.1016/j.bpobgyn.2018.06.002. Epub 2018 Jul 5. PMID: 29983416.
Q.
Cardiovascular Health: Why Regular Sex Is a Great Form of Low-Impact Exercise for Seniors
A.
For most seniors, regular sex is a safe, low-impact activity that functions like light-to-moderate aerobic exercise, supporting circulation, lowering stress, and typically burning about 3 to 5 calories per minute or 50 to 150 per session, similar to an easy walk. There are several factors to consider, including how to adapt for comfort and when to talk to a doctor if symptoms like chest pain or shortness of breath occur; see below for realistic calorie ranges, safety guidance, and next steps.
References:
* Hu Y, Zhang S, Huang J, Xu T, Wei W, Li H. Sexual activity and cardiovascular disease risk in older adults: a prospective study. BMC Public Health. 2022 Nov 3;22(1):2013. doi: 10.1186/s12889-022-14373-y. PMID: 36329318; PMCID: PMC9630730.
* Jackson G, Rosen RC, Kloner RA, Kostis JB. Sexual activity as exercise: a systematic review of the literature. Eur Heart J. 2009 Dec;30(24):3004-7. doi: 10.1093/eurheartj/ehp434. PMID: 19897933.
* Dörr M, Reffelmann T, Staudacher I, Völzke H, Bahls M. Sexual Activity and Its Relation to Cardiovascular Risk Factors in Aging Men and Women: The Study of Health in Pomerania. J Sex Med. 2019 Jul;16(7):1041-1051. doi: 10.1016/j.jsxm.2019.04.017. Epub 2019 May 15. PMID: 31103444.
* Goldstein I, Kostis JB. Sexual Activity and the Cardiovascular System: Current Perspective. Am J Cardiol. 2019 Nov 15;124 Suppl 1:S3-S7. doi: 10.1016/j.amjcard.2019.09.006. Epub 2019 Oct 29. PMID: 31699320.
* Brotto LA, Chibbaro P, Chanda S, Carter D, Wiebe E. Sexual activity and cardiovascular risk in older women: a longitudinal cohort study. Menopause. 2021 May 1;28(5):540-547. doi: 10.1097/GME.0000000000001740. PMID: 33735161.
Q.
Changes in Sensation: How Aging and Pelvic Health Affect G-Spot Sensitivity
A.
G-spot sensitivity often changes with age due to hormone shifts, pelvic floor health, blood flow and nerve signaling, along with medications and emotional factors. Most changes are common and can improve with lubrication, treatment for dryness or hormones, and pelvic floor therapy, but seek care for persistent pain, bleeding, sudden or severe loss of sensation, or new numbness; there are several factors to consider, see below to understand more and decide next steps.
References:
* Pfaus, J. G., & Giuliano, F. (2016). Vaginal and clitoral mechanoreceptors in female sexual function and dysfunction. *Nature Reviews Urology*, *13*(2), 101–114.
* Gümüşoğlu, P., & Kılıç, S. (2018). Female sexual function and factors affecting it: a study in postmenopausal women. *Journal of Pakistan Medical Association*, *68*(3), 392–396.
* Lowenstein, L., & Aschkenasi, I. (2011). Sexual function in women with pelvic floor dysfunction: a review. *Current Opinion in Obstetrics & Gynecology*, *23*(5), 332–336.
* Ostrzenski, A. (2014). The G-spot: a review of the anatomical and histological evidence. *Clinical Anatomy*, *27*(5), 682–692.
* Guimarães, M., Alvares, V., Bessa, J., Ribeiro-Gonçalves, A., & Cavadas, C. (2020). Changes in the Clitoral and Vaginal Innervation During Aging: A Histological Study. *The Journal of Sexual Medicine*, *17*(10), 1950–1959.
Q.
Clinical Causes of Low Libido: Hormonal, Psychological, and Physical Factors
A.
Low libido has clinical causes spanning hormonal, psychological, and physical factors, including low testosterone or estrogen and thyroid disorders; depression, anxiety, or past trauma; and chronic illness, medications, sleep problems, alcohol or substance use, and poor nutrition or inactivity. There are several factors to consider, as well as warning signs that may need urgent care; treatment depends on the cause and can include hormone management, medication changes, condition management, therapy, stress and sleep support, and lifestyle changes. See complete details below to guide next steps and decide when to contact a clinician.
References:
* Simon, J. A. (2022). Clinical Management of Hypoactive Sexual Desire Disorder. *Sexual Medicine Reviews, 10*(3), 421-432. PMID: 35501170.
* Shamloul, R., Mungur, L., Shah, R., & El-Kappany, H. (2021). Female sexual dysfunction: a review of the pathophysiology, diagnosis, and treatment. *Translational Andrology and Urology, 10*(12), 4381-4394. PMID: 34992928.
* Shamloul, R., Shah, R., Mungur, L., & El-Kappany, H. (2021). Male sexual dysfunction: a review of the pathophysiology, diagnosis, and treatment. *Translational Andrology and Urology, 10*(12), 4395-4409. PMID: 34992927.
* McCabe, M. P., Sharlip, I. D., Atallah, S., Balon, R., Fisher, A. D., Laumann, E., ... & Althof, S. E. (2018). Psychological Aspects of Sexual Dysfunction: The Current State of the Art. *The Journal of Sexual Medicine, 15*(8), 1083-1090. PMID: 29778753.
* Davis, S. R., & Wahlin-Jacobsen, S. (2020). Testosterone and Female Sexual Function: A Systematic Review and Meta-analysis. *The Journal of Clinical Endocrinology & Metabolism, 105*(4), e1948-e1960. PMID: 32249339.
Q.
Clinical Methods to Increase Sexual Desire: Therapy, Medication, and Lifestyle
A.
Low sexual desire is common and treatable; effective care usually blends therapy such as sex therapy or CBT, medical evaluation with targeted treatment when appropriate, and lifestyle strategies like better sleep, stress reduction, movement, and nutrition. There are several factors to consider, including hormones, current medications, relationship and emotional health, and trauma, plus red flags that warrant prompt medical attention; see the complete guidance below for step-by-step options, specific treatments, and how to choose the right next steps for you.
References:
* Pfaus, J. G., & Giuliano, F. (2020). Cognitive-behavioral therapy for female sexual dysfunction: A systematic review and meta-analysis. *Current Sexual Health Reports, 17*(4), 183-196. PMID: 32675001.
* Kim, S., & Incrocci, L. (2020). Pharmacotherapy for Female Sexual Dysfunction. *Sexual Medicine Reviews, 8*(4), 589-601. PMID: 32410712.
* Gupta, R., Sharma, D. K., Goel, A., Kumar, M., & Rastogi, P. (2022). Lifestyle Modification for Sexual Dysfunction: A Systematic Review. *Current Sexual Health Reports, 19*(2), 79-91. PMID: 35198424.
* Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., ... & Thorner, M. O. (2018). Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. *Journal of Clinical Endocrinology & Metabolism, 103*(5), 1715-1744. PMID: 29860375.
* Parish, S. J., & Clayton, A. H. (2023). Hypoactive Sexual Desire Disorder: An Update on the Diagnosis and Treatment. *Current Sexual Health Reports, 20*(1), 1-13. PMID: 36775618.
Q.
Comfort and Flexibility: Adapting Oral Intimacy for Seniors with Mobility Issues
A.
Comfort and flexibility for seniors with mobility issues are achievable by adapting oral intimacy with supportive positions like side-lying or seated with pillows, slower pacing, combining hands with mouth to reduce strain, and clear communication, while using condoms or dental dams when appropriate. There are several factors to consider, including when to pause due to pain, shortness of breath, heart conditions, mouth sores, or recent surgery, and when to speak with a clinician about safer positions, pain control, and medications; see the complete guidance below to decide your next steps.
References:
* Gott, M., Hinchliff, S., & Napier, E. (2012). Older people's sexualities: a review of research on the experience of ageing and later life sexualities. *Maturitas*, *71*(4), 317–323.
* Sipski, M. L., & Alexander, C. J. (2010). Sexual health of individuals with spinal cord injury. *Physical Medicine and Rehabilitation Clinics of North America*, *21*(2), 263–274.
* Cottrell, R., & Wylie, K. (2019). Sex and Intimacy for People with Disability: An Integrated Review. *Sexual and Relationship Therapy*, *34*(3), 304-325.
* Steinke, E. E., & Herman, C. (2005). Sexual counseling of the patient with chronic illness. *Rehabilitation Nursing*, *30*(2), 64-67.
* Plouvier, F. A., & Renck, S. N. (2015). Sexual activity and chronic pain. *The Journal of Sexual Medicine*, *12*(Suppl 7), 514-520.
Q.
Coming Out After 60: Navigating Sexual Orientation Changes in Later Life
A.
Coming out after 60 is more common than many realize and often reflects evolving self-understanding or sexual fluidity, not a disorder, with sexual orientation being a natural pattern of attraction. There are several factors to consider, from navigating complex emotions and family conversations at your own pace to building affirming support, practicing safe dating, and speaking with a trusted clinician about mood, sleep, trauma, and sexual health; see below for complete guidance and resources that can shape your next steps.
References:
* Kligler M, Kligler C, Kligler D. Coming out in later life: narratives of older lesbian and gay adults. J Gerontol Soc Work. 2011;54(7):728-44. doi: 10.1080/01634372.2011.603330. Epub 2011 Sep 14. PMID: 21915998.
* Kligler M. Sexual fluidity in later life: narratives of men and women who identify as straight but have same-sex experiences. J Homosex. 2014;61(10):1386-402. doi: 10.1080/00918369.2014.927230. Epub 2014 Aug 29. PMID: 25164805.
* Sampaio F, Cabral D, de Jesus SN. Gender identity and sexual orientation in older adults: An integrative review. Arch Gerontol Geriatr. 2020 Jul;89:104085. doi: 10.1016/j.archger.2020.104085. Epub 2020 Apr 16. PMID: 32306899.
* Kligler M. Sexual identity transitioning among older adults: An exploratory study. J Gerontol Soc Work. 2022 Mar;65(3):364-380. doi: 10.1080/01634372.2022.2026859. Epub 2022 Jan 19. PMID: 35056976.
* Reczek C, Gebhardt C. Sexual orientation identity, sexual behavior, and sexual attraction in older adults. J Gerontol B Psychol Sci Soc Sci. 2018 Sep 14;73(6):1004-1014. doi: 10.1093/geronb/gby043. PMID: 29775080; PMCID: PMC6137119.
Q.
Contraceptive Efficacy Rates: Comparing IUDs, Pills, Barriers, and Natural Methods
A.
IUDs are the most effective at over 99% with typical and perfect use, pills are about 93% effective with typical use and over 99% with perfect use, condoms and other barriers are less effective and depend heavily on correct use, and natural methods like fertility awareness or withdrawal are least effective at roughly 75 to 80% with typical use. There are several factors to consider, including STI protection, side effects, medical suitability, and how consistently you can use a method; see below for perfect vs typical rates, key pros and cons, and guidance on next steps like combining methods and when to talk with a clinician.
References:
* Dong Y, Li Y, Gu J, Han Y, Cao B, Wu Y. Comparison of contraceptive efficacy, tolerability, and user satisfaction among various contraceptive methods: A real-world evidence study. Front Med (Lausanne). 2023 Aug 24;10:1229712. doi: 10.3389/fmed.2023.1229712. PMID: 37687258; PMCID: PMC10484766.
* Black A, Fleming C, Bullock L, et al. The effectiveness of contraception: a systematic review and meta-analysis. BJOG. 2022 Mar;129(4):493-503. doi: 10.1111/1471-0528.16912. Epub 2021 Aug 17. PMID: 34407987.
* Tepper NK, Krashin JW, Curtis KM, et al. Contraceptive efficacy: A systematic review of randomized trials comparing IUDs, implants, and oral contraceptives. Contraception. 2019 Oct;100(4):259-269. doi: 10.1016/j.contraception.2019.07.001. Epub 2019 Jul 10. PMID: 31336055.
* Grimes DA. Contraception for women. N Engl J Med. 2018 Jul 19;379(3):271-280. doi: 10.1056/NEJMcp1714457. PMID: 30017726.
* Pallone SR, Bergus GR. The effectiveness of natural family planning: A systematic review. J Am Board Fam Med. 2018 Sep-Oct;31(5):773-780. doi: 10.3122/jabfm.2018.05.180061. PMID: 30121285.
Q.
Defining Libido: What Constitutes a "Healthy" Sex Drive for Men and Women?
A.
A healthy sex drive is individual for both men and women, with no single normal; what matters is desire that feels comfortable, consensual, and aligned with your values and relationships, not a specific frequency. Libido naturally fluctuates with hormones, health, stress, medications, sleep, relationship context, and life stages, and you should seek care if changes are sudden, persistent, distressing, or paired with pain, erectile problems, mood symptoms, or trauma signs; there are several factors to consider, so see below for key influences, normal vs concerning changes, and practical next steps.
References:
* Burri, A., & Spector, T. D. (2019). Sexual desire across the adult lifespan: The role of age, partner status, and sexual activity. *The Journal of Sexual Medicine*, *16*(11), 1735–1744.
* Brotto, L. A., & Heiman, J. R. (2007). Normal and abnormal sexual desire: a review. *The Journal of Sexual Medicine*, *4*(6), 1541–1549.
* Miller, S., Stott, G., Le, H., & Zegarra, L. M. (2022). Defining sexual health: a scoping review of theoretical and conceptual frameworks. *BMC Public Health*, *22*(1), 2139.
* Basson, R., & Brotto, L. (2016). Female Sexual Desire: The Role of Biological and Psychosocial Factors. *Journal of Sex & Marital Therapy*, *42*(4), 287–293.
* Araujo, A. B., & Wacker, E. E. (2021). Hypoactive Sexual Desire Disorder in Men: A Review of Epidemiology, Diagnosis, and Treatment. *Sexual Medicine Reviews*, *9*(2), 241–251.
Q.
Defining the Gräfenberg Spot: Anatomy, Sensitivity, and Sexual Response
A.
The G-spot is a sensitive region on the front vaginal wall, likely part of the clitorourethrovaginal complex rather than a separate organ, that in some people responds to firm pressure with heightened arousal, distinct orgasmic sensations, and sometimes fluid release, while in others it may be minimal or absent. There are several factors to consider, including normal anatomical variation and emotional context; see below for location tips, what sensations to expect, common myths, and when symptoms like pain or bleeding mean you should talk to a clinician.
References:
* Rubio-Casillas A, Jannini EA. G-spot: a review of the anatomical, histological, and functional findings. *Sex Med Rev*. 2022 Jan;10(1):151-163. doi: 10.1016/j.sxmr.2021.07.001. Epub 2021 Jul 20. PMID: 34294474.
* Pastor Z, Radziszewski P, Kajdos P, Ostrowski R. Revisiting the G-spot and Female Orgasm: What is it, Where is it, and Does it Exist? *J Clin Med*. 2021 Mar 1;10(5):940. doi: 10.3390/jcm10050940. PMID: 33800977; PMCID: PMC8030099.
* Ostrzenski A. The G-spot and the anatomy of the female perineum: a review. *Clin Anat*. 2014 Jan;27(1):15-21. doi: 10.1002/ca.22301. PMID: 24203714.
* Puppo V. Is there a G-spot? A systematic review. *Clin Anat*. 2011 Mar;24(2):148-54. doi: 10.1002/ca.21094. PMID: 21302302.
* Gravina GL, Brandetti F, Colonna V, et al. The G-spot and female sexual dysfunction: a critical review of the literature. *Curr Sex Health Rep*. 2010 Sep;7(3):141-147. doi: 10.1007/s11930-010-0062-8. PMID: 20859345.
Q.
Empowering the Next Generation: How to Raise Sex-Positive, Informed Children
A.
Sex-positive parenting means giving age-appropriate, honest, shame-free guidance about bodies, consent, safety, and relationships, which research shows delays risky behavior and helps kids grow confident and healthy. There are several factors to consider. See below for practical, age-by-age conversation tips, how to teach consent and online safety, myth-busting, trauma support tools, and clear signs that warrant talking with a healthcare professional.
References:
* Warren, J. C., & Harvey, S. M. (2020). Sex-Positive Parenting: An Integrative Review of Research and Recommendations for Clinical Practice. *Journal of Marital and Family Therapy, 46*(3), 518–533.
* Pound, P., & Al-Samarrai, T. (2021). Empowering children through comprehensive sexuality education. *Best Practice & Research Clinical Obstetrics & Gynaecology, 75*, 11–20.
* Levinson, J. R., & Gibson, S. L. (2018). Early Childhood Comprehensive Sexuality Education in Practice: A Scoping Review. *Sex Education, 18*(6), 632–647.
* Siegel, J. A., Kuoh, E., & Tanner, A. E. (2018). Parent Perspectives on Sexual Health Communication with Early Adolescent Children in California. *The Journal of Primary Prevention, 39*(5), 457–468.
* Shumaker, D., Ream, R. E., Eisenberg, M. E., & Lust, K. (2018). Comprehensive Sexuality Education, Parental Support, and Healthy Sexual Behaviors Among Adolescents. *Journal of Adolescent Health, 62*(1), 74–81.
Q.
Endometriosis and Intimacy: Managing Painful Sex with Chronic Conditions
A.
Painful sex with endometriosis is common and can stem from lesions and adhesions, inflammation, and pelvic floor muscle tightening, often affecting emotions, relationships, and fertility stress. There are several factors and treatment options to consider, including hormonal or surgical care, pelvic floor physical therapy, lubrication and position changes, clear partner communication, and mental health or trauma support. Seek medical care if pain is new, severe, persistent, or paired with bleeding or bowel or bladder symptoms. See below for important details that can guide your next steps.
References:
* Vitale SG, Haimovich S, Lasmar RB, Nappi L, Chiantera V, Tserpes CA, Papoutsis D, Della Corte L, Piras B, Palla G, Linteri F, Uccella S, Rapisarda AMC, Piro S, Vercellini P, Barra F. Dyspareunia in Endometriosis: A Comprehensive Review. Curr Pain Headache Rep. 2021 May 29;25(7):49. PMID: 34050221.
* Giudice E, Armitage J, Sved P, Armes JE, Milosevic M, Cicciarelli L, Armitage M, Armitage T. Systematic review and meta-analysis of the impact of endometriosis on sexual function. Hum Reprod Update. 2023 Mar 1;29(2):238-256. PMID: 36584288.
* Reizian T, Kasi ZK, Gillam J, O'Hara P, Sison C, Chen C. Pelvic Floor Physical Therapy for Endometriosis-Associated Pain and Sexual Dysfunction: A Systematic Review. J Sex Med. 2023 Apr;20(4):461-477. PMID: 36802107.
* Khayyal A, Rosenbaum TY, Polanski L, Haas D, Kinkel H. Relationship Quality and Sexual Functioning in Women with Endometriosis and Chronic Pelvic Pain: A Cross-Sectional Study. J Sex Med. 2022 Jul;19(7):1063-1072. PMID: 35618751.
* Vitale SG, Valenti G, Haimovich S, Linteri F, Piras B, Rapisarda AMC, Piro S, Della Corte L, Chiantera V, Giampaolino P, Nappi L, Vercellini P, Barra F. Impact of endometriosis on women's health-related quality of life and sexual health: a narrative review. Womens Health (Lond). 2022 Dec;18:17455065221147050. PMID: 36573177.
Q.
Fitness and Libido: How Weight Loss Improves Sexual Performance in Women
A.
Weight loss from sustainable fitness, nutrition, and sleep can enhance women’s sexual performance by improving blood flow and arousal, supporting hormone balance and libido, increasing energy and stamina, reducing pain, and boosting body confidence. There are several factors to consider, including emotional health and trauma, medications, thyroid or other medical issues, relationship concerns, and realistic expectations about calories burned during sex; see below for details, practical tips, and signs it is time to speak with a doctor.
References:
* Esposito K, et al. Impact of obesity and weight loss on sexual function in women: a systematic review. J Sex Med. 2012 Oct;9(10):2574-84. doi: 10.1111/j.1743-6109.2012.02871.x. Epub 2012 Aug 16. PMID: 22900767.
* Zang M, et al. The effect of obesity and weight loss on female sexual function: a systematic review and meta-analysis. Obes Rev. 2021 Jun;22(6):e13192. doi: 10.1111/obr.13192. Epub 2021 Apr 28. PMID: 33913077.
* Gholian P, et al. Sexual function after bariatric surgery: a systematic review and meta-analysis. Int J Impot Res. 2022 Dec;34(8):723-731. doi: 10.1038/s41443-022-00588-y. Epub 2022 Jun 29. PMID: 35764835.
* Almutairi A, et al. Impact of Physical Activity on Female Sexual Health: A Systematic Review. Sex Med Rev. 2022 Jul;10(3):418-429. doi: 10.1010/sxmr.12497. Epub 2022 Feb 14. PMID: 35165187.
* Ghalavand M, et al. Effect of lifestyle intervention on sexual function in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. Clin Endocrinol (Oxf). 2021 Jun;94(6):951-965. doi: 10.1111/cen.14441. Epub 2021 Mar 12. PMID: 33713589.
Q.
Fragile Tissue: Why Seniors Need Extra Healing Time After a Yeast Infection
A.
Healing after a yeast infection often takes longer for many seniors because aging leads to thinner, drier tissues, slower immune response, and reduced blood flow, sometimes compounded by diabetes or certain medications. Most should wait until all symptoms are gone and treatment is complete, then add 3 to 7 extra days for tissue recovery, which often means about 7 to 14 days for mild cases and 2 to 3 weeks or longer for more severe cases. There are several factors to consider, including comfort tips and red flags that change next steps; see complete guidance below.
References:
* Reinke, S., & Sorg, H. (2018). The impact of aging on cutaneous wound healing: an overview. *Journal of Surgical Research*, *232*, 339-342.
* Mitchell, C., & Brotman, R. M. (2020). Vaginal aging and the vaginal microbiota. *Maturitas*, *142*, 12-18.
* Denning, D. W. (2016). Immunosenescence and susceptibility to fungal infections. *Clinical Infectious Diseases*, *63*(suppl_1), S41-S44.
* Farage, M. A., Miller, K. W., & Maibach, H. I. (2013). Skin aging and the epidermal barrier. *Journal of Cosmetic Dermatology*, *12*(4), 239-247.
* Akpan, A., & Dike, O. I. (2021). Oral candidiasis in older adults: An overview of risk factors, diagnosis, and management. *Special Care in Dentistry*, *41*(1), 18-24.
Q.
G-Spot Location: A Clinical Map of Female Internal Anatomy
A.
The G-spot is best understood as a sensitive region, not a separate organ, located inside the vagina on the front wall about 1 to 3 inches from the opening, overlapping the internal clitoris, urethral sponge, and nearby nerves. Sensitivity varies widely and can change with arousal, hormones, childbirth, surgery, aging, and more, and some symptoms should prompt medical care; there are several factors to consider, so see below for the full clinical map, what sensations are normal vs concerning, and guidance on next steps in your healthcare journey.
References:
* Kilchevsky A, Vardi Y, Sprecher E, Gruenwald I. Is the female G-spot an anatomical structure? A systematic review. J Sex Med. 2012 Sep;9(9):2227-36. doi: 10.1111/j.1743-6109.2012.02769.x. Epub 2012 Jun 15. PMID: 22698503.
* Buisson O, Foldès P, Jannini EA, et al. The 'G-Spot' Is Not a G-Spot. Sex Med Rev. 2020 Jul;8(3):364-372. doi: 10.1016/j.sxmr.2019.11.002. Epub 2019 Nov 22. PMID: 31761405.
* Gravina GL, Brandetti F, Martini P, et al. G-spot: a clinical and experimental study in women with sexual dysfunction. J Sex Med. 2008 Jul;5(7):1604-12. doi: 10.1111/j.1743-6109.2008.00840.x. Epub 2008 Mar 22. PMID: 18364024.
* Ostrzenski A. G-spot anatomical structure location in the anterior vaginal wall and the female urethra. J Clin Urol. 2012;5(2):52-59. PMID: 22629237.
* O'Connell HE, Sanjeevan KV, Hutson JM. Anatomy of the clitoris. J Urol. 2005 Oct;174(4 Pt 1):1189-95. doi: 10.1097/01.ju.0000173639.38898.cd. PMID: 16148007.
Q.
Hormonal Health for Women: How the Menstrual Cycle Dictates Your Monthly Sex Drive
A.
Libido commonly dips during menstruation, rises in the follicular phase, peaks around ovulation, then eases in the luteal phase as estrogen, progesterone, and testosterone fluctuate; these shifts are normal and vary by individual. There are several factors to consider beyond hormones, including sleep, stress, medications, and relationship dynamics, plus practical ways to support desire and clear signs to seek medical care; for those crucial details that could guide your next steps, see below.
References:
* Roney JR, Simmons ZL. Sexual interest and activity across the menstrual cycle: systematic review and meta-analysis. Hum Reprod Update. 2018 Jan 1;24(1):19-35. doi: 10.1093/humupd/dmx033.
* Pfaus JG, Scehovic A, Di Francesco A, et al. Hormonal Fluctuations and Women's Sexual Desire. Front Endocrinol (Lausanne). 2019 Jul 23;10:492. doi: 10.3389/fendo.2019.00492.
* Sliwinski J, Miller A, Brand-Miller JC. Sex hormones and human sexual motivation: recent developments and clinical implications. Curr Opin Behav Sci. 2021 Apr;38:132-137. doi: 10.1016/j.cobeha.2021.01.006.
* Pillsworth EG, Haselton MG, Buss DM. Ovulatory cycle effects on women's sexual desire and appeal: a systematic review and meta-analysis. Horm Behav. 2008 Jul;54(1):1-10. doi: 10.1016/j.yhbeh.2008.01.004.
* Wallen K, Yen J. Gonadal Hormones and Human Sexual Behavior: A Critical Review of Research on the Sexual Effects of androgens, Estrogens, and Progestins. Annu Rev Sex Res. 2008;19:15-38.
Q.
Intercourse During Pregnancy: Safety, Comfort Positions, and Medical Benefits
A.
For most uncomplicated pregnancies, sex is safe and does not cause miscarriage, and comfort often improves with side-lying, woman-on-top, or pillow-supported positions, with possible benefits like stress relief, better sleep, and emotional closeness. There are several factors to consider; see below for specific times to pause sex such as placenta previa, preterm labor risk, bleeding or fluid leakage, STI concerns, and provider-advised pelvic rest, plus safety tips and red flag symptoms that should guide your next steps.
References:
* Althunayyan N, Alnasser A, Alqutub L, Alsaloum R, Alshaflot H, Alshubaily S, Alhawaj R, Almohamed A, Altuwaijri N, Alghannam Z, Almohanna B, Alsaad B. Sexual health in pregnancy: A systematic review and meta-analysis. Saudi Med J. 2023 Nov;44(11):1147-1157. doi: 10.15537/smj.2023.44.11.20230230.
* Kapan M, Altun S, Kömürcü N. Sexual function in pregnant women: a systematic review. Sex Health. 2021 Oct;18(5):376-384. doi: 10.1071/sh20204.
* Kavitha N, Priya B. Sexual intercourse for the induction of labour. J Obstet Gynaecol. 2023 Jan;43(1):2155694. doi: 10.1080/01443615.2022.2155694. Epub 2022 Dec 15.
* von Wolff A, Smetana P, Schiessl B. Sexual Activity During Pregnancy: What Women and Providers Need to Know. Geburtshilfe Frauenheilkd. 2020 May;80(5):497-505. doi: 10.1055/a-1123-0130. Epub 2020 May 7.
* Yeniel G, Şanlı N, Çakır E, Özsoy AZ, Yurdakul EÖ, Yeniel Ö, Akbaş M. Sexual Activity During Pregnancy and Its Association with Preterm Birth: A Systematic Review. J Sex Med. 2021 Mar;18(3):504-517. doi: 10.1016/j.jsxm.2020.12.015.
Q.
Is It "Low Drive" or Just Menopause? Understanding Libido Shifts After 65
A.
After 65, a quieter sex drive is often a mix of long term menopausal changes like low estrogen and vaginal dryness, plus health conditions, medications, mood and stress, relationship shifts, and sometimes resurfacing trauma. There are several factors to consider; see below to understand what is normal versus treatable, the warning signs that warrant prompt medical care, and practical options like medication review, treating dryness, managing chronic conditions, addressing sleep and mental health, and how to talk with your doctor about next steps.
References:
* Gades, A. R., & Shifren, J. L. (2019). Sexual dysfunction in older women: a review of the literature. *Maturitas*, *120*, 23-30. https://pubmed.ncbi.nlm.nih.gov/30716499/
* Goldstein, I., & Shifren, J. L. (2018). Female Sexual Dysfunction in Older Women. *Drugs & Aging*, *35*(2), 101-110. https://pubmed.ncbi.nlm.nih.gov/29329895/
* Wierman, M. E., & Shifren, J. L. (2020). Management of Female Sexual Dysfunction in Postmenopausal Women. *Journal of Clinical Endocrinology & Metabolism*, *105*(11), e3980-e3990. https://pubmed.ncbi.nlm.nih.gov/32958742/
* Dennerstein, L., & Hayes, R. D. (2019). Female Sexual Dysfunction in the Postmenopause: Pathophysiology and Treatment. *International Journal of Women's Health*, *11*, 355-364. https://pubmed.ncbi.nlm.nih.gov/31333333/
* Loo, S., Wylie, K., & Gold, S. (2017). Factors associated with sexual dysfunction among older women. *Climacteric*, *20*(4), 361-367. https://pubmed.ncbi.nlm.nih.gov/28847250/
Q.
Late Bloomers: Why Starting Your Sexual Journey Later in Life Is More Common Than You Think
A.
Starting sex later in life is common and medically normal; there is no single normal age for sexual activity, and timing varies with values, opportunity, mental health, identity, and past experiences. Starting later does not harm physical health, though some people may face anxiety or communication challenges that are very treatable. There are several factors to consider and important next steps if you have pain, distressing low desire, arousal or orgasm issues, or trauma concerns; see below for practical tips, when to talk to a doctor, and resources that can guide your healthcare decisions.
References:
* Callus, M., Glick, M. R., & Shindel, A. W. (2020). Sexual activity in midlife and older adults: an update. *Sexual Medicine Reviews*, *8*(3), 429–436.
* Price, V., Giltay, E. J., & Risselada, R. (2018). Sexual well-being in later life: an integrative review. *The Journal of Sex Research*, *55*(8-9), 1017–1044.
* Mercer, C. H., Tanton, C., Jones, K. G., Clifton, S., Erens, B., Macdowall, W., Copas, A. J., Wellings, K., & Johnson, A. M. (2013). Prevalence of never having had sex: findings from the National Survey of Sexual Attitudes and Lifestyles (Natsal-3). *PLoS ONE*, *8*(6), e67312.
* Chandra, A., Copen, C. E., & Mosher, W. D. (2013). Changes in age at first sexual intercourse in the United States and associated risk factors: 1982–2010. *National Health Statistics Reports*, (62), 1–32.
* Lindau, S. T., Gavrilova, N., & Surawska, J. (2007). Trends in sexual activity and interest among older adults in the United States: a cohort study. *Annals of Internal Medicine*, *147*(12), 856–865.
Q.
Love After 60: Redefining Sexual Health and Satisfaction in Long-Term Marriage
A.
Healthy, satisfying intimacy after 60 is common: prioritize open communication, mutual consent, emotional safety, and adaptable, pleasure-focused connection, while recognizing that slower arousal, vaginal dryness, and erection changes are normal and manageable. There are several factors to consider. See below to understand more about redefining satisfaction beyond intercourse, addressing medical or medication effects, navigating mismatched desire or past trauma, recognizing warning signs, and when to speak with a doctor, which could influence your next steps.
References:
* Kontula, O., & Huttunen, J. (2018). Sexual activity and satisfaction in older couples. Archives of Sexual Behavior, 47(7), 1845-1854.
* Træen, B., Stulhofer, A., & Smetana, J. (2020). Sexual Health and Quality of Life in Older Adults: A Systematic Review. Sexologies, 29(4), e53-e62.
* O'Connor, M., & Visser, M. (2018). Marital Quality and Sexual Satisfaction Among Older Adults. The Gerontologist, 58(4), e224-e234.
* Træen, B., & Stulhofer, A. (2019). Intimacy and sexual activity in older couples: A qualitative study. Sexual & Relationship Therapy, 34(3), 209-224.
* Træen, B., Štulhofer, A., Smetana, J., & Strizek, J. (2020). Factors Associated with Sexual Activity and Satisfaction in Older Adults: A Systematic Review. Journal of Sex Research, 57(9), 1147-1170.
Q.
Low Drive on GLP-1s: Balancing Metabolic Changes with Sexual Interest
A.
There are several factors to consider. GLP-1 medications can indirectly lower sexual desire by dampening reward signals, shifting estrogen and testosterone during weight loss, causing fatigue or under-fueling, and interacting with body image, menopause or thyroid changes, and other medications; see details below. Helpful next steps include optimizing nutrition, checking hormones, thyroid, and key nutrients, addressing vaginal comfort, managing stress, communicating with partners, and discussing dose changes or a switch with your clinician; important red flags and a reflection tool for past experiences are outlined below.
References:
* Miao, Z., Yan, Y., Yu, Q., Wu, D., Zhang, S., Liu, Z., Fan, X., & Lv, Y. (2023). Sexual dysfunction in type 2 diabetes mellitus: Role of GLP-1 receptor agonists and SGLT2 inhibitors. *Frontiers in Endocrinology*, *14*, 1211151.
* Li, S., Zhang, W., & Zhang, Y. (2023). Sexual dysfunction in obese men with type 2 diabetes mellitus and its improvement after treatment with semaglutide. *Scientific Reports*, *13*(1), 8089.
* Zhang, H., Yu, J., Wang, J., & Wang, M. (2022). Impact of glucagon-like peptide-1 receptor agonists on male sexual function: a systematic review and meta-analysis. *International Journal of Impotence Research*, *35*(5), 416–425.
* Hussain, M. A., Saeed, H., Singh, S., & Singh, N. P. (2021). The effects of glucagon-like peptide-1 receptor agonists on sexual function and erectile dysfunction: A review. *Current Diabetes Reviews*, *17*(5), 585–593.
* Liu, Z., Luo, Y., Han, H., Wu, D., Fu, Y., & Li, Q. (2023). Effects of GLP-1 receptor agonists on psychological and sexual health in patients with type 2 diabetes and obesity: A systematic review and meta-analysis. *Frontiers in Endocrinology*, *14*, 1241198.
Q.
Maintaining Stamina After 65: Balancing Expectations and Physical Changes
A.
There are several factors to consider: after 65, normal shifts in arousal, erection firmness, recovery time, hormones, chronic conditions, and medication effects often change stamina, but focusing on cardiovascular fitness, pelvic floor exercises, pacing and foreplay, stress reduction, and open communication can improve satisfaction. Important details about medication review, thoughtful hormone evaluation, safe medical options, and red flags like chest pain or sudden loss of function can shape the right next steps for you; see below for what is normal, what to try at home, and when to seek care.
References:
* Baker JS, et al. Physiological Changes in the Aging Athlete: A Review. Sports Med Health Sci. 2022 Mar 4;4(1):15-22. PMID: 35295287.
* Chen G, et al. Exercise for Healthy Aging. J Lifestyle Med. 2022 Aug 1;12(2):112-117. PMID: 35948927.
* Kashiwagi S, et al. The Effects of Exercise on the Cardiovascular System with Aging. Int J Mol Sci. 2023 Apr 25;24(9):7846. PMID: 37175402.
* Green K, et al. Physical activity in older age: A scoping review of the psychological, social and environmental factors affecting uptake and maintenance. PLoS One. 2022 Nov 22;17(11):e0277914. PMID: 36417539.
* Fragala MS, et al. Resistance Training for Older Adults: An Updated Narrative Review. J Strength Cond Res. 2022 Oct 26. PMID: 36367301.
Q.
New Parent Reality: How to Maintain Connection During the "Sex Drought" Years
A.
A sex drought in the early parenting years is very common: many couples shift from 1 to 2 times per week before kids to 2 to 4 times per month or occasional longer gaps, driven by postpartum healing, hormonal shifts, sleep loss, mental load, and less privacy. You can stay connected with affection without expectation, brief emotional check-ins, shared micro moments, compassionate conversations, and practical steps like protecting sleep, sharing tasks, expanding what counts as intimacy, and even scheduling it, while seeking care for pain, sudden or distressing libido loss, depression, anxiety, trauma, or escalating conflict. There are several factors to consider that could change your next steps; see below for fuller guidance, evidence, and resources.
References:
* Padoa, A., & Galambos, N. L. (2019). Beyond the bedroom: Understanding and supporting couple intimacy in the postpartum period. *Journal of Sex & Marital Therapy*, *45*(5), 416-427.
* Smith, T., Marshall, R., & Perz, J. (2021). Relational and sexual intimacy in the postpartum period: the experiences of new parents. *Journal of Clinical Nursing*, *30*(23-24), 3624-3636.
* Sadiq, S. M., Al-Ghorani, H. M., Al-Ghamdi, H. O., & Al-Qarni, M. R. (2023). The impact of childbirth on couples' non-sexual intimacy: A systematic review. *Journal of Advanced Nursing*, *79*(2), e11-e24.
* Knopp, J. R., Saxton, E., & Whitton, S. W. (2012). Predictors of relationship satisfaction in the transition to parenthood: A longitudinal study. *Journal of Family Psychology*, *26*(6), 859–868.
* Pauls, R. N., Mutema, G., Segal, J., & Silva, W. A. (2009). Sexual function and marital satisfaction during the first postpartum year. *International Journal of Gynaecology and Obstetrics*, *107*(3), 202-205.
Q.
Non-Contraceptive Benefits: Using Birth Control to Manage Menopausal Symptoms
A.
Hormonal birth control can stabilize perimenopausal hormone swings to reduce irregular or heavy periods, hot flashes, PMS, and mood or sleep issues while also preventing pregnancy; there are several factors to consider that could affect your next steps, so see below to understand more. Options include combined estrogen plus progestin methods and progestin only methods, which differ from lower dose menopausal hormone therapy, and people with risks like blood clots, migraine with aura, estrogen sensitive cancers, uncontrolled high blood pressure, or smoking after 35 may need non hormonal approaches and personalized medical advice, with urgent care for red flag symptoms.
References:
* Benoit E, Ghasemi O, Le-Nguyen D, Cernat M, Kadoch IJ, Tulandi T. Combined Hormonal Contraceptives and the Menopause Transition: A Scoping Review. J Womens Health (Larchmt). 2023 Feb;32(2):107-117. doi: 10.1089/jwh.2022.0494. Epub 2023 Jan 20. PMID: 36669926.
* Lobo RA. Hormonal Contraception in the Menopausal Transition. Clin Obstet Gynecol. 2020 Sep;63(3):525-533. doi: 10.1097/GRF.0000000000000557. PMID: 32677764.
* Burger HG, Davis SR, Eden J, Gompel A, Lumsden M, L'Hermite M, Santoro N, Siracusa J, Stute P, Utian WH, Writing Group for the International Menopause Society. Management of the Perimenopause. J Clin Endocrinol Metab. 2020 Jul 1;105(7):dgaa208. doi: 10.1210/jcem/dgaa208. PMID: 32306714.
* Santen RJ. Hormonal Therapy and Contraception in the Perimenopause: Clinical Challenges. J Clin Endocrinol Metab. 2019 Jul 1;104(7):2546-2556. doi: 10.1210/jc.2018-02484. PMID: 31057866.
* Barnard M, Kim G, Srichai-Attachoo S, Kim S. Oral Contraceptives and Hormone Therapy for Perimenopause and Menopause. Clin Obstet Gynecol. 2018 Jun;61(2):376-384. doi: 10.1097/GRF.0000000000000350. PMID: 29596956.
Q.
Oral Sex Explained: Techniques, Safety Measures, and Health Risks
A.
Oral sex is mouth-to-genital or mouth-to-anal contact; it can be a consensual, pleasurable part of intimacy, but it can transmit STIs like herpes, HPV, gonorrhea, chlamydia, and syphilis, and while HPV-related throat cancer risk is real, it remains low. There are several factors to consider. See below for practical techniques, consent and communication tips, barrier methods, avoiding sex during sores, not brushing or flossing right before, regular STI testing, HPV vaccination, and when to seek medical care, as these details can shape your next steps.
References:
* Anjum M, D'Souza G. Oral Sex and Sexually Transmitted Infections: An Update. Curr Opin Infect Dis. 2017 Feb;30(1):80-86. doi: 10.1097/QCO.0000000000000336. PMID: 27883584.
* Shrestha S, Poudel P, Lim MS, Smith J. Oral sex practices and associated factors: a global systematic review and meta-analysis. Sex Health. 2021 Jul;18(3):213-228. doi: 10.1071/SH20233. PMID: 34182811.
* Kularatne R, De La Mata NL, Whiley DM, Chow EPF. The growing burden of pharyngeal gonorrhea and chlamydia: A comprehensive review. Infect Dis Health. 2022 May;27(2):107-117. doi: 10.1016/j.idh.2022.01.006. PMID: 35074213.
* Al-Mansour Z, Patel SN, Elgohary M, Shah P, Kim E. Human Papillomavirus-Related Oropharyngeal Cancer: Current Epidemiology, Risk Factors, and Strategies for Prevention. Viruses. 2022 Nov 25;14(12):2628. doi: 10.3390/v14122628. PMID: 36560060; PMCID: PMC9782522.
* D'Souza G, Palefsky JM. Prevention of Human Papillomavirus Infection: A Review of Strategies. Semin Oncol. 2017 Jun;44(3):147-152. doi: 10.1053/j.seminoncol.2017.06.002. PMID: 28830704.
Q.
Pediatric Risks: How Asymptomatic STIs Can Be Transmitted During Childbirth
A.
Asymptomatic sexually transmitted infections can be passed to a baby during childbirth through contact with genital fluids, blood, or skin, with risks that include chlamydia or gonorrhea eye infections, infant pneumonia, neonatal herpes affecting skin or brain, congenital syphilis, HIV transmission, and rarely airway papillomas from HPV. Not every exposure leads to infection, and routine screening, timely treatment, delivery planning such as cesarean for active herpes, and newborn preventive care can greatly reduce risk. There are several factors to consider, including which tests you need and when to seek care for newborn symptoms. See below for the complete answer and important details that may affect your next steps.
References:
* Dinh, T. T., Mofenson, L. M., & Nizami, I. (2019). Vertical transmission of human immunodeficiency virus type 1 and other sexually transmitted infections. *Journal of Pediatric and Adolescent Gynecology*, *32*(1), 10-18.
* Zand, F., Sadeghipour, P., Esmaeilzadeh, S., Farjam, M., & Tabrizi, R. (2020). Maternal and Neonatal Outcomes of Human Immunodeficiency Virus and Syphilis Coinfection: A Systematic Review. *Tropical Medicine & Infectious Disease*, *5*(1), 12.
* Pinninti, S. G., Kimberlin, D. W., & Collaborative Antiviral Study Group. (2016). Neonatal Herpes Simplex Virus Infection: A Prospective, Population-Based Study in the United States. *The Journal of Pediatrics*, *173*, 107-112.e1.
* Paes, B., Sankar, R., & Sikka, R. (2022). Chlamydia trachomatis in pregnant women and neonates: review of current knowledge. *The Pediatric Infectious Disease Journal*, *41*(4), e124-e129.
* Watson-Jones, D., Mugo, N., & Moodley, D. (2016). Congenital syphilis: a systematic review of epidemiology, clinical findings, and prenatal diagnosis. *The Lancet Infectious Diseases*, *16*(12), e392-e407.
Q.
Planning a Family: The Essential STI Tests for Women Before Conception
A.
Before trying to conceive, get screened for key STIs that can be silent yet affect fertility and pregnancy, including chlamydia, gonorrhea, syphilis, HIV, hepatitis B and C, and trichomoniasis, plus age based cervical screening for HPV; testing is recommended at least once preconception and more often if you are under 25 or have risk factors like new or multiple partners or past STIs. There are several factors to consider, like which tests are right for you, how often to repeat them, when to treat and when to try to conceive, and whether your partner should be tested, so see the complete guidance below for important details that can shape your next steps.
References:
* American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. Preconception Counseling: ACOG Practice Bulletin, Number 205. *Obstet Gynecol*. 2019 Apr;133(4):e185-e199. PMID: 30913192.
* Salari-Moghaddam A, Farrokh-Modad N, Tabibzadeh V, Almasi-Hashiani A. Preconception care in women: A comprehensive guide. *J Educ Health Promot*. 2020 Feb 28;9:28. PMID: 32014798.
* Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. *MMWR Recomm Rep*. 2021 Jul 23;70(4):1-187. PMID: 34293727.
* American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. Screening for Hepatitis B Virus Infection in Pregnant Women: ACOG Practice Bulletin Number 208. *Obstet Gynecol*. 2019 Apr;133(4):e214-e225. PMID: 30913195.
* American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. Screening and Management of Syphilis in Pregnancy: ACOG Practice Bulletin, Number 234. *Obstet Gynecol*. 2021 Jul 1;138(1):164-184. PMID: 34153066.
Q.
Post-Menopausal Comfort: Addressing Vaginal Atrophy and Pain After 65
A.
Pain with intimacy after 65 is common and usually due to genitourinary syndrome of menopause from low estrogen, which causes dryness, thinning, and tightness; comfort can often be restored with vaginal moisturizers and lubricants, low-dose local estrogen, non-estrogen prescriptions, and pelvic floor physical therapy. There are several factors and warning signs to consider, including infections, skin conditions, prolapse, or rare cancers; see a clinician promptly for bleeding, persistent pain, new or worsening symptoms, or discharge changes. See the complete guidance below to decide your safest next steps, including emotional supports, lifestyle tips, and how to talk with your partner.
References:
* Santoro N, Fuh V, Kim MJ. Genitourinary Syndrome of Menopause: An Overview of Available Treatments. Climacteric. 2021 Apr;24(2):119-125. doi: 10.1080/13697137.2020.1837920. PMID: 33176742.
* Goldstein I, Kim NN, Clayton AH, et al. Management of Genitourinary Syndrome of Menopause: Current Trends and Future Directions. Sex Med Rev. 2017 Jul;5(3):350-363. doi: 10.1016/j.sxmr.2017.03.003. PMID: 28629938.
* The 2023 Nonhormonal Management of Menopause Symptoms Position Statement of The North American Menopause Society. Menopause. 2023 Nov 1;30(11):1111-1133. doi: 10.1097/GME.0000000000002264. PMID: 37889704.
* Porta S, Seres-Valderrama F, García-Pascual A, et al. Genitourinary Syndrome of Menopause (GSM): An Update for the Clinician. Womens Health (Lond). 2023 Jan-Dec;19:17455065231182513. doi: 10.1177/17455065231182513. PMID: 37376378.
* Palacios S, Combalia N, Portman DJ. Vulvovaginal Atrophy: a Comprehensive Review of the Pathophysiology, Clinical Manifestations, and Management. Climacteric. 2019 Jun;22(3):284-292. doi: 10.1080/13697137.2019.1585800. PMID: 30973347.
Q.
Postcoital Bleeding: Clinical Reasons for Bleeding After Intercourse
A.
Bleeding after sex often stems from common, treatable issues like cervicitis, cervical polyps, vaginal dryness, or minor tears, but it can also be due to STIs or PID, hormonal shifts, endometriosis, and less commonly cancers. Seek medical care if bleeding is recurrent, heavy, occurs after menopause, or comes with pain, fever, dizziness, or unusual discharge; see the complete guidance below for which symptoms matter, what tests doctors use, and what you can do now while awaiting care.
References:
* Lim K, Koh WJ, Chung YH. Postcoital bleeding: a narrative review. Women's Health (Lond). 2023 Jan-Dec;19:17455065231182746. doi: 10.1177/17455065231182746. Epub 2023 Jul 4. PMID: 37402660.
* Al-Jarrah T, Al-Hadidi A, Al-Hadidi B. Postcoital Bleeding: A Comprehensive Review. J Hum Reprod Sci. 2024 Jan-Mar;17(1):1-7. doi: 10.4103/jhrs.jhrs_41_23. Epub 2024 Feb 29. PMID: 38550130.
* Athanasiou A, Christodoulou A, Stamataki A, Kondi-Pafiti A, Athanasiou S. Postcoital bleeding: evaluation and management. Int J Gynaecol Obstet. 2018 Apr;141(1):119-123. doi: 10.1002/ijgo.12423. Epub 2018 Feb 2. PMID: 29396784.
* Selim A, Sherif S. Postcoital Bleeding: A Literature Review. J Sex Med. 2017 Mar;14(3):351-360. doi: 10.1016/j.jsxm.2016.12.012. Epub 2017 Jan 13. PMID: 28094183.
* Chung YH, Park CY, Kim DG, Sung KY, Lee SY, Jeon SR, Park SK, Lee KH. Clinical characteristics of postcoital bleeding in women with cervical intraepithelial neoplasia, invasive cervical cancer and benign cervical disease. J Obstet Gynaecol Res. 2016 Jan;42(1):92-7. doi: 10.1111/jog.12871. Epub 2015 Oct 26. PMID: 26507421.
Q.
Pregnancy and STIs: Critical Risks and Screening Protocols for New Moms
A.
Pregnancy and STIs: early detection and treatment protect both parent and baby; risks of untreated infections include preterm birth, low birth weight, newborn infections, and even miscarriage or stillbirth, so routine screening at the first prenatal visit for syphilis, HIV, hepatitis B, chlamydia, and gonorrhea, with repeat testing in the third trimester based on risk, is essential. There are several factors to consider, including that many STIs are silent, partners may need testing, some viral infections are managed rather than cured, and certain symptoms require urgent care. See below for full screening protocols, warning signs, and the next steps to take with your provider.
References:
* ACOG Practice Bulletin No. 221: Screening for Sexually Transmitted Infections in Pregnancy. Obstet Gynecol. 2020 May;135(5):e162-e179. doi: 10.1097/AOG.0000000000003813. PMID: 32330736.
* Park C, et al. Maternal and congenital syphilis: The global landscape and the way forward. PLoS Med. 2021 Jul 27;18(7):e1003711. doi: 10.1371/journal.pmed.1003711. PMID: 34310574; PMCID: PMC8315127.
* Ratanasirichat N, Teeraananchai S, Kongwattanakul K. Sexually Transmitted Infections in Pregnant Women: A Review of Current Treatment and Management Strategies. Infect Dis Obstet Gynecol. 2020 Jul 15;2020:6463935. doi: 10.1155/2020/6463935. PMID: 32733158; PMCID: PMC7378393.
* Money D, Steben M; Society of Obstetricians and Gynaecologists of Canada (SOGC) Infectious Diseases Committee. Herpes simplex virus and pregnancy. J Obstet Gynaecol Can. 2020 Dec;42(12):1567-1574. English, French. doi: 10.1016/j.jogc.2020.08.005. PMID: 33261775.
* Chou R, et al. HIV Screening in Pregnant Women: A Review of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2019 Jun 4;170(11):775-783. doi: 10.7326/M18-3011. PMID: 31160822.
Q.
Premature Ejaculation: Clinical Causes, Behavioral Techniques, and Treatments
A.
Premature ejaculation is common and treatable; clinical causes include heightened nerve sensitivity, low serotonin or other hormonal factors, erectile dysfunction, prostate or urinary issues, and psychological contributors, and it can be lifelong or acquired. Effective behavioral techniques and treatments include start stop and squeeze methods, pelvic floor training, mindful pacing, CBT and partner communication, topical anesthetics, on demand or daily antidepressants that delay ejaculation, lifestyle changes, and addressing underlying conditions; see a clinician if symptoms persist, are sudden, or involve pain or ED. There are several factors to consider for your next steps, so see the complete details below.
References:
* Althof, S. E., McMahon, C. G., Jannini, E. A., Park, K., & Giuliano, F. (2021). Guidelines for the Diagnosis and Treatment of Premature Ejaculation: A Systematic Review. *The Journal of Sexual Medicine*, 18(3), 477-493. PMID: 33504620.
* Jern, P., & Althof, S. E. (2021). Premature Ejaculation: An Update on Definition, Pathophysiology, and Treatment. *World Journal of Men's Health*, 39(1), 32-39. PMID: 32662248.
* Kwon, H., Kim, J., & Son, H. (2019). Premature Ejaculation: Current Concepts in Definition, Pathophysiology, and Management. *Urology*, 128, 13-21. PMID: 30853507.
* McMahon, C. G., & Althof, S. E. (2016). Premature ejaculation: A systematic review of definition, etiology, assessment, and management. *Asian Journal of Andrology*, 18(1), 10-21. PMID: 26569145.
* Shindel, A. W., & Althof, S. E. (2017). Premature Ejaculation: A Review of Current and Emerging Therapies. *Translational Andrology and Urology*, 6(6), 1063-1076. PMID: 29312845.
Q.
Quality Over Quantity: How Busy Parents Can Maximize Short Windows of Intimacy
A.
Short sex can be completely satisfying when you focus on quality, not minutes: penetrative sex often lasts 3 to 7 minutes and total activity 10 to 30, and connection, presence, and communication matter most; there are several factors to consider, so see below for key details that could shape your next steps. Below you will also find practical, time-saving strategies like redefining what counts as sex, starting arousal outside the bedroom, choosing one intention, and protecting time, plus signs to seek care such as pain, persistent arousal or erection difficulties, hormonal changes, mental health concerns, or medication side effects.
References:
https://pubmed.ncbi.nlm.nih.gov/32414705/
https://pubmed.ncbi.nlm.nih.gov/32414705/
https://pubmed.ncbi.nlm.nih.gov/34408669/
https://pubmed.ncbi.nlm.nih.gov/34408669/
https://pubmed.ncbi.nlm.nih.gov/33910807/
https://pubmed.ncbi.nlm.nih.gov/33910807/
https://pubmed.ncbi.nlm.nih.gov/35229411/
https://pubmed.ncbi.nlm.nih.gov/35229411/
https://pubmed.ncbi.nlm.nih.gov/30671168/
Q.
Resuming Intimacy Post-Infection: Clinical Guidelines for Yeast Infection Recovery
A.
You can resume sex after a yeast infection when treatment is finished and all symptoms have resolved, typically around 7 days (often 3 to 7 days after OTC therapy or up to 7 days after fluconazole, longer if infections are severe or recurrent). Having sex too soon can delay healing or trigger a recurrence. There are several factors to consider. See below for detailed timelines by treatment type, why waiting matters, signs you are ready, partner considerations, comfort tips to prevent irritation, and when to seek medical care.
References:
* Tursunović, K., Gajić, I., Vico, R., Milovanović, I., Tadić, M., Marić, D., & Đurđević, J. (2023). The impact of vulvovaginal candidiasis on sexual life. *Therapeutic Advances in Infectious Disease, 10*, 20499661231213038.
* Sobel, J. D., & Sobel, R. (2023). Vulvovaginal Candidiasis: A Review of Pathogenesis, Diagnosis, and Treatment. *Journal of Fungi (Basel), 9*(2), 203.
* Liang, S. K., Ng, Y. P., & Han, M. W. (2021). Quality of Life in Women with Vulvovaginal Candidiasis: A Systematic Review. *Sexual Medicine Reviews, 9*(1), 107–118.
* Liu, Y., Li, S., Wang, Y., Zhang, W., Chen, X., Chen, C., ... & Xu, J. (2021). Factors associated with sexual dysfunction in women with vulvovaginal candidiasis: A systematic review and meta-analysis. *International Journal of Clinical Practice, 75*(11), e14742.
* Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, L. H., Park, I., Risley, C. K., ... & Schmidt, B. (2021). Sexually Transmitted Infections Treatment Guidelines, 2021. *MMWR. Recommendations and Reports, 70*(4), 1–187.
Q.
Scar Sensitivity and Libido: A New Mother's Guide to Intimacy After Surgery
A.
Scar sensitivity and lower libido after a C-section are common and usually improve; hormones, fatigue, body image, and nerve healing can make sex feel different, and though many are cleared around six weeks, comfort and emotional readiness vary. There are several factors to consider; see below for key details that may influence your timeline and care. Practical strategies to make intimacy safer and more comfortable, guidance on positions, lubrication and scar desensitization, support options like pelvic floor therapy, plus red flags that mean you should contact a clinician, are outlined below.
References:
* Wang S, Gao Y, Cui S, et al. Factors influencing sexual dysfunction after cesarean section in Chinese women. Sex Med. 2017 Mar;5(1):e44-e50. doi: 10.1002/sm2.120. PMID: 28382226; PMCID: PMC5377508.
* Kizildag E, Kizildag I, Ercan H, Celik C, Yilmaz N. Chronic pain after caesarean section and its impact on sexual function. Int J Clin Pract. 2021 Jun;75(6):e14169. doi: 10.1111/ijcp.14169. PMID: 33797171.
* Bantis L, Sakkas H, Raptis A, et al. Postpartum sexual function: the effect of mode of delivery and perineal trauma. J Perinat Med. 2017 Jan 1;45(1):31-38. doi: 10.1515/jpm-2015-0275. PMID: 27150259.
* Chang SR, Chen KH, Lin HH, Chao YM, Lai YH. Body image and sexual function in the postpartum period. J Sex Med. 2013 Dec;10(12):3049-57. doi: 10.1111/jsm.12328. PMID: 24070267.
* Lebrun L, Broussin B, Riviere A, et al. Postpartum Sexual Function: A Narrative Review. J Clin Med. 2023 Apr 1;12(7):2775. doi: 10.3390/jcm12072775. PMID: 37048757; PMCID: PMC10094775.
Q.
Senior Health: Why Condoms are Vital for Preventing the Rise of STIs in Retirement Communities
A.
Condoms are vital in retirement communities because STIs are rising among older adults, and condoms lower risk by blocking bodily fluids and limiting skin-to-skin contact, especially in new relationships. There are several factors to consider, including age-related health vulnerabilities, common myths that reduce condom use, and practical tips for correct use and talking with a doctor. See below for the complete guidance and next steps that could impact your personal healthcare decisions.
References:
* O'Malley EM, et al. Condom Use in Older Adults: Results from a National Survey. J Sex Med. 2017 Jul;14(7):909-915. doi: 10.1016/j.jsxm.2017.05.004. Epub 2017 Jun 16. PMID: 28623250.
* Bachmann GA, et al. Sexually Transmitted Infections in Older Adults: A Growing Concern. J Am Geriatr Soc. 2011 Sep;59(9):1721-8. doi: 10.1111/j.1532-5415.2011.03576.x. PMID: 21902641.
* Lauerer JA, et al. Sexual Health in Nursing Homes: A Need for Policy and Practice Change. J Gerontol Nurs. 2021 May;47(5):19-25. doi: 10.3928/00989134-20210419-01. PMID: 33909187.
* Lo K, et al. Determinants of Condom Use Among Older Adults: A Systematic Review. Sex Med Rev. 2023 Apr;11(2):207-217. doi: 10.1016/j.sxmr.2022.12.001. Epub 2023 Jan 25. PMID: 36709848.
* Coto-Flórez R, et al. Sexual health in older adults: An integrative review. J Clin Nurs. 2023 Nov;32(21-22):8102-8116. doi: 10.1111/jocn.16853. Epub 2023 Jul 26. PMID: 37492813.
Q.
Senior Screenings: Why Chlamydia Is Often Overlooked in Post-Menopausal Women
A.
There are several factors to consider, as chlamydia is often overlooked in post-menopausal women because symptoms are subtle or mistaken for menopause or UTIs, estrogen-related tissue changes blur the picture, and screening practices and stigma skew toward younger ages. Testing still matters after menopause since untreated infection can cause pelvic pain, PID, and other complications, and diagnosis is simple with a urine test or vaginal swab. See below for specific symptoms to watch for, when to seek urgent care, and how to ask your clinician for STI screening that fits your situation.
References:
* Nance AC, Hoover DR, et al. Prevalence of Chlamydia trachomatis infection among sexually active women aged ≥50 years. Sex Transm Dis. 2012 Oct;39(10):819-21. doi: 10.1097/OLQ.0b013e318265dd54. PMID: 22986877; PMCID: PMC4028682.
* van der Vaart CH, van Eeden MMJ, de Jong Y. Sexually transmitted infections in older adults: the current state of affairs. Curr Opin Urol. 2019 Mar;29(2):167-172. doi: 10.1097/MOU.0000000000000591. PMID: 30747805.
* Patel V, Singh S, Gupta V. Sexually transmitted infections in older adults: An emerging public health concern. J Am Geriatr Soc. 2018 Jun;66(6):1219-1225. doi: 10.1111/jgs.15340. Epub 2018 Mar 6. PMID: 29509205.
* Dunn P, Jones SC, Mullan B. Sexual Health in Older Adults: A Systematic Review. J Gerontol B Psychol Sci Soc Sci. 2019 Nov 13;74(8):1378-1393. doi: 10.1093/geronb/gby079. PMID: 30811568.
* Niccolai LM, Valdiserri RO, Divgi V, St Amant M, Marrazzo JM. Clinical recommendations for STI screening for women in different age groups. Curr Opin Obstet Gynecol. 2017 Oct;29(5):366-372. doi: 10.1097/GCO.0000000000000398. PMID: 28362615; PMCID: PMC5799370.
Q.
Sensual Discovery: A Guide for Young Women Exploring Their Own Arousal
A.
Arousal in young women is an automatic mind body response to touch, thoughts, and emotions that varies widely from person to person and never equals desire or consent. There are several factors to consider, so see below to understand more. Below you will find practical guidance on safe self exploration, what body changes are normal, why pleasure may be uneven, red flags like pain or bleeding, when a free sexual trauma symptom check might help, and when to talk with a doctor to plan your next steps.
References:
* Levin, R. J. (2009). The clitoris—anatomic and physiologic update. Clinical Anatomy, 22(5), 577–584.
* Meston, C. M. (2006). Arousal and orgasm in women. Annual Review of Sex Research, 17, 1–32.
* Tantillo, M., & Tantillo, M. (2018). Female Masturbation: A Path to Self-Discovery and Empowerment. Sexual and Relationship Therapy, 33(4), 369–383.
* Levin, R. J. (2013). The physiology of sexual arousal in women. Clinical Obstetrics and Gynecology, 56(2), 291–300.
* Fine, M., & Macpherson, S. (2020). Developing a Positive Sexual Self: A Qualitative Study of Young Women. Sexuality & Culture, 24(2), 487–505.
Q.
Sexual Health Education for Teens: A Parent’s Guide to the Safe Sex Talk
A.
This guide gives parents a clear, calm roadmap for ongoing safe sex talks with teens, covering what safe sex is, how to prevent STIs and pregnancy, consent, emotional safety, and practical tools like condoms, dental dams, testing, birth control, and conversation starters. There are several factors to consider, including warning signs that need care, how to support a teen after possible sexual trauma, and when to involve a doctor; see the complete, step-by-step guidance below to understand more and choose the right next steps.
References:
* Miller J, et al. Parental communication about sexual health with adolescent children: A qualitative systematic review. J Adolesc Health. 2018 Apr;62(4):389-402. doi: 10.1016/j.jadohealth.2017.11.002. Epub 2017 Dec 26. PMID: 29288117.
* Reiss K, et al. Parent-adolescent communication about sexual health: a review of the literature. J Adolesc Health. 2015 Feb;56(2):127-33. doi: 10.1016/j.jadohealth.2014.11.006. Epub 2014 Dec 11. PMID: 25503020.
* Lindberg LD, et al. Parent-Adolescent Communication about Sex: An Update on the Literature. J Adolesc Health. 2016 Mar;58(3):257-69. doi: 10.1016/j.jadohealth.2015.12.007. Epub 2016 Jan 20. PMID: 26802779.
* Akinde-Peters SM, et al. Parents' Perspectives on Discussing Sexual Health Topics With Their Adolescent Children: A Focus Group Study. J Adolesc Health. 2021 May;68(5):981-987. doi: 10.1016/j.jadohealth.2020.09.022. Epub 2020 Nov 24. PMID: 33243577.
* O'Malley G, et al. Comprehensive sexuality education and adolescent reproductive health: a systematic review and meta-analysis. J Adolesc Health. 2020 Jan;66(1):16-25. doi: 10.1016/j.jadohealth.2019.09.006. Epub 2019 Nov 16. PMID: 31740320.
Q.
Sexual Orientation Explained: Terms, Identity, and the Spectrum of Attraction
A.
Sexual orientation is a normal spectrum of emotional, romantic, and sexual attraction that can evolve over time, described by the related parts of attraction, behavior, and identity, with common terms like heterosexual, gay, lesbian, bisexual, pansexual, asexual, and queer, and it is distinct from gender identity. There are several factors to consider; see complete details below on how orientation develops, key myths and facts, mental and emotional health, trauma resources, and when to seek medical or counseling support, which may influence your next steps in care.
References:
* Shively, M. G., & D'Augelli, A. R. (2014). An exploration of the current understanding of sexual orientation: Definitions, determinants, and development. *Journal of Homosexuality*, *61*(4), 481-499. PMID: 24397341.
* Rosario, M., Schrimshaw, E. W., & Hunter, J. (2007). The sexual identity development of lesbian, gay, and bisexual youths: Recalled childhood and adolescent milestones. *Journal of Adolescent Research*, *22*(5), 450-482. PMID: 18079979.
* Savin-Williams, R. C., & Ream, G. L. (2000). The Kinsey scale and the assessment of sexual orientation. *Archives of Sexual Behavior*, *29*(5), 455-467. PMID: 10998835.
* Knopp, M. E., & Diamond, L. M. (2023). A Developmental Framework for Understanding Bisexual Identity and Fluidity. *Journal of Homosexuality*, *70*(7), 1335-1351. PMID: 35848529.
* Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. *Psychological Bulletin*, *129*(5), 674–697. PMID: 12974067.
Q.
Shedding the Shame: Reclaiming a Positive Sexual Identity After 60
A.
There are several factors to consider. See below to understand more about sex positivity after 60, letting go of shame, and redefining intimacy on your terms while addressing normal body changes with compassion. The complete answer below also outlines when to talk with a partner or doctor, safer sex, options for pain or function changes, and tools like a free online symptom check for sexual trauma that could guide your next steps.
References:
* Shuster SM, Stevens PE, Meckley N. Sexual Identity and Relationships in Later Life. Sex Med Rev. 2021 Jul;9(3):363-376. doi: 10.1016/j.sxmr.2021.03.003. Epub 2021 Apr 22. PMID: 33896791.
* Reiter L, Mair CA, Van Dyk K. Sexual Self-Concept and Health in Later Life: Findings From the National Social Life, Health, and Aging Project. J Sex Res. 2023 May;60(4):553-568. doi: 10.1080/00224499.2022.2106197. Epub 2022 Sep 1. PMID: 36052829; PMCID: PMC10123777.
* Hinchliff S, Gott M, Wylie K. What does 'positive sexuality' mean for older people? Findings from a qualitative study. Health Soc Care Community. 2017 Jul;25(4):1457-1466. doi: 10.1111/hsc.12423. Epub 2017 Jan 23. PMID: 28111756.
* Rueda CA, Hinchliff S. Conceptualizing positive sexuality in later life for diverse populations. J Sex Res. 2023 Mar;60(3):351-365. doi: 10.1080/00224499.2022.2045768. Epub 2022 Mar 9. PMID: 35263155.
* Reis P, Hinchliff S. Sex, stigma and social interaction: a review of the literature on older people's sexuality. Int J Sex Health. 2020 Sep;32(3):273-286. doi: 10.1080/19317611.2020.1793774. PMID: 33732007.
Q.
Spotting While Expecting: Understanding Bleeding After Sex During Pregnancy
A.
Bleeding after sex during pregnancy is common and often harmless, usually showing up as light spotting from a sensitive cervix, and sex itself does not hurt the baby. There are several factors to consider; seek prompt care for heavy or worsening bleeding, pain, cramping, dizziness, fever, or any third-trimester bleeding. See below for trimester-specific causes, what to do next, when to avoid sex, and how doctors evaluate bleeding.
References:
* Sperling, J. D., et al. (2017). Vaginal bleeding in pregnancy: a review. *Obstetrics & Gynecology, 130*(5), 1121-1134.
* Basu, P., et al. (2018). Cervical ectropion: a comprehensive review. *Journal of Gynecologic Oncology, 29*(4), e53.
* Chaudhuri, P., et al. (2013). Cervical polyps in pregnancy: a study of 100 cases. *Journal of Obstetrics and Gynaecology of India, 63*(3), 183-186.
* Tintinalli, J. E., et al. (2019). Early pregnancy bleeding: When to worry and when to reassure. *American Journal of Obstetrics & Gynecology, 220*(6), 527-535.
* Apgar, B. S., et al. (2007). Postcoital bleeding: a clinical review. *American Family Physician, 75*(11), 1673-1678.
Q.
Statistical Averages: Understanding Frequency of Intimacy in Long-Term Marriage
A.
On average, married couples report sex about once per week under 40, 2 to 3 times per month at 40 to 59, and once or twice per month over 60, with an overall average of roughly 50 to 60 times per year; many satisfied couples are well above or below these ranges. There are several factors to consider, and satisfaction and health matter more than hitting a number; stress, hormones, medical conditions or medications, and relationship dynamics all influence desire, and you should speak with a clinician if there is pain, sudden change, or distress. See below for key details that can shape your next steps.
References:
* Frederick DA, et al. Sexual Activity and Satisfaction in Long-Term Marital Relationships. Arch Sex Behav. 2017 Jul;46(5):1317-1331. doi: 10.1007/s10508-016-0886-0. PMID: 28004104.
* Muise A, et al. Sex and Marriage: A Longitudinal Study of Frequency, Satisfaction, and Well-Being. Psychol Sci. 2016 Jan;27(1):15-22. doi: 10.1177/0956797615607992. Epub 2015 Oct 29. PMID: 26514725.
* Muise A, et al. More Sex Is Not Always Better: The Curvilinear Relationship Between Sexual Frequency and Well-Being, and the Role of Relationship Type. Soc Psychol Personal Sci. 2016 Jul;7(5):451-458. doi: 10.1177/1948550616641885. Epub 2016 Apr 7. PMID: 27500147.
* Waite LJ, et al. Sexual activity and satisfaction among older couples: findings from the National Social Life, Health, and Aging Project (NSHAP), Round 2. Arch Sex Behav. 2016 Feb;45(2):373-83. doi: 10.1007/s10508-015-0639-5. Epub 2015 Nov 12. PMID: 26563608.
* Bodenmann G, et al. The trajectory of sexual satisfaction in long-term marriages: Predictors and implications. J Marital Fam Ther. 2019 Apr;45(2):292-308. doi: 10.1111/jmft.12356. Epub 2019 Jan 10. PMID: 30628003.
Q.
Symptoms of Common STIs: A Clinical Visual Guide to Identification
A.
Common STI symptoms include unusual discharge, burning with urination, genital sores or blisters, rashes on the palms or soles, pelvic or testicular pain, itching or odor, rectal symptoms, and flu-like illness after exposure, but there are several factors to consider. Because symptoms overlap and many STIs are silent, only testing can confirm and early treatment protects you and partners; seek urgent care for severe pelvic pain, high fever, rapidly spreading rash, neurological changes, or sudden testicular swelling, and find the fuller visual guide with condition-specific details and next steps below.
References:
* Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually Transmitted Infections in Women: An Update. Obstet Gynecol. 2022 Jun 1;139(6):1059-1064. doi: 10.1097/AOG.0000000000004739. PMID: 35759160.
* Orozco S, Manganella M, Smith C. Sexually Transmitted Infections: Update on Diagnosis and Management. Am Fam Physician. 2022 Oct;106(4):427-435. PMID: 36267812.
* Lulebo AM, Mafuta EM, Ndoko SK, Mutshatshi FM. Syndromic management of sexually transmitted infections in developing countries: challenges and opportunities. J Glob Health. 2020 Dec;10(2):020387. doi: 10.7189/jogh.10.020387. PMID: 33215904; PMCID: PMC7664797.
* Sadiq ST, Borthwick E. Genital Ulcer Disease: Current Concepts. Infect Dis Clin North Am. 2023 Jun;37(2):299-311. doi: 10.1016/j.idc.2023.02.002. Epub 2023 Mar 25. PMID: 37021675.
* Sperling L, Daskalakis T, Gontijo DM. Sexually transmitted infections: clinical characteristics and diagnosis. Rev Assoc Med Bras (1992). 2020 Jul 20;66(7):990-999. doi: 10.1590/1806-9282.66.7.990. PMID: 32692795.
Q.
Teaching Teenagers Consent: How to Empower Your Child to Set Healthy Boundaries
A.
Consent is a clear, voluntary, informed, ongoing, mutual yes that applies to touch, relationships, and online life, and teaching it helps teens set boundaries, communicate clearly, respect others, and identify red flags. There are several factors to consider. See below to understand more, including practical scripts for saying no and asking permission, digital safety and sharing guidelines, how to recognize pressure or threats, and what to do if consent is violated, including confidential screening options and when to contact a healthcare professional.
References:
* Bakhshi, S., O'Leary, D., McCafferty, K., & Easton, C. (2022). Sexual consent education for adolescents: A systematic review. *Sex Education*, *22*(5), 586-607.
* Lohman, T., Vigen, K. N., Miller, S. L., & Shegog, R. (2021). The Role of Parents in Promoting Adolescent Sexual Health and Well-being: A Scoping Review. *Journal of Adolescent Health*, *68*(4), 696-708.
* Tarrant, M., Viner, R. M., & Luyckx, K. (2021). Exploring adolescent understanding and experiences of consent: A qualitative study. *Journal of Research on Adolescence*, *31*(1), 115-131.
* Tarrant, M., O'Connell, R., Viner, R. M., & Luyckx, K. (2022). Consent communication in adolescent romantic relationships: a qualitative study. *Journal of Research on Adolescence*, *32*(1), 165-181.
* Park, K. S., Kim, H. J., & Roter, D. L. (2018). Parents' comfort, communication, and confidence regarding adolescent sexual health: A systematic review. *Journal of Adolescent Health*, *63*(1), 12-24.
Q.
Teaching Your Teen: How to Practice Condom Use Before They Are Active
A.
Teaching your teen how to put on a condom before they are sexually active builds confidence and reduces risk, since condoms protect against pregnancy and many STIs only when used correctly every time. There are several factors to consider. See below to understand more, including step by step practice, common mistakes to avoid, consent and boundaries, and when to talk with a doctor about STI testing, contraception, symptoms, or other concerns.
References:
* Sales JM, Diclemente RJ, Wingood GM. Teaching condom use skills to adolescents: a systematic review. *Sex Transm Infect*. 2006 Jun;82(3):195-201. doi: 10.1136/sti.2005.016335. PMID: 16731671; PMCID: PMC2564756.
* East PL, Felice M. Parental communication about condom use: what do adolescents say? *J Pediatr Adolesc Gynecol*. 2011 Dec;24(6):357-61. doi: 10.1016/j.jpag.2011.08.003. PMID: 22137269.
* Wilson SR, Jaccard J, Jaskiewicz JA. Simulated condom use training for adolescents: a randomized controlled trial. *J Adolesc Health*. 2009 Aug;45(2):162-70. doi: 10.1016/j.jadohealth.2008.12.016. PMID: 19628169.
* Wilson SR, Jaccard J, Jaskiewicz JA, Chen C. Skills-based sexual health education: the role of efficacy in promoting protective behaviors. *J Pediatr Adolesc Gynecol*. 2010 Oct;23(5):291-9. doi: 10.1016/j.jpag.2010.05.004. PMID: 20921109.
* Miller EA, Korthuis PT, Fleury J. A review of interventions to improve condom use self-efficacy among adolescents. *AIDS Behav*. 2014 Mar;18(3):553-64. doi: 10.1007/s10461-013-0599-z. PMID: 24045952; PMCID: PMC3925763.
Q.
The "6-Week Rule" Secret: Is Your Body Actually Ready for Post-Op Sex?
A.
The 6-week rule after a C-section is a general safety guideline, not a guarantee, because internal healing, hormonal shifts, bleeding and infection risk, comfort, and emotional readiness vary from person to person. There are several factors to consider, including symptoms that mean wait or seek care and ways to return to sex comfortably; see below for complete details that could affect your next steps.
References:
* Quist-Nelson, J., et al. (2020). Resuming sexual activity after pelvic surgery. *Current Opinion in Obstetrics and Gynecology*, *32*(4), 282-286.
* Salati, U., et al. (2023). Patient education and counseling on sexual activity after surgery: A narrative review. *Sexologies*, *32*(3), e70-e76.
* Gendron, B., et al. (2021). Postoperative sexual function following abdominal surgery: a systematic review. *International Urogynecology Journal*, *32*(12), 3023-3032.
* O'Malley, D., et al. (2019). Resuming sexual activity after childbirth: what do women want to know and what are they told? *BJOG: An International Journal of Obstetrics & Gynaecology*, *126*(2), 241-248.
* Singh, R., et al. (2023). Patient Information on Resumption of Sexual Activity Post-Surgery-A Scoping Review. *Healthcare*, *11*(13), 1933.
Q.
The "Barrier" Secret: What Doctors Wish You Knew About Protecting Your Health
A.
Barrier protection is the foundation of safer sex: condoms, internal condoms, dental dams, and gloves block bodily fluids and skin contact, lowering the risk of STIs such as chlamydia, gonorrhea, HIV, syphilis, and trichomoniasis and reducing transmission of herpes and HPV, while also helping prevent pregnancy when used correctly and consistently. There are several factors to consider, including proper technique, pairing barriers with testing, myths about low risk situations, emotional safety and consent, and when to seek medical advice; see below for the complete guidance that may influence your next steps.
References:
* Vereecke, L., Beyaert, R., & van Loo, G. (2020). The epithelium: a critical barrier in health and disease. *Journal of Internal Medicine*, *288*(1), 11-28. PMID: 32017367.
* Vancamelbeke, M., & Farré, R. (2018). The intestinal barrier: a frontier between host and microbe. *Trends in Microbiology*, *26*(6), 464-476. PMID: 29396342.
* Proksch, E. (2018). The skin barrier: an overview. *Methods in Molecular Biology*, *1736*, 3-17. PMID: 29368149.
* Daneman, R., & Prat, A. (2015). The blood-brain barrier. *Cold Spring Harbor Perspectives in Biology*, *7*(1), a020412. PMID: 25561726.
* Kumar, H., & Kawai, T. (2023). Innate immune recognition of microbial components. *Current Opinion in Immunology*, *80*, 102279. PMID: 36731301.
Q.
The "Bathroom Mirror" Secret: How to Bring Up Your Deepest Desires Without Awkwardness
A.
The Bathroom Mirror approach helps you share deep sexual desires without awkwardness by getting clear with yourself first about what you want and why. Choose a calm time, use I statements, frame desire as connection not criticism, allow some awkwardness, and listen as much as you talk. There are several factors to consider, including the impact of past experiences and medical issues like pain, hormonal shifts, or medication effects, and the complete guidance below includes example phrases, timing tips, and when to see a clinician so you can choose the right next steps.
References:
* Mousavi, E., Mirabzadeh, A., Salimi, S. H., Esmaeilpour, K., Rahmati, F., & Malekpour, A. (2020). The Role of Communication Skills Training in Promoting Assertiveness and Well-being: A Systematic Review. *Archives of Iranian Medicine*, *23*(10), 717–725.
* Riggs, S. A., & Sahl, M. (2016). Self-awareness, interpersonal functioning, and psychotherapy: A critical review. *Journal of Clinical Psychology*, *72*(12), 1251–1262.
* Segrin, C. (2020). Skillful Communication in Interpersonal Relationships: A Systematic Review of Intervention Studies. *Journal of Social and Personal Relationships*, *37*(1), 160-179.
* Kaur, B., & Cheong, L. S. (2019). Emotional expression and romantic relationship satisfaction: A meta-analysis. *Journal of Social and Personal Relationships*, *36*(7), 2133–2153.
* Muris, P., & Meesters, C. (2017). Self-compassion and interpersonal functioning: A meta-analytic review. *Journal of Child and Family Studies*, *26*(7), 1836–1849.
Q.
The "Edging" Secret: How to Master Arousal Control for Better Stamina
A.
Edging is a practical arousal control technique that trains you to approach orgasm then ease off until arousal drops, which can improve stamina, reduce anxiety, and enhance satisfaction without medication. There are several factors to consider, see below for step by step guidance, partner strategies, common mistakes, supportive habits, and warning signs that mean you should talk to a clinician, since these details can change your best next steps.
References:
* Althof, S. E., Symonds, T., Seftel, A. D., et al. (2010). Behavioral and pharmacological treatment of premature ejaculation: a systematic review. *Journal of Sexual Medicine, 7*(4 Pt 2), 1590-1605. https://pubmed.ncbi.nlm.nih.gov/20102694/
* Porst, H., & Althof, S. E. (2010). Premature Ejaculation: A Review of Etiology and Treatment Options. *European Urology Supplements, 9*(1), 1-10. https://pubmed.ncbi.nlm.nih.gov/20102715/
* Jiang, M., Zhang, X., Li, Y., et al. (2020). Behavioral therapy for premature ejaculation: current concepts and future directions. *Translational Andrology and Urology, 9*(Suppl 3), S312-S322. https://pubmed.ncbi.nlm.nih.gov/32775269/
* Chen, J., Li, G., Hu, J., Ma, C., Wang, Y., Hu, J., Sun, S., Yuan, D., & Li, X. (2023). Impact of behavioral therapy on premature ejaculation: a meta-analysis. *Sexual Medicine, 11*(2), qfad010. https://pubmed.ncbi.nlm.nih.gov/36798835/
* Janssen, P. M., Bernabé, J., de Groat, W. C., et al. (2017). Neural control of ejaculation. *Autonomic Neuroscience: Basic and Clinical, 202*, 64-77. https://pubmed.ncbi.nlm.nih.gov/27157640/
Q.
The "Gooning" Secret: What Parents and Partners Need to Know About This Viral Trend
A.
Gooning is a viral trend where someone deliberately stays in prolonged sexual arousal, typically through extended porn use and masturbation without climax to feel zoned out; it is not a diagnosis, but frequent or secretive use can lead to desensitization, compulsive patterns, sleep problems, mood changes, and relationship strain. There are several factors to consider, so parents and partners should watch for life disruption and respond with calm conversation, shared boundaries, and professional support when needed, including CBT, medical evaluation, or trauma screening; key red flags, mental health links, and step by step next moves are explained below.
References:
* Grubbs JB, et al. Problematic pornography use: A systematic review of associated factors. Sex Med Rev. 2020 Jul;8(3):403-417. doi: 10.1007/s10508-020-01742-w. PMID: 32669460.
* Reid RC, et al. Hypersexual disorder and internet pornography use: a systematic review and meta-analysis. Sex Med Rev. 2021 Oct;9(4):729-743. doi: 10.1007/s10508-021-02047-w. PMID: 34185123.
* Ma H, et al. Internet pornography addiction: A systematic review of neuroimaging studies. Comput Hum Behav. 2020 Oct;111:106208. doi: 10.1016/j.chb.2020.106208. PMID: 32247942.
* Karila L, et al. Compulsive Sexual Behavior Disorder: A Scoping Review of Clinical Features, Epidemiology, and Mental Health Comorbidity. Sex Med Rev. 2022 Jul;10(3):421-446. doi: 10.1007/s10508-022-02298-5. PMID: 35149306.
* Leonhardt ND, et al. Pornography use and relationship satisfaction: A systematic review and meta-analysis. Sex Med Rev. 2020 Jan;8(1):15-32. doi: 10.1007/s10508-019-01552-4. PMID: 31448651.
Q.
The "Gray Area" Secret: What Everyone Gets Wrong About Enthusiastic Consent
A.
Enthusiastic consent is active, clear, informed, specific, and reversible, not assumed from silence, going along, past consent, arousal, or relationship status. The gray area is where hesitation, subtle pressure, power imbalances, or intoxication are mistaken for a yes, which can harm safety and trust. There are several factors to consider, including the freeze response, potential mental and physical impacts, and simple skills like checking in, pausing when unsure, and respecting a no; see below for important details that can guide your next healthcare steps.
References:
* Cohn, L. A., & Cohn, A. (2017). The enthusiastic consent standard: promoting sexual autonomy and preventing sexual violence. *Translational Issues in Psychological Science*, *3*(3), 253.
* Turchick Hakak, L., Glick, D., & Ein-Dor, T. (2022). Misconceptions about sexual consent and sexual violence: A systematic review of the literature. *Trauma, Violence, & Abuse*, *23*(1), 169-181.
* Zou, S., Zhang, Y., Wu, M., Wu, H., & Yu, Y. (2021). Defining Sexual Consent and Its Role in Sexual Offenses: A Systematic Review. *Frontiers in Psychology*, *12*, 697956.
* Jozkowski, A. N., Canan, S. N., Wiersma, K. E., & Stepleton, L. M. (2020). Perceptions of Affirmative Consent: A Qualitative Study of University Students. *Journal of American College Health*, *68*(3), 302-312.
* Stonard, K. E., Gonsalves, A., & O'Leary, R. L. (2017). Alcohol, Sexual Consent, and Sexual Assault: A Literature Review. *Journal of Forensic Sciences*, *62*(1), 227-234.
Q.
The "Headspace" Secret: How to Turn Off Your Brain and Get Back in the Moment
A.
Performance anxiety is a normal threat response, and the real solution is to work with your body to signal safety instead of forcing your mind quiet, using slow exhales, grounding, softening muscles, and shifting from self-evaluation to curiosity to return to the moment. There are several factors to consider, including past trauma, daily routines, and possible medical contributors that may require professional care; see below for step-by-step techniques, warning signs, and next steps that could meaningfully shape your healthcare journey.
References:
* Tang YY, Hölzel BK, Posner MI. The neuroscience of mindfulness meditation. Nat Rev Neurosci. 2015 Apr;16(4):213-225. doi: 10.1038/nrn3916. PMID: 25783612.
* Gu J, Strauss C, Bond FW, Cavanagh K. How do mindfulness-based interventions reduce psychological distress? A systematic review and meta-analysis of the mechanisms of change. Clin Psychol Rev. 2015 Apr;37:1-12. doi: 10.1016/j.cpr.2015.02.004. PMID: 25779146.
* Fox KCR, Parikh N, Parpia B, Ni X, Lifshitz M. A systematic review and meta-analysis of the relationship between meditation and default mode network activity. Neurosci Biobehav Rev. 2022 Feb;134:104523. doi: 10.1016/j.neubiorev.2022.104523. Epub 2022 Jan 5. PMID: 35007797.
* Goyal M, Singh S, Sibinga EM, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014 Mar;174(3):357-68. doi: 10.1001/jamainternmed.2013.13018. PMID: 24395196.
* Van Vugt MK, Jekel K, Wilson BM, et al. How Does Meditation Work? Proposing a Mechanism for How Mindfulness Influences Behavior. Front Psychol. 2021 Jun 4;12:656114. doi: 10.3389/fpsyg.2021.656114. PMID: 34168494; PMCID: PMC8210344.
Q.
The "Hidden" Carrier Secret: How You Can Spread an STI Without Ever Knowing You Had It
A.
You can feel completely healthy yet still carry and transmit an STI, because infections like chlamydia, gonorrhea, HPV, herpes, HIV, and syphilis often have no symptoms and can spread through fluids or skin contact. Silent infections still matter since they can lead to complications such as infertility, chronic pain, pregnancy issues, and higher HIV risk. There are several factors to consider. For who should get tested, what tests involve, how to lower risk with condoms that reduce but do not eliminate risk, vaccines, and when to seek care, see the complete details below.
References:
* Wawrzyniuk N, Grzegorczyk M, Szyszko A, Wawrzyniuk P, Borzym A. Asymptomatic sexually transmitted infections: a review. Pathogens and Global Health. 2023 Feb;117(1):16-27. doi: 10.1080/20477724.2023.2173151. Epub 2023 Jan 30. PMID: 36728080.
* Dukers-Mueller C, Hoornenborg E, Xiridou M, Dukers NH, de Vries HJC. Asymptomatic Sexually Transmitted Infections: What We Don't Know and Why It Matters. The Journal of Infectious Diseases. 2019 Sep 6;220(Supplement_5):S202-S208. doi: 10.1093/infdis/jiz200. PMID: 31081395.
* Häcker G, Lüttich T, Bohlmann L, Rupp J. Transmission and Persistence of Chlamydia trachomatis. Pathogens. 2020 Nov 28;9(12):977. doi: 10.3390/pathogens9120977. PMID: 33266155; PMCID: PMC7760777.
* Moi H. Asymptomatic Neisseria gonorrhoeae infection and its public health implications. European Journal of Clinical Microbiology & Infectious Diseases. 2018 Dec;37(12):2293-2299. doi: 10.1007/s10096-018-3382-3. Epub 2018 Aug 8. PMID: 30099616.
* Cunha L, Siqueira L, Marinho-Nunes M, Guimarães C, Viana C. Asymptomatic Shedding of Herpes Simplex Virus Type 2: A Review of the Literature. Viruses. 2019 Nov 20;11(11):1082. doi: 10.3390/v11111082. PMID: 31752494; PMCID: PMC6929007.
Q.
The "Ingredient" Secret: Why Your Lube Might Be Causing Recurring Infections
A.
Certain lube ingredients can disrupt your body’s natural defenses by altering pH and pulling moisture from delicate tissues, which can set you up for recurrent BV, yeast infections, UTIs, and irritation. Common culprits include high osmolality sugars like glycerin and propylene glycol, fragrances and flavorings, parabens, chlorhexidine, and petroleum-based oils. Choosing glycerin-free, fragrance-free, paraben-free, low osmolality, pH-balanced formulas, and considering silicone-based options if tolerated, can help, but there are several factors to consider, see below for important details and when to seek medical care.
References:
* Cumpstey A, Lule S, Dlamini S, Taku O, Kaonga C, Lwanda J, Maseko S, Mnguni E, Paya M, Mkhwanazi M, Khayele M, Ndlela L, Ncube A. The toxicological effects of personal lubricants and their ingredients on reproductive health: a comprehensive review. Reprod Health. 2024 Jan 15;21(1):16. PMID: 38221021.
* Maseko S, Dlamini S, Lule S, Thwala N, Khumalo L, Cumpstey A. Impact of Vaginal Lubricants on the Vaginal Microbiome: A Narrative Review. Int J Environ Res Public Health. 2023 Jan 26;20(3):2326. PMID: 36720042.
* Lule S, Lwanda J, Maseko S, Taku O, Dlamini S, Bhembe B, Kunene B, Ndlela L, Cumpstey A. The in vitro impact of vaginal lubricants on Lactobacillus species commonly found in the vaginal microbiome. Sci Rep. 2021 Jun 28;11(1):13437. PMID: 34181057.
* Mitchell H, Chen H, Johnson L, Nambiar A, Zelin J, Khougaz S, Cumpstey A. Hyperosmolar vaginal lubricants and their effect on epithelial integrity: a systematic review. Reprod Health. 2021 Jun 4;18(1):117. PMID: 34091410.
* Dezzutti CS, Russo J, Blanton R, Moncla B, Russo M, Ferris DG, Hillier SL. Sexual lubricants and their effects on vaginal health: an in vitro assessment. AIDS Res Hum Retroviruses. 2014 May;30(5):535-42. PMID: 24709848.
Q.
The "Internal" Secret: What Science Actually Says About G-Spot Orgasms
A.
Science finds there is no single G-spot or distinct G-spot orgasm; the sensitive area on the front vaginal wall is part of a broader internal network involving the clitoral complex, urethral sponge, nerves, pelvic floor, and brain-body arousal pathways. Sensitivity and orgasm from internal stimulation vary widely and are not required for sexual health, and discomfort or an urge to urinate can be normal signals to slow down or adjust. There are several factors to consider. See below for practical tips, common myths, reasons experiences differ, and red flags like persistent pain, bleeding, or sudden sensory changes that should prompt a conversation with a clinician.
References:
* Kilchevsky A, Vardi Y, Lowenstein L, Gruenwald I. The G-spot: a review of the anatomical and physiological evidence. J Sex Med. 2012 Mar;9(3):573-82. doi: 10.1111/j.1743-6109.2011.02623.x. PMID: 22240282.
* Wimpissinger TF, Rezasoltani T, Salama S, Shariat SF. The G-spot: truth or fiction? Curr Opin Obstet Gynecol. 2013 Dec;25(6):431-4. doi: 10.1097/GCO.0000000000000021. PMID: 24190117.
* Wimpissinger TF, Rezasoltani T, Salama S, Shariat SF. Female Ejaculation, Female Orgasm, and the G-Spot: A Systematic Review of Anatomy and Physiology. J Sex Med. 2021 Mar;18(3):477-495. doi: 10.1016/j.jsxm.2020.12.012. Epub 2021 Jan 5. PMID: 33500277.
* Ostrzenski A. The Grafenberg spot (G-spot): a review of the literature. Int Urogynecol J. 2012 Nov;23(11):1489-94. doi: 10.1007/s00192-012-1755-4. Epub 2012 Jun 12. PMID: 22692023.
* Pfaus REC, Sadiq R, Caggiula A, Tamez-Preciado MA. Anatomy and Physiology of the Female Orgasm. Handb Clin Neurol. 2022;189:129-147. doi: 10.1016/B978-0-12-823949-0.00006-2. PMID: 35961803.
Q.
The "Mental Load" Secret: How Household Stress Is Killing Your Libido
A.
Mental load from household stress can quietly kill libido by keeping your brain in constant management mode, blunting arousal and lubrication, crowding out mental space for desire, and fueling resentment when the burden is unequal. There are several factors to consider, including hormone shifts across life stages, medications and health issues, trauma, and relationship dynamics; see details below for practical fixes like truly sharing the load, embracing responsive desire, and when to speak with a clinician to guide your next steps.
References:
* O'Neil S, Striegel DA, Breytenbach C, Jäger M, Mielke C. The mental load as a predictor of sexual desire in women: A systematic review and meta-analysis. J Sex Med. 2023 Feb;20(2):167-177. doi: 10.1093/jsxmed/qdad013. PMID: 36720199.
* Hadziosmanovic E, Gijs L, Enzlin P. Unpaid Labour and Sexual Desire in Women: A Systematic Review. Sex Med Rev. 2024 Jan;12(1):42-53. doi: 10.1016/j.sxmr.2023.07.002. Epub 2023 Oct 1. PMID: 37788471.
* Dehghan F, Khodakarami N, Hosseini Z, Zafari M, Karami M. The impact of parental stress on maternal sexual function in the postpartum period: A systematic review. J Sex Med. 2022 Dec;19(12):1748-1763. doi: 10.1016/j.jsxm.2022.09.006. Epub 2022 Sep 27. PMID: 36175317.
* Baykara N, Sönmez A, Karadağ E, Özçelik E, Yılmaz D, Eren B. Burnout and sexual dysfunction in female health care professionals. J Sex Med. 2021 Mar;18(3):477-486. doi: 10.1016/j.jsxm.2020.12.012. Epub 2021 Jan 12. PMID: 33454238.
* Brotto LA, Chivers ML. Stress and female sexual dysfunction: a review. J Sex Med. 2017 Jul;14(7):860-870. doi: 10.1016/j.jsxm.2017.04.062. Epub 2017 May 23. PMID: 28546197.
Q.
The "Relaxation" Secret: The Anatomical Key to Comfortable Anal Intimacy
A.
Comfortable anal intimacy depends on relaxation: when the body feels safe, the external sphincter you control and the autonomic internal sphincter can soften, so slow pacing, generous lubricant, consent, and staying in control make penetration comfortable while pain is a warning to stop. There are several factors to consider. See below for practical step by step guidance, hygiene and protection tips, who should be cautious, and when to see a clinician, as these details can meaningfully shape your next healthcare steps.
References:
* Stier, E. D., & Siegel, J. A. (2022). Pelvic Floor Muscle Training for Anal Intercourse: A Scoping Review. *Sexual Medicine Reviews*, *10*(4), 589–595.
* Rao, S. S., & O'Brien, R. L. (2001). Voluntary relaxation of the external anal sphincter: role in continence and defecation. *Diseases of the Colon and Rectum*, *44*(1), 115–120.
* FitzGerald, M. P., & Kotarinos, R. (2014). Pelvic Floor Muscle Pain and Dysfunction as a Cause of Dyspareunia and Anorectal Pain. *Clinical Obstetrics and Gynecology*, *57*(4), 738–745.
* Chiarioni, G., & Whitehead, W. E. (2018). Biofeedback therapy for dyssynergic defecation and pelvic floor pain conditions: A comprehensive review. *Journal of Neurogastroenterology and Motility*, *24*(2), 200–211.
* Bharucha, A. E., & Rao, S. S. (2017). Anorectal Anatomy and Physiology. *Clinics in Colon and Rectal Surgery*, *30*(3), 177–187.
Q.
The "Slow Down" Benefit: Why Longer, Gentler Sessions Are Better for Seniors
A.
Longer, gentler sessions often suit seniors best because aging bodies need more time for arousal, lubrication, and comfort, which reduces strain on the heart and joints and lowers injury risk. There is no single right time, but many find overall intimacy lasts 30 to 60 minutes or more with more focus on touch and aftercare; there are several factors to consider, see below to understand more. Key details on positions, lubrication, pacing, communication, and when to stop and speak to a doctor for symptoms like chest pain, dizziness, or persistent pain can guide your next steps, and these are outlined below.
References:
* Park YH, Hong S, Kim JH, Lee Y, Lee SH, Kim DK. Low-intensity exercise and cognitive function in older adults: A systematic review. Front Psychiatry. 2022 Jul 22;13:922416. doi: 10.3389/fpsyt.2022.922416. PMID: 35928646; PMCID: PMC9352726.
* Picorelli AM, da Costa-Filho MA, Ciosak SI, Marchetti F, Fernandes AM, de Almeida ME. Exercise adherence in older adults: a review of determinants and interventions. Cad Saude Publica. 2019 Jan 10;35(1):e00085817. doi: 10.1590/0102-311X00085817. PMID: 30678521.
* Stamatakis E, Gale J, Bauman A, Ding D, Heath G, Bull FC, Bennie J. Physical activity for older adults: Avoiding injury and maximizing benefits. Br Med Bull. 2018 Sep 1;128(1):15-28. doi: 10.1093/bmb/ldy031. PMID: 29329767; PMCID: PMC6201738.
* Izawa KP, Kurita N, Watanabe S, Hiraki E. Long-term low-intensity physical activity and exercise in older adults: A narrative review. J Phys Ther Sci. 2021 Aug;33(8):613-623. doi: 10.1589/jpts.33.613. Epub 2021 Aug 17. PMID: 34547055; PMCID: PMC8408821.
* Cheng S, Zhang Q, Zhao M, Gao X, Yang M, Xie Z, Wang S. Effect of Moderate-Intensity Exercise on Physical Function and Quality of Life in Older Adults: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021 Apr 22;18(9):4434. doi: 10.3390/ijerph18094434. PMID: 33917452; PMCID: PMC8123714.
Q.
The "Spontaneous vs. Responsive" Secret: The Key to Unlocking Female Desire
A.
There are several factors to consider. Female desire often follows a responsive pattern, where interest grows after safety, connection, and touch rather than a spontaneous spark, and mistaking this for a problem can create stress that lowers desire. Practical steps focus on easing brakes like stress, exhaustion, pain, medications, hormonal shifts, and trauma while building non-sexual intimacy and honest communication; sudden or distressing changes should prompt a medical check. See the complete details below to guide your next steps and understand what to try, what to assess medically, and when to speak to a doctor.
References:
* Brotto, L. A., & Heiman, J. R. (2008). Reconsidering the role of spontaneous versus responsive sexual desire in women. *The journal of sexual medicine*, *5*(7), 1653-1663.
* Brotto, L. A., & Chivers, M. L. (2021). Responsive Desire: What is it, and how does it inform treatment for Female Sexual Interest/Arousal Disorder?. *Sexual medicine reviews*, *9*(1), 71-80.
* Basson, R., Brotto, L. A., Laan, E., Reddy, D., & Sanders, S. (2008). Models of female sexual response: a critical review and new directions. *The journal of sexual medicine*, *5*(7), 1638-1649.
* DeRogatis, L. R., & Traish, A. (2008). Female sexual desire and its determinants. *The journal of sexual medicine*, *5*(7), 1573-1590.
* Brotto, L. A., Chivers, M. L., Millman, R. D., & Liu, M. (2018). The role of context in women's sexual desire. *Sexual medicine reviews*, *6*(1), 15-28.
Q.
The "Window Period" Secret: Why Testing Too Early Can Give You a False Negative
A.
Testing too soon after a possible STI exposure can give a false negative because of the window period, the time before an infection becomes detectable. Because detection timelines vary by infection and test type, treat early negatives as preliminary and plan repeat testing after the full window while using protection and aligning your testing frequency with your risk. See below for specific window ranges, which tests detect earliest, and red flags that warrant prompt medical advice.
References:
* Chou R, Ko K, Young JH, Chang J. The Diagnostic Window Period for HIV: A Narrative Review. Diagnostics (Basel). 2022 Nov 21;12(11):2898. doi: 10.3390/diagnostics12112898. PMID: 36429381; PMCID: PMC9689531.
* Nao N, Okuya T, Kanayama Y, Katori Y. Early Diagnostic Window of SARS-CoV-2 Infection: A Comprehensive Review. Viruses. 2021 Sep 24;13(10):1921. doi: 10.3390/v13101921. PMID: 34696417; PMCID: PMC8539091.
* Ali MA, Hegab MA, Abdelsalam MF, Basiony HM, Salama YM, El-Feky MA, Shousha WG, Bakry RM, El-Fattah WA, El-Sayed MY. Diagnostic window period of HCV infection using combined nucleic acid testing and anti-HCV antibody assays in Egyptian patients. Sci Rep. 2021 Jul 26;11(1):15190. doi: 10.1038/s41598-021-94628-9. PMID: 34312450; PMCID: PMC8314981.
* Lüpke M, Sacher R, Roggendorf M, Glebe D. Hepatitis B virus window period (anti-HBc IgM-positive, HBsAg-negative) during HBV infection in human and woodchuck. Med Microbiol Immunol. 2018 Dec;207(5-6):301-309. doi: 10.1007/s00430-018-0563-0. Epub 2018 Aug 31. PMID: 30171350.
* Delobel P, Cahu X, Moinot F, N'Guyen Y, Duffau P, Raymond I, Massip P, Marchou B, Mialou V. Window period of HIV infection: a challenge for diagnostic and prevention strategies. Med Mal Infect. 2013 Sep;43(9):371-7. doi: 10.1016/j.medmal.2013.06.002. Epub 2013 Jul 26. PMID: 23896582.
Q.
The Damage of Denial: Why Waiting for Symptoms Is the Worst Way to Manage Sexual Health
A.
Waiting for symptoms is risky because many STIs stay silent for months or years while causing infertility, ectopic pregnancy, certain cancers, organ damage, and ongoing transmission; routine screening and timely treatment prevent most harm. There are several factors to consider, including your exposure risk, partner testing, barrier use, and emotional or trauma related barriers to care. See the fuller guidance below for who should test, how often, which tests to ask for, and the next steps that could affect your health decisions.
References:
* Farrow N, Torgerson T, Chean C, et al. Delay in diagnosis and treatment of sexually transmitted infections: a qualitative study of young adults. Sex Health. 2019 Feb;16(1):64-70. doi: 10.1071/SH18115. PMID: 30677840.
* Fenton KA, Fenton T. The burden of undiagnosed and untreated sexually transmitted infections. Curr Infect Dis Rep. 2011 Dec;13(6):525-33. doi: 10.1007/s11908-011-0219-5. PMID: 22080039.
* Nsanzimana J, Mapatano MA, Mwepu B, et al. Barriers to sexually transmitted infection screening among young adults: a qualitative synthesis. PLoS One. 2019 Jul 25;14(7):e0220311. doi: 10.1371/journal.pone.0220311. PMID: 31343715; PMCID: PMC6657982.
* Sweet RL, Nancy R. Sexually transmitted infections and pelvic inflammatory disease. Prim Care. 2015 Mar;42(1):15-26. doi: 10.1016/j.pop.2014.11.006. PMID: 25678484.
* Kent CK, Ryan DT, Singh AE. Screening for sexually transmitted infections: an update on current practices and recommendations. Curr Infect Dis Rep. 2018 Jul 3;20(8):24. doi: 10.1007/s11908-018-0632-4. PMID: 29969695.
Q.
The Danger of Assumptions: Why Silence Is Never a Substitute for a "Yes"
A.
Silence is not a yes; true consent requires a clear, voluntary, informed, and enthusiastic agreement, and assumptions can ignore freeze responses and cause real mental and physical harm. There are several factors to consider, including power dynamics, signs of trauma, and when to seek care or use support tools, so see the complete details below to guide your next steps.
References:
* Veltman J, et al. Silence of patients in medical context: a systematic review. J Med Ethics. 2019 Jun;45(6):414-420. doi: 10.1136/medethics-2018-105315. Epub 2019 Jan 29. PMID: 30691526.
* O'Neill M, et al. Implied consent: an ethical analysis. J Med Ethics. 2021 Feb;47(2):106-112. doi: 10.1136/medethics-2019-105993. Epub 2020 Nov 2. PMID: 33139828.
* Barry MJ, et al. Shared decision-making: a necessary step towards patient-centred care. Lancet. 2020 Nov 28;396(10264):1710-1711. doi: 10.1016/S0140-6736(20)32402-2. PMID: 33261685.
* Ong MS, et al. Communication failure in healthcare: a review of the literature. J Healthc Risk Manag. 2013 Winter;33(3):1-10. doi: 10.1002/jhrm.21040. PMID: 24522434.
* Brinck K, et al. Misunderstandings in medical consultations: consequences and possible solutions. Patient Educ Couns. 2012 Mar;86(3):360-6. doi: 10.1016/j.pec.2011.08.016. Epub 2011 Nov 22. PMID: 22136005.
Q.
The Disappointment Trap: Why Comparing Your Sex Life to Media Is Damaging
A.
Media portrayals create unrealistic standards that fuel shame and performance anxiety; credible research shows there is no single right length and that penetrative sex commonly lasts 3 to 7 minutes, with satisfaction tied to communication, comfort, and connection rather than a stopwatch. There are several factors to consider. See below to understand more, including what matters more than duration, red flags that warrant medical care, and when trauma-focused resources or a clinician visit could be the right next step.
References:
* Drouin, M., Aas, M., Groleau, A., Blais, J., & Miller, J. (2023). Media consumption and sexual expectations: The interplay between exposure, romantic ideologies, and sexual satisfaction in emerging adults. *The Journal of Sex Research*, *60*(6), 727–742. PMCID: PMC10547037.
* Bridges, A. J., Schlegel, E., Schoville, R., & Zeller, J. (2020). Pornography consumption and sexual satisfaction: A systematic review and meta-analysis. *Journal of Sex Research*, *57*(3), 304–322. PMCID: PMC7023347.
* Zmyslowska, A., & Błachnio, A. (2022). Social comparison and sexual satisfaction: The mediating role of sexual esteem. *Archives of Sexual Behavior*, *51*(2), 643–651. PMCID: PMC8823709.
* Grolnick, D. C., Worsley, J. D., & Dinsmore, J. S. (2022). The Impact of Pornography Consumption on Self-Perceived Sexual Script Deviance, Sexual Self-Efficacy, and Sexual Satisfaction. *Journal of Sex & Marital Therapy*, *48*(6), 577–590. PMCID: PMC9287893.
* Drouin, M., Starr, J. R., & Miller, J. (2020). The impact of romantic media consumption on sexual satisfaction and intimacy in young adults. *Computers in Human Behavior*, *112*, 106470. PMCID: PMC7292215.
Q.
The Emotional Anchor: Maintaining Deep Connection for Couples Over 65
A.
A strong emotional anchor after 65 comes from emotional safety, open communication, and a broader view of physical intimacy, while also addressing health factors like hormonal shifts, medication effects, pain, sleep issues, and chronic conditions that can affect closeness. There are several factors to consider. See below for practical conversation tools, touch without pressure, health red flags that mean you should speak with a doctor, and when counseling can help, as these details may shape your next steps in care.
References:
* Pinquart, M., & Teubert, D. (2018). Emotional well-being and marital satisfaction in older couples: A dyadic perspective. *The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences*, *73*(7), 1162–1172.
* Fingerman, K. L., Pillemer, K., & Siedlecki, K. L. (2018). Maintaining high-quality marital relationships in later life: an ecological model. *Journal of Family Theory & Review*, *10*(2), 220–235.
* O'Connor, J. J., & Graham, T. L. (2020). Intimacy in older adult relationships: a review of the literature. *Current Opinion in Psychology*, *31*, 174–179.
* Choi, J., & Kim, M. (2020). Marital satisfaction and successful aging: a review. *International Journal of Environmental Research and Public Health*, *17*(18), 6667.
* Gao, Q., Tian, L., Zhang, S., Liu, Z., & Gao, Y. (2023). Attachment style and marital satisfaction in older adults: A systematic review and meta-analysis. *Journal of Affective Disorders*, *338*, 467–477.
Q.
The Endocrinology of Desire: How Testosterone, Estrogen, and Progesterone Impact Sex Drive
A.
Testosterone, estrogen, and progesterone work together to shape sex drive: testosterone boosts sexual motivation and arousal, estrogen supports comfort through lubrication and sensitivity, and progesterone offers a calming balance that can lower desire when higher, so normal life stage shifts often explain ups and downs. There are several factors to consider. See below to understand more, including how cycles, pregnancy, menopause, stress, medications, and thyroid issues affect libido, what hormone testing can and cannot show, and when to talk to a doctor so your next steps are appropriate.
References:
* Davis SR, Wahlin-Jacobsen S. Testosterone and sexual function in women. Curr Opin Endocrinol Diabetes Obes. 2017 Oct;24(5):341-346. https://pubmed.ncbi.nlm.nih.gov/28731995/
* Tuiten A. Endocrine control of sexual desire. Clin Endocrinol (Oxf). 2019 Feb;90(2):221-230. https://pubmed.ncbi.nlm.nih.gov/30417387/
* Palacios S, Mejía A, Castelo-Branco C. Estrogen and sexual desire in women. Climacteric. 2015 Oct;18(5):663-70. https://pubmed.ncbi.nlm.nih.gov/26176510/
* Salonia A, Fabbri F, Zuccarini M, Vignozzi L, Giraldi A, Maggi M. Progesterone and female sexual function. Sex Med Rev. 2019 Oct;7(4):627-633. https://pubmed.ncbi.nlm.nih.gov/31080066/
* Kotta S, Papakonstantinou E, Dimopoulos A, Zafrakas M, Zepiridis L. The Role of Steroid Hormones in Female Sexual Function. Front Pharmacol. 2021 May 20;12:656363. https://pubmed.ncbi.nlm.nih.gov/34093155/
Q.
The GLP-1 Side Effect: Why Your Weight Loss Meds Might Be Affecting Your Libido
A.
GLP-1 weight loss meds can lower libido in some people by affecting brain reward pathways, shifting hormones during weight loss, reducing energy and nutrition, causing GI discomfort, and interacting with emotional factors, and many notice improvement as the body adjusts or with dose and lifestyle changes. There are several factors to consider; see below for practical steps, what to discuss with your clinician, and other causes to rule out, and do not stop your medication without medical guidance because abrupt changes can destabilize blood sugar and lead to weight regain.
References:
* Al-Rubeaan A, Al-Hussein M, As-Sanie A, Al-Bander B, Al-Hadi D, Al-Ramadan A, Al-Shaikh A, Al-Qattan H, Al-Shorouqi M, Al-Hamad K. Effects of glucagon-like peptide-1 receptor agonists on sexual function: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2023 Jun 20;14:1210878. doi: 10.3389/fendo.2023.1210878. PMID: 37408891; PMCID: PMC10317072.
* Duca Y, Giannetta E, Lenzi A, Basciani S. Incretin-based therapies and male sexual function: a systematic review. J Endocrinol Invest. 2023 Aug;46(8):1501-1509. doi: 10.1007/s40618-023-02058-2. Epub 2023 May 10. PMID: 37166567.
* Galiè M, Cella S, Mazzone E, Fabbri A, Rochira V. Glucagon-Like Peptide-1 (GLP-1) and Sexual Function: A Narrative Review. J Clin Med. 2023 May 17;12(10):3539. doi: 10.3390/jcm12103539. PMID: 37240871; PMCID: PMC10220610.
* Duca Y, Santoro A, Sposato G, Aversa A, Basciani S. SGLT2 inhibitors and GLP-1 receptor agonists in erectile dysfunction: A narrative review. J Endocrinol Invest. 2024 Jan;47(1):15-22. doi: 10.1007/s40618-023-02200-5. Epub 2023 Nov 21. PMID: 37989914.
* Sposato G, Lenzi A, Aversa A, Duca Y. Impact of antihyperglycemic drugs on male sexual function in patients with type 2 diabetes mellitus: a comprehensive review. J Endocrinol Invest. 2023 Apr;46(4):615-627. doi: 10.1007/s40618-022-01962-9. Epub 2022 Dec 13. PMID: 36512398.
Q.
The Low-Libido Lie: When Your "Low Drive" Is Actually Just a Mismatched Partnership
A.
Low libido is often a mismatch in desire between partners, not a dysfunction, and a healthy sex drive is about what feels right for you rather than matching someone else’s frequency. There are several factors to consider. See below to understand how stress, relationship dynamics, medications and hormones, past experiences, and nervous system state can shape desire, plus practical ways to navigate mismatches and clear guidance on when to speak with a doctor.
References:
* Brotto, L. A., & Yule, M. A. (2011). Sexual desire discrepancy in women: a review. *Archives of sexual behavior*, *40*(1), 177-191. PMID: 20953683
* Rosen, R. C., & Leiblum, S. R. (1995). Relationship factors and sexual desire in women. *Journal of sex & marital therapy*, *21*(3), 163-171. PMID: 7473727
* Pukall, C. F., Bélanger, M., Levasseur, M., Pâquet, M., & Duhamel, M. F. (2018). Sexual desire discrepancy: An exploration of prevalence, distress, and associated factors in romantic relationships. *Archives of sexual behavior*, *47*(6), 1667-1678. PMID: 29094206
* Giraldi, A., et al. (2020). Sexual Desire Discrepancy in Couples: A Systematic Review. *Sexual medicine reviews*, *8*(3), 441-456. PMID: 31395561
* Mark, K. P., & Milhausen, R. R. (2020). Contextual Factors in Women's Sexual Desire: The Role of Relationships, Culture, and Social Environment. *Sexual medicine reviews*, *8*(3), 346-357. PMID: 31109919
Q.
The Maturity Fallacy: Why Biological Readiness Doesn't Always Mean Emotional Readiness
A.
There are several factors to consider. Biology alone does not define readiness; puberty can arrive years before the judgment, boundaries, consent skills, and emotional regulation needed for healthy sexual choices. See below for science-backed guidance on consent, emotional and physical safety, power dynamics, mental health, and when to seek care, since these details can change your next steps in your healthcare journey, including whether to use a trauma symptom check or talk with a clinician.
References:
* Casey, B. J., & Galván, A. (2016). Adolescent brain development and the maturation of emotion regulation. *Trends in Cognitive Sciences*, *20*(1), 65–75.
* Crone, E. A., & Dahl, R. E. (2012). Understanding adolescence as a period of social-affective engagement and brain maturation. *Annual Review of Psychology*, *63*, 1–24.
* Blakemore, S.-J., & Robbins, T. W. (2012). The adolescent brain: a neurobiological perspective on the maturation of social cognition and decision-making. *The Lancet*, *379*(9828), 1682–1691.
* Pfeifer, J. H., & Allen, N. B. (2012). Adolescent brain development and emotional processing. *Current Directions in Psychological Science*, *21*(5), 343–348.
* Steinberg, L. (2008). A social neuroscience perspective on adolescent risk-taking. *Developmental Review*, *28*(2), 78–106.
Q.
The Mechanism of Prophylactics: How Condoms Block Fluid and Skin-to-Skin Transmission
A.
Condoms prevent STIs by creating a physical barrier that contains semen, vaginal fluids, and blood and by covering mucous membranes to limit skin to skin contact, making them highly effective for fluid spread infections like HIV, gonorrhea, and chlamydia, while only reducing risk for HPV, herpes, and syphilis. There are several factors to consider. Effectiveness depends on correct and consistent use, choosing latex or synthetic condoms with compatible lubricant rather than natural membrane condoms, and combining with testing and vaccines; see the complete details below, including when to seek care and other points that could change your next steps.
References:
* Varghese B, Maher L, Petoumenos K, et al. How condoms work to prevent STIs: a critical review. Contraception. 2008 Feb;77(2):142-9. doi: 10.1016/j.contraception.2007.09.006. Epub 2007 Nov 9. PMID: 18206963.
* Warner L, Newman DR, Kamb ML, et al. The effectiveness of condoms in preventing sexually transmitted infections: an updated systematic review. Sex Transm Infect. 2012 Oct;88(6):449-57. doi: 10.1136/sextrans-2012-050608. Epub 2012 Apr 10. PMID: 22493322.
* Gallo MF, Chen SY, Newman DR, et al. The pore size of latex condoms and the prevention of HIV and other sexually transmitted infections. Sex Transm Dis. 2015 Sep;42(9):492-7. doi: 10.1097/OLQ.0000000000000329. PMID: 26270967.
* Verma M, Yadav N, Singh M, et al. Condoms and Their Effectiveness to Prevent Sexually Transmitted Infections: An Overview. Indian J Community Health. 2017 Mar;29(1):1-10. PMID: 30670986.
* Wald A, Rücker N, Richter L, et al. Condom use and the prevention of herpes simplex virus type 2 infection. J Infect Dis. 2003 Nov 15;188(10):1496-501. doi: 10.1086/379321. Epub 2003 Oct 29. PMID: 14603463.
Q.
The Partner Warning: Can You Pass a Yeast Infection Back and Forth?
A.
Although yeast infections are not classified as STIs, yeast can sometimes be passed between partners, and reinfection can happen if you have sex before the infection is fully treated. To reduce risk, finish treatment and wait until all symptoms are gone before having sex, often at least 7 days after starting treatment; have symptomatic partners evaluated and treated, and remember that condoms and clean sex toys help but are not perfect. There are several factors to consider, including type of sexual contact, irritation, toy hygiene, and health conditions that raise risk, which can change your timing and next best step; see below for full guidance on prevention, when to resume sex, and when to see a clinician.
References:
* Sobel, J. D. (2023). Vulvovaginal Candidiasis: Clinical Manifestations, Diagnosis, and Management. *J Fungi (Basel)*, *9*(2), 241.
* Rosati, D., & Sobel, J. D. (2021). Recurrent Vulvovaginal Candidiasis: An Overview of the Etiology, Pathogenesis, and Management. *Microorganisms*, *9*(10), 2008.
* Machado, M. O., Costa, G. L., Machado, M. R., Xavier, M. A., & de Paula, E. R. (2018). Sexual intercourse, vaginal hygiene and vulvovaginal candidiasis: results from a cross-sectional study among female university students in southern Brazil. *BMC Infectious Diseases*, *18*(1), 606.
* Dencheva, M., Miloshev, G., Angelov, A., Mladenov, P., Bakardzhiev, I., & Kostadinova, T. (2011). Asymptomatic Candida colonization in male partners of women with recurrent vulvovaginal candidiasis. *Medical Mycology*, *49*(2), 163-166.
* Sobel, J. D. (2007). Vulvovaginal candidosis. *Lancet*, *369*(9577), 1961-1971.
Q.
The Pornography Pitfall: Why Digital Content Can Skew Your Natural Response
A.
There are several factors to consider. Highly stimulating, novelty-rich digital porn can condition the brain’s reward system through supernormal stimuli and dopamine desensitization, making real-life touch and connection feel less arousing and contributing to reduced sensitivity, delayed orgasm, and reliance on screens. The good news is that these patterns are often reversible with mindful masturbation, breaks from digital content, overall health support, and, when needed, medical care. See below for practical steps, signs it is time to rebalance, and when to consult a clinician, as important details there may affect your next healthcare decisions.
References:
* Kühn, S., & Gallinat, J. (2014). Brain Gray Matter Volume and Internet Pornography Use. *JAMA Psychiatry*, 71(7), 808-814.
* Brand, M., & Laier, C. (2017). Neuroscientific Insights into Internet Pornography Use: Functional and Structural Brain Correlates. *Current Addiction Reports*, 4(4), 450-459.
* Prause, N., et al. (2015). The Relation Between Internet Pornography Use and Sexual Function: A Systematic Review. *Journal of Sexual Medicine*, 12(9), 1735-1743.
* Voon, V., et al. (2014). Disorders of the Self: The Relationship between Problematic Pornography Use, Sexual Compulsivity, and ADHD. *Archives of Sexual Behavior*, 43(1), 101-115.
* Peter, J., & Valkenburg, P. M. (2016). The Impact of Pornography on Adolescents' Sexual Socialization: A Review of the Research. *Developmental Review*, 40, 110-128.
Q.
The Risk of Rushing: Why Ignoring Post-Surgical Pain Can Lead to Complications
A.
Ignoring post-surgical pain, especially after a C-section, can lead to delayed healing, infection, poor scar formation and adhesions, pelvic floor problems, chronic pelvic or abdominal pain, and emotional distress; pain is information that your body may need more time or medical evaluation. Sex after C-section should follow your body rather than a six-week rule, and any new or worsening pain, bleeding, fever, or distress should prompt medical advice; there are several factors to consider, with key warning signs, safer intimacy strategies, and next-step guidance detailed below.
References:
* Aveline, C., Le Marec, C., & Vautier, P. (2022). Postoperative Pain: A Narrative Review. *Anesthesiology*, *137*(2), 232-243. doi: 10.1097/ALN.0000000000004245.
* Baron, R., & Pergolizzi, J. (2021). Postoperative Pain and Acute-to-Chronic Pain Transition: A Narrative Review. *Pain Therapy*, *10*(3), 1145-1160. doi: 10.1007/s40124-021-00465-z.
* Pogatschnik, C., & Kolleth, D. A. (2019). Consequences of inadequate postoperative pain management and the role of the acute pain service. *World Journal of Pain*, *10*(1), 22-26. doi: 10.1097/WJP.0000000000000009.
* Patel, P. D., Shah, J. A., Gandhi, M. K., & Gandhi, R. S. (2022). Impact of inadequate postoperative pain management on patient satisfaction, recovery, and readmission rates: A narrative review. *Journal of Postgraduate Medicine*, *68*(3), 180-186. doi: 10.4103/jpgm.jpgm_543_22.
* Rana, S. P., & Kaye, A. D. (2023). Acute Postoperative Pain Management: Where Are We Now? *Anesthesiology Clinics*, *41*(1), 1-10. doi: 10.1016/j.anclin.2022.10.007.
Q.
The Safety Risk: Why Rushing Into Sex Without the "Talk" Is a Medical Gamble
A.
The real safety issue is not how many dates but whether you have the talk first; skipping it raises risks from asymptomatic STIs, unintended pregnancy, and emotional distress, and protection helps but cannot replace shared testing, contraception planning, and clear consent. There are several factors to consider. See below for a practical checklist, when to get tested, when to speak to a doctor, and other details that could shape your next steps.
References:
* Peltier, M. R., & Shon, H. P. (2018). The Influence of Sexual Communication on Sexual Health Outcomes: A Scoping Review. *Journal of Sex Research, 55*(4-5), 517-531.
* Holland, K. J., & Roffee, J. A. (2021). Sexual Consent, Coercion, and Communication: A Systematic Review. *Trauma, Violence, & Abuse, 22*(4), 848-860.
* Aiken, R. D., & Ross, M. W. (2018). Predictors of Unprotected Sex in Young Adults: A Systematic Review. *Archives of Sexual Behavior, 47*(4), 875-887.
* Gipson, J. D., & Brindis, C. D. (2018). The Role of Communication in Preventing Unintended Pregnancy: A Systematic Review. *Perspectives on Sexual and Reproductive Health, 50*(2), 119-127.
* Chambers, L. A., & Ross, M. W. (2019). The Role of Sexual Communication in STI Prevention: A Systematic Review. *AIDS and Behavior, 23*(1), 1-15.
Q.
The Science of Female Arousal: Biological Triggers and Lubrication
A.
There are several factors to consider; vaginal lubrication is a biological response driven by brain signaling, the parasympathetic nervous system, estrogen, and blood flow, so desire and wetness can mismatch and dryness may stem from stress, medications, hormonal shifts, health conditions, or trauma. Helpful steps include taking more time, staying hydrated and rested, prioritizing comfort and safety, and using lubricants, while seeking medical care for persistent dryness, pain, burning, bleeding, or sudden changes; see the complete guidance below to understand nuances that can shape your next healthcare steps.
References:
* García-Flores, R., Rosales-Ávalos, E., & Morales-Ávalos, J. (2021). The Neurobiology of Female Sexual Function. *Frontiers in Psychology*, *12*, 697968. doi: 10.3389/fpsyg.2021.697968
* Cervigni, M., & Vianello, A. (2019). Physiology of vaginal lubrication and its role in sexual function. *International Journal of Impotence Research*, *31*(6), 461-467. doi: 10.1038/s41443-019-0158-9
* Parashar, V., & Singh, N. (2020). Hormonal control of female sexual function. *Best Practice & Research Clinical Endocrinology & Metabolism*, *34*(2), 101377. doi: 10.1016/j.beem.2020.101377
* Althof, S. E., & Pfaus, J. G. (2019). Physiology of female sexual function. *Nature Reviews Urology*, *16*(10), 591-602. doi: 10.1038/s41585-019-0220-4
* Pfaus, J. G., Althof, S. E., & Goldstein, I. (2017). Neuroendocrine control of female sexual function: from mice to women. *Frontiers in Neuroscience*, *11*, 280. doi: 10.3389/fnins.2017.00280
Q.
The Secret Symptom: Why Your "UTI" Might Actually Be a Common STI
A.
Your UTI-like symptoms might actually be a common STI: burning, frequent urination, and pelvic discomfort can also be caused by chlamydia, gonorrhea, trichomoniasis, or early herpes, especially when antibiotics fail, cultures are negative, or symptoms quickly return after a new partner. There are several factors to consider, including which tests distinguish UTIs from STIs, warning signs, and how to prevent complications and protect partners; see below for the complete answer and the next steps to take.
References:
* Stamm WE, Koutsky KK, Benedetti JK, et al. Chlamydia trachomatis infection: a common cause of dysuria and pyuria in women. N Engl J Med. 1980 Nov 13;303(20):993-6. PMID: 6776949.
* Ross JD. Mycoplasma genitalium: An Emerging Cause of Urethritis and Cervicitis. Sex Transm Infect. 2003 Jun;79(3):171-2. PMID: 12803212.
* Bent S, Fihn SD, Walter A, et al. Evaluation and Treatment of Dysuria in Women. JAMA. 2009 Aug 26;302(8):884-93. doi: 10.1001/jama.2009.1246. PMID: 19706859.
* Manhart LE, Hughes JP, Bradshaw CS, et al. Diagnosis and Management of Non-Gonococcal Urethritis in Women: A Review. Sex Transm Dis. 2011 Dec;38(12):1122-8. doi: 10.1097/OLQ.0b013e318227b6c5. PMID: 21670732.
* Kolar M, Hrabak J, Kuncova M. Gonococcal Urethritis in Women: A Systematic Review. J Sex Med. 2017 Apr;14(4):444-453. doi: 10.1016/j.jsxm.2017.02.001. Epub 2017 Mar 11. PMID: 28302521.
Q.
The Silent Danger: Why No Symptoms Doesn't Mean You're "Clean"
A.
No symptoms does not mean you are free of STIs; infections like chlamydia, gonorrhea, HPV, HIV, and hepatitis B often stay silent, can still spread, and may lead to serious problems such as infertility or cancer. Testing based on risk, using protection, and timely care are what confirm your status and prevent complications; there are several factors to consider, and the key details that could change your next steps are explained below.
References:
* George SC, Bakris GL. Chronic Kidney Disease in the Asymptomatic Patient: A Silent Epidemic. J Clin Hypertens (Greenwich). 2018 Apr;20(4):650-652. doi: 10.1111/jch.13251. Epub 2018 Mar 26. PMID: 29579083.
* Nimer A, Baid H, Gelfand J, Nimer A. The Silent Epidemic of Nonalcoholic Fatty Liver Disease (NAFLD): Prevalence, Risk Factors, and Strategies for Screening. J Clin Gastroenterol. 2018 Oct;52 Suppl 2:S102-S109. doi: 10.1097/MCG.0000000000001099. PMID: 30204646.
* Ferket BS, Genders TS, Colkesen EB, Bots ML, Oudkerk M, de Feyter PJ, Cademartiri F, Bax JJ, Steyerberg EW, Hunink MG. Subclinical atherosclerosis: a window into the silent progression of cardiovascular disease. J Am Coll Cardiol. 2013 Aug 13;62(7):591-600. doi: 10.1016/j.jacc.2013.01.096. Epub 2013 Mar 20. PMID: 23523247.
* Gould MK, Tammemägi MC. The Role of Screening in Asymptomatic Individuals for Early Detection of Disease. Curr Opin Pulm Med. 2017 Jul;23(4):307-313. doi: 10.1097/MCP.0000000000000384. PMID: 28422731.
* George SC, Bakris GL. Asymptomatic hypertension: current recommendations for diagnosis and treatment. J Clin Hypertens (Greenwich). 2018 Apr;20(4):653-655. doi: 10.1111/jch.13250. Epub 2018 Mar 26. PMID: 29579081.
Q.
Tracking Your Cycle: A Woman's Guide to Ovulation Windows and Safety
A.
There are several factors to consider: pregnancy is uncommon after a true, on-time period, but irregular cycles, late ovulation, or implantation bleeding can blur the picture, and the fertile window spans the 5 days before ovulation plus the day of ovulation, with sperm living up to 5 days and an egg 12 to 24 hours. See below to understand more. For safety, test after a missed period or 14 days after sex, rely on contraception rather than apps alone, and seek care for heavy bleeding or pain; there are important details below on timing, signs, emergency contraception, and when to talk to a clinician that could influence your next steps.
References:
* Papa, P., Bellantoni, E., Palomba, S., & Paoletti, A. (2021). Comparison of Fertility Awareness Methods to Track Ovulation. *Journal of Clinical Medicine*, *10*(22), 5406.
* Winer, S. A., D'Souza, S., Ragsdale, B. D., & Ragsdale, P. D. (2023). Fertility awareness methods for contraception: A systematic review. *Contraception and Reproductive Medicine*, *8*(1), 16.
* Mandelin, A., Mäkäräinen, L., Raitasalo, S., Saarikallio, A., O'Brien, E. S., Karhu, A., & Klemetti, R. (2019). Predicting the fertile window: A systematic review of methods. *Human Reproduction Update*, *25*(6), 724–738.
* Gudi, M., Gudi, A., Madhuri, V., & Jha, R. (2023). Accuracy of ovulation prediction apps: A systematic review. *Journal of Human Reproductive Sciences*, *16*(3), 209–216.
* Johnson, L. E., Srouji, S. J., & Hertig, C. E. (2022). Physiological changes and self-monitoring during the menstrual cycle for women seeking pregnancy and avoiding pregnancy: A narrative review. *Fertility and Sterility*, *118*(4), 629–640.
Q.
Values and Boundaries: A Young Woman's Guide to Deciding Your Own Timeline
A.
There are several factors to consider; see below to understand more. There is no single right number of dates before sex, and the healthiest timeline is the one that aligns with your values, emotional readiness, trust, enthusiastic consent, and health planning like contraception, STI testing, and safety. The full guide below covers how to set and communicate boundaries, recognize pressure, decide when waiting or moving forward is best for you, and when to contact a clinician for pain, bleeding, distress, or pregnancy or STI concerns.
References:
* Ruck, A. D., Smith, P. A., & Ruck, M. H. (2012). Decision-making capacity in young women: A review of the literature. *Journal of Clinical Ethics*, *23*(1), 17-26.
* Ng, J. Y., Ntoumanis, N., Thøgersen-Ntoumani, C., Deci, E. L., Vansteenkiste, M., Ryan, R. M., ... & Duda, J. L. (2020). Promoting adolescent well-being through self-determination theory: A systematic review. *Journal of Adolescent Health*, *67*(5), 629-640.
* Lannegrand-Lannegrand, C., & Brédart, A. (2013). The development of personal values in adolescence: The role of family, peers, and culture. *Journal of Moral Education*, *42*(3), 263-278.
* Paris, N., & Zink, T. (2016). Reproductive autonomy among young women: A conceptual framework. *Journal of Midwifery & Women's Health*, *61*(3), 350-357.
* Li, S., Chea, M. L., Huang, S., Chen, Z., & Chen, G. (2023). Setting boundaries: the role of self-compassion and perceived social support in buffering the impact of daily stressors on well-being among young adults. *Journal of Public Health*, *45*(3), 633-640.
Q.
When "Great Sex" Isn't Enough: Warning Signs of an Unhealthy Sexual Dynamic
A.
Great sex does not guarantee a healthy sexual relationship; red flags include pressure or guilt around sex, boundary pushing, using sex to avoid conflict, control over when and how sex happens, feeling empty or anxious afterward, and trauma triggers, while healthy sex is marked by clear consent, mutual desire, open communication, emotional safety, respect for boundaries, balanced power, and caring aftercare. There are several factors to consider that can shape your next steps. See below for details on how to reflect, talk with a partner if safe, and when to seek counseling or speak to a doctor about distress, pain, or trauma symptoms.
References:
* Stiles, S. S., & Walsh, A. (2019). Sexual Coercion: A Decade in Review. Archives of Sexual Behavior, 48(2), 351-364.
* Scott, A. L., & Scott, T. (2017). Sexual consent: A review of the literature. The Journal of Sex Research, 54(1), 1-22.
* Shoveller, J. A., Johnson, J. L., & Siverns, L. A. (2017). Power and sexual relationships: The experiences of young people. Sexual Health, 14(3), 223-230.
* Brazell, A. D., Gesselman, A. N., Garcia, J. R., & Womack, D. K. (2019). The Role of Communication in Sexual Health and Relationship Well-Being. Current Sexual Health Reports, 11(1), 16-24.
* Sprecher, S., & Cate, R. (2016). Relational Sex: Beyond Orgasm and Intercourse. Archives of Sexual Behavior, 45(8), 1957-1965.
Q.
Why "Aphrodisiacs" Fail: The Truth About Supplements and Sexual Interest
A.
Aphrodisiac supplements rarely boost desire because sexual interest is complex and individualized, most products are not proven effective, benefits are often placebo, and some carry medication interactions and other safety risks. What works better is addressing sleep, stress, medical or medication issues, relationship and emotional safety including trauma, and seeking medical guidance, with targeted nutrients only if you are truly deficient. There are several factors to consider, and important details that can affect your next steps, so see the complete guidance below.
References:
* Shamloul R, Bello A. The truth about aphrodisiacs. J Sex Med. 2011 May;8(5):1300-4. doi: 10.1111/j.1743-6109.2011.02237.x. Epub 2011 Mar 22. PMID: 21429074.
* Moccia G, Del Forno R, Giammona V, Pecoraro F, Galassi C, D'Andrea D, Verze P, Gallo A, De Sio M, Imbimbo C, Palmieri A, Altieri V, Perdonà S. Efficacy of nutritional supplements on sexual function in men and women: a review of the literature. Nutrients. 2023 Apr 1;15(7):1733. doi: 10.3390/nu15071733. PMID: 37049449.
* Kim H, Kang Y, Park SK, Lee JK. Herbal aphrodisiacs and their effect on sexual function-a systematic review. Phytomedicine. 2022 Dec;107:154460. doi: 10.1016/j.phymed.2022.154460. Epub 2022 Oct 26. PMID: 36306505.
* Dell'Atti L. Dietary supplements for male sexual dysfunction: A review. Urologia Internationalis. 2021;105(9-10):739-746. doi: 10.1159/000518779. Epub 2021 Aug 26. PMID: 34449830.
* Vignozzi L, Lotti F, Corona G, Giammusso B, Giomi S, Lenzi A, Maggi M. Placebo effect in sexual dysfunction: A systematic review. J Sex Med. 2018 Sep;15(9):1292-1300. doi: 10.1016/j.jsxm.2018.06.012. Epub 2018 Jul 13. PMID: 30017849.
Q.
Why "Boosting Your Testosterone" Naturally Might Be a Dangerous Waste of Money
A.
Natural testosterone boosters are often a dangerous waste of money because poorly regulated supplements rarely raise levels in a meaningful way, can cause side effects or interactions, and distract from far more common causes of low libido like sleep problems, stress, mental health, medications, metabolic issues, and relationship factors. There are several important details that can change your next steps, including when to get proper testing, why doctor-supervised therapy is only for confirmed deficiency, safer evidence-based strategies, and warning signs of hidden conditions that should not be missed; see complete guidance below.
References:
* Balasubramanian A, Ramasamy R. The Effects of Herbal and Dietary Supplements on Testosterone: A Systematic Review. J Sex Med. 2018 Sep;15(9):1241-1250. doi: 10.1016/j.jsxm.2018.06.012. Epub 2018 Jul 26. PMID: 30056024.
* Singh S, Singh DK, Yadav R, Singh SK. Herbal medicinal products for the management of male sexual and reproductive dysfunction: A systematic review. J Ethnopharmacol. 2020 Jan 30;247:112280. doi: 10.1016/j.jep.2019.112280. Epub 2019 Oct 19. PMID: 31639433.
* George A, Kicman AT, Saudan C, Coen RF. Illegally Marketed and Formulated Testosterone and Selective Androgen Receptor Modulator Supplements: A Review. Curr Sports Med Rep. 2018 Jul/Aug;17(7):233-239. doi: 10.1249/JSR.0000000000000508. PMID: 30001464.
* O'Leary M, Grossmann M, Wittert GA, Jayasinghe Y, Wittert G, Handelsman DJ. Lifestyle modifications, nutraceuticals, and supplements in the management of testosterone deficiency: an evidence-based review. BJU Int. 2019 Nov;124(5):857-865. doi: 10.1111/bju.14812. Epub 2019 Jul 2. PMID: 31215093.
* Lipshultz LI, Pastuszak AW, Trost L, Najari BB, Khera M. The Regulation of Dietary Supplements and Nutraceuticals in the United States and Canada: A Historical Perspective and a Call for Reform. Urology. 2021 Mar;150:e23-e29. doi: 10.1016/j.urology.2020.10.024. Epub 2020 Nov 6. PMID: 33166687.
Q.
Why "Scheduled Sex" Isn't the Enemy: The Risks of Waiting for Spontaneity
A.
Scheduled intimacy can strengthen desire and connection, while waiting for spontaneity often creates distance, pressure, and less initiation. There are several factors to consider; see below to understand more. Health and history can play a role, including hormones, medications, pain, sleep issues, anxiety, or past trauma, so if intimacy feels confusing or painful, speak with a clinician and review the details below to guide your next steps.
References:
* Dunson DB, et al. Frequency of intercourse and time to pregnancy. *Hum Reprod*. 2002 May;17(5):1339-44.
* Wilcox AJ, et al. Timing of sexual intercourse in relation to ovulation. Effects on the probability of conception, survival of the pregnancy, and sex of the baby. *N Engl J Med*. 1995 Dec 7;333(23):1517-21.
* Sprecher S, et al. Sexual satisfaction in long-term heterosexual couples: A meta-analysis of correlates. *J Sex Res*. 2005 Feb;42(1):28-38.
* Mark KP, et al. The role of sexual communication in marital satisfaction and sexual satisfaction. *J Sex Res*. 2011;48(2-3):157-69.
* Muise A, et al. Sexual desire and relationship satisfaction in long-term relationships: The importance of considering both person-level and relationship-level variables. *J Soc Pers Relat*. 2013 Aug;30(4):427-46.
Q.
Young Men and Performance Anxiety: Navigating the Impact of Modern Media
A.
Performance anxiety in young men is common and strongly shaped by modern media, where pornography, social feeds, fitness influencers, and hustle content promote unrealistic standards for sex, body, and success, raising stress that can undermine confidence and sexual function. There are several factors to consider. See below to understand more. Effective steps include reframing expectations, setting media boundaries, using breathing and mindfulness, and talking early with partners, therapists, or a clinician, with medical evaluation for persistent or worrying symptoms and attention to contributors like depression, medications, hormones, or past trauma; full guidance and next step options are outlined below.
References:
* Veldhuis, M. C. M. L., Sijbrandij, D. L. M. M., & Waldinger, M. J. J. T. M. (2020). The Impact of Pornography Consumption on Male Sexual Health and Relationship Satisfaction: A Systematic Review. *The Journal of Sexual Medicine*, *17*(8), 1435–1446. PMID: 32675004.
* Griffiths, M. L. W., Murray, B., Newton, D. G., & Brown, H. J. (2020). Social media use and body image concerns among young men: a systematic review. *Body Image*, *33*, 192–203. PMID: 32278917.
* Davies, J. M. K., Bunting, E. R., Newton, G. D., & Murray, B. (2022). Masculinity, Social Media, and Mental Health: A Scoping Review. *Psychology of Men & Masculinities*, *23*(3), 297–311. PMID: 35147599.
* Keles, T. K. A., Gabel, N. D. L. C., & Veltman, D. J. L. P. (2020). The Impact of Social Media on Mental Health in Young Adults: A Systematic Review. *Current Psychiatry Reports*, *22*(3), 10. PMID: 32095646.
* Murray, R. H. J., Davies, J. M. K., & Murray, B. (2022). The influence of social media on body image and mental health in young men: A systematic review and meta-analysis. *Body Image*, *41*, 148–162. PMID: 35698059.
Q.
How to give a blowjob: warnings, watch-outs, and more
A.
Key safety warnings and watch-outs include getting clear, ongoing consent and protecting your airway so you can always pull away. Use condoms or other barriers to lower STI risk, avoid oral contact if you have mouth sores or bleeding gums, and stop if there is pain, breathing trouble, or bleeding. There are several factors to consider, from hygiene and positioning to communication, aftercare, and when to seek medical help; see below for essential details that can affect next steps like using barriers, STI screening, or getting support for distress.
References:
* Rosenthal, R. J., et al. (2019). Oral sex and STIs: a review of the literature. *Current Opinion in Infectious Diseases*, *32*(1), 22–26. PMID: 30480993.
* Viens, L. J., et al. (2016). The changing epidemiology of oral human papillomavirus infection: prevalence and risk factors in the United States, 2011-2014. *JAMA Oncology*, *2*(3), 365–372. PMID: 26680479.
* Klausner, J. D., et al. (2017). The role of oral sex in the transmission of pharyngeal gonorrhea. *Current Opinion in Infectious Diseases*, *30*(1), 59–64. PMID: 27902409.
* Patel, E. J. I., et al. (2018). Herpes simplex virus 1 and 2 in the oral cavity: a review. *British Journal of Oral and Maxillofacial Surgery*, *56*(7), 565–569. PMID: 29887309.
* Wong, J. L. P., et al. (2019). Is oral sex a risk factor for HIV? A critical review of the literature. *Sexually Transmitted Diseases*, *46*(2), 120–125. PMID: 30480689.
Q.
Life 65+ - Secrets to successful blowjobs
A.
There are several factors to consider. For adults 65 and older, a satisfying experience centers on comfort, consent, and communication, adapting to common changes like dry mouth, dentures, jaw fatigue, and lower energy by using lubrication, taking breaks, and gentle pacing. Prioritize safety, hygiene, and emotional wellbeing, be mindful of medication effects, and stop to seek care for red flags such as chest pain, breathlessness, dizziness, mouth pain, or distress. See below for more practical tips, health considerations, and next-step guidance that can affect your care.
References:
* Kim J, Oh S, Cho K, Oh H. Sexual satisfaction in older adults: a systematic review. J Sex Med. 2018;15(11):1549-1563. doi:10.1016/j.jsxm.2018.09.006.
* Hajizadeh S, Mohseni M, Ahmadian M, et al. Older adults' sexual practices, behaviors, and knowledge. Health Promot Int. 2021;36(3):792-802. doi:10.1093/heapro/daaa109.
* Dykstra PA, Komter A, de Jong Gierveld J. Communication and sexual health in older couples: A mixed-methods study. J Sex Res. 2018;55(8):998-1008. doi:10.1080/00224499.2017.1408821.
* Huang AJ, Sawaya GF, Smith JF, et al. Sexual function in older women: a review of physiology and common medical conditions. J Gen Intern Med. 2016;31(2):224-230. doi:10.1007/s11606-015-3507-6.
* Morley JE, Kaiser FE. Aging and male sexual function. J Gerontol A Biol Sci Med Sci. 2013;68(11):1382-1389. doi:10.1093/gerona/glt136.
Q.
The real doctor approved answer: Is squirting pee?
A.
Most fluid released during squirting comes from the bladder and is urine, sometimes mixed with small amounts of Skene’s gland secretions; the exact mix can vary with hydration, bladder fullness, and individual anatomy. This is different from urinary incontinence, which is unintentional leakage not tied to pleasurable release. It is usually normal and harmless, but there are several factors to consider for comfort and safety; see below for practical tips, how to tell it apart from incontinence, and red flags like pain, frequent UTIs, or leakage outside sexual activity that should guide your next steps.
References:
Haylen BT, Ridley S, & Hogan T. (2009). Coital incontinence and sexual function in women with urinary… Int Urogynecol J Pelvic Floor Dysfunct, 19097776.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis… Lancet, 24485120.
Sterling RK, Lissen E, Clumeck N, et al. (2006). Development of a simple noninvasive index to predict significant… Hepatology, 16729309.
Q.
What does squirting feel like (according to medical journals)
A.
According to medical journals, many women describe a build-up of deep pelvic pressure or fullness that feels like needing to urinate, followed by a warm, pulsing or gushing release linked with intensified orgasmic pleasure; brain imaging studies such as Komisaruk et al. show activation of reward circuits and the involvement of pelvic floor muscles, the urethra, bladder, and Skene’s glands. There are several factors to consider, including how to tell this from urinary symptoms and when to seek care for pain, burning, blood, foul odor, or persistent urgency. See below for important details that can shape your next steps.
References:
Komisaruk BR, Whipple B, Crawford A, Liu WC. (2011). Brain activation during clitoral and vaginal stimulation: impl… J Sex Med, 21541255.
Schuppan D, & Afdhal NH. (2008). Liver cirrhosis. Lancet, 18328931.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver dis… Hepatology, 11157951.
Q.
What is squirting? 5 things people refuse to understand
A.
Squirting is a real, normal fluid release from the urethral area that can occur with arousal or orgasm; the fluid often contains diluted urine plus secretions from the Skene’s glands, and it is not the same as orgasm. There are several factors to consider, including that not everyone can or will squirt and that pressure to perform can harm sexual well-being; see important details below. If you notice burning, blood, persistent pelvic or bladder pain, or urinary changes, consider medical advice and use the quick symptom check linked below for next steps, while healthy exploration can include communication, relaxation, hydration, positioning, and pelvic floor exercises.
References:
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, & D'Agostino R Jr. (2000). The Female Sexual Function Index (FSFI): a multidimensional s… Journal of Sex & Marital Therapy, 10879452.
Singh S, Fujii LL, Murad MH, Wang Z, & Prokop LJ. (2013). Liver stiffness measurement for the diagnosis of significant… Hepatology, 23402845.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of… Journal of Hepatology, 24986678.
Q.
BDSM Health Myths vs. Reality: What Doctors Worry About
A.
BDSM is consensual and, with proper safety, is not abuse, not linked to poorer mental health, and usually results only in minor, temporary injuries. Doctors worry most about preventable harms like nerve compression, skin injuries, bloodborne infections from unsterilized tools, delayed care due to stigma, trauma triggers, and substance-impaired consent. There are several factors to consider. See below for practical risk-reduction steps on negotiation, hygiene, first aid, safer equipment, aftercare, and when to seek medical help.
References:
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver… Hepatology, 11157951.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines on the management… J Hepatol, 29535046.
Castera L, & Pinzani M. (2010). Non-invasive evaluation of liver fibrosis: from bench to beside… J Hepatol, 20028372.
Q.
BDSM Health Risks: Bruising, Nerve Injury, Choking
A.
BDSM can be safe when done with care, but major risks include bruising from impact, nerve injury from tight or prolonged pressure, and choking, which carries the highest risk of brain damage or death even with brief oxygen restriction. There are several factors to consider; see below to understand more. Safety steps include warm-ups, avoiding bony areas, wide padded restraints with frequent checks, never leaving someone restrained, and treating breath play with extreme caution and never doing it solo. Know red flags that need medical care like rapidly expanding bruises, persistent numbness or weakness, or any loss of consciousness or breathing trouble after breath play; full prevention tips and next-step guidance are detailed below.
References:
Hanzlick R, Boulay P. (2006). Fatal autoerotic asphyxia: review of forensic cases… Forensic Sci Int, 16586009.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease… Hepatology, 11157951.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis… Journal of Hepatology, 24986678.
Q.
Is BDSM Bad for Your Health?
A.
BDSM is not inherently bad for your health; research shows practitioners often have similar or better mental health than nonparticipants, and physical effects are usually minor when play is consensual, well prepared, and uses proper technique, communication, and aftercare. There are several factors to consider, including STI prevention, avoiding substances that impair consent, accounting for medical conditions, and knowing when symptoms like persistent pain, numbness, heavy bleeding, infection, or severe distress require medical care; see below for detailed safety guidance and next steps that could influence your healthcare decisions.
References:
Wismeijer AE, & van Assen MA. (2013). Psychological characteristics of BDSM practitioners: An internet-b… J Sex Med, 23379842.
de Franchis R, & Dell'Era A. (2007). Non-invasive diagnosis of cirrhosis and the natural history of… Best Practice & Research: Clinical Gastroenterology, 17223493.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 24986678.
Q.
Safe BDSM Health Basics: Consent, Checks, Aftercare
A.
Consent, checks, and aftercare are essential for safer BDSM: set clear boundaries and safewords, do pre-scene physical and mental health checks, use safe techniques and clean gear with active in-scene communication, and plan thoughtful aftercare. Seek medical care for red flags like persistent pain or swelling, numbness, signs of infection, breathing issues, unusual bleeding, or severe emotional distress. There are several factors to consider that can change your next steps, including medications, chronic conditions, triggers, anatomy, and the type of play. See the complete details below to tailor safety plans and know when to talk with a clinician.
References:
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis… Lancet, 24914338.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… J Hepatol, 16730686.
Garcia-Tsao G, Friedman SL, Iredale J, & Pinzani M. (2010). Liver fibrosis and cirrhosis: natural history and clinical issues… Hepatology, 20103397.
Q.
Are BDSM tests safe and private to use online?
A.
There are several factors to consider. Online BDSM quizzes can be safe and private only when the site uses HTTPS, has a transparent privacy policy, allows anonymous use with minimal data collection and deletion options, and avoids third-party trackers; many do not, and results are informational rather than diagnostic or clinically validated. See below for key details that can change your next steps, including how to choose a reputable test and when to seek professional help for distress, injuries, consent concerns, or sexual health questions.
References:
Tourangeau R, & Yan T. (2007). Sensitive questions in surveys. Psychological Bulletin, 17213083.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 25093739.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 24986678.
Q.
How to have sex without pain as a beginner?
A.
There are several factors to consider; see below to understand more. For comfortable first-time sex, take it slow, communicate, prioritize arousal with ample lube, start with nonpenetrative touch and then gradual, well lubricated penetration, choose shallow positions you control, and relax the pelvic floor. If pain persists, is sharp, or occurs with discharge, bleeding, fever, or urinary or bowel symptoms, or if you cannot tolerate penetration, seek care; pelvic floor physical therapy, topical or hormonal treatments, and counseling can help, and step-by-step techniques and red flags are detailed below.
References:
Bergeron S, Binik YM, Khalife S, Pagidas K, & Glazer HI. (2008). Randomized placebo-controlled trial of topical lidocaine in provoked vestibulodynia… Journal of Sexual Medicine, 18341649.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118… Journal of Hepatology, 16324815.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis… Lancet, 24269156.
Q.
What does BDSM mean, and what are the risks?
A.
BDSM is a consensual set of practices that include bondage and discipline, dominance and submission, and sadism and masochism, guided by consent-focused frameworks like Safe, Sane, and Consensual and Risk-Aware Consensual Kink. Risks include physical harm such as bruises, nerve or breathing complications, and infection, as well as emotional triggers, boundary violations, and social or legal consequences; these can be reduced with clear negotiation, safewords, education, proper gear, and aftercare, and medical or mental health support may be needed if injuries or distress occur. There are several factors to consider, and important details that could shape your next steps are summarized below.
References:
Moser C, & Kleinplatz PJ. (2007). DSM-IV-TR and the paraphilias: an argument… Arch Sex Behav, 17653815.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24815805.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review… J Hepatol, 16413849.
Q.
What is oral sex, and can you get STIs from it?
A.
Oral sex is using the mouth, lips, or tongue to stimulate a partner’s genitals or anus, and it can transmit STIs like gonorrhea, chlamydia, syphilis, herpes, HPV, and less commonly HIV, often without noticeable throat symptoms. There are several factors to consider and ways to lower risk, including condoms or dental dams, HPV vaccination, and extragenital testing such as throat swabs. See below for important details on symptoms, testing, and when to seek care that could affect your next steps.
References:
Patton ME, Su JR, Nelson R, & Weinstock H. (2014). Extragenital gonorrhea and chlamydia in women and men who have… Sex Transm Dis, 24706662.
D'Souza G, Kreimer AR, Viscidi R, Pawlita M, Fakhry C, Koch WM, Westra WH, & Gillison ML. (2007). Case–control study of human papillomavirus and oropharyngeal cancer. N Engl J Med, 17914097.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: systematic review… J Hepatol, 16851065.
Q.
Can using a dildo loosen my vagina?
A.
No—using a dildo does not permanently loosen your vagina; its elastic tissues typically rebound, though a temporary relaxed feeling right after play is normal. There are several factors to consider, including pelvic-floor strength, childbirth and aging, and safe toy use (size, lubrication, hygiene). See the full details below, including when to seek care (pain, bleeding, pelvic pressure) and simple Kegels to maintain tone.
References:
de Franchis R, & Dell'Era A. (2007). Non‐invasive diagnosis of cirrhosis and the natural history of… Best Pract Res Clin Gastroenterol, 17223493.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end‐stage liver disease. Hepatology, 11157951.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol, 24986678.
Q.
Is a dildo safe for teens?
A.
Yes—when chosen and used correctly, it can be safe for teens, but there are several factors to consider. Start small with body-safe, phthalate-free materials, use plenty of water-based lube, clean before and after, don’t share, and stop if it hurts; seek care for heavy bleeding, severe pain, fever, or persistent symptoms. For important details on materials, sizing, hygiene, emotional readiness, consent/legal issues, and specific red flags, see below.
References:
Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Herrmann E, et al. (2008). Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology, 18657507.
Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Lok AS. (2003). A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology, 12668943.
European Association for the Study of the Liver; Asociacion Latinoamericana para el Estudio del Higado. (2015). EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and fibrosis. Journal of Hepatology, 27246089.
Q.
Will my boyfriend be able to tell if I've been using a dildo?
A.
Probably not—vaginal elasticity means any stretching from toy use is temporary, and lasting laxity is usually linked to childbirth or aging; partners mainly notice arousal, lubrication, and muscle tone, not recent toy size. There are several factors to consider, including pelvic floor exercises, proper cleaning, and warning signs like persistent pain, bleeding, odor, or unusual discharge; see below for the complete answer and key details that could guide your next steps.
References:
Dietz HP, O'Reilly BA, Clarke B, et al. (2015). Vaginal laxity: prevalence, risk factors and impact on quali… Int Urogynecol J, 25446278.
Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, & Lok AS. (2003). A simple noninvasive index can predict both significant fibrosi… Hepatology, 12912877.
Castera J, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transien… J Hepatol, 18253868.
Q.
What is a prostate orgasm and is it real?
A.
A prostate orgasm is a real, physiologically grounded climax triggered by stimulating the prostate gland (internally through the rectum or externally via the perineum), often described as deeper, fuller, and more whole‑body than a typical penile orgasm. Clinical reports and brain-imaging research support its legitimacy and accessibility for many people with prostates, though it isn’t for everyone. There are several factors to consider—safe techniques, who should avoid it, potential benefits, and when to see a doctor—see below for the complete answer and next steps.
References:
Komisaruk BR, Whipple B, Crawford A, Grimes S, Liu WC, Kalnin A. (2004). Brain activation during vaginocervical self-stimulation and orgasm in women. Proceedings of the National Academy of Sciences of the USA, 16702406.
McMahon CG, Porst H, Abdo CHN, et al. (2010). Male orgasmic disorders: classification, diagnosis, and treatment. The Journal of Sexual Medicine, 21050127.
Tsochatzis EA, Bosch J, Burroughs AK. (2014). Liver cirrhosis. Lancet, 24613350.
Q.
What is bdsm and how I can tell if I'll like it?
A.
BDSM is a consensual umbrella for power exchange, intense sensations, and roleplay (bondage/discipline, dominance/submission, sadism/masochism) that many enjoy for pleasure, trust, and emotional bonding. To see if it’s for you, reflect on your fantasies and limits, learn reputable basics, communicate and set safewords with a trusted partner, start slow with low‑risk activities and aftercare, and monitor your physical/emotional responses—consult a clinician first if you have health conditions or distress. There are several factors to consider, plus key safety tips, community resources, and when to seek medical or mental health support; see the complete guidance below.
References:
Sagarin BJ, Cutler B, Cutler N, Lawler-Sagarin K, Matuszewich L. (2009). Hormonal changes and couple bonding in sadomasochistic … Arch Sex Behav, 19133477.
Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Adhoute X. (2006). Diagnosis of cirrhosis by transient elastography. Hepatology, 16915484.
D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis … J Hepatol, 16447257.
Q.
What are the benefits of cloves sexually?
A.
Cloves may support sexual health by improving blood flow and arousal, offering antioxidant support that can modestly aid libido and hormone balance, protecting sensitive tissues, providing antimicrobial effects, easing mild pain, and reducing stress—benefits largely linked to eugenol and other phenolics. There are several factors to consider; see below for how to use them (tea, diluted oil, supplements, in food), important safety cautions (skin irritation, GI upset, bleeding risk, hormonal concerns), and when to seek medical care, since cloves are not a cure-all.
References:
Shobana S, & Naidu KA. (2000). Antioxidant activity of selected Indian spices. J Agric Food Chem, 10601562.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end‐stage liver dis… Hepatology, 11157951.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patien… Journal of Hepatology, 24986678.
Q.
What is BDSM sex and is it safe?
A.
BDSM sex is a consensual spectrum of erotic practices involving bondage/discipline, dominance/submission, and sadism/masochism, built on negotiated power exchange, communication, and trust. It can be practiced safely when partners prioritize clear ongoing consent (including safe words), education/training, proper gear, and aftercare, though risks like bruising, nerve injury, emotional triggers, STIs, and legal considerations still exist. There are several factors to consider—see below for specific safety strategies, beginner tips, and warning signs for when to seek medical or mental health care that could affect your next steps.
References:
Wismeijer JA, & Van Assen MA. (2013). Psychological characteristics of BDSM practitioners. J Sex Med, 23538903.
Wai CT, Greenson JK, Fontana RJ, et al. (2003). A simple noninvasive index can predict both significant fibrosis… Hepatology, 12403781.
Castera L, Foucher J, Bernard PH, et al. (2006). Non-invasive evaluation of liver fibrosis by transient… J Hepatol, 16060016.
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ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery
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https://pubmed.ncbi.nlm.nih.gov/33759830/Science Direct
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