Every week people ask me a variety of questions, either in person or via e-mail, often touching on similar themes and sexual issues. As a way to reach out and help as many people as I can, I've created this column as an ongoing dialogue that will help shed some light on many of the questions that arise from folks both locally and globally.Feel free to e-mail me (go to my contact page, here) with your questions or inquiries pertaining to sex. I will respond as time allows.
Your identity will always be kept confidential.

Q: I am a man in my late forties and I don't get aroused the way I used to. I feel sexually excited in my head when I see or am with a beautiful woman, but it doesn't give me an instant erection like it used to. What is wrong with me?

A: There is nothing wrong with you. As the male body starts to age, the physiology changes, and for some men this means there is no longer a "direct line" from the eyes or brains to the penis. It is common for a man to feel sexual excitement in his head, but the penis might literally need a hand in order to follow. In addition to the natural aging process, factors like stress and anxiety can have a major impact on the ability to obtain and maintain an erection, as can lack of sleep. The key for a man who is experiencing this type of change in his arousal pattern is to NOT panic or obsess about it. First of all, it is important to accept that the body is changing and not expect an erection to happen via visual stimulation or fantasy alone. The penis needs to be physically stimulated, either by hand or by mouth, depending on if you are alone or with a partner. It is important to explain to a partner what is going on so he or she doesn't think desire for them has lessened. It is also important to take your time, give the body a chance to relax into a sexual situation and not try to get hard. Chances are that the harder you try, the softer you stay. So give your penis time; through patience and touch it will rise to the occasion.

Q: I am a woman in my early thirties and I am unable to have an orgasm during intercourse with my partner. I have no problem reaching orgasm when I am masturbating with my vibrator. My boyfriend says there is something wrong with me, is there?

A: No, there is nothing wrong with you. What you are experiencing is quite common. First of all, the majority of women do not reach orgasm during intercourse. Most women reach orgasm by clitoral stimulation and in most cases (depending on the position) the needed stimulation is not provided by intercourse. In addition, having an orgasm is about letting go of control and being vulnerable, and to do that with another person requires a deep trust. Sometimes we think we trust somebody, but that doesn't always translate into an emotionally deep, heartfelt trust. Try having your boyfriend use his fingers and/or mouth to stimulate your clitoris, guide him to the most sensitive parts and teach him how to touch you. It can also be helpful to have him next to you when you masturbate, or to masturbate together as a way to build trust.

  Q: I am a woman in my late twenties and I don't really enjoy having intercourse with my boyfriend. It hurts and I feel dry? What can I do about this?

A: It sounds to me like your problem might stem from a lack of foreplay. Women's bodies often need some time to get ready for sex, meaning they need touch, caresses, relaxation, kissing and so forth. As the body gets warmed up sexually, the blood is directed to the vaginal area, lubrication is produced and the muscles in the vaginal walls start to relax and expand, in other words the vagina is getting ready for the entry of a penis or fingers or hand. It can be very helpful and pleasant to have your partner stimulate the vaginal opening and inner and outer lips with his fingers as a way to get your vagina wet and open and ready for a penis or dildo to enter. If your body doesn't produce enough lubrication for easy entry, do Not hesitate to use lube from a bottle, being wet enough is essential to enjoy any kind of penetration.

Q: I am a 40-year-old, divorced woman and lately I have found myself looking at women rather than men, and I fantasize about having sex with women when I masturbate. I have never been with a woman sexually, and have never thought about women in this way, so this is stressful, but yet exciting to me. I don't want to label myself "lesbian" and I dare not tell any of my friends, but I need advice what to do
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A: It is not uncommon for women around your age to discover that they are attracted to other women, and it doesn't automatically make you a lesbian. It makes you a woman who likes women. It can be a result of many things, which are often topics covered in therapy and too complicated to go into here, but most importantly for now is to welcome your feeling and give yourself permission to explore. I encourage you to go with the feelings you are having, let yourself fantasize and have pleasure without any judgment. Depending on where you live and what is available in terms of events for women I encourage you go to out and explore what it feels like to be around women who are attracted to women. Don't put any pressure on yourself, just show up and see what it feels like. If there are no women's events where you live there are a number of websites where you can meet women to chat, make friends or date. Going to bookstores and finding books about women to women love and sex can also be very helpful. Let the process have its own pace and don't push yourself into something until you feel ready. Enjoy and good luck.

Q: I am a 25 year-old man and I have a less than average size penis. I know size matters to women and I am nervous about being seen naked so I have never had sex. Right now I am dating a woman that I really like, but I am afraid she will leave me when she sees how small I am. What can I do about this?

A: Size is less important than you think. It is really more about how you use your penis than how big it is that matters. It is primarily in porn that size is so important, not in real life. Sex is so much more than a penis in and out of a vagina! It is about pleasure, connection and love. I have yet to hear that the best lover for a woman is the man with a big dick. Many women actually find it painful to be penetrated by a big penis. A good lover is attuned to his partner; he listens to her bodily response, pays attention, takes time, uses his hands and mouth, and takes pleasure in everything he does. One does not need a big penis for any of this. So I encourage you to take the focus away from the size of your penis and focus on how to make love to a woman. There are a number of books and DVDs available to guide you in this process.

Q: I am a gay man in my thirties and I am afraid of penetration. I have been with men sexually and tried once to be penetrated, but it hurt. Does this mean I can never have anal sex?

A: Not at all, of course you can have anal sex. The key for good anal sex is time, lube, breathing and more lube. It is essential that your partner warm you up by using his fingers, first just externally, to relax the anal sphincters. While he is doing this, your job is to focus on breathing deeply into your belly as a means to relax your rectal muscles. When your partner feels that your rectum is relaxing and opening up he can very gently penetrate you with his fingers first, and if one or two fingers slide in easily without any resistance he can gently try penetrating you with his dick. The key for the person penetrating is to really listen to how the receiver's body responds and use that as a cue for the next step. It is important to be sober for anal sex, as any kind of high will reduce the ability to be attuned to each other 's body, and can more easily cause pain and harm.

Q: I am a man in my late thirties and lately it has been hard for me to get and maintain an erection during love making with my wife. I am very attracted to her, but because I am so afraid of losing my erection I don't feel like having sex so often any more. Is this a medical problem? What is wrong with me?

A: The change in erection pattern that you are experiencing is very common, and if you are otherwise healthy it is most likely not a medical problem. It will of course not hurt to see your MD for a checkup and to get peace of mind. The main reasons for erectile problems are more often rooted in the mind than in the body. Stress, anxiety and exhaustion are all known to manifest as erectile problems. Small or big issues in the relationship can also have a major impact on the ability to get and stay erect. If the erection fails you once it can easily create anxiety about it happening again and thus create a vicious cycle, which sounds to be the case for you now. In order to break this cycle I suggest that you talk to your wife about what is going on with you so that she understands, first and foremost, that you are still attracted to her, and second having it out in the open can lessen your anxiety. Then you can work on this together without the pressure of you having to be super hard from beginning to end. It is important to slow things down, give your body a chance to unwind and get into a more relaxed state of being. You might need more sensory stimulation on your dick than you needed before and ask your wife to give you a hand, or use your own hand. If things don't get better you might want to see a therapist either alone or with your wife to explore in more depth what is going on with you and your relationship.

Q: I am a divorced woman in my early fifties and lately I have started to date again. The man I am currently dating is a lot more sexually adventurous than I am used to from my long marriage and it triggers insecurities in me. He wants to explore anal sex with me, and while I like the idea of that it makes me quite nervous with regard to cleanliness. How do I make sure that I am clean?

A: This is a great question that many are afraid of asking. The best way is to use anal douche, you can buy it on line for less than $20, and it will clean out your rectum quickly and efficiently without any pain. Since you are concerned with cleanliness, anal douching before lovemaking will help you relax, which is essential in order to enjoy any kind of anal play. For a more thorough cleaning you can use an enema (can be purchased on line or in pharmacies). This cleans out both your rectum and colon and requires a bit more time and effort, but it is easy and not painful. If you just want to make sure you are clean after going to the bathroom, or for external butt play like massaging the anal opening or oral-anal lovemaking (known as rimming,) wiping your anal opening with baby wipes is sufficient. So always have a box of baby wipes (fragrance free) within reach in your bathroom. And remember the rectum, in contrast to the vagina, does not produce any lubrication, so for any kind of anal massage or penetration use lube, lube and more lube (water based lubricants are latex-compatible). There should never be any unwanted pain involved in anal play!

Q: I am a man in my late thirties, married for ten years to a woman that I love and have two kids with, but I don't feel the same desire to have sex with her that I used to feel a few years ago. Does this mean I am not attracted to her anymore?

A: No I don't think that is the case, I imagine it is more a reflection of you falling into a routine that is comfortable, but not that sexually exciting. The daily routine of life can easily create a grind where one gets a little numb and out of touch with sexuality and seduction. One of the keys to maintain sexual desire in long-term relationships is to create an ongoing level of novelty. The novelty can be subtle, but yet palpable; i.e. have an adult date on a weekday, buy her flowers, call home to say you're thinking about her and so on. It is also important to keep up the esthetic in the relationship, meaning, be well-groomed, pay attention to weight and fitness and the way one dresses. These might seem like shallow values, but when it comes to sexual attraction and arousal, it matters; love alone is often not enough in the long run. Your lack of desire might also be due to stress and exhaustion, which is quite common for men your age, with demanding jobs, and paternal obligations after work and on weekends, leaving you with very little time for yourself. You might be feeling burnt out, which calls for action in terms of taking time for yourself and doing something that you enjoy doing. Finally, I suggest that you don't wait to feel desire in order to be sexual, but initiate sex even if you are not "in the mood." Desire is easily buried under stress and tiredness, but will quickly resurface through sexual action, in other words; let sexual action precede desire, versus desire precede sex.