Dr Ayan: A potentially deadly droop . . .

Hi folks, just a quick todgertalk health tip. . . I was at a media medics seminar last week on erectile dysfunction. The shocking thing is that it is treatable in over 90% of cases but men often find it hard to talk about it.

Causes include smoking, diabetes, high blood pressure, stress, psychological reasons but most importantly heart disease. A recent study has shown that 3-5 years after men develop erectile dysfunction, particulalry over 40, they are very liekly to suffer a heart attack. For this reason alone, please please please make sure you let your doctor know if you're having trouble down below, as it may be an early warning sign for heart disease. For some free information and a self-test, visit www.40over40.com

Some Manbits For The Ladies, #12 & #2

Wahey! No sooner did we put the call out for chaps willing to have their manly mither picked over by the TT team than the e-mails piled in. So we thought, Cor Blimey O'Reilly - where are we going to put Something For The Ladies? And then, one of our female readers popped up with the exact same question, meaning we can combine the two and have a day off. Hurrah!

Anonymale writes: OK, here goes. I am a man in his 50s who has recently got divorced after 20 years in a sexless marriage and taken up with a 35 year-old woman. She is quite insatiable in bed and we regularly screw for hours in all sorts of positions, and yet I find that no matter how much she turns me on, I can't come inside her. In a way this works to her advantage as I can keep it up for ages!

Luckily she is very understanding, but I have even felt obliged to fake an orgasm or two before now as she has hinted she feels a bit rejected (am I the only man to have done this, I wonder?). I saw a similar post a few months back with a woman asking why her bloke has to wank to come when he's with her, I would just like her to know it may well be a common problem, especially with blokes who have had to resort to "Mrs Palm and her 5 daughters" for any length of time.

Meanwhile, RLT writes: We hear a lot about premature ejaculation, but unfortunately I have to ask about the opposite. I have been with my new man for quite a while now, it’s going really well. He is really keen and everything is good. However, when we have sex he can't 'finish'. This has never been a problem before and to be honest, I'm a bit concerned and frustrated. He does orgasm every session, from other things, but with penetration, it just doesn't happen.

It feels good, he is clearly enjoying it, and we have tried different positions, different condoms, more foreplay etc, but its just not happening. He is often on the brink, but something is in the way. He says he just has a lot of stamina and finds it hard to relax. I know he is really stressed at the moment and has a lot of issues, but surely he should be relaxed enough to orgasm? Gah - you can understand my frustration and to be honest slight embarrassment. Its starting to introduce insecurity on my part. Any advice?

Dr Ayan says: The question here is whether you do come when you masturbate on your own – in other words, do you ever reach the feeling of orgasm, even if it is with via 'Mrs Palm and her daughters'? If the answer is ‘yes’, there is probably a deep psychosexual reason behind why you can't come inside her. By this I mean something buried in your subconscious mind which is holding you back.

Obviously, you won't be consciously aware of it. So don't try and think of reasons - but they could be anything from an irrational fear of getting her pregnant or something deeper from past experiences. It sounds crazy, but this is almost certainly the case. You clearly fancy her as you can 'screw for hours', so there's no conscious issue. It's a reasonably common problem and I think it's worth you asking your GP to refer you to a psychosexual counsellor. It's not that you are impotent or don't fancy her, so that is definitely the way to go in my mind. A good psychosexual counsellor can often draw out issues that you never knew were there, deal with them and allow to you get on with a complete sex life again. Here's a link for more help.

‘Mr Sex’ says: Well played, Dr A. Anonymale is right – we did address something similar to this a while back, but that was more a ‘won’t come’ than a ‘can’t come’.

Firstly, to our male reader; you’re a man in your 50s, and you’re finding it hard to ejaculate in penetrative sex. Guess what? I was in that position when I was 20 years younger than you. It’s a condition called ‘getting older’, and, by and large, is a good thing. Rather that than the two-pumps-and-a-squirt performance levels of what we laughingly call our ‘prime’, eh?

The problem both you and RLT have is that, like everyone else in the world, you have an idealised rumpo goal. Ridiculously simply put, you both want to give your partner an orgasm, and have one yourself. Absolutely nothing wrong with that (and I can hear our readers across the globe simultaneously going “DURRRRR”), but when we put downers on ourselves and each other when it doesn’t happen, we’re loading the dice against it happening the next time. And the time after that. And the time after that. And so on.

I’m not a gambling man, but I bet RLT has had a satisfactory penetrative sexual experience without climaxing herself at least once in her life, and I bet it didn’t bother her either. I also bet that she was happy enough with the intensity and intimacy of the moment. Obviously, no-one wants that all the time, but the point I’m trying to make is that when it comes to sexual problems, the more you worry about them, the more they start to hang around. Easier said than done, of course, but it’s a start.

As for faking orgasms, yes, it is possible for men; all you need is a condom, the palming skills of David Copperfield, and a clear run at the toilet door. But one day you will get caught, and it will be a train-wreck of colossal proportions, and you will run the risk of faking the next one on your own. Both you and your partner have to accept that not everything is running like clockwork and enjoy what you already have (without frustration or embarrassment), so it can get better over time.

Everybody: comment!

Dr Ayan: Danger Down Under?

No, we're not talking about holidays to Oz, but oral sex of course. Yet again, it's been brought to my mind by a patient who asked me the question last week.

The risks are higher to a person performing fellatio on a man rather than cunnilingus on a woman, but don't be reassured by that, because the bottom line is you can theoretically catch everything from either act. Ok, I know, the doctor only talks about the doom and gloom side of sex. Well, I'm not here to preach. I think the point is to be aware of the risk, and remember, the quicker you act if you think you're at risk, the easier it'll be to treat. Remember - most STI's are treatable, so if you do have a lapse, get down to the GUM clinic sharpish.

Here's a useful link which leads to others about what you can and can't catch from oral sex.

Dr Ayan: Peeing razor blades

Why 'urine infection' symptoms should always be taken seriously in men....

It's one of those things that women get commonly but men should really never get - urine infections. Why? Well, if you think about the urethra which is the tube that leads from your bladder to the outside world, in men it is usually relatively long compared to a woman. This makes it hard for bacteria to travel up it into the male bladder, whereas in a woman, bugs from the back passage have only a small way to travel to get into the bladder. Of course activities like having unprotected anal sex will increase the chance of developing a urine infection.

So what do you do if you get burning on passing urine? What are the possible causes?

Rarely some men are born with abnormalities of the structure of their renal tract, but this is rare.

• If you are over 50, think about your prostate - it could be infected and enlarged...


• It could be a stricture (narrowing of the urethra) which can happen as a result of a sexually transmitted infection, sometimes many years down the line


• It could be a sign that you've caught a sexually transmitted infection


• You could have a bladder or kidney stone
  

So what should you do? Well, either go down to your local sexual health clinic or see your doctor, but do not ignore it. The bottom line is that urine infections in men almost always need checking out... they don't 'just happen' like they do in women.

You can also check any symptoms on NHS Direct, either online, on digital TV, or talking directly on the phone to a nurse 24 hours a day (0845 46 47). They can also give you the address and details of your closest sexual health clinic.

Dr Ayan: Jock Itch

Here's a quick medical signpost based on the fact that I've seen three guys in the last month with the same "Oh yeah, and while I'm here, Doc..." issue. They all find it hard to keep their hands out of their trousers because of an itch that won't go away, coupled with a mild red rash. It's something the Americans call 'jock itch' which always amuses me for some reason... All three had checked themselves for crabs...

Most commonly, the itching is because of a fungal infection affecting the skin of the groin, testicles and penis - a little bit like athlete's foot but in the groin. Any area of the body which sweats or is not well aerated can be a good breeding ground for fungal infection.The good news is that is not serious. My advice would be to wash the area as usual, dry thoroughly and avoid towel sharing. To get rid of it, use an antifungal cream from the chemist for a week - something like Canesten, Daktarin or Lamisil twice as day, generously over and just around the surrounding area. If it does not clear up see your GP...