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Sex Q&A

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    Our kids, a girl 14 and a boy 16, have come across pornography on the Internet. They’ve also seen some printed materials that were being handed around among their friends. We’ve talked a little about it together, but I wonder what kind of guidance parents should give their kids about pornography?

    Even though it is illegal for minors to purchase pornography, young people are very likely to encounter it before they become adults. So, parental guidance is very helpful.

    The most important thing kids need to know about pornography is that it most often does not depict reality. It may also lead to unrealistic expectations about sex and sexuality. Adolescents want to know what is normal, and they want to know if they are normal. They need to know that most of the pornographic images they encounter will not be normal in three important ways.

    First: the models or actors in pornographic images are often chosen for abnormally large sex organs and breasts. Their bodies are cosmetically, and often surgically or hormonally, enhanced. And their images are often altered in the printing or photographic process. Hair and blemishes are removed. Musculature and facial features are highlighted. And teeth are straightened and whitened. We can let our kids know that they will grow up to have healthy sex lives without looking like this.

    Second: in staging sexually explicit scenes for the camera, models and actors often take fairly uncomfortable positions to allow their sex organs to be seen while having sex. This makes the sex acts themselves quite unrealistic. We can let our kids know that they should not expect sex to be like this in real life.

    Third:  a lot of pornography is tailored for individuals who have quite a narrow range of sometimes uncommon sexual preferences. We can let our kids know that they should not expect themselves to find all pornographic images interesting or arousing.

    Finally, we need to acknowledge that many healthy, caring adults use pornography. Most of them use it to enhance their sex lives knowing that it is much more about fantasy than it is about reality.

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    I'm going to have my first pelvic exam. Can a doctor tell if you've had sexual intercourse?

    Not generally. Pelvic examination doesn't reveal if you've had vaginal intercourse or if you masturbate, unless there are specific signs:

    • symptoms of a sexually transmitted infection such as herpes or genital warts
    • the presence in the vagina of semen from a recent act of intercourse
    • torn tissue from violent or rough sex

    If hymeneal tissue that a clinician has previously observed appears changed, she may think that sexual intercourse has occurred, but she cannot be sure unless she is told.

    Usually, the only way the clinician will know if a woman's had sex is if the woman tells her. That's why it's important to tell your clinician if you are having sex. Don't let embarrassment become a health risk. Let your clinician know what is going on with your sex life so that she can make a more informed evaluation of your health status.

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    I have two embarrassing questions, but I really need answers: If virgins use vibrators, do they lose their virginity? Can they still have kids in the future?

    These are good questions. But it's too bad that so may people feel embarrassed to ask the questions they have about sex and sexuality, which are so important to our health. Embarrassment can become a health risk if women and men, young and old, are afraid to talk with their health care providers about their sexual concerns. We should all try to find health care providers who are as relaxed talking about our sexual concerns as they are talking about anything else. And we should always speak up about our concerns to make sure we have the information we need to stay healthy.

    People think of virginity in different ways. Most people and cultures think of virgins as women or men who have not had sexual intercourse with another person. For most people "sexual intercourse" means vaginal intercourse. For others, it means anal intercourse or oral sex play, as well. Very few people consider masturbation, or self-pleasuring, as a way to lose virginity — even if someone else is present. Masturbation is natural and normal. Many, if not most, women and men masturbate throughout their lives — before they have partners and while they have partners. There are nearly no health hazards associated with masturbation (health hazards only exist if infected sex toys or objects are shared).

    Some religious fundamentalists believe that a woman is no longer a virgin if she does not have a hymen — the thin, skin-like tissue that stretches over part of the vaginal opening. This is a mistaken teaching, however, because many women are born with so little hymenal tissue that it may seem they have none. Many other women stretch their hymens open during activities that have nothing to do with sex. These activities include working out, gymnastics, horseback riding, and other sports. Penetrative masturbation — with or without sex toys, such as vibrators or dildos, may also stretch the hymen open.

    But masturbation does not affect the fertility of women — or men. Partners who share sex toys, however, should always keep them clean so that they do not pass sexually transmitted infections, such as chlamydia and gonorrhea, to each other. Untreated, these infections can cause infertility in women and men. So, partners who share sex toys can use condoms to keep their toys clean or clean them according to packaging instructions each time they are exchanged between partners.

    The use of sex toys is mostly private and, for lots of people, not a subject of everyday conversation. Some people who are embarrassed to talk about their use of sex toys may not know how many of their friends and neighbors use them, too. Perhaps they would be less embarrassed if they knew how common sex toys are in the U.S. Forbes magazine once reported that $15 billion dollars worth of sex-related goods were sold in the U.S. Embarrassed or not, a lot of people seem to be using them.

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    Lately sex has been really painful. Does this mean that something is wrong?

    Yes, something is wrong. Painful intercourse has many causes.

    In men, it can be caused by an infection, an allergic reaction to spermicide or latex, or by an irritation from previous sexual or non-sexual activities.

    In women, the causes are more varied and complex: There may be vaginal dryness, which could be caused in two ways. It could be that a woman is not aroused enough to lubricate because there has not been enough foreplay before penetration. Or, she may not have enough of the hormone estrogen in her system to create lubrication. This type of vaginal dryness is often associated with perimenopause or menopause. Other physical causes include endometriosis, infection, yeast overgrowth, or allergic reaction to latex or spermicide.

    Emotional causes of painful intercourse for women include gender identity conflict, a history of rape or incest, or intense childhood suppression of sex, all of which can lead to vaginal spasms that prevent penetration. Other emotional causes include hostility, anger, or resentment toward her partner or previous partners.

    Because painful intercourse has so many possible causes, it is best to consult a health care professional to determine the cause and get the best treatment. Men may want to consult a urologist. Women may want to consult a women's health care provider.

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    Lately after my boyfriend and I are done having sex, I swell up down there, and it is really sore, and it burns when I urinate. What is making this happen?

    There are many possibilities. Swelling of the vulva may be caused by an allergy to a contraceptive, spermicide, or lubricant; a yeast infection or other kind of vaginitis; a lack of lubrication; or a sexually transmitted infection. A change in soaps or laundry detergent could also be the cause. Any of these can lead to irritation of the vagina and vulva and create tiny abrasions that would sting if they came in contact with urine.

    Having sex can introduce bacteria into the vagina and urethra, causing urinary tract infections (UTIs). That could create a burning sensation during urination. Some women who use spermicide regularly, with the diaphragm for instance, are prone to having UTIs.

    Very sensitive nerve endings in the vulva can lead to a condition called vulvodynia. It causes chronic and potentially severe pain for many women. The pain is often made worse by any kind of physical contact — sex, tampons, or tight clothing. Vulvodynia can sometimes be treated with various prescription medicines.

    What to do? Wait a few days to allow the vulva to heal, and then try switching the type of condom, lubrication, spermicide, soap, or detergent you are using and see if the reaction still occurs. If that doesn't help, visit your clinician and discuss your sexual history. The two of you can decide if a physical exam and/or testing for UTIs or sexually transmitted infections might be helpful.

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    Sometimes during intercourse with my boyfriend I pee, but I don't realize it till after. Is this normal?

    While some women may leak urine during sex, it is more likely that what you are observing is not urine. During orgasm, one out of 10 women "ejaculate" — they have an abrupt discharge of fluid. The fluid is very similar to the fluid produced by the prostate gland in men. In women, the fluid is secreted by the Skene's glands located in the vulva near the opening of the urethra. These glands, though much smaller than the male prostate, are similar enough in function that some scientists are considering renaming them "prostate" glands. Other glands may also be involved in female ejaculation.

    If the fluid you are releasing smells like urine, though, try making sure your bladder is empty before having sexual intercourse. If you continue to release a fluid that smells like urine, you may have a urinary tract infection or weak pelvic muscles. Both can be reasons for urinary incontinence — unintentional leaking of urine. They can be treated, but need to be evaluated by a gynecologist, urologist, or women's health nurse practitioner.

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    My boyfriend gets upset that sometimes my vagina is looser than other times. He thinks I'm cheating, but I'm not. What's going on?

    Here are five possibilities:

    1. Women's vaginas are less elastic when they are not sexually aroused. They become more elastic — "looser" — the more sexually excited they become. A woman may feel "tighter" to a man when she is less aroused, less comfortable, and having less pleasure than her partner.

    2. Hormonal shifts during a woman's menstrual cycle affect vaginal secretions and may affect vaginal elasticity. She may feel "looser" on certain days of her cycle than on others.

    3. Certain drugs, such as antihistamines or marijuana, may make the walls of the vagina feel dry so they seem "tighter."

    4. A woman's vagina may feel tighter or looser in different positions for intercourse.

    5. Some men tend to be anxious about their sexual performance. Some have an exaggerated sense of jealousy. It's always best to discuss such problems with a partner or with a professional. But some men may put the blame on their partners because they are unable to recognize their own insecurities.

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    How can I make my orgasms better or stronger?

    Many women and men find that the longer they postpone orgasm, the stronger it is. Many women also find that clitoral stimulation during vaginal intercourse makes orgasm more likely and more powerful. Both women and men can do exercises to strengthen the pelvic floor muscles that play a very important role in orgasm. Kegel exercises are done by tightening and relaxing the muscles used to stop urination. Strengthening these muscles can also alleviate urinary incontinence, improve sexual sensation, and aid muscle tone recovery from childbirth. Because they are internal muscle exercises, they can be done privately anywhere, anytime. Kegels should be done five times in a row, several times a day:

    1.     Tighten pelvic muscles a little, and hold for five seconds.

    2.     Tighten a little more, and hold for five seconds more.

    3.     Tighten as much as possible, and hold for another five seconds.

    4.     Relax the muscles in reverse steps, holding five seconds at each step.

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    I've been using the shot for more than a year, and I'm not anywhere near as wet as I used to be. I am only 22 years old, and the only time I get wet now is if I am in the middle of extremely stimulating intercourse. I used to be wet just at the thought of stimulation. What can I do? Will it ever come back?

    Hormonal methods of birth control may affect a woman's sex drive in different ways. Many women who use them feel less inhibited sexually because they don't have to worry about unintended pregnancy. Some women, however, find that the dose of hormones used in a method may inhibit their sexual desire and/or arousal. Inhibited sexual desire or arousal may, in turn, affect the way a woman lubricates. It may help to change the dose of hormones by choosing a different method — patch, pill, ring, or shot — or changing from one combined oral contraceptive to another. Many women choose non-hormonal methods, such as the IUD or fertility awareness-based methods, to avoid changes in sex drive.

    Changes in sexual arousal and lubrication patterns may also be associated with other events in a woman's life. Having a new sex partner, or being with the same partner for many years, may affect the patterns of all the stages of a woman's sexual response cycle: desire, arousal, excitement, and orgasm. Various health conditions — including depression and diabetes, for example — may also affect her sex drive. Age itself also has an effect. In fact, during perimenopause and menopause, many, if not most, women experience vaginal dryness.

    Women who would like increased lubrication should not be shy about using over-the-counter lubricants to enhance sexual pleasure. There are hundreds of products on the market to choose from. There are only two important cautions: Oil-based lubricants can damage latex condoms. Silicone-based lubricants can damage barrier contraceptives made of silicone, such as Lea's Shield and FemCap, and a wide variety of sex toys that are also made of silicone. So, if you use sex toys or latex condoms, you won't go wrong if you purchase a water-based lubricant.

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    What exactly do people mean when they say "safer sex"? Is it always about condoms?

    Condoms are an important part of safer sex, but safer sex means more than just using condoms. Safer sex is a relative term. It is anything you decide to do to lower the risk of becoming infected or infecting someone else, especially with dangerous infections, such as HIV, the virus that can cause AIDS. Here are some examples:

    If you decide to have sexual intercourse, using a latex or female condom makes it safer.

    If you decide to have oral sex instead of unprotected vaginal or anal intercourse, it is safer.

    If you decide to have protected oral sex instead of unprotected oral sex, it is safer.

    If you decide to rub against each other with your clothes off instead of having intercourse or oral sex, it is safer. Rubbing against each other with your clothes on is even safer.

    If you decide to masturbate each other instead of rubbing against each other with your clothes off, it is safer.

    If, after masturbating each other, you wash your hands before touching your own genitals, it is even safer.

    If you decide to masturbate alone or have phone sex or cybersex instead of physical contact with someone else, it is even safer.

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    My partner is apprehensive about having sex when I'm menstruating or having breakthrough bleeding (I'm on the pill). His high school sex ed teacher told him that menstrual material could get lodged in his urethra and cause an infection. That doesn't make sense to me. How could menstrual material be any more infectious than other body fluids that are exchanged during sex?

    You're right. Menstrual fluid is no more likely to infect a woman's partner than sweat, saliva, or vaginal secretions caused by sexual arousal.

    Unfortunately, your partner's former sex ed teacher is not the only one who has been misinformed. Menstruation has been misunderstood and feared in western civilization for thousands of years. The ancient Hebrews believed that menstruation was one of many ritual impurities that required ritual cleansing. By the time of the early Christians, menstruation was seen as a physical pollution that caused all kinds of illness and disease, as well as spiritual pollution. For example, in the year 562, the Archbishop of Arles in France declared, "Whoever has relations with his wife during her period will have children that are either leprous or epileptic or possessed by the Devil." It is amazing how long it is taking to dispel such unhealthy notions.

    The widespread western phobia about menstruation was one of the excuses used until well into the 20th century to bar women from many activities allowed men: standing near or touching the altar of a church, singing in a church choir, or getting an education.

    In some parts of the world, however, menstruation was seen as a source of great physical and spiritual power. In certain cultures of the South Pacific, for example, men ritually cut themselves to bleed so that they could claim that they, too, had periods.

    Today, we understand that menstruation is an important part of the fertility cycle of women. We know that human females have a greater menstrual flow than any other animals. That is because many blood vessels are needed to support the development of a human fetus if a pregnancy takes place. When pregnancy does not take place, the supporting tissue and blood is lost in a woman's menses, and new supporting tissue develops to prepare for ovulation in support of another potential pregnancy if fertilization and implantation take place.

    We also know that there is nothing dirty or unclean about menstruation. We know that menstrual fluid itself is not infectious, and it does not cause disease or sickness. Many women today enjoy their periods as a proud reminder of their femininity. Many others see it as an uncomfortable inconvenience that they could do well without. And many have found that they can enjoy their sexuality and express themselves sexually during menstruation.

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    Is it true that having sex at a young age, especially for girls, increases the chance of certain types of cancer?

    It depends more on when and how often young people are exposed to a virus that can lead to cancer. For example, certain types of the human papilloma virus (HPV) can cause changes in the cervix that can lead to cervical cancer. The more sex partners young people have, the more likely they will be exposed to HPV. And the more partners a young person's sex partner has had, the more likely a young person will be infected with HPV. Having unprotected sex with many different partners throughout your lifetime, or having unprotected sex with partners who have had many different partners in their lifetimes, increases the likelihood that you may be exposed to a virus that may lead to cancer.

    We know more about the risks of certain cancers for young women than the risks for young men, who are much less likely to develop genital cancer. Women who abstain from vaginal intercourse until their 20s — and who have fewer partners in their lifetime than other women — may have certain advantages over women who do not. They are less likely to

    • get sexually transmitted infections
    • become infertile
    • develop cancer of the cervix, which is caused by certain types of sexually transmitted human papilloma viruses

    Sexual relationships present physical and emotional risks — even with the advent of the new HPV vaccine. Abstinence is a very good way of postponing those risks until you are able to handle them.

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    Does the G-spot really exist?

    Although many women and authorities have identified the G-spot, many women cannot locate it. When located, it is found an inch or two beyond the vaginal opening in the wall of the vagina closest to the bellybutton.

    Women find that the G-spot is very sensitive to sensual stimulation, swells slightly during sex play, and plays a role in vaginal orgasm. Some recent studies also show that stimulation of the G-spot by the pressure of childbirth may help reduce pain.

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    Can Zoloft affect my sex drive? I never feel intimate anymore, and it's really hurting my relationship — my partner gets so upset because he doesn't think I find him attractive anymore. I just don't feel like having sex, ever.

    Zoloft is one brand name of certain kinds of prescription medication that are technically called selective serotonin reuptake inhibitors (SSRIs). Other common brand names for SSRIs include Celexa, Lexapro, Paxil, and Prozac. SSRIs are used to treat depression, anxiety, panic disorder, and other conditions, including premenstrual dysphoric disorder. Like all medications, SSRIs may have side effects for some people. The possible side effects of SSRIs include decreased sex drive and/or more difficult orgasm — for women and men. Each SSRI may have different effects on different people.

    Talk with your health care provider if you find that the SSRI — or any other medication — you are taking is affecting your sex life. Your provider may be able to substitute a different SSRI or a different kind of medication. Or your provider may suggest testing for other potential causes of decreased sex drive and function, which include certain hormone deficiencies and thyroid conditions.

    Don't let embarrassment prevent you from enjoying your sexuality as much as you can. Always be open about your sexual concerns with your health care provider, who will try to help you solve sexual problems that may be related to your medications.

    Similarly, share with your partner any concerns you may have about changes in your sex drive — no matter what the reasons may be. It may be difficult to assure partners that one's feelings are not about them, but it is worth trying — communication is everything. Understandably, partners may find it difficult to accept that their significant other's appetite for sex has changed, especially if it needs to be for an extended or indefinite period of time. In such cases, professional counseling with a sex therapist may be helpful.

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    What causes men to become impotent or lose sexual desire?

    There are many possible causes for impotence — the inability to become or stay erect — which is also called erectile dysfunction or inhibited arousal. It is often, but not always, associated with lack of sexual desire. There are many psychological causes for impotence, and there are many physical causes. Sometimes desire and arousal are affected by a combination of both.

    There are three basic kinds of psychological problems that lead to lack of desire and/or arousal. The first has to do with the way we each view our own as well as other people's sexuality. Our individual feelings about sex are unique and are shaped by our early learning experiences, including our family's attitudes about sexuality — positive and negative. Men with problematic feelings about sex may find it difficult to experience desire and/or arousal. For example, men who are raised to believe that potential sex partners are bad people who only want to harm them may be impotent with new partners.

    The second kind of psychological problem has to do with selecting a partner and the time and place to have sex. For example a partner who was once thought of as very attractive may now be thought of as less attractive. The timing might also turn out to be wrong — like right after a heavy meal, for example, or when a man is too stressed out from work. It's possible that location may be just as wrong — some married couples find it impossible to have sex while staying for visits in their parents' homes.

    The third kind of psychological problem has to do with the quality of the relationship between partners — the levels of trust and intimacy that are needed for sexual desire and arousal to take place. Desire and arousal are based, in part, on muscular relaxation. If there is not enough trust and intimacy to become relaxed, desire and arousal may be difficult. This can happen whenever we feel threatened or slighted or anxious. Keeping a secret from a partner, for example, may create anxiety and interfere with desire and arousal.

    Besides psychological causes, there are hundreds of physical causes of impotence. A partial list includes abnormal nerve function, alcohol or other recreational drug use, diabetes, hormone deficiency, impaired blood flow, removal of a cancerous prostate gland or certain other surgical procedures, and smoking. Some medicines may also cause impotence, including certain medications for allergies, anxiety, colds, depression, hypertension, lethargy, panic or personality disorder, restlessness, and sleeplessness.

    A good book to read about the lack of desire and arousal in men is The Sexual Male — Problems and Solutions, by Richard Milsten and Julian Slowinski. It was published in 1999 by W.W. Norton & Company in New York.

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    Does having vaginal intercourse cure acne? I heard two older guys at the gym making jokes about it.

    No. Having vaginal intercourse does not cure acne. Many people believe this myth, though, and many claim that it has happened to them. And there are good reasons that it may have seemed to.

    As we know, acne is a common side effect of puberty. When all of the hormonal changes of puberty end, so does acne — for most people. The age at which the hormonal changes are complete varies, but this stage of maturity is usually reached by the time a young person turns 17 or 18. This is also when many people have their first intercourse.

    Other misunderstood evidence for this myth concerns the pill and other combined hormone methods of birth control — the patch or the ring: Many young women use them when they start to have intercourse. Not only is it likely that they are mature enough for their acne to naturally go away, but combined hormone methods actually help clear up acne conditions.

    These two coincidences have reinforced the myth that having sex is a cure for acne. But they're just coincidences.

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    I've heard that the pill and other hormonal methods of birth control will lower my sex drive? Is that true?

    All medications have side effects for some of the people who use them. The side effects of the pill have been studied for more than 40 years. Many of these studies have examined the effect of the pill on sexual desire and arousal. A recent review of 30 original studies concluded that using the pill, the patch, the ring, and the shot has no effect on sexual desire or arousal for most women. For other women, sexual desire and arousal are affected: Some experience more sexual desire and arousal. Some experience less.

    The causes of these changes in sex drive are not clearly understood. Some may be psychological — for example, a woman may enjoy her sexuality more when she doesn't need to worry about getting pregnant. Some may be hormonal — for example, the estrogen in the pill may affect the testosterone in a woman's body in ways that influence her sex drive.

    Women should watch for signs of side effects of any medication they choose. Women who use the pill and find that they have decreased sexual desire may want to try a different type of birth control pill or choose an entirely different way to prevent pregnancy. If a woman using other methods experiences an unwelcome change in her sex drive and thinks it is caused by her method, she may want to change to another method.

    The key to successful use of hormonal methods of birth control is to have a continuing and open conversation with your clinician. Be frank and open about your sexual concerns so your clinician can offer the best advice possible.

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    I've never been able to have an orgasm when I have sex. Is something wrong with me? I try really hard, but it never happens.

    The inability to have orgasm is common in women and less common in men. About one out of three women have "inhibited orgasm" — they have reached orgasm in the past, but no longer can. About one in 10 women have never had an orgasm. This is called anorgasmia. Some women are able to reach orgasm during clitoral masturbation, but cannot during penetrative sex play. If you have pain during intercourse, you should consult an obstetrician/gynecologist. If you are not experiencing pain yet are not having an orgasm, consider having an initial consultation with a sex therapist (see below) — or give yourself more time to see if orgasm eventually occurs.

    Some women who cannot reach orgasm do not feel that orgasm is important for their sexual experience. Some women feel cheated. Some women "fake" orgasm in order to end sex play or to please their partners, who may not realize that they aren't reaching orgasm.

    Inhibited orgasm in men may mean ejaculation without orgasm. It may also mean delayed ejaculation — it takes them longer to reach orgasm than they would like. In some men, inhibited orgasm is associated with taking certain anti-depressants or other medications. Delayed orgasm in women and men can be frustrating. It happens to many women and to many gay men.

    Individuals and couples who are disappointed with their experiences, or lack of experience, with orgasm may benefit from professional sex therapy. To find a certified sex therapist, call the nearest Planned Parenthood health center at 1-800-230-PLAN for a referral. Or you may locate a certified therapist through the American Association of Sex Educators, Counselors, and Therapists.

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    Does it take longer for a woman to reach orgasm than it does for a man? Why?

    On average, it takes women 10-20 minutes to reach orgasm during foreplay, and men average 7-14 minutes. But these are averages that include people who take a lot longer to reach orgasm as well as those who don't take nearly as long. Although there are plenty of theories, we don't know for sure the biological reasons, if any, for why most women need more time than men to reach orgasm during sex. But we do know some of the psychological and social reasons:

    • Women's sexual and reproductive anatomy has been misunderstood throughout thousands of years of western and eastern history. Not until the latter half of the 20th century were women expected to understand their own sexual anatomy or to explore the ways they might experience sexual pleasure. Many women, today, don't know how to reach orgasm through masturbation or through partnered sexual activity. This lack of understanding can inhibit the sexual arousal and excitement needed to reach orgasm.
    • Most women experience orgasm through clitoral stimulation. But in most women, the clitoris is positioned in such a way that it is often not stimulated during vaginal intercourse. So in cultures like ours, that place a high value on vaginal intercourse, many women do not receive sufficient clitoral stimulation to bring them to orgasm more quickly, if at all. In most kinds of partnered sex play — manual, body-rubbing, oral, anal, or vaginal — a man's penis is directly stimulated. This is often not true for a woman's clitoris.
    • In cultures like ours, there are many reasons for women to feel sexually inhibited. Many women feel anxious about unintended pregnancy and sexually transmitted infection. They may worry whether they've picked the right partner or if their partner is faithful. And many women feel anxious about whether they should really enjoy themselves sexually. All of these concerns, and others, can lead to performance anxiety that reduces a woman's ability to relax and enjoy her sexuality.
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    Someone told me that it was healthy to have sex during my girlfriend's period because it will aid in the prevention of endometriosis. Is that true?

    It may be true, but it hasn't been scientifically proven. Scientific studies have shown that there is an association between having sex during menstruation and decreased endometriosis. This does not necessarily mean that having sex caused the decrease. It may be, for example, that women who have endometriosis have less sex than other women, especially during menstruation, because they are in so much pain and discomfort. More studies need to be done to prove how having sex during menstruation and decreased endometriosis are associated.

    In recent years, sex scientists have also associated a wide range of health benefits with sexual expression. Most of us are very aware of the health risks caused by having sex, but sex play is increasingly associated with many health benefits, including longevity; absence of heart disease, stroke, and breast cancer; healthy immune function; menstrual cycle regularity; relief of menstrual cramps; pain management; and improved quality of life. Future studies may tell us more about how these conditions are associated with sex play.

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    A couple of nights ago I fooled around with my best friend. Does that mean I’m gay?

    Not necessarily. Our sexual orientation — homosexual, heterosexual, or bisexual — is not based on the sex of the people we may have sexual contact with. It is based on the sex to which we are predominantly attracted. Someone who is gay or lesbian, for example, has a primary erotic, psychological, emotional, and social interest in people of the same sex. Likewise straight people have a primary erotic, psychological, emotional, and social interest in people of the opposite sex, and bisexual women and men have primary erotic, psychological, emotional, and social interests in people of either sex. In fact, most people understand their sexual orientation long before they actually have any kind of sex play with anyone.

    Often people have sex with partners outside of their sexual orientation. For example, there are people with predominately same-sex fantasies and erotic attractions who have opposite-sex partners because they don’t want anyone to know they have same-sex desires and fantasies. Clinically speaking, such people are homosexual, even if they have never had same-sex sex.

    On the other hand, many people, like those in prison or other single-sex communities, may have same-sex sex but have opposite-sex fantasies and erotic attraction. They are “situationally” homosexual because they have very limited alternatives. These women and men are, in fact, heterosexual. Bisexual people, who are equally attracted to both sexes, may spend years or a lifetime with one partner but still identify as bisexual because they remain attracted to both sexes. And then there are people who just enjoy playing with partners outside their sexual orientations every once in a while.

    It is possible that our understanding of our sexual orientation will change as we grow up through childhood, adolescence, and adulthood. And we may have partners of the opposite or the same sex or both. But because there is such a cultural stigma against homosexual and bisexual orientations, it may take years, well into adulthood, for some people to fully identify and accept their sexual orientations.

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    In a conversation about sex, a friend made a reference to something called the "Kinsey scale." What is that?

    The Kinsey scale is a way to rate a person's sexual orientation. It was developed by biologist Dr. Alfred Kinsey and his associates in the late 1940s and early 1950s. The seven points on the scale show the range of sexual orientation in humans that was reported in Dr. Kinsey's surveys. Kinsey used the word heterosexual to describe people who desire sex with people of the other gender. He used homosexual to describe people who desire sex with people of the same gender. The Kinsey scale categories are

    0 — exclusively heterosexual
    1 — predominantly heterosexual, infrequently homosexual
    2 — predominantly heterosexual, but more than infrequently homosexual
    3 — equally heterosexual and homosexual (bisexual)
    4 — predominantly homosexual, but more than infrequently heterosexual
    5 — predominantly homosexual, infrequently heterosexual
    6 — exclusively homosexual

    Today, many sexologists see the Kinsey scale as a little simplistic. They suggest that sexual orientation is more complex. But the Kinsey scale is still often used.

This column is for informational purposes only and is not intended to constitute medical advice, diagnosis, or treatment. If you have a medical problem, please call toll-free 1-800-230-PLAN for an appointment with the Planned Parenthood health center nearest you.

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