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How’s Your Sex Drive?

Published by Bayer Men’s Health SA.

How’s Your Sex Drive? Interview discussion with Dr. Elna Rudolph. Brought to you by Bayer in the interest of men’s health. #owntheoomph

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How are your erections?

How are your erections?

Published by Bayer Men’s Health SA.

How are Your Erections? Discussion with Dr. Elna Rudolph. Brought to you by Bayer in the interest of men’s health.


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Sex Q & A with Dr. Elna Rudolph

Sex Q & A with Dr. Elna Rudolph

Dr. Elna Rudolph answers a few questions about sex.

My partner wants to try anal sex more often, but I don’t enjoy it. I’m worried that if I don’t do it, he will feel unfulfilled…

There are certain no-no’s when it comes to sex in relationships and they are different for each couple. The one might never want to have sex unless she first had a shower, the other will never allow oral sex, and another will not do it with the lights on. These taboos should be respected by the partner, but it does not mean that they cannot shift when the reasons behind them are explored and some basic information with specific suggestions are given in the form of sex education or formal therapy.

When it comes to anal sex being one of the taboos, there are usually two reasons: Firstly some people have religious or moral issues with it. These can be quite difficult to shift and should sometimes just be respected. The other reason is that it is just too uncomfortable and therefore really not enjoyable. Guys expect that they will be able to just penetrate their partners as easily as it looks in porn. The reality is that most people have to go through a process to get used to being stimulated first around and then in the anus. Start with some light touch and rubbing and then move to inserting a well lubricated little finger and then progressively go larger from there. If you are really committed to it, you could also practice by yourself to get used to what it takes for the anal sphincter to relax. Like any muscle, it has the ability, but it takes time. If you perceive the attempt at penetration to be threatening and you anticipate the pain, the muscle will just go into spasm and make it more difficult and unpleasant.

How many times a week is it normal to masturbate? I’m in a long-term relationship and masturbate at least once a week, but my partner says he never does.

It depends on many things. If there is so-called “desire discrepancy” in a couple (which is the case in most relationships!) the partner with the higher desire is left frustrated if he or she does not masturbate. Masturbating is also a form of self-loving and soothing. You might get something completely different from masturbating than what you get from sex and therefore remain to have a need for it although you are in a very sexually fulfilling relationship. More than five times a week probably becomes excessive (according to international definitions anyway). It is also normal to never masturbate if you are in steady relationship. Whatever works for you.

I found a stash of lesbian porn on my husband’s computer and watched a video out of curiosity. It really got me off. What does this mean? Am I a closet lesbian?

Not necessarily. Up to 80% of women get turned on by some girl-on-girl action! You are a lesbian (if we have to use such a rigid term) if you would like to build a life with another woman. If lesbian porn excites you, you have just expanded your repertoire of excitement and fantasy.

I sometimes feel like my husband and I are more in the best friend zone than sexually connected. What can I do to get the spark back?

Make sure that you create special experiences when it comes to sex. The longer the relationship, the more difficult it is to create more and more exciting sexual experiences and then you get stuck in a rut.

It is however possible to create a special experience in a different way each time. Take time to make love through sensual massages and external stimulation, do the romantic candle lights and special music thing, make regular dates for love making, increase the oxytocin (bonding hormone) between you by looking each other in the eye, hugging and cuddling – all things to make a concerted effort to say: this is a special relationship with an intimate bond, not merely a friendship.

The more you are like friends, the more difficult these things are, but get started sooner rather than later!

How do I get my partner to go down on me more often?

Ask for it! Make sure you have the hair and hygiene under control and buy some special lubes that taste nice to encourage him. Returning the favor also goes a long way in encouraging him! (His favour might not be oral sex, it might be something else he loves that you are not doing frequently – find out what that is).

My guy doesn’t know how to make me climax – while he’s well-endowed, he’s not an expert at making it work. How do I nudge him in the right direction?

Firstly, you have to be honest about the fact that you are not getting there. Make it about you, not him. Tell him that there is only a specific way that works for you to come and you want to show him how to help you to get there. Show him how you do it and let him get involved in taking over more and more of the stimulation each time.

If he is offended by this and does not want to cooperate, think twice about sorting out a budget or raising kids with him!

How do I tell if he has an STI?

Sometimes you see a discharge, sore, blister, bump or wart in your genital area. It might have a bad smell or burn when you urinate. The reality is that most of the times you won’t even know about it. You will have to get tested.

I’ve just woken up from a night of tantric sex, but I’ve broken out in a nasty rash – I think it might be from the latex condoms we used. Are there any others we could try?

You could get latex-free condoms, but they are very difficult to find. Order them off the internet. It can also be due to oils you used for massaging.

I’m really in love with my partner but I struggle to get turned on by him. What should I do?

Check your hormone levels. Getting turned on is heavily dependent on testosterone. If you are taking an oral contraceptive, it breaks down and block your testosterone and therefore it is difficult to become sexually aroused. Some women just don’t produce enough testosterone. It can be supplemented through the skin, though. Never ever through injections!

My partner is amazing in bed, but he enjoys taking drugs before sex. I sometimes do it with him, but it bothers me that he wants to be high when we’re having sex. How do I tell him?

Be honest about it. tell him that you value the relationship and that you would like to have real intimacy with him and not just a fun, exhilarating experience. Ask him to do it your way every second time.

My partner is always super aroused when we’re in public, and not so much in private. While the thrill of getting caught is sexy, I’m over the riskiness. How do I get him to be as aroused when we’re at home?

It has to do with his sexual arousal template that was probably formed in his brain before the age of nine! He will have to learn that he has a very rigid arousal template and that it can actually be adapted and expanded. He also has to learn that sex is sometimes not that exciting, sometimes it is more special and for the purpose of bonding than for the purpose of that ultimate high. Guys with a rigid arousal template often have problems with real intimacy and if the problem is really severe, it should be addressed in therapy.

I’m very attracted to my partner, but during sex, I get uncomfortable and clamp up. How do I get over this?

That sounds like it could be vaginismus. We are a team of professionals that specialise in helping women deal with this problem. I wish there was a one-liner answer to that one, but unfortunately there isn’t. It’s usually caused by a combination of medical conditions, childhood trauma, religious upbringing with excessive guilt, poor sex education, psychological as well as relationship issues. These all need to be addressed for you to stop clamping up with the man you love.

Help! His penis is too big!

You can use muscle relaxants, better lube, vaginal dilators and even physiotherapy to get over this hurdle! There is also a device from Pure Romance, called Super Stretch Lips, that you can put over his penis to keep a part of it outside of the vagina during intercourse, but it is usually the girth that is the problem. Make sure you have pleeently of foreplay in order for your body to get ready for penetration.

Help! His penis is too small!

Make sure you get satisfied before penetration happens. You can also do kegel exercises and even see a physiotherapist that specialises in the area to help you strengthen your muscles in order to “feel” him better. A device like a We-Vibe also helps to improve the sensation during penetration if you need more than what he ‘has to offer’.

My boyfriend asked me to stick a finger in his bum while we were having sex. At first, I wasn’t keen, but eventually I agreed, and he said he had the most intense orgasm ever. Now he wants to do it all the time. Does this mean he’s gay?

No, not at all! It just means that he has discovered his p-spot. The nerve that supplies sensation this area is the same as the one that supplies your clitoris, so you do the math.

My new boyfriend has marathon-runner stamina in the bedroom. Sex goes on forever. I actually start getting bored and sometimes even chafed. How can I make him come faster?

Ask him to! If he can’t, he has what is called delayed ejaculation. Although it is a difficult condition to treat in sex therapy or sexual medicine, it can be done. Firstly, check if he is not on anti-depressant drugs that may be causing the problem. That can easily be changed to a different type, if it is the case. You can also tell him that you will help him come in another way or he can get himself there (which is usually much quicker) but you are only up for ten minutes of penetration in any one round (the vagina struggles to stay lubricated for longer than that in most women).

I want to do a striptease for my guy but I’m really uncoordinated and I’m worried it’s going to be more comedy than sexy. What’s the best costume to wear that’s easy and sexy to remove?

Probably a man’s shirt, tie and a top hat. Make sure you have the sexy stockings with dispensers and heals that you can still move in to complete the outfit (or at least that is what I’m told by the Carmen Electra Strip Tease DVD that was given by a friend! Not exactly the content covered in a Master’s Degree in Sexual Health!).

I don’t feel pain during sex, but afterwards, I bleed for two to three days, as if I’m having a period. What’s up?

You probably have an infection. See a gynae or doctor who knows something about this as soon as possible! Worst case scenario – it might be a cancer, so don’t wait!

I had my period twice last month. Google says it may be due to stress and my diet. But now I’m feeling some pain below my stomach. What could it be?

Ovarian cysts can cause abnormal bleeding and lower abdominal pain. You need to see a gynae or at least get a pelvic ultrasound done.

What can I do to reduce wetness before and during intercourse?

It may sound a bit strange, but you can just be practical about it and keep a towel handy to remove some of the excess moisture. We also compound a special cream to be applied into the vagina prior to sex to reduce the lubrication. Just also check for an infection. Sometimes the wetness is not lubrication but actually from an infection. Another option is to go onto a low dose estrogen contraceptive. That often causes vaginal dryness which could help in your case.

How do I tighten and strengthen my vaginal muscles?

You can get lots of information about Kegel Exercises on the internet – with different variations and programmes. Many women find it difficult to isolate these muscles and end up squeezing everything but their vaginal muscles. There are physiotherapists who specialise in this area. They will teach you how to do it through biofeedback.

My husband is 63; I’m 31, but he wants sex every day – sometimes twice a day! I can’t keep up. What should I do?

It can be that he just has a very healthy appetite but it can also be that he has a discomfort in his pelvic area that is released through intercourse, something called persistent genital arousal disorder, or it might be that he has an addiction. With professional help, it can be established which one of the three it is. The point however, is that his high desire cannot be your responsibility. You can have sex as many times as you are willing and able to, but the rest of the time, he will have to sort it out himself.

It can also be a hormonal imbalance which can be addressed medically, so get help if you are taking strain.

I lost my brother six months ago, but am still feeling the loss so I have bouts of depression that kill my sex drive to the point where I don’t even want to be touched or kissed, and its taking strain on my marriage. I can’t take anything hormone based as I have a factor 5 laiden disorder. Is there anything I can do or try to help me out my slump?

One the one hand you just have to be patient with yourself and give yourself time to get over this extremely traumatic life experience. It takes time and it is normal to lose your libido when you have depression.

On the other hand, make sure you get professional help. See a psychologist and take an anti-depressant that does not take your libido away. Something that works very well, but only if you are not anxious, is a drug called bupropion. It can actually boost your libido even if you don’t have depression.

My cramps before and during my period are awful! Is there anything I can do to ease them?

You can go onto the pill or have the Mirena inserted. Natural medicine like Premular or Femiscript also helps. Many women find benefit from using Evening Primrose Oil.

My IUD cut my guy during sex. Is something wrong?

Yes, definitely! It is falling out and probably not effective as a contraceptive anymore! Have it removed and replaced immediately. Sometimes when the strings are cut too short, they sting the partner, but if he got a cut, it was from the actual device itself and it should be removed.

My partner and I are both virgins. How can we make our first time really special?

By taking it really slow. Make sure you have covered base one, two and three before you try to have sex. Also make sure he can insert two fingers into your vagina without hurting you. Don’t expect to have orgasms, just enjoy the uncharted waters of really being one for the first time. You can add more movement and stimulation as time goes on.

My friends say they love having their nipples played with. Mine aren’t sensitive so I don’t really enjoy it. Is there something wrong with me?

No, you probably have other areas that get you going, focus on those and make sure you partner knows about them. If they are not very sensitive, normal kissing and sucking might not feel like much to you. Try a bit more pressure that goes towards pain (but not painful) – that could be very intense and pleasurable for women with nipples that are not very sensitive. Vibration also makes a difference.

What does an orgasm feel like?

It is different for every women – some say it feels like sneezing and others like dying! You have to find out for yourself. One thing that all orgasms have in common is a climax (or a few of them) and then a fall. There is a definite point where you can feel that you are experiencing a release. If the release is gradual or the pleasurable sensation just kind of weans off, you did not have an orgasm. You will know if you did.

I keep getting yeast infections, but my guy won’t treat himself at the same time.

Yeast infections love the vaginal pH, they usually don’t survive on a guy’s penis. The fact that you are getting recurrent infections is not due to him not being treated, it is most likely due to you not being sufficiently treated, or it might not a yeast infection but bacterial vaginosis or even an STI. If it is an STI, he will need to be treated as well. Guys get candida only if they have very low immunity like with HIV or diabetes.

Getting rid of yeast infections often require repeated regular dosages of oral anti-fungal medication, restoring the balance of the pH in your vagina and removing triggers for yeast infections like bubble baths and food that is high in sugar.

We often see atypical yeast infections like candida glabrata. You should get a vaginal swab MCS and ask for specific culture and sensitivity for the candida.


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Bad Sex is a Health Warning

Bad Sex is a Health Warning

By Mary Bradley

Weak erections or premature ejaculation, while a “downer” literally, can also be a sign of serious underlying health issues. If you’re going more than a month with no mojo, you should check it out with a doctor.

Guys are often accused by women of obsessing about sex, including the hardness and staying power of their erections, not to mention how often they get it up and, for that matter, get it on.  The thing is men may be onto something with their focus on their member, …  if for the wrong reasons.

Like the canary in the coal mine, not being able to get it up, keep it up, or shooting too quickly or not quickly enough may be a sign, sometimes the first, of underlying health problems, including cardiovascular disease, hormonal imbalances and neurological problems among others.

Dr. Prithy Ramlachan, co-author of a study on male sexual dysfunction published 2014 in South African Medical Journal   explains that for healthy erections a lot must be working right, including a healthy vascular system, good blood supply, balanced and adequate hormones including testosterone and thyroid hormones, and a satisfying psycho-social world.   According to Ramlachan, a fraught relationship with one’s sexual partner; negative cultural or religious attitudes about sex; depression and anxiety; as well as self-esteem issues including job loss and financial stress can affect a man’s erections for the worse. The last are significant issues for many South African men with the country’s high unemployment rate and economic uncertainty.

When any of the above factors are out of whack or not up to snuff, the result can be problems in the bedroom including weak erections, ejaculation difficulties, low libido and, possibly, serious underlying health problems.

Tellingly, many of the risk factors for male sexual dysfunction are the same for cardiovascular disease (CVD) and include high blood pressure, overweight especially the roll around the belly, high LDL cholesterol, raised blood sugar including diabetes and insulin resistance, smoking, and poor diet, advancing age and stress and depression. You’ve heard ‘em before, when it comes to your heart, but these risks also affect your penis. Talk about cutting close to the bone!

Experts estimate 40% of men will suffer erectile dysfunction (ED) at some point in their lives.  While rates are much higher among older men (52% of men aged 40-70, cited in a 2013 article in The Journal of Royal College of Physicians), 14% to 20% between ages 18 and 40 experience sexual problems, according to a 2011 study of European males.  Dr. Ramlachan, conducting an exploratory study at a primary healthcare clinic in KZN, found a prevalence of 64.9% in a sample of more than 500 men aged 18 and over.  That’s both guys on either side of you at the rugby game suffering ED, excluding yourself of course!

Why the connection between CVD and a happy penis? The answer is a matter of good plumbing. Erections require good blood flow and pressure, and top-notch piping, aka, vascular system. Weak erections can be a first sign of otherwise silent CVD.

Why would CVD show up first in the penis? Penile blood vessels are much narrower at 1-2 mm diameter than vessels elsewhere, including the coronary (3-4 mm) and carotid (5-7 mm) arteries; it follows, the penile artery will exhibit effects of arthrosclerosis – cholesterol-laden fat deposits combined with inflammation – and high blood pressure – sooner than larger blood vessels.  Anything that inhibits healthy blood flow will inhibit erections.

Not surprisingly, ED is an independent risk factor for heart disease, and here’s the kicker; it’s especially indicative of CVD in younger men.

A study published in 2009 Mayo Clinic Proceedings found that men aged 40-49 with erectile dysfunction were twice as likely to develop heart disease as men without ED.  Indeed, ED sufferers have an 80% higher risk of heart disease than dudes who don’t have erection problems. Experts have concluded that a guy with organic, as opposed to psychological, ED is at risk of experiencing a major cardiovascular event within 3-5 years of the onset of ED symptoms.

….so that’s the bad news.

The good news is that, you’ve got a 3-year window, after first experiencing bad sex, to take preventative action, through lifestyle changes and medical treatment. If the side-effects of turning your health around, include avoiding a major CV event and improving your sex life; that’s terrific news!

The bottom line is that the younger you are and experience ED, the more important to take action now, get screened and lower your risk of CVD.

Occasional softness or inability to get it up or keep it up once in a while is generally not a concern. That’s part of life in the 21st century fast-lane.  However, don’t write-off repeated soft erections or bad sex as merely a result of overwork or not enough sleep.  Dr. Elna Rudolph, medical doctor and sexologist at My Sexual Health Clinic, advises that, if symptoms persist a month, get screened by a doctor for underlying health problems. Dr. Ramlachan says that too often men discount symptoms as a result of overwork, stress or aging and delay or avoid seeing a doctor, because they don’t think it’s serious.

Sex problems may not suggest only CVD. They can be a sign of blood sugar imbalances including insulin resistance, which can put you at risk for diabetes. According to a 2007 study in The American Journal of Medicine, diabetic men had more than 2.5 times the rate of ED than non-diabetics.  High blood sugar and insulin levels can damage blood vessels and result in poor penile blood flow, as well as damage nerve function needed for A-1 erections.  Not surprisingly, CVD can be a knock-on effect of untreated insulin resistance, especially when it comes in the form of metabolic syndrome.

Men with metabolic syndrome have a higher incidence of ED. Metabolic syndrome is that constellation of symptoms that include high blood pressure, abdominal obesity, cholesterol abnormalities and insulin resistance.  So, if you’re suffering ED, be on the lookout … Metabolic Syndrome increases your chances of heart disease and diabetes.

As well, diabetes and insulin resistance are linked to lower testosterone in men.   While testosterone levels gradually decrease with age, eating too many refined and sugary foods or being sedentary or over-weight can affect testosterone levels for the worse.  Sometimes it’s not a problem of too little testosterone but too much estrogen, caused by excess body fat, among other factors. Excess estrogen can overwhelm the testosterone you’ve got, leading to signs of low testosterone like weakness, fatigue, low libido and ED.   Dr. Justin Howlett, urologist at UCT Private Academic Hospital, routinely tests testosterone levels in patients with ED.

ED, ejaculation problems and low libido can be a sign of poor thyroid function. The thyroid gland and its hormones   govern metabolism and energy levels. They affect pretty much every system in your body including production of sex, stress and blood pressure hormones. When the thyroid is out of whack, you can suffer a cluster of symptoms including fatigue, weakness, hair loss, ED and, in the case of too much thyroid hormone, anxiety and premature ejaculation.

Depression can also lead to sexual dysfunction and vice versa.   Another side-effect of low testosterone, along with sexual dysfunction, is depression.   The chicken and egg relationship of mood and sexual performance continues; SSRIs, commonly prescribed drugs to combat depression, include ED as a side-effect.

SSRI’s are not the only drugs that may affect a guy’s mojo. Beta-blockers can do the same.  Cape Town cardiologist J.P. Smedema explains that a side-effect of many drugs, including over-the-counter meds, can include sexual dysfunction. The important thing, Smedema says, is to let your doc know immediately of any changes in your sex drive or erections after starting a new medication. Often alternate meds won’t cause symptoms.

Similarly, stress and anxiety can contribute to ED, ejaculation problems and lack of desire.

Conditions like Parkinson’s, kidney disease, brain and spinal cord injury can impact sexual performance including stroke, dementia and prostate and rectal surgery.  A study reported at the 2008 Clinical Congress of the American College of Surgeons found rates of sexual dysfunction among patients under 50 who’d suffered traumatic injury of any kind in the past year was triple the normal population!

Excess porn viewing has been linked to erectile dysfunction. Rudolph suggests that it is not porn itself but the intimacy problems watching too much can reinforce. She notes that porn addiction and resulting sexual dysfunction are some of the toughest problems to treat and can wreak havoc on a man’s sexual relationships.

So, what to do, if you’re unhappy with your sexual performance?


Dr. Rudolph says that, in this day and age with the pharmaceutical advances and expanded knowledge of the effects of lifestyle on sexual health, there is seldom reason for a man to suffer bad erections.

The first step, if you’re noticing poor performance, is to visit your doctor and be screened for health issues that could cause or contribute to the problem.

She’ll ask you what’s up or, as the case may be, what’s not up and want details about the nature of the problem and how and when it began. ED with gradual, as opposed to sudden, onset may suggest different causes.   Whether you experience spontaneous nighttime erections is clue to the cause and resolution of sexual dysfunction.

Howlett explains the initial blood tests for ED include blood sugar, cholesterol and testosterone. Depending on levels, he will check prostate specific antigen (PSA), thyroid hormones, as well as inflammatory markers and kidney and liver function. He routinely checks blood pressure.  If he discovers markers for heart disease, he’ll refer to a cardiologist for treatment and, depending on the severity, begin treating the sexual dysfunction with lifestyle changes and meds, as appropriate.

After addressing lifestyle issues, he explains, the first line of treatment for ED is usually a PDE-5 inhibitor, the most familiar being sildenfal, aka Viagra. If these fail, penile injections are the next treatment of choice and have a high success rate. Nevertheless, their use must be monitored for side-effects like prolonged erections (Priapism) that can cause permanent damage.

The next treatment in South Africa is likely vacuum pumps. These devices draw blood into the penis creating an erection. Should they not work, according to Howlett, penile prostheses are an option. Interestingly, the greatest need for penile implants in his practice stems from patients who’ve bought penile injections on-line and not been adequately supervised by a physician.

Howlett strongly urges men avoid herbal or “natural” remedies to resolve sexual problems. Unlike pharmaceuticals, supplements are unregulated. Some have been found to contain ingredients not on the label, including PDE-5 inhibitors.  “If you are treated with nitrates for chest pain and don’t know you’re on PDE-5 inhibitors, the result could be fatal,” he explains.

Dr. Rudolph’s practice includes clinical psychologists on-site who treat psychological issues that may cause or exacerbate a man’s sexual dysfunction.  Howlett, Rudolph and Ramlachan see psychological factors as key when treating the patient with performance issues and may, or may not, use depression or anxiety meds as part of that.

Bottom line, there is a lot you can do to prevent and resolve penis-performance problems that don’t involve medical treatment or drugs.

  • Healthy Diet. – Make sure you eat heart-healthy food– The Mediterranean Diet is what the 2012 Princeton III Consensus Recommendations for Management of ED and CVD specifically recommends. That diet emphasizes fruits and vegetables, beans and legumes, whole grains, fish, lean meat, poultry and dairy and polyunsaturated oils. Avoid trans and excessive saturated fats and sugary and refined foods.
  • Regular Exercise – Studies have shown improved erectile function for men who are physically active compared to coach potatoes. In one 2012 Journal of Sexual Medicine study of men between 18 and 40, those who were physically active had not only improved erectile function but better orgasms and overall sexual satisfaction.
  • Butt out – Smokers have 1.5 to 2 times greater risk than non-smokers of ED. Smoking damages blood vessels and cigarettes are not the only problem. Howlett has seen recreational drugs, including cannabis, negatively affect patients’ erections.
  • Keep Trim – Being overweight, especially abdominal obesity, is linked to worsening ED. Obese men were found to have ED twice as often as normal weight guys.
  • Manage Stress – Stress and anxiety can lower testosterone as well as your libido and sexual performance. Anxiety can cause PE and ED.
  • Watch the biking – Studies have found that excessive bicycling can cause erection problems, due to chronic friction and pressure in the penile region. Interestingly, studies indicate that horseback riding is not a problem. Go figure!
  • Limit Porn – While studies conflict, there appears a link between excessive porn viewing and sexual problems, especially among younger men, some of whom watch in excess of several hours a day of the hot and horny stuff on-line. A review published in the 2016 issue of Behavioral Sciences observes how men exposed to excess porn may exhibit signs of ED, delayed ejaculation and decreased libido and sexual satisfaction.  The authors speculate that the limitless novelty and extreme nature of some porn eventually desensitize men to sex with real partners and hamper arousal.

Improve your Sex Life

  • Stop Smoking,
  • Do regular vigorous exercise
  • Maintain a normal weight
  • Eat a healthy diet
  • Maintain a healthy LDL/HDL cholesterol ratio

Common Risks for ED

  • High Blood Pressure
  • Cardiovascular Disease
  • Medications including SSRI’s, Beta blockers and many other meds
  • Smoking
  • Overweight especially abdominal obesity
  • Low testosterone (hypogonadism)
  • Blood sugar problems including insulin resistance and diabetes
  • Psycho-social factors including self-esteem issues, depression and anxiety
  • Increasing age