FAQ: The Most Commonly Asked Questions about Sex, According to a Urologist

As a urologist, I get asked about sex a lot from my patients and friends alike. In fact, I get more questions about sex than urination.  Some of these questions are straightforward, while some can be specific and complicated. While I wish I could say I have the answer to every question I get, that simply isn’t the case.  Even as a sexual health expert, I’m constantly learning.  I learn from my colleagues, and I learn from my patients. I’m fortunate to have an avenue like this to share my knowledge. What follows is a collection of the most commonly asked questions I get about sex.  I suspect some of you may have had similar queries, but perhaps didn’t feel comfortable voicing them.  Well, I hope you learn something about yourself and what most people out there continue to find perplexing about sex.

Is Erectile Dysfunction Inevitable/Normal At My Age?

Erectile dysfunction (ED) is a common concern among my male patients. Many wonder whether experiencing ED is an inevitable part of aging. The truth is that while age can be a contributing factor due to changes in blood flow and hormonal levels, ED is not an inevitable consequence of getting older and ED is not normal at any age. It’s also important to point out that ED can occur at any age.  While it is more commonly seen in older men, I have plenty of younger patients who struggle with their erections.  Unfortunately, too often younger men who seek help for ED are dismissed or ignored.  They’re told that it must “all be in your head,” but that’s not always the case.

It’s essential to understand that various factors beyond age contribute to ED.  These include underlying health conditions like diabetes, cardiovascular disease, and hypertension, unhealthy lifestyle choices like smoking and excessive drinking, medication side effects, interrelationship conflict, and psychological factors like stress and anxiety.  If you’re someone who finds it hard to get or stay hard, seek professional guidance from someone who specializes in sexual health.  ED is not inevitable and may be a symptom of a more serious mental or physical health issue that needs attention.

How Often Should I Get Tested for Sexually Transmitted Infections?

If you’re someone who engages in sex with more than one person, sexually transmitted infections (STI) should always be top of mind.  Many STIs are on the rise.  According to the Centers for Disease Control and Prevention (CDC), in 2021, chlamydia, gonorrhea, and syphilis continued to increase in the United States.  While sex should be fun, it’s important to take the necessary steps to protect yourself and get screened for the most common sexually transmitted infections. How often you get tested can vary depending on your risk.  While anyone who has sex can get an STI, sexually active gay, bisexual, and other men who have sex with men (MSM) are at greater risk. In addition to having higher rates of syphilis, more than half of all new HIV infections occur among MSM.  People who have sex with multiple or anonymous partners, those who engage in sex work, and anyone having sex under the influence of drugs and/or alcohol should get tested regularly.

The CDC recommends all sexually active adults and adolescents from ages 13 to 64 should be tested at least once for HIV.  They also recommend all sexually active gay, bisexual, and other MSM should be tested at least annually for syphilis, chlamydia, and gonorrhea.  Those engaging in higher-risk sexual behaviors should be screened for HIV and other STIs more frequently (about every 3-6 months). In recent years, there has been increased focus on STI and HIV prevention using medication.  Pre-exposure prophylaxis with medications like Truvada and Descovy (both oral medications) and Apretude (an injectable) reduces the risk of getting HIV from sex by about 99% when taken as prescribed. Doxy-PEP stands for doxycycline post-exposure prophylaxis, which represents another recent strategy to help reduce STI risk.  It involves taking one 200mg pill of doxycycline as soon as possible but no later than three days after having sex without a condom.  In several studies using Doxy-PEP reduced the risk of STI by up to 75%. Thankfully, we’ve come a long way in our fight against HIV and STI.  The trick to keeping yourself safe from these is knowing your risk and testing regularly.  If you belong to a high-risk group, consider discussing some of the prevention strategies we discussed with your healthcare provider.

What Causes Premature Ejaculation, and Can It Be Treated?

Premature ejaculation (PE) involves ejaculating sooner than desired, often within minutes of starting sexual activity.  PE is thought to be one of, if not the most common sexual health problem.  As many as 1 out of 3 people say they have struggled with PE at some point.  PE is also a condition that does not just affect the individual experiencing it, but their partner as well.  Premature ejaculation can lead to feelings of inadequacy, depression, anxiety, and relationship issues. The exact cause of premature ejaculation isn’t known. PE was once thought to be a psychological issue, but healthcare providers now recognize that premature ejaculation involves a complex interaction of psychological and biological factors. Psychological factors may include depression, anxiety, stress, guilt, unrealistic expectations about sex, lack of confidence, history of sexual repression and/or abuse, and relationship problems.  Biological factors include age, hormone levels, certain neurotransmitters like serotonin, and erectile dysfunction. Fortunately, effective treatments for PE exist, ranging from behavioral therapies, exercises, and counseling to medications or topical applications.  Determining the cause of PE is crucial in tailoring the most effective treatment plan for each individual so if you’re someone with premature ejaculation, make sure to seek help from a sexual health professional.

Is Pain During Sex Normal?

There’s that “normal” word again.  We already know how I feel about it.  But I’ll make an exception in this case and say emphatically that pain during sex is absolutely not normal. I can’t tell you how many times I’ve been asked this question, mostly from my female patients. Unfortunately, women hear from their peers and even their physicians that sex is sometimes painful and go on to believe that it’s normal.  If they muster up the courage to discuss the topic with a provider, they are often met with disbelief, dismissed, or told simply to have another glass of wine.

Pain during sex, also known as dyspareunia, is a common problem with a lifetime prevalence of up to 30%.  If you’re someone experiencing dyspareunia, you’re not alone.  There’s nothing inherently wrong with you.  And you don’t just need to have another drink and push through it.  Dyspareunia can stem from various factors, including insufficient lubrication, hormonal deficiencies, vaginal infections, pelvic floor issues, endometriosis, and/or psychological factors But there are real, science-based solutions out there, so sex no longer has to be painful.  Every person has the right to engage in pleasurable sex if they so desire.  So, if dyspareunia is preventing you from doing that, seek out help from someone experienced in treating individuals who experience sexual pain.

What Lifestyle Modifications Can I Make to Improve My Sexual Function?

As a general rule, what’s good for your overall health is good for your sexual health.  With 2024 just around the corner, you may already be making a list of resolutions you plan on keeping.  Why not make one to improve your sexual health? Exercise is good for the mind, body, and soul.  Regular physical activity can help improve energy, mood, and sleep, reduce anxiety, improve testosterone levels, and build endurance.  And guess what: all those things help improve sexual function.  If you’ve been out of the gym for a while, start slow.  Walking, swimming, and light cardiovascular exercise can help keep your ticker and pecker in tip-top shape. Specific pelvic floor exercises like Kegels can also help strengthen the muscles needed for sexual activity.

Eating a well- balanced, heart-healthy diet may give your sex life the jump start it needs.  Several studies have found sexual health benefits from the Mediterranean diet specifically.  In one recent study, participants who consistently followed a Mediterranean diet had better erectile performance, blood flow, exercise capacity, higher testosterone levels, and healthier arteries than those who were less consistent.  If you’re looking to level up your bedroom game, consider following the tenets of Mediterranean cuisine: eat plenty of fruit, vegetables, and healthy fats and minimize red meat as much as possible. Sexual health remains an integral part of overall health and well-being.  And questions come up for everybody from time to time.  While the ones I’ve shared today represent only a small sample, hopefully, you leave here having learned a little more about how I think about sex when talking to patients and how you can take steps to have a more fulfilling sex life.  If you still have questions that need answering, reach out to your local sexual health expert or follow me on social media. I never grow tired of discussing all things sex and I promise you’ll be entertained and educated at the same time.