Sexual health

 

 

Sex is sex. What do you mean by sexual health?

Although there are many ways to have satisfying and fulfilling sex, it remains an unusual experience for far too many of us. Fifty-six per cent of men are dissatisfied with their sex life and 83 per cent believe there's room for improvement in their sexual performance. Since enjoyable sex is so important to our sexual health, as well as our overall well-being, it's vital we find ways of improving our experiences between the sheets (or wherever else we choose to have them). If you can, you'll:

• enjoy sex more.
• feel better about yourself.
• be less at risk of sexually transmitted infections (STIs) and other problems such as erectile dysfunction (impotence) or premature ejaculation.
• live longer - maybe. (It's becoming increasingly clear that enjoying a fulfilled and intimate relationship can make an important contribution to good overall health and that a satisfying sex life can be a significant component of any such relationship. Effectively preventing, detecting, and treating diseases of your sexual and reproductive system could also help increase your lifespan.)
  

Is sex good for your health?

Sex helps keep you fit. Men's heart rates can rise rapidly during sex from an average of 70—80 beats per minute at rest to 100—175 beats per minute during the build-up to orgasm and 110—180 beats during orgasm itself. The heart rates men experience during sex can be similar in intensity to those generated by vigorous aerobic exercise; in fact, an hour of passionate sex could easily burn off 360 calories, equivalent to about two pints of beer.
It helps you look younger. Couples who have sex at least three times a week look more than 10 years younger than couples who have sex twice a week, according to a 10-year study of over 3500 people aged 18—102 in Britain, Europe and the United States. After looking at all the factors that influence how old people look, sexual activity emerged as the most significant factor after physical and mental exercise.
Regular sex could keep you alive for longer. The more orgasms a man has, the longer he is likely to live, at least according to a study of over 900 middle-aged men in Wales. Men with a high frequency of orgasms during sexual intercourse (ie. twice a week or more) are 50 per cent less likely to die from any cause within 10 years than men who have infrequent orgasms (less than one a month). Of course, these statistics could simply mean that healthy men have more sex rather than it being the sex that keeps men healthy but the figures are consistent with other research that strongly suggests that people with intimate relationships are healthier than those who feel lonely and isolated.
It boosts your hormones. Testosterone levels increase during and after sex, especially if there's a long period of foreplay. This not only helps maintain your sex drive but may also increase your fertility. Sex additionally boosts the levels of a little-known hormone known as DHEA (dehydroepiandrosterone). This is reputed to have a wide range of benefits, including improving your sense of physical and emotional well-being, increasing energy levels, and reducing the risk of heart problems.

Why am I dissatisfied with my sex life?

Although modern men undoubtedly know far more about sex than their fathers, too many still have some rather strange ideas about it. Their heads are full of images from both mainstream movies and pornography that have convinced them that the key to a great sex life is simply to be constantly ready and eager and to have a massive, rock-hard penis, an encyclopaedic knowledge of every conceivable sexual position, as well as the ability to generate virtually endless amounts of thrusting. It's a process, moreover, that always culminates in penetration and a simultaneous multiple orgasm during which men ejaculate like hose-pipes; condoms aren't necessary because, somehow, women never get pregnant and nobody's at risk of catching an STI. It almost goes without saying that, in this version of good sex, men never have any doubts about their attractiveness, their ability to function sexually, or their sexual identity.
Attempting to model your sex life on what you see at the cinema, on video, or in magazines will almost certainly guarantee you bad sex. For a start, it's a fantasy: if we try to recreate this kind of sex in our own bedrooms we're setting ourselves up for disappointment and failure.
Secondly, the men who populate this make-believe world are there precisely because they aren't very much like most of us: they have muscular bodies, massive penises, know precisely how to satisfy any lover (even if they've only just met them), and can have sex for hours without ejaculating. If we try to measure ourselves against these latter-day Casanovas we'll probably end up with a case of severely dented self-confidence (as well as an extremely sore, over-used penis). And, finally, there's normally very little communication or intimacy between the partners we see on our screens. Their sex is cold and functional, and, although this kind of experience can sometimes feel right, most of us want much more from our sexual relationships.
The traditional male model of sex is also dangerous, both to ourselves and our partners. A lack of interest in, and knowledge of, STIs puts us all at increased risk of diseases like chlamydia, gonorrhoea, and HIV (the virus that causes AIDS). Not sharing responsibility for contraception can expose women to the hazards and distress of an unplanned pregnancy (not to mention, potentially, years of motherhood) and men to the major responsibilities of fatherhood. What's more, if we don't understand how our sexual and reproductive system works, and what can go wrong with it, we're also much less likely to detect the early signs of a wide range of problems that can affect every part of our genitals (both inside and out).

So how can I make my sex life more, er, sexy?

Be more realistic about sex
This may mean jettisoning some of your cherished and long-held beliefs. For example:

Men should always be ready for sex.
FALSE. Some men clearly have higher levels of sexual desire than others, but almost all men have a range of other needs in their lives (work, taking the children to school, sport, enjoying a drink) that are just as important to them as sex, if not more so. Stress, depression, and ill-health can also significantly reduce sex drive. In fact, loss of sexual desire is surprisingly common among men.
It's important to have a large penis.
FALSE. Although many partners may get excited by the idea of a man with a larger penis, most are also perfectly satisfied by one of average length. Ninety per cent of women feel that penis size doesn't affect their orgasms, according to a broad survey conducted for a women's sex magazine.
Men's erections must be rock-hard.
FALSE. Some may be but many aren't. About one in 10 men is consistently unable to achieve an erection hard enough for sex. Many more men will have occasional erection problems (perhaps as a result of stress or too much alcohol), while others will be able to get erections that are good enough for sex but certainly won't feel as if they're strong enough to support the roof of the Parthenon.
Men should produce lots of semen.
FALSE. They might in pornographic fiction, but in reality the average amount of fluid produced during ejaculation is about one teaspoonful (3 ml), although it can range from 1.5—6 ml. There's no obvious connection between how much you produce or how far it shoots out and your masculinity.
Women can orgasm just from intercourse.
FALSE. Just plugging your penis into a woman's vagina and wiggling it around may be enough to make some women orgasm but many will probably just lie there thinking about what they'd rather be watching on television. Even though most men have probably heard that women require clitoral stimulation in order to achieve an orgasm, they sometimes act as if they don't really believe it. 
The thing is that unless you've got a double-headed penis, it's difficult to have vaginal intercourse and stimulate the clitoris directly at the same time. That matters, because when it comes to a woman's orgasm, the clitoris is what really counts.
The visible part of the clitoris, located at the top of a woman's external genitals, is usually about the size of a small pea. But it's recently been discovered that the entire organ is very much larger. In fact, the visible 'glans' is connected to a hidden 'body' which is about as big as the first joint of the thumb. This body, in turn, has two 'arms,' each up to three-and-a-half inches long. Although the full role of the clitoris isn't yet understood, it's clear that it's at least as sensitive as the penis and just as significant during sex; indeed, both get bigger during sexual arousal. This shouldn't be surprising since both the clitoris and the penis are actually formed from the same tissues during our early days as a foetus.
Just as men's preferences for penile stimulation vary, so do women's preferences for their clitoris. Some find direct touching too sensitive while others like it to be rubbed or licked quite vigorously. No book can tell you how best to turn on a woman; you need to ask her to show or tell you. If she's willing to masturbate while you watch, this will give you very valuable clues.
All orgasms are stupendous.
FALSE. Anyone who's honest will tell you this simply isn't true. Some orgasms are fantastic, others are barely noticeable, and they can vary from day to day almost as much as the weather. Men who are overweight and have sedentary jobs can find their orgasms become less powerful and pleasurable because of poor tone in their pelvic-floor muscles (these are responsible for expelling semen). 'Kegel' exercises are the best remedy: these simply involve regularly squeezing and relaxing the muscles you'd use to stop urinating in mid-stream.

Focus on fun and pleasure, not performing.
For many men, sex is like a climbing a mountain. You start at the base camp where you kiss and cuddle, and after a long slog up the lower slopes and then the steeper faces, you end up at the summit with penetration, ejaculation, and self-congratulation. Although it's certainly possible to have great sex this way, after a while it can easily become boring and predictable.
Learn what you like.
One good way of doing this is to spend more time masturbating. Seriously. By experimenting on your own you can discover much more about how you like to be touched. Once you've found out, tell your partner.
Don't feel obliged to try different sexual positions.
Most sex manuals are packed with examples of hundreds of different ways of having sex. Some of them will feel great, some will feel lousy, and some will be unachievable by anyone who's not an Olympic gymnast. But the main problem with most information about sexual positions is that it reinforces the idea that sex is some kind of performance and that it's good only if you're constantly trying lots of different things. Variety can be important, but you should be guided primarily by what you and your partner find satisfying and exciting.
Try not to rush towards intercourse.
The word 'foreplay' is unfortunate since it strongly suggests that kissing, licking, sucking, and rubbing are somehow only preliminary stages in the run-up to the main event. Unless the goal of sex is pregnancy, there's no obvious or automatic reason why it should always include penetration. There are many other ways of having fun and achieving orgasm. It's often better simply to do what feels right, not what you think you should be doing after five, 10, or 15 minutes. It may be that you both want to spend 20 minutes just kissing or rubbing against each other with all your clothes on. Even if not doing what you've always done feels artificial and a different kind of performance, stick with it. With time, this kind of sex should begin to feel more natural and spontaneous.
Try to relax and focus on the physical sensations of sex.
That way, you're much more likely to enjoy sex and give more pleasure to your partner. Try these suggestions:

• Reduce your general levels of stress. It's generally not helpful to use sex as a distraction from whatever's worrying you; it won't tackle the underlying causes of your stress and it probably won't work anyway.
• Regularly use simple relaxation techniques, such as deep breathing or tensing and relaxing your major muscle groups in turn.
• Make sure that the sex you're having isn't adding to your stress levels. It probably isn't a good idea to end up in bed with someone you really don't like or who wants sex without a condom when you want to use one.
• Don't use mind-games to try to stop yourself ejaculating too quickly. They reduce your enjoyment of sex—let's face it, thinking about your dream soccer team or quadratic equations might be interesting activities but they aren't exactly erotic (at least, not for most of us) and there are much better ways of tackling premature ejaculation.
• Focus on the 'here-and-now' when you're masturbating or having sex. Although there's nothing wrong with sexual fantasy, try having sex without it for a while (and dump any pornography, too). This could help you become more aware of the physical sensations you experience during sex and relax more into them.
• Don't hold back from moving around as much as you need to when you're having sex (yes, men are allowed to squirm with pleasure) or moaning and groaning.

Try not to take sex too seriously.
We often approach it as if we were about to race a Grand Prix or attend a religious service. Although sex is a supremely important activity, it can also be absurd and funny. Having a laugh during and after sex—so long as it's not at your or your partner's expense—can help you feel relaxed as well as much more in touch with what's going on.

OK, so what are the alternatives to intercourse?

Massage.
Start by massaging your partner, tantalizingly leaving the genitals until last. Then let you partner massage you.
Mutual masturbation.
Experiment, too, with a range of specially formulated lubricants. These now come in a bewilderingly large range of flavours and consistencies (including ones that replicate the body's sexual fluids); some even warm up as you use them.
Oral sex
An old favorite, but many men still see it as a starter rather than the main course.
Frotting
Rubbing your bodies against each other.
Using sex toys
Vibrators and dildos can get you both whirring. Try raiding your kitchen, too: cucumbers and bananas needn't be just for eating, and many people find ice cubes can excite their nipples and sexual organs.
All these options can be spiced up by dressing up, having sex in the bath or shower, trying different venues outside the home (e.g. in a car, in the countryside, in a hotel), role-playing, and just about anything else you can think of. You can try pretty much whatever you like providing your partner freely agrees.

Is masturbation good for you or bad for you?

It's certainly had a bad press. Victorian moralists believed masturbation was sinful 'self-abuse,' and doctors warned it could make you go blind or mad. Even in the 1990s, a US Surgeon General was forced out of office for suggesting that young people should learn about masturbation in school. Although few people now believe masturbation is wrong, many of us still feel slightly guilty about solo sex. Perhaps it's a legacy of the prudish past or maybe it's also because masturbation's seen as a sign of failure. After all, real men are supposed to have real sex, not make-believe sex with a bottle of oil and a box of tissues. But next time you feel inadequate about masturbating, remember that one survey of over 7000 men found that those having sex with a partner every day were more likely to masturbate once a week or more than men who rarely or never had sex with a partner.
Masturbation can be fun and relaxing (crucially, there's no pressure to perform) and it's also completely safe (unless you happen to be turned on by cheese graters).

How do I talk to my partner about sex and what I like?

Whether you've just started a sexual relationship or have been in one for 30 years, it's still important to talk about it. You'd probably discuss what colour to paint your living room, what car to buy, or where to go on holiday, so why not talk to your partner about sex, too?
Find ways of communicating better with your partner about every aspect of your relationship. This should also help to improve your sex life.
Express how much you like your partner's body. You don't only have to do this in bed. Putting an arm round your partner's shoulder, squeezing their hand or initiating a kiss are all important. Explain why you find them desirable and sexy, perhaps not just in terms of the obvious features but also the things that appeal specifically to you (e.g. the curve of their lip, that mole on the inner thigh, the way they walk). If your partner does the same to you, make sure you acknowledge it rather than seem to take it for granted.
Develop a physically intimate relationship that extends beyond sex. If a couple are relaxed with, and enjoy, each other's bodies in non-sexual ways, this can have significant sexual benefits. Simply holding hands or cuddling while watching television can create a greater sense of intimacy, as can learning how to provide a simple but relaxing massage.
Talk about what you want in bed. This is best done without criticism or blame, so don't say something like 'I hate the way you never suck my prick.' You're much more likely to get a positive response if you say something like 'Seeing your lips round my cock drives me wild.' If your partner really doesn't feel comfortable about oral sex, you could try suggesting some sort of compromise (e.g. your partner licks the inside of your thighs while masturbating you).
Be aware of what your partner wants, rather than make assumptions. One way is simply to say 'Does that feel good?'; another is to do more of whatever produces pleasurable noises ('mmmm' or 'ahhhhh') and less of whatever produces silence or 'ugh' sounds. Watch out for physical signs, too: if your partner's nipples stiffen or genitals moisten, then you're probably doing okay; however, you should try something different if you feel your hand, head, or penis being pushed away. Ask what your partner wants, too—and take it seriously. You can't really expect your partner to do what you'd like if you're not prepared to reciprocate (or at least discuss it).
Share your sexual fantasies. You may need to be sensitive about this—your partner might not appreciate it if all your fantasies are about a previous lover, for instance, or involve herds of wild animals—but sharing can be both a sign of trust and a clear signal of your sexual desires. But you can't expect your partner automatically to agree to act out all your fantasies (or vice versa). Not everyone likes being covered in strawberries and cream. Again, it's something to discuss and reach an agreement about.
Discuss how often you and your partner want sex. Often, at the start of a relationship, a couple will have sex at almost every opportunity. After a few months, however, sex may steadily become less frequent. This is a normal development but it can be a time when differences emerge in partners' levels of sexual desire. This can cause frustration and resentment in the partner who feels deprived, and guilt and anger in the partner who feels pressured to have sex when not feeling aroused. Many couples in this position find it helpful to agree a mutually acceptable arrangement. It's also important to remember that this needn't exclude non-sexual physical intimacy at other times.
If you find it hard to talk about your sexual needs with a partner, perhaps because you feel embarrassed or ashamed, you could start by trying to have a more abstract conversation about sex. If you see an article in a newspaper or a television programme that deals with sexual issues, you might discuss what you think of it. Over time, as you become more at ease with talking about sex, you may feel ready to take the risk of being more personal.
The better you feel about yourself, the more you're likely to enjoy sex. You'll probably feel less inhibited, more open to new ideas and experiences, and better able to tell your partner what you want during sex.
If it feels impossible to discuss sex at all then it's more than likely that your sex life is not all it could be and that it won't improve much over time. But you don't have to give up. Perhaps the best way of breaking through the barrier is for you and your partner to see a couples counsellor or a sex therapist. Don't worry: you won't end up being forced to have sex on his or her office floor, but you should find it'll become much easier to explore, and sort out, your sexual inhibitions.
However, and whatever, you communicate, one thing is clear: it's vital to be honest. Pretending you're happy with your sex life when you're not can easily begin to cause resentment and even anger; it can end up putting a strain on the entire relationship. Honesty's especially important if you have a sexual problem, such as erectile dysfunction (impotence). However uncomfortable it feels to be honest, it's more than likely that the long-term consequences of dishonesty will feel much, much worse.

What if I don't feel comfortable with my sexuality?

Be honest about your sexuality. While scientists struggle to understand the roots of our sexual identity—it's still not clear whether we're straight, gay, or bisexual because of our genetic make-up, for instance, or as a result of our experiences as we grow up—it's beyond doubt that human males exhibit a very diverse range of sexual preferences.
Most men are attracted to women only, but a significant minority is sexually interested only in other men, while a third group is attracted to both men and women. None of these preferences is better, more moral, or healthier than any other; what's most important is that a man should feel comfortable with his sexual preference.
Many straight men worry that enjoying sexual stimulation of their nipples, anus or prostate gland means that they must somehow be gay, even though they're attracted only to women. The reality is that all men—straight, gay, and bisexual—have many erogenous zones besides their penis. The fact that more gay men than straight men enjoy stimulation of their prostate means only that straight men tend to have a much more limited view of what's acceptable and unacceptable between the sheets. In fact, there are many ways in which a heterosexual man can enjoy prostate stimulation besides having another man's penis inserted into his rectum (a partner's finger or a dildo will do perfectly well).
A more distressing problem affects men who know they're gay but can't admit it to their friends, relatives, or sometimes even to themselves. In some cases, these men may live with women, and perhaps have children too, and appear to the world to be happily heterosexual. Their difficulty in 'coming out' may be linked to feelings of guilt, shame, or a fear of hurting, or being rejected by, others. It could also be related to the fact that, despite the moves towards greater equality for homosexuals in most Western countries in the past 30 years, gay men and lesbians are still widely subjected to discrimination, prejudice, and even violence. For many gay and bisexual men, coming out remains a stressful and dangerous step.
Men who are unsure of their sexual orientation, or who feel hesitant about coming out, can contact a wide variety of organizations for advice and support. Although it's difficult to generalize, it does seem as if most men ultimately benefit from being more open about their sexuality. The stress of living a lie about such a fundamental part of one's life cannot be over-estimated.

What about safe sex and sexually transmitted infections?

Your sex life will be a lot happier and healthier if you take good care of yourself—and those you have sex with. Click here for an introduction to sexually transmitted infections (STIs) puncturing the common myths and here for more detailed information on the main types of STI.
There are many health problems which can affect the sexual and reproductive organs. At least one man in three will have some sort of prostate-gland disorder during his lifetime, about the same proportion will experience a sexual dysfunction, and one in 20 will be affected by fertility problems (such as a low sperm count).
Each year, one in 100 men is likely to catch an STI such as gonorrhoea, chlamydia, or HIV. Although testicular cancer affects just one in 450 men, its incidence has doubled in the last 20 years and looks set to continue to rise. Yet many men's knowledge of potential problems with their sexual organs is limited. One survey found that just over half of men knew that prostate cancer was a disease that could only affect men; under a third of men knew even one of the major symptoms. The more you know about these problems, the easier it will be for you to prevent them arising in the first place and to detect and treat them if they do.
The symptoms of the main STIs are here. Some symptoms aren't always obvious, can take a long time to show up, or can appear briefly and then disappear. If you're sexually active with more than one person, or you're about to have sex with a new partner, you should seriously consider having a routine STI check-up. If you think you have an STI, you must see a doctor: it's difficult for you to diagnose your condition accurately, and in any event it's impossible for it to be effectively treated without drugs available only on prescription. Click here to learn what happens at an STI clinic and to locate your nearest one.
Whether or not you're sexually active, you should also look out for symptoms of other important sexual health problems. These include:

• Lumps, scars, or bending in the penis.
• A discharge from the penis.
• A tight foreskin.
• The inability to achieve an erection.
• Painful erections or an erection that won't go down.
• Rapid or delayed ejaculation during sex.
• Loss of sexual desire.
• Problems with urination: pain, increased frequency, a weak urinary stream, or blood in the urine.
• Pain during ejaculation.
• Blood in the semen.
• Testicular pain or lumps or a change in size, shape, or firmness of one or both testicles.
• Sores, blisters, ulcers, or growths on the genitals.

Have 'safer sex', unless you're sure both you and your partner are HIV negative (i.e. not infected with the virus). Essentially this is a way of behaving sexually that minimises the risks of transmitting the virus. As discussed, earlier, it's called 'safer' rather than 'safe' sex as it involves greatly reducing the risk rather than eliminating it completely. Safer sex will also reduce your chances of contracting or passing on many other STIs.
Be assertive. Choosing safer sex can be difficult. Even if you want to use a condom, you might feel embarrassed if you're not confident you know how to put one on; alternatively, you might be worried about losing your erection. (Click here for tips on using a condom.) On the other hand, your partner might not want to have sex with a condom. You might then think that if you insist on using one, it implies that you've got an infection or that you don't trust your partner. It can all get very complicated and there's no easy way to talk about this. But if your partner's reluctant to use a condom, the only viable strategy is for you to say you're not prepared to have penetrative sex without one.
Be open. If you have an STI, it's your responsibility to tell your partner(s). They can then decide if they want to have sex with you and, if so, how. If they've already had sex with you, they may need to get themselves checked to see if they've been infected. You might think that it's not up to you to tell partners on the grounds that it's their responsibility to make sure that whatever they do is safe. You could also be worried that nobody will want to have sex with you if they know you have an STI or that they will be angry with you if you tell them they've been exposed to a risk of infection. Perhaps your best guide is to ask yourself if you'd want a partner to tell you of any potential risk to your health and to act accordingly.
Be fully involved in decisions about contraception. A lack of interest in contraception not only annoys women (quite understandably) but can also mean that a couple ends up using a form of contraception that doesn't meet both of their needs when it comes to preventing pregnancy, minimizing the risks of STIs, or, very importantly, simply having fun. Given that about a dozen methods of birth control are now widely available, it should be possible to find at least one that feels right. For more on contraception, click here.

Should I have an HIV test?

If you're worried that you could be HIV positive (i.e. you have been infected with HIV), a blood test will tell you one way or the other. If you discover that you are HIV positive, you can then get medical advice and treatment that could make a big difference to your health. You'll also be able to take steps to protect anyone you have sex with and inform any past sexual partners who might have been at risk. If you find you are HIV negative, however, and you're sure that your partner is too, then you can safely ditch the condoms and start having unprotected sex—unless, of course, you're using them as a form of contraception. (But you must remember that it takes three months for HIV to become detectable in a blood test, so if you've been infected in that period the test could show incorrectly that you're HIV negative.)
One big argument against having a test is that it can be a very frightening experience, whatever the result. (If you do go ahead, you may want to consider getting the support of a close friend as well as making sure you have the test at a clinic that offers counselling before and after the result. Many clinics also offer a same-day results service, which some people find helps reduce the stress of waiting.) You'll need to be confident you can cope if you do get bad news: you might want to wait if you're suffering from other sources of stress at the moment. If you are HIV positive, it could well affect your relationships with your partner and anyone else you choose to tell. Some employers may also be reluctant to offer you a job, you could find it harder to obtain insurance, and a few countries place restrictions on the entry of people known to be HIV positive.
It can be a difficult decision, and there's no right or wrong course of action. Only you can decide, but you might find it helpful to get more information and advice from an organization specializing in HIV issues. Click here to learn what happens at an STI clinic and here to locate your nearest one.

FAQ: common concerns about sexual health

I find foreplay boring
Although it can be great to have fast sex occasionally, if you keep skipping foreplay your partner might well soon start skipping you. There could be four explanations for your feelings about foreplay. The first is that you still believe in the outdated male notion that foreplay is largely an irrelevance and that what really counts is simply sticking your penis in. Secondly, you may never have tried foreplay and therefore could remain unaware of its many pleasures. Thirdly, you may never have learned that you have many erogenous zones besides your penis (e.g. your nipples, testicles, thighs, anus, lips, buttocks, and abdomen). Finally, it's possible that you're scheduling sex as if it's a meeting and not leaving yourself enough time to get into it. Whatever the reason, take a chance—try foreplay and see what you've been missing.
Condoms ruin sex
Most men find that sex with a condom doesn't feel the same as sex without one; there is, inevitably, some effect on sensation. However, wearing a condom gives you one big advantage: you do know that the sex you're having is much, much safer. You can also try and spice up your condom experience by asking your partner to put it on for you—you can even make this part of sex play (e.g. a shared sexual fantasy) rather than something that can often seem like a medical procedure. Adding lubrication can also help improve sensitivity. Some men claim that because condoms help delay ejaculation they actually lead to a more powerful orgasm. Click here for more on using condoms.
I feel very inhibited around sex
It's common occasionally to feel embarrassed or shy, but if your feelings are stronger and getting in the way of sex then you need to find out why. Some men who had very religious or prudish parents have been brought up to believe that sex is somehow shameful or dirty. Others may have been punished if caught playing with their penis as a child or masturbating when a teenager, leaving them with the belief that sex is wrong. A bad first sexual experience, such as being criticized by a partner for coming too quickly or not being able to get an erection, could also cause problems, as could a history of sexual abuse. The best way to deal with sexual inhibitions is to see a sex therapist or counsellor.
I'm worried I've picked up a dose of the clap but I'm scared about the tests a clinic will want to carry out
You'll probably be offered a range of tests to check for all the major STIs. Gonorrhoea and chlamydia are usually checked by a swab pushed into the tip of the urethra (the tube running through your penis). There's no denying it stings—and rather more than cheap after-shave—but it doesn't last more than a few seconds. (And despite what some blokes say, the swab certainly isn't the size of a coat hanger.) But if the idea of this really bothers you, ask if the clinic can use a more recently introduced urine test for these diseases. Other diseases, such as syphilis and HIV, require a blood test. If you're needle-phobic, make sure you tell the doctor or nurse so they can be as gentle and reassuring as possible. However scared you are by the tests, you should remember it's likely that you'll be even more worried by the idea of having an infection that remains undiagnosed and untreated.

Peter Baker