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By Everyday Health. Listen to the ► Podcast at How To Sex.

 Chlamydia, Genital Herpes, Gonorrhea, Hepatitis B, HIV, HPV, Molluscum Contagiosum, Syphilis, Trichomoniasis, Chlamydia, Genital Herpes, Gonorrhea, Hepatitis B, HIV, HPV, Molluscum Contagiosum, Syphilis, Trichomoniasis.

The number of cases of sexually transmitted diseases (STDs), now more commonly referred to as sexually transmitted infections (STI), in the United States hit an all-time high in 2019, according to data released on April 13, 2021, by the Centers for Disease Control and Prevention (CDC). The CDC’s surveillance report shows that nearly 2.5 million new cases of gonorrhea, syphilis, and chlamydia were reported that year.

Chlamydia remained the most common condition reported to the CDC, with close to 1.8 million cases, up 19 percent since 2015. Gonorrhea diagnoses reached 616,392, up 56 percent since 2015. And primary and secondary syphilis diagnoses reached 129,813, up 74 percent since 2015.

Of high concern is that congenital syphilis cases, that is, syphilis in newborns, nearly quadrupled between 2015 and 2019, reaching 1,870 cases. From 2018 to 2019 the number of stillbirths caused by syphilis increased from 79 to 94, and the number of congenital syphilis-related infant deaths rose from 15 to 34 deaths.

While the 2019 STD statistics reflect pre-COVID-19 pandemic numbers, preliminary data from 2020 suggests many of the same trends continued during the pandemic. Experts attribute some of the growth in STDs in 2020 to disruptions in STD testing and treatment programs caused by the pandemic.

While 2.5 million cases of chlamydia, gonorrhea, and syphilis may sound like a lot, it’s likely an undercount: Many people with these and other STDs, formerly known as venereal diseases, go undiagnosed and untreated. The CDC estimates that nearly 20 million new sexually transmitted infections occur every year, accounting for almost $16 billion in healthcare costs annually.

Inequities in STD Burdens

The numbers of STDs increased in all age groups and among all racial and ethnic groups in 2019, according to CDC statistics. However, some groups saw higher rates of STDs than others:People ages 15 to 24 accounted for 61 percent of chlamydia cases and 42 percent of gonorrhea cases.
Gay and bisexual men accounted for nearly half of all primary and secondary syphilis cases.

Here’s what you need to know about how to spot, treat, and prevent STDs.

What Is the Definition of an STD?

“STDs are diseases that are passed from one person to another through sexual contact,” a representative of the CDC says.

According to the CDC, some of the common STDs are chlamydia, gonorrhea, herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV), human papillomavirus (HPV), and syphilis. "Many of these STDs do not show symptoms for a long time," per the CDC, "but they can still be harmful and passed on during sex.”

Virtually all STDs can be transmitted through anal, vaginal, or oral sex. In addition, some STDs can also be transmitted through close skin-to-skin contact, even if no intercourse occurs.

HPV, for example, can be spread through skin-to-skin touching. In addition, “Molluscum contagiosum, a viral skin disease, can be spread through sexual or casual contact, as can scabies, an itchy skin condition caused by a mite infestation. It is also possible to get scabies from an infected sleeping bag or bed,” says Edward W. Hook III, MD, an endowed professor of infectious disease translational research in the departments of medicine, epidemiology, and microbiology at the University of Alabama in Birmingham, who works with the CDC.

STDs don’t just affect the genital regions: “Oral herpes can be transmitted through oral and genital sex,” says Dr. Hook.

It is important to remember that STDs may have no symptoms. However, new vaginal or urethral discharge or a new rash after sexual contact should be evaluated by a medical professional.

When symptoms do occur, they can include the following:

Chlamydia Symptoms of chlamydia can include vaginal discharge in women, penile discharge in men, and burning during urination in men and women.

Gonorrhea Gonorrhea can cause thick, cloudy, or bloody discharge from the vagina or urethra, and pain or burning when peeing. If you have gonorrhea in your anus, it may cause itching in and around the anus, discharge from the anus, and pain when defecating. Gonorrhea in the throat may cause a sore throat.

Hepatitis B Acute hepatitis B can cause fever, fatigue, loss of appetite, nausea or vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice (yellowing of the skin and whites of the eyes). Symptoms can appear anywhere from six weeks to six months following exposure to the hepatitis B virus. Chronic hepatitis B sometimes causes symptoms similar to acute disease.

Genital Herpes Signs of genital herpes typically include red bumps that develop into blisterlike sores in the genital area and sometimes on the buttocks or thighs. A new infection with HSV-2, the virus that causes most cases of genital herpes, may also cause flulike symptoms, including fever, headache, feeling tired and achy, and swollen glands.

Oral Herpes Symptoms of oral herpes can include itching of the mouth or lips, sores or blisters on the lips or inside the mouth, and flulike symptoms such as fever, headache, body aches, and swollen glands.

HIV Early symptoms of HIV infection can resemble those of the flu: fever, headache, muscle aches, and sore throat. They may also include swollen lymph nodes, diarrhea, nausea and vomiting, a fungal infection of the mouth, and a rash on the abdomen, arms, legs, or face. If HIV goes untreated, later symptoms can include fatigue, weight loss, night sweats, joint pain, short-term memory loss, and recurrent infections.

HPV Most strains of HPV cause no symptoms and are detected only after abnormal cells are discovered during a Pap smear. However, some types of HPV cause genital warts, which appear as skin-colored or whitish growths on the genitals or anus.

Molluscum Contagiosum Often the only sign of this skin disease is pink or flesh-colored bumps with a dimple (indentation) in the center. It is most common in children, who typically get it from skin-to-skin contact or from shared towels or similar items. In adults, it can be sexually transmitted.

Pubic Lice Symptoms of pubic lice include itching in the genital area, tiny bugs in your pubic hair, and visible nits (eggs) on hair shafts. Pubic lice can also infest the hair on legs, armpits, eyebrows, eyelashes, and other facial hair such as mustaches and beards.

More on Scabies and Pubic Lice



How to Know If That Rash Is Scabies

Scabies This skin infestation causes intense itching that is typically worse at night. It can also cause small red bumps or a rash and raised lines on the skin where the mites have burrowed.

Syphilis In the primary stage, syphilis causes a painless sore, or ulcer, at the location the bacteria entered the body, often in the genital area. In the secondary stage of syphilis, a rash may occur on the torso and elsewhere on the body.

Trichomoniasis Another common STD, trichomoniasis is a parasitic infection that can cause burning and itching in the genital area for men and women as well as painful intercourse. Trich can also cause a smelly discharge and painful or frequent peeing.

Can I Have an STD and Not Know It?

Yes. Many STDs don’t cause any symptoms, especially during the early stages, so the only way to know for sure if you have one is to get tested. Keep in mind that you can get an STD from having sex with someone who has no symptoms and may not know they have an STD.

Are Adolescents Disproportionately Affected?

The CDC reports that half of newly reported cases of STDs occur in people between the ages of 15 and 24, noting that young women’s bodies are biologically more susceptible to STDs.

“Chlamydia and HPV are common as soon as you become sexually active,” Hook says. “Gonorrhea and genital herpes peak in the late twenties to thirties.”

All STDs, though, including HIV, can and do occur at any age.

When and How Often Should I Get Tested?

“Women should be tested for chlamydia on a regular basis. Some gynecologists test for it automatically, but not all do,” Hook says.



Chlamydia Treatment and Prevention

Testing for chlamydia, gonorrhea, and trichomoniasis involves collecting either a urine sample or a swab from the vagina or penis.

For other STDs, including HIV, syphilis, and genital herpes, blood testing is most accurate.

To test for HPV, a sample of cervical or anal cells must be collected.

How often an individual needs to be tested for STDs depends on their level of risk for infection.

The CDC recommends the following for testing for chlamydia:Annual screening in sexually active women age 25 and younger and in older women who are at an increased risk for infection because of a new sex partner or multiple sex partners
Annual screening in men who have sex with men, based on exposure history, with more frequent screening in people at the highest risk
Screening in all pregnant women at their first prenatal visit
Annual screening in sexually active people living with HIV

The CDC's recommendations for gonorrhea testing include the following:Annual screening in sexually active women who are at risk for infection, which includes women ages 25 and younger
Annual screening in men who have sex with men, based on exposure history, with more frequent screening in people at the highest risk
Screening in all pregnant women under age 25 and older women who are at an increased risk
Annual screening in sexually active people living with HIV

The CDC's recommendations regarding screening for syphilis include these guidelines:Screening in all pregnant women at their first prenatal visit
Annual screening in men who have sex with men
Annual screening in sexually active people living with HIV

The CDC has additional recommendations for other STDs.

In all cases, more frequent screening or screening for additional STDs may be appropriate for certain individuals, depending on their risk factors, including sexual behavior and how common a particular disease is in their area.

Where Can I Get Tested for STDs?

Your family doctor or ob-gyn should be able to do STD testing. In some areas, other options include specialized STD or sexual health clinics.

You can find locations in your area that offer fast, free, and confidential testing using the CDC’s Get Tested tool.

How Can I Protect Myself From Getting an STD?

Abstaining from all sexual contact is the only way to reduce your risk of STDs to zero. But the following measures can also help:Having only one sexual partner, and ensuring that person is monogamous too, lowers your risk of STDs.
Proper use of a condom every time you have sex greatly reduces the risk of all STDs.
Getting vaccinated against hepatitis B is the best way to avoid this viral infection. The hepatitis B vaccine can be given to people of any age.
Getting the HPV vaccine protects you against strains of the virus that cause genital warts and cervical and other cancers. The HPV vaccine is routinely available to people ages 9 through 26. It is additionally approved for adults ages 27 through 45 but not routinely recommended. Adults age 27 or older who believe they would benefit from HPV vaccination should discuss it with their doctors.

What Are the Treatment Options for Common STDs?

Some STDs are curable with medical treatment, while others can be managed to control symptoms and reduce the risk of transmission.

These STDs can be cured with antibiotics:Chlamydia
Gonorrhea
Syphilis
Trichomoniasis

STDs that can be cured with insecticides include the following:Pubic lice
Scabies

Minor surgical procedures such as cryosurgery (freezing) or laser surgery can treat certain STDs:Genital warts caused by HPV
Molluscum contagiosum

STDs that can be managed with antiviral medication include these infections:Chronic hepatitis B
Genital herpes
HIV

When precancerous cells caused by HPV are found on the cervix, treatment may include watchful waiting or surgery to remove the abnormal tissue.

Does Having One STD Make You More Likely to Get Another?

“Having one STD does not predispose you to others, aside from the behavioral risks shared by all STDs,” says H. Hunter Handsfield, MD, a professor emeritus of medicine at the University of Washington Center for AIDS and STD in Seattle, who also served on the board of the American Sexual Health Association.

“However,” says Dr. Handsfield, “having genital herpes due to HSV-2, but not HSV-1, roughly doubles the risk of HIV if sexually exposed to the virus.”

What Happens If STDs Are Left Untreated?

“The longer something goes untreated, the more likely it is to cause complications,” Hook says. “Left untreated, infections from gonorrhea and chlamydia can travel from a woman’s cervix to her uterus and fallopian tubes, which may cause infertility.”

Untreated syphilis "can become neurosyphilis, causing neurological disease,” says Suzanne Fenske, MD, an assistant professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai in New York City. Late-stage complications of syphilis also include aortic aneurysm and other cardiovascular problems.

Untreated HIV can impair the immune system’s ability to fight off infections and diseases, leading to so-called opportunistic infections, neurological complications, and sometimes cancer.

Untreated chronic hepatitis B can lead to liver failure, cirrhosis, liver cancer, and death.

Failing to treat STDs can have risks for future generations as well. Women who have herpes, chlamydia, gonorrhea, or syphilis can transmit the infection to their baby at birth, which is why testing for STDs; and following safer sex recommendations; during pregnancy is so important.

HIV can also be passed from mother to child during pregnancy, labor, or delivery, but the risk of transmission can be reduced if the mother takes antiretroviral drugs throughout her pregnancy and the baby receives HIV medicines for several weeks after birth.

Does the Number of Sexual Partners Affect My Chances of Getting an STD?

“As a broad rule, more partners means higher risk,” Handsfield says. “However, there are innumerable exceptions. Some people have 100 or more partners per year and remain free of most if not all STDs. Others have one or two partners and multiple infections over time.”

The bottom line is to use condoms or dental dams (small sheets of latex) to lower your risk and discuss STD testing with your medical provider if you are sexually active.

Can STDs Recur?

A curable STD that has been treated correctly will not recur, but it is possible to get the same STD again. In fact, it’s fairly common. To avoid getting the same STD again, your sexual partner, or partners, must also be treated. And to avoid getting the same or other STDs after treatment, practice safer sex, including using condoms each time you have sex.

The good news is that getting infected more than once does not appear to cause more long-term complications.

“In women, a second or third infection with chlamydia may raise the risk of complications like pelvic inflammatory disease,” says Handsfield. “But for the most part, people with multiple episodes of STDs do not fare any worse than after the first infection.”

Chlamydia: Often a Silent Disease

Many people don't realize they have chlamydia because they don't experience symptoms. That's why the condition is often called a silent infection. But untreated chlamydia can cause serious complications in both men and women, including ectopic pregnancy in women. To prevent such complications, young women and men at high risk of chlamydia are advised to get tested for it yearly.

Genital Herpes: A Lifelong Infection

An easily transmitted disease, genital herpes is caused by a virus that stays in the body for life. The infection can cause painful sores to form on the genitals, thighs, or buttocks, but the severity of symptoms ranges widely from no symptoms at all to recurring sores, painful urination, and flulike symptoms. Medication can prevent or shorten outbreaks, as well as lower the chance of passing the virus to a sexual partner.

Gonorrhea: Still Curable, but Antibiotic Resistance Is a Problem

Gonorrhea is highly contagious and, like chlamydia, may cause mild or no symptoms. If left untreated, though, it can cause serious complications, including pelvic inflammatory disease in women and epididymitis in men. While gonorrhea is curable, some strains of the bacteria that cause it have become resistant to most antibiotics.

As of December 2020, the CDC recommends a single 500-milligram (mg) intramuscular dose of the antibiotic Rocephin (ceftriaxone) for uncomplicated gonorrhea. Treatment for coinfection with Chlamydia trachomatis with oral doxycycline (100 mg twice daily for seven days) should be administered when chlamydial infection has not been excluded.

Hepatitis B: Disease of the Liver

Hepatitis is an inflammation of the liver, and the hepatitis B virus is one of several viral causes of hepatitis. There are also nonviral causes. In the United States, infants have been routinely vaccinated against hepatitis B since 1991, and the rate of acute hepatitis B in the United States has plummeted since then. Worldwide, however, chronic hepatitis B infection is common.

HIV: Incurable but Preventable

HIV is a virus that attacks the body's immune system, impairing its ability to fight off infections and diseases over time. The final stage of HIV infection is called acquired immunodeficiency syndrome, or AIDS. AIDS is a life-threatening disease. You can reduce your risk of getting sexually transmitted HIV by using condoms correctly and consistently.

Just about everyone who is or has been sexually active has had HPV at some point. In most cases, the virus clears up on its own, but when it doesn’t, it can cause genital warts and a variety of types of cancers, depending on which strain of the virus you have. The Gardasil 9 (HPV 9-valent) vaccine protects against both warts and cancer and is approved for adolescents and young adults.

Molluscum Contagiosum: May Clear on Its Own

This viral infection can be sexually transmitted or spread through contact with infected skin or contaminated objects, such as towels and toys. It can also be spread from one area of the body to another by touching a lesion then an unaffected area of skin. In many cases it goes away on its own, but treatments are available if it doesn’t.

Syphilis: Life-Threatening if Not Treated

Syphilis is a bacterial infection that is growing more common in the United States, particularly among men who have sex with men. It can be cured with penicillin or, in the case of a penicillin allergy, other antibiotics. Left untreated, syphilis can affect the heart and brain and be life-threatening. Syphilis that is passed from mother to infant (congenital syphilis) is also a severe, life-threatening condition.

Trichomoniasis: A Parasitic Infection

Trichomoniasis is more common in women, particularly young women, than men. The parasite that causes trichomoniasis can infect the penis or vagina but not the mouth, anus, or other body parts. While symptoms of trichomoniasis may raise a medical provider’s suspicions, a definitive diagnosis requires a laboratory test.

By Everyday Health. Listen to the ► Podcast at How To Sex.

Contraceptive methods that use hormones alter how your body works in order to prevent pregnancy. These range from daily-use options, such as birth control pills, to long-term-use approaches, such as hormonal IUDs, which can stay in place for several years, says Dr. Bond.

Hormonal Contraception Option: Birth Control Pills

There are two types of birth control pills: combination pills that contain both estrogen and a form of progesterone called progestin, as well as progestin-only pills (also known as the mini pill).

The pills work by preventing ovulation, so there is no egg for sperm to fertilize, or by thickening cervical mucus so sperm cannot travel to an egg.

Birth control pills need to be taken every day as directed. Most types of progestin-only pills must be taken within the same three-hour time window every day. Some pills can also be used to stop your period.

How effective are birth control pills? Combined and progestin-only birth control pills are more than 99 percent effective if used perfectly and 93 percent effective if used typically.

How much do they cost? You need a prescription to get birth control pills. They may cost nothing or up to $50 a month and can be free or low-cost with most types of health insurance, Medicaid, or other government programs.

Hormonal Birth Control Side Effects

Some people don’t do well on hormonal contraception. “Each woman is different, and you have to understand your body,” says Bond. If you notice one or more of these side effects, let your doctor know:

• Nausea
• Weight gain
• Changed menstrual cycles, including spotting

Some women like the effect of ‘the pill’ on their breast size. They are glad to have that kind of ‘weight gain’.

Who Shouldn’t Take Hormonal Birth Control?

For some people, the use of hormones is not recommended. “The pill is easy and awesome, but if you have migraines with aura (vision changes during a bad headache) or have a history of deep vein thrombosis, stroke, or other cardiac changes,” talk to your doctor to learn if you should consider another birth control option, says Dr. Greves. Moreover, if you have a blood-clotting disorder, you don’t want to take estrogen, and if you have breast cancer, you don’t want to take estrogen or progestin. Smokers and those considered overweight or obese should talk to their doctors about which contraceptives are recommended for them.

Hormonal Contraception Option: The Shot, Depo, or Depo-Provera

An injection of medroxyprogesterone (Depo-Provera) (also known as the birth control shot) can prevent pregnancy for three months.

The shot contains high-dose progestin to prevent ovulation, and it also makes cervical mucus thicker to prevent sperm from reaching the egg.

In most cases, your doctor or nurse will give you the shot every quarter, but in some cases, you may be able to bring the shot home to give it to yourself.

How effective is the shot? Injectables are more than 99 percent effective with perfect use and 96 percent effective with typical use.

How much does it cost? It can cost nothing or up to $150, and it can be free or low-cost with many health insurance plans, Medicaid, and some government programs.

Hormonal Contraception Option: Birth Control Implant, or Nexplanon

The birth control implant, also called Nexplanon, is a small rod about the size of a matchstick that is placed into the upper arm. It releases progestin to prevent pregnancy for up to three years.

The implant must be inserted by a trained healthcare provider and can be removed at any time if you want to get pregnant.

How effective is the implant? The implant is more than 99 percent effective.

How much does it cost? It can cost anywhere between $0 and $1,300, but it’s totally free with most health insurance plans, Medicaid, and some government programs.

Like combination birth control pills, the vaginal ring contains both progestin and estrogen.

It’s a small ring that a woman wears inside her vagina, and the hormones work to prevent ovulation and pregnancy.

There are two types of vaginal rings: ethinyl estradiol and etonogestrel (NuvaRing) and ethinyl estradiol and segesterone (Annovera). Each NuvaRing lasts for up to five weeks. You take the old one out and put in a new one about once a month, and it can be used to safely skip your period. Each Annovera ring lasts for one year, but you must put it in your vagina for three weeks, then take it out for one week every month, during which time you’ll typically have a period.

How effective is the vaginal ring? Vaginal rings are more than 99 percent effective if used perfectly and 93 percent effective if used typically.

How much does it cost? You need a prescription to get the vaginal ring. NuvaRing can cost anywhere from $0 to $200, and Annovera can cost anywhere from $0 to $2,200. But vaginal rings can be free or low-cost with most health insurance plans, Medicaid, and some government programs.

Like the vaginal ring, the patch (brand names Xulane or Twirla) also releases estrogen and progestin, but through a patch worn on your stomach, buttocks, or back.

The patch must be changed once a week for three weeks, and then you skip a week and have your period. Xulane can also be used to prevent your period if you add a new patch on the fourth week instead of skipping a week.

How effective is the patch? The patch is more than 99 percent effective if used perfectly and 93 percent effective if used typically.

How much does it cost? You need a prescription to get the patch. One pack of three patches lasts for up to one month and can cost from $0 to $150. It is free with most health insurance plans, Medicaid, and some government programs.

Note: Hormonal treatments may also prevent a conception from securely attaching to the mother’s womb (nidation), resulting in a very early miscarriage which often appears to be a normal menstruation.

Intrauterine devices (IUDs) are one of the most effective forms of birth control. IUDs are inserted into the uterus by a trained healthcare professional and can work for up to 10 years, depending on which type you choose. They can also be removed any time if you want to get pregnant.

Copper (Nonhormonal) IUD

The Paragard copper IUD (also called the copper IUD) is the only nonhormonal IUD on the market. It’s a small piece of flexible plastic shaped like a T that has copper wrapped around it, which prevents sperm from reaching an egg because sperm are repelled by copper.

The copper IUD can be used as a regular form of birth control or as a form of emergency contraception (see more information about emergency contraception below). Paragard IUDs are the most effective form of emergency contraception. If you have one inserted within five days after having unprotected sex, it’s more than 99.9 percent effective against pregnancy and then provides very reliable contraception for up to 10 years.

Hormonal IUDs

Like the nonhormonal IUD, hormonal IUDs are a small piece of flexible plastic shaped like a T. They release a tiny amount of progestin into your body over several years, which helps prevent pregnancy.

There are four brands of hormonal IUDs available in the United States: Mirena, Kyleena, Liletta, and Skyla. Different brands last for different lengths of time. Whichever you choose, you can have your IUD removed whenever you want.

An IUD must be inserted and removed by a doctor, nurse, or another trained healthcare provider.

How effective is the IUD? All IUDs are more than 99 percent effective both for perfect and typical use.

How much do they cost? Anywhere from $0 to $1,300; they are free or low-cost with many health insurance plans, Medicaid, and other government programs.

Note: IUD devices may also prevent a conception from securely attaching to the mother’s womb (nidation), resulting in a very early miscarriage which often appears to be a normal menstruation.

Other than condoms, these older methods of contraception typically aren’t as effective. “Sponges or a diaphragm? I don’t want to say they are outdated, but they aren’t talked about as much today by healthcare providers,” says Bond. Most barrier methods need to be inserted into the vagina before sex, so “they take away from the romance aspect of engaging in sex,” she adds.

Similarly, “a diaphragm doesn’t work that great,” says Greves. “It’s better than nothing, but I don’t remember the last time I recommended it to someone.”

On the other hand, male condoms and internal condoms remain effective forms of contraception that can also help prevent sexually transmitted infections (STIs).

Barrier Method Option: Diaphragm

A diaphragm is a shallow, flexible cup made of silicone that you put inside your vagina. It covers the cervix and acts as a barrier so sperm can’t reach an egg.

Diaphragms are most effective when they’re used with spermicide (a cream or gel that kills sperm).

Your doctor must fit you for a diaphragm and give you a prescription, and then you can get one at a pharmacy, drugstore, or health center. After that, you can insert it and remove it yourself.

How effective is the diaphragm? If used perfectly with spermicide, the diaphragm is 84 percent effective. With typical use, it’s 83 percent effective.

How much does it cost? Anywhere from $0 to $250. You can probably get a free or inexpensive diaphragm with most types of health insurance, Medicaid, and some government programs. Spermicide, which is available over-the-counter at the drugstore, costs about $5 to $15 per kit.

Barrier Method Option: Sponge

The sponge is small and round and made of soft, squishy plastic.

You insert it deep inside your vagina up to 24 hours before you have sex. It covers your cervix and contains spermicide to help prevent pregnancy. The Today sponge, the only brand of sponge available in the United States; is sold at pharmacies, drugstores, and some supermarkets.

How effective is the sponge? With perfect use, the sponge is 80 to 91 percent effective (it’s more effective if you’ve never given birth); with typical use, it’s 73 to 86 percent effective.

How much does it cost? It costs about $15 for a pack of three. You may be able to get low-cost or free sponges at Planned Parenthood or another health center.

Barrier Method Option: Cervical Cap

Like the diaphragm, the cervical cap is a silicone cup, but it’s smaller. You insert the cap deep in your vagina to cover the cervix and prevent sperm from reaching an egg. It’s also more effective when used with spermicide.

FemCap is the only type of cervical cap available in the United States.

Cervical caps are sold in pharmacies, drugstores, and health centers, but you need a prescription. A nurse or doctor will need to examine you to determine which size cervical cap is best for you.

How effective is the cervical cap? Like the sponge, the cervical cap is more effective if you’ve never given birth. If you’ve never given birth, the cervical cap is 86 percent effective. If you have given birth, the cap is 71 percent effective.

How much does it cost? The cap costs between $0 and $275, not including spermicide. You can probably get a cervical cap for free or low-cost with most types of health insurance, Medicaid, and other government programs.

Barrier Method Option: Male Condoms

Male condoms are worn as a sheath over the penis during sex. They prevent pregnancy by stopping sperm from getting into the vagina, so it can’t reach and fertilize an egg.

Male condoms are used to avoid pregnancy, and they can also reduce the transmission of STIs. Most male condoms are made of latex, but some are made of plastics like polyurethane, polyisoprene, and nitrile for those who are allergic to latex. Lambskin and other animal membrane condoms also prevent pregnancy, but they don’t protect you from STIs.

How effective are condoms? If used perfectly, male condoms are 98 percent effective, or 87 percent effective if used typically.

How much do they cost? Male condoms are available in most drugstores, grocery stores, convenience stores, health clinics, online, and vending machines. A box of three usually costs between $2 and $6. Lower-cost or free condoms are available at various health centers.

Barrier Method Option: Internal Condoms

Internal condoms are soft plastic pouches that you put inside your vagina or anus before you have sex. They prevent pregnancy by covering the inside of your vagina, creating a barrier that stops sperm from reaching an egg. They also help prevent transmission of STIs if worn in the vagina or anus.

Internal condoms were once known as “female” condoms, but they can be used by people of any gender. The only brand of internal condom that’s available in the United States is the FC2 Female Condom. It’s available online, at many health centers, and by prescription in drugstores.

How effective are internal condoms? If used perfectly, internal condoms are 95 percent effective. If used typically, they are 79 percent effective.

How much do they cost? They usually cost about $2 or $3 each, but they are covered by most types of health insurance if you have a prescription. Some health centers may offer them for free.

Natural family planning or fertility awareness methods,(FAM); generally involve a woman taking note of the most fertile days of her menstrual cycle and avoiding sex during these days.

They include the Billings ovulation method, in which a woman looks at the consistency of her cervical mucus (long and stringy just before ovulation), and tracking basal body temperature (which rises a small amount during ovulation) to predict the time with the lowest odds of pregnancy.

RELATED: 6 Family Planning and Natural Approaches to Birth Control That Are Legitimate Contraception Methods

FAM takes a lot of dedication, both to track changes over several months and to avoid vaginal sex (or use condoms) when most fertile. “I don’t think FAM is reliable,” says Bond. “There is pre-ejaculation that can contain sperm that you can become pregnant by. If you are not sure about taking some kind of pill, or other hormonal contraception, you should consider using condoms, because they are easy and don’t require that much change in the body.”

How effective is FAM? The effectiveness of fertility awareness methods including the Billings method varies widely, with a failure rate of less than 1 percent to up to 12 percent with perfect use, and from 2 percent all the way up to 34 percent with typical use.

How much does it cost? About $10 for a thermometer.

Pulling out, also known as withdrawal, is when a man removes his penis from the vagina just before ejaculating. It’s tricky, because pre-ejaculate can form before withdrawal. Avoiding pregnancy means keeping all sperm away from the vagina, and with this method, even a small amount of sperm can get into the vagina and lead to pregnancy. This method is best used when combined with another birth control method, such as condoms.

How effective is withdrawal? The withdrawal method is 96 percent effective with perfect use and 80 percent effective with typical use.

How much does it cost? Nothing, but condoms are recommended.
Abstinence and Outercourse

Avoiding any kind of vaginal, anal, or oral sex is called abstinence, and activities such as kissing, dry-humping, masturbating, massage, and talking about fantasies are considered outercourse. The idea is to keep sperm away from the vagina to avoid pregnancy, but these methods require a lot of dedication and willpower.

Terms like ‘titty fucking’, ‘crotch fucking’, ‘jerking off’, and anal copulation; as well as fellatio (oral-induced male ejaculation), cunnilingus (oral-induce female climax), or nipple stimulation; are the most common outercourse options for a pleasurable climax without vagina penetration by the penis.

How effective are abstinence and outercourse? 100 percent.

How much does it cost? Nothing.

Considering a vasectomy? Learn about its effectiveness, risks, and impact on sexual performance. Make an informed choice!

Permanent Methods of Contraception: Tubal Ligation and Vasectomy

For women, sterilization or tubal ligation is a way to permanently prevent pregnancy. It requires surgery to seal off the fallopian tubes so that an egg can never reach a sperm and be fertilized.

Learn More About How to Get Your Tubes Tied: What to Know About Permanent Birth Control

For men, vasectomy is the option for permanent birth control. A vasectomy is a simple surgery in which the small tubes in the scrotum that carry sperm are cut or blocked off, so sperm can’t leave the body and cause pregnancy.

Permanent sterilization methods do not protect against sexually transmitted infections; condoms are still necessary to reduce the chances of contracting an STI. While vasectomy and tubal ligation reversal procedures exist, they are pricey and not always effective. Choose these options if you are sure you don’t want to have children (or more children).

How effective is permanent contraception? Tubal sterilization and vasectomy both have a failure rate close to 0 percent.

How much does it cost? Tubal ligation can cost anywhere from $0 to $6,000.

A vasectomy costs between $0 and $1,000.

Both tubal ligation and vasectomies may be totally free (or low-cost) with some health insurance plans, Medicaid, and other government programs.

If used as soon as possible after unprotected sex, emergency contraception (EC) is a safe way to prevent pregnancy. Methods are more or less effective depending on a few variables, such as your weight and how long it has been since you had unprotected sex.

EC comes in several forms:

The Progestin (Levonorgestrel) Pill, or Plan B One-Step

The progestin (levonorgestrel) pill, also known as the “morning-after pill” and by the leading brand name, Plan B One-Step, must be taken within 72 hours (three days) of unprotected sex.

How effective is the progestin (levonorgestrel) pill? Levonorgestrel pills can lower your chance of getting pregnant by 75 to 89 percent if you take them within three days after unprotected sex.

How much does it cost? Plan B usually retails for approximately $40 to $50 nationwide. Generic versions usually cost about $11 to $45. If you have health insurance or Medicaid, it’s likely that you can get the progestin pill for free, you just have to ask your nurse or doctor for a prescription (even though you don’t need a prescription to buy these types of pills over-the-counter). You may also be able to get the morning-after pill for free or low-cost from a health center or family planning clinic.

Ella

A pill that contains ulipristal acetate, also known by the brand-name Ella, must be taken within five days of unprotected sex. You need a prescription to get Ella, either by seeing your doctor or getting a prescription online.

How effective is Ella? Ella reduces your chances of getting pregnant by 85 percent if you take it within five days after unprotected sex.

How much does it cost? Ella usually costs about $50 at a pharmacy or drugstore, but it might be free if you have health insurance or Medicaid. You may also be able to get Ella for free or low-cost from a health center or family planning clinic. Depending on which state you live in, you may be able to get a prescription for Ella directly from your pharmacist.

The Yuzpe method

The Yuzpe method involves taking higher than usual doses of combination birth control pills that have both estrogen and progestin. This method is most effective within three days of unprotected sex, and it must be done under the supervision of a physician (the number of pills you would take depends on the brand of birth control you use).

How effective is the Yuzpe method? The Yuzpe method is thought to be about 75 percent effective at preventing pregnancy.

How much does it cost? It costs the same as combination birth control pills, which you would usually already have on hand if you are using this method.

Note: Hormonal treatments may also prevent a conception from securely attaching to the mother’s womb (nidation), resulting in a very early miscarriage which often appears to be a normal menstruation. The hormone dose also induces a prompt mentruational flow.

The Copper IUD

The copper Paragard IUD is a non-hormonal IUD. Once the IUD is inserted into the uterus, it makes it hard for sperm to fertilize an egg. When used as a form of EC, the copper IUD is most effective if used within five days after unprotected sex

How effective is the copper IUD? It’s more than 99.9 percent effective against pregnancy and then provides very reliable contraception for up to 10 years.

How much does it cost? It costs the same as when it’s used for regular contraception, anywhere from $0 to $1,300, but it is often free or low-cost with many health insurance plans, Medicaid, and other government programs.

Note: IUD devices may also prevent a conception from securely attaching to the mother’s womb (nidation), resulting in a very early miscarriage which often appears to be a normal menstruation. Some liken it to a ‘coat-hanger abortion’ device, but inserted by a medical professional, to limit damage to the woman’s body, while effectively puncturing any amniotic sack in the uterus.

RELATED: Learn More About Emergency Contraception

By Everyday Health. Listen to the ► Podcast at How To Sex.

By Anonymous. Listen to the Podcast at How To Sex.

I Fucked up.

I am writing this mainly because there is not a lot of information about this particular injury

Around October of last year I was having sex with my girlfriend, when I thrust too hard at the wrong angle and tore my Urethra and two blood vessels in my penis.

When the injury first occurred I was close to climaxing. Because of this, when the injury happened and the blood vessels and urethra were torn, blood started mixing into my urethra. I was cumming blood

I was not in pain but I could feel that my dick was not pointing in the right direction and turned on the lights, blood was everywhere and pouring out of me at an alarming rate (think you’re cumming but it doesn’t stop and its blood)

At this point I’m panicking and yell out that I need to go to the hospital immediately.

I throw on loose pants without zipping them up, a hoodie, and grab a towel to soak the blood that’s coming out. Then me and my girl go to the hospital.

The hospital near me specialized in bodily injury and doesn’t have the type of urologist doctor that I need to see, so I have to drive 30 minutes away to the closest hospital that has a Urology department.

Once I get to this secondary hospital, I am immediately taken in and put into a room of my own once they see my dick; and about an hour later I see a Urologist who runs some tests and tells me about the ruptured urethra and blood vessels.

 I need surgery.

The surgery is a process called “de gloving” where they “de-glove” the skin around your penis, roll it down, and make an incision into the underside of the skin and go in and stitch up the torn vessels and urethra, these are dissolvable stitches and they stay in your penis until they go away on their own.

About 8 hours later I actually went into surgery, I don’t remember anything. I was wheeled into the operating room and the anesthesiologist cracked a dumb joke, and then I was out.

I woke up with my penis wrapped up in bandages and a catheter in me. If you have never had to use a catheter, count yourself lucky. I was told I needed to keep the catheter in for 10 days.

These were the longest 10 days of my life. If you asked me what the pain was on a scale of 1-10, it was 7 with the opioids, and 11 without them.

Any little movement with my penis and I got searing pain. Wearing any type of clothes was out because I just could not take it, I was pretty much naked during those ten days. Anytime the catheter twisted? Pain. Anytime I had to roll out of bed to go get something from the fridge? Pain.

Worst of all? Erections.

As the men reading this will know, erections are not really voluntary, we just get them sometimes. Morning wood is a real thing and its not controllable.

Want to know what getting an erection feels like when you have stitches in your dick and a catheter? Worse than words could ever explain.

 I woke up screaming three times a night. I would tear something and I could see the stale blood along the catheter as my erections came and went. The blood became crispy, and if I didn’t clean it when it happened, the next erection would be 5 times as painful because it would grow along the stale, sharp leftover blood on the catheter.

I quickly learned how to kill erections, but it was still really bad. I’m actually leaving out some details because I’m not fully recovered yet and the phantom pain comes back as I’m trying to recall it.

As of today, I have the catheter out and can walk around again, but erections are still painful, I imagine that will go away in the next few weeks.

Yes, You Really Can Fracture a Penis shaft — Here's What That Means

Proceed with caution if you're squeamish.

BY SOPHIE SAINT THOMAS - 2018

There are a lot of sexual myths out there, but doctors confirm that broken penises aren't one of them. Remember when Lexie Grey supposedly broke Mark Sloan's penis back when all our favorite characters on Grey's Anatomy were still alive? Nope, Shonda Rhimes wasn't making that up. While there aren't actually bones in the penis, a penile fracture is a real-life injury. We spoke to several urologists to learn how it happens, what a broken penis looks like, and how to treat one.

What exactly is a fractured penis (often known as a "broken dick")?

First, a quick refresher on what inside a penis can break in the first place: A penis contains two chambers of tissue called the corpus cavernosum, which fill with blood when the penis becomes erect.

Blunt force to an erect penis can tear the sheath surrounding these chambers (and even rupture the erectile tissue inside) so that the blood inside leaks out to other areas of the penis. If you need another visual, Alex Shteynshlyuger, a urologist in New York City, says to think of this covering less like a bone and "more like a sausage casing." (Doctors, however, call the covering of the corpus cavernosum the "tunica albuginea.")

How do penile fractures happen?

A penis can be broken during vigorous penetrative sex or through masturbation. When this happens during partnered sex involving a penis and vagina, "generally speaking, the penis will come out of the vagina and strike against the pubic bone," says Leslie Deane, an associate professor of urology at Rush University Medical Center in Chicago.

While a penis can fracture during sex in any position, research suggests that Female on top, or rear-entry positions such as ‘reverse cowgirl’ or ‘doggy style’ may lead to penile fractures more often than ‘missionary’ or ‘spooning.’ A penis may be more likely to exit a vagina or anus entirely when thrusting from behind and then, instead of reentering, bang against something hard like the perineum. (If you're an anal sex beginner, it's important to take things slow. Deane says penile fractures aren't uncommon, and that he sees several cases a year. He adds that he observes higher rates of the injury around Valentine's Day and that alcohol is sometimes involved.

What does a broken dick look like?

According to Stacy Loeb, an assistant professor of urology and population health at New York University, a penile fracture may be accompanied by a popping noise, a rapid loss of erection, and acute pain. "The penis may develop swelling and bruising, referred to as an 'eggplant deformity,'" Loeb says. This means that the eggplant emoji isn't totally off-base as a representation of dicks: It just looks like a broken one. Shteynshlyuger adds that some penile fractures lead to bleeding from the tip of the urethra and that patients may notice blood in their urine. If you're having fun with a penis that suddenly "pops," goes soft, and causes its owner immense pain, seek medical attention immediately. You might have a broken dick on your hands.

How is a broken penis treated?

Still reading? Good, because there's some positive news: If treated, broken dicks stand a great chance of making a full recovery. Unfortunately, Deane says, surgery is required in most cases. While there are less severe penile injuries that can occur during sex, such as a tear of one of the superficial veins, the only way to know for sure what's going on is to head to the emergency room.

It's also important to do it fast: "Surgical repair of the tear usually results in good outcomes," Shteynshlyuger emphasizes. However, "If a penile fracture is severe and not treated in a timely manner, it can lead to problems with obtaining or maintaining erections, [or] it may also cause scar formation in the penis and a condition called Peyronie's disease, which causes curvature and deformity of the penis."

After surgery to repair the ruptured "sausage casing" inside the penis, the recovering patient should be able to have sex again in about six to eight weeks, although Deane advises going slow at first. This doesn't mean that wild, headboard-rattling sex is off the table after a penile fracture, but it's not a bad idea for patients to ease their way back in.

Hard Flaccid Syndrome

A rare condition that affects some men, is called Hard Flaccid. They have a stiff, but smaller-than-erect cock. It’s painful, inhibits real erection, prevents ejaculation, and has constant pain which increases during urination.

Our best investigations conclude that it comes from a likely combination of muscle injury coupled with an anxiety or stress disorder. Many people manifest stiff muscles under stress. More often it’s neck, back, or chest muscles.  But rarely it’s the pelvic floor muscles which connect the pelvic bone to the tailbone. When women do Kegal exercises for better vagina constriction, they are working those same pelvic floor muscle groups.

But when a physical injury leads to muscle spasms, like common back injuries cause, The spasms can lead to a precipitous chain of other ‘self preservation’ conditions.

The Hard Flaccid Syndrome is believed to be just such a ‘perfect storm’ chain of events.

Let’s hear from a few men who are dealing with this, and what their progress entails.

‘Old Will’ said;

“I had Hard-Flaccid for about two years. Low labido, cold penis, glands sometimes had white spots. Then for about 8 months I practiced relaxing, worked on my anxiety and anger issues and it all over time went away.

I started off on anxiety meds and that's when I noticed hard-flaccid getting better. Suddenly it hit me that the only thing I hadn't thought of was managing my anxiety. I was on that for about 2 months. Then when I got off the meds it started to get a little worse but I figured, if it was really anxiety that caused it, then I needed to calm down, and stop obsessing over it. I mean, I was absolutely obsessed with curing my hard flaccid. So, I just stopped looking into it. I stopped looking for cures online. I made the decision to just enjoy life for a change, better myself and not think about all this all day. And slowly, it just returned to normal.

When I first really started taking my mental health seriously, which was about 8 months ago, and the true beginning of my recovery process I lifted weights about 5 days a week. I wouldn't call myself heavyweight lifter. I did light moderate weight lifting. But I haven't been to the gym since November. I plan on going back. I'm a firm believer of exercise improving body and mind.

 I masturbated during my healing process. I do think it would have made things move along a little faster, if I didn't masturbate at all, but I figured it was worse if I stressed over it. So, if I was gonna masturbate, I was going to enjoy it and have no regrets about it.

 I know how difficult this is for people so I wanted to share my story and hope it helps many of you.”

‘Whirl Mind’ responded;

 “Mine likely developed from a lot of sitting, possibly bad diet for a few days or spicy food that led to minor constipation/difficult bowel movements, and general stress that increased clenching. Who knew I could injury myself by crapping too hard?

Not totally sure though and I’m still in a minor flare, softer down there today though.

Mine also went away pretty much completely for about 2 weeks recently, without sticking to any routine. I’m noticing some pelvic floor inflammation and extra pain at the base as of a few days ago and the HF has returned but in a more minor way. Hoping I can get over this again and also trying to work on my anxiety.

My condition had suddenly turned into the thin & weightless “long flaccid” and it freaked me out at first, but after 5 days or so of that I pretty much just accepted any variance in that as good and got myself into a positive feedback loop. Note that I am an extremely high-strung person and this wasn’t easy but I was so desperate that it was imperative that I just let go. So pushing everything surrounding this shit to the back of my mind but also staying afloat on any positive changes like better hang, better fullness temporarily etc. I think this mental state was and is a huge part of the condition to focus on for most people but also a big reason why it is so fickle.

I don’t know if something in particular in terms of lifestyle or diet caused this recent return to HF but I do know that my anxiety surrounding the condition was a little worse for a few days this week. I can clearly feel the issue of dysfunction at the base which seems to stem from my IC and BC muscles, because when the both the Hard-Flaccid and Long-Flaccid states leveled out and I was feeling good and much closer to normal I still dealt with many of the muscular symptoms, or what I’m assuming are muscular.

Anxiety can be so hidden in our psyche and I’ve literally watched it, like a switch going on and off, effect at least the peripheral symptoms of this condition. I’ve practiced no-fap, which means abstaining from jerking off; mainly as an experiment but my erection quality is astounding at this point in time.

As anxiety is dealt with, libido should increase as well as Erection Quality in the absence of a more severe issue. The uncertainty of this condition is so hard to deal with, and with some firmness & tightness down there, now present again.

 I’m seriously trying to get a grip on my anxiety and will probably do some light stretches. For me personally I found that sometimes getting into a routine all to fix HF would make things worse since I was so fixated on it, so if anything I’m trying to find a balance with everything.

Keep in mind I never stuck to any routine and was somewhat inconsistent, the change to Long-Flaccid happened so suddenly while I was just trying to sleep, and in pain; and the improvements that followed seemed to only come with time, working on anxiety and trying to live without thinking about this condition.”

Gunz GotBunz added his encouragement;

“Your symptoms are my symptoms, and I found that after being completely calm, and using the relaxation & mindfulness techniques every day, it was so easy for my wife to stimulate me my penis was so long and hard! I felt the glory of Rome that day!

But alas that was but once. Anxiety always takes a toll on the body, and the more I achieve mindfulness the better and bigger my erection gets!”

Numb Penis: What’s Going on and How to Fix It!

By Dugan

You’re watching a hot sex scene, getting it on in your backseat, or you’re taking a little “me time” with your favorite website, and, well, you notice things aren’t happening down there. What’s going on? It could be something called penis numbness. There are quite a few reasons a man can be the bewildered owner of a numb penis. Read on to learn how penis numbness reached you and then how to get him back up and at ’em!

1) Penile Injury – Known also as penile traumas, penis injuries can cause penis numbness . A penile injury damages the blood vessels, which are essential to a healthy penis because they bring the blood that produces an erection. Lots of things can hurt a penis, such as rough sex, too much masturbating, using a too-tight grip for self-pleasure, sexual aids, and group sports.

2) Neuropathy – Neuropathy is when a limb or appendage goes numb. This numb penis is often the effect of an illness or condition but can also be the result of the regular pinching of a nerve (say in the hip area). Neuropathy wears 2 masks. One time it feels like a cold numbness, and the next time it feels like pins-and-needles or lightning shooting through the penis. Medical conditions such as diabetes, obesity, lupus, multiple sclerosis, and some cancers can cause neuropathy.

3) Peyronie’s Disease – Peyronie’s disease is a condition in which the penis has a curve of more than 20 percent. In addition to being a painful disease, Peyronie’s disease has been associated with loss of penile sensation in some men. The scar tissue that causes Peyronie’s can be less sensitive than regular tissue, resulting in loss of genital sensation.

4) Lifestyle – Lifestyle is a big part of health, but it’s often the thing people are most reticent to change. Diet and exercise are significant factors that need to be addressed if there aren’t already healthy behaviors in practice. Stress can also make the problem worse, so be sure to incorporate stress-reduction techniques into each day. Changes in lifestyle have been shown time and time again to yield big results.

Penis Power: How to Get It Back!

Want a more-sensitive penis? In most cases, a man can regain sensitivity with a little dedication and a little help. Here are a few ways to breathe life back into a man’s boner.

Address the root disease if it’s the cause. Work with doctors and therapists to first treat the disease and then treat the symptom, not vice versa. Whole-body health should always be the number one focus.

Wear looser pants and underwear to give the big guy some space and not have to spend the day hugging fabric, which desensitizes it.

Spend some time each day letting it all hang out in a personal space. A little air also prevents too much contact for the penis.

More movement – sitting all day can deaden the nerves in the pelvic basin. Get up every hour or two to give them some freedom.

Don’t go too hard, or too often, when sexing it up.

For men who cycle, get a padded bicycle seat cover and padded shorts to reduce the hard compression against the nerves for prolonged rides.

Proper penis care can also preserve sensation and decrease the chances of penis numbness. Lightly, but thoroughly, wash it with a gentle cleanser and warm water, then rinse and air dry.

Use a reliable skin treatment oil, like Shea Butter, Almond oil, or other safe moisturizer. Avoid lotions with harmful ingredients. All of it gets absorbed into your organs, and can be toxic.

Sex lubricants that might be fine for a woman’s internal organs, may be terrible for a man’s external organ. Water-based lubes evaporate very quickly, especially with rapid stroking. If your lover is stroking you hard, and the once-viscos lube, is now a tar-like glue, It can not only tear your very thin cock skin, but it can also lead to bursting internal cells inside your shaft or glans.

By alf_2712. Listen to the Podcast at How To Sex.

Bondage sex is often associated with Sado Masochism. But that vaste generalization does a great disservice to a wide range of sexual proclivities. Each part of this grouping ought to be understood on it’s own attributes.

Bondage is simply adding real or perceived restrictions in a sexual encounter. It’s the fantasy of lost control over a situation which thrills many lovers. It often incorporates a fantasy scenario and some role-playing.

Sadism is the infliction of discomfort to a lover.

Masochism is a self-inflicted discomfort.

Today we’re hearing from Alfie, about her lover’s favorite kink. He allows himself to be restrained and subjected to sexual frustration, in the form of a very delayed ejaculation.

Healthy lovemaking of this sort may include switching roles, or may remain in fixed roles of a dominant & a submissive.

Sometimes it’s only a fantasy desired by one of them, yet the other lover plays a role simply to satisfy the other’s sexual sesires. Here’s Alfie.

Spread eagle is my definitely my favorite bondage position. I love it. Tying at the feet is not always necessary, but the hands, absolutely. Even though a pair of cuffs in the middle do have their place, I’m a firm believer in hands at the corners. Some sort of strapping under the bed, whatever; we just want his arms out. Face up, of course.

n  a bed big enough for both of you

n  some kind of restraint system already attached at all four corners of the bed frame, to tie his limbs outward, toward the four corners of the bed

n   a bowl or basket containing:

A: a bottle of tasty massage oil,

B: a cock ring, and

C: a feather, furry mitt, or something which is very ticklish.

Besides these, the following are preferred;

n  big tits If you’ve got them

n  and minty gum can be nice.

No need for a blindfold. believe me, his eyes are your friend. You might also keep a glass of water, gotta keep those spit and sweat glands pumping. Ice water if you’re a bitch.

And a word on gagging. it’s up to you! But if you’re gonna gag, gag properly (i.e. rubber is better than your thong). Let’s get started! But let him breathe freely. His muffled voice is more for your experience of domination.

Get your man on your bed. Your face and hairdo should be impeccable and sultry, with lipstick mascara, and whatever else makes you look like a high-class slut. But somehow keep your hair from falling into your face on onto his oily body.

 You want his to see your impeccable face and styled hair for the entire event.

If there’s a clock in the room, hide it.

Get him on his back and give him a kiss. A pillow under his head is good. And he’s naked, right? Completely naked? Dote on him and ask if he likes the position of the pillow. This doting just camouflages the torment you have planned for today.

You don’t have to be also naked, yet; but let your clothing help set a sensual mood. A Silky robe or his favorite lingerie is a good choice to start with.

Make focused attention on his comfort before you gently attach the restraints. Adjust the wrist restraints so you can fit one finger between the material and his skin. You want barely any wiggle room in his arms.

And his legs? Well, that’s up to you. Being bound on the bed and all accessible is going to make him squirm whether his legs are forced straight or not. I say leave em. But he might accidently hurt you if he suddenly flinches his legs.

Once all restraints are attached, extend each of his limbs and tighten the length up, so he’s truly spread-eagle and limited from squirming around during the event.

Tease and denial is the name of the game here. Or “edging” if you like. And edging it is.

We’ll be taking him right to the edge of an orgasm, more than a few times.

You know you’re doing well if you lose count. I hope your blowjob skills are up to date, ‘cause tongue is king here. Not to say it’s your only asset (it’s not). but subjecting him to excruciating pussy-torture can come a bit later.

 In case it’s not clear already, this guide is written from a woman’s perspective; so if you’re not one, some parts of it may not be applicable.

So! Your man-slave is bound and the fun can begin.

What’s first? Well, “what’s first” is the part that I don’t really know about. I hope the setting is nice, the light not too bright; the room not too cold. Sensual music or nature sounds can be nice.

I like to get on top for a moment after the restraints are on, & give him a hickey, then slither down to his knees.

Scratch his stomach and sides on the way down (good nails are good to have; nothing like a French manicure at your man’s balls). Yeah, scratch his balls a little.

 Sensual disrobing:

By now it’s time to take something off. Make it a sensual performance for his enjoyment. I let my g string panties stay on a little longer, but you ain’t got a smooth stomach for nothing.

Now it’s time to bring out the massage oil. I Hope you taste tested it first. Sweet Almond or olive oil is reliable. Sweet Almond unscented oil has a very neutral taste. Artificial scents might smell nice, but usually are bitter tasting, and might upset your stomach. Plan on lots of tasting.

Mmm, oil. Again, don’t use any water-base lubricant for this event. Whatever oil it is you use, it’ll warm up in your hand and be a little more liquidy. We don’t need to let it yet, though.

So kneel facing him, right up between his thighs; & get yourself all slippery; it’s easy to start with your own arms, and then your chest and beyond. Show him how slippery. Cover yourself from your neck down to your thighs.

Now straddle over his waist as you coat his arms, shoulders, neck, chest, and armpits. It’ll make little suction noises when you dump it on your hands and on to his body. Cover everything in front of you, down to his knees, up to his nipples, only enough on his cock to get it shiny. Don’t put oil on his head, or yours. Take a minute to lightly rub his armpits, flanks, and nipples.

Now slowly slide your panties down each hip, then shift off him as you draw a leg out of the thong. Then get up and stand over him, facing his feet, with your ass and cunt in his full view.  Now slowly descend to your knees, and apply oil on your ass, once coated sufficiently, lean over with a hand resting on the mattress right next to his crotch, so he can see you further rub the oil slowly over your anus and labia.

Add some more oil on his pelvis, thighs, hips, just make sure you’re carefully supporting your own weight as you slide your hands over his oily body. We don’t need any cracked ribs ruining the event.

When you’re both coated, rotate around and kneel between his thighs.

Now slowly  lean over and give one of his nipples a lick, then lay flat on top of him again.

Let your tits make first body contact to his chest, and pause to oscillate a bit, before fully landing your entire torso onto his, with your  thighs along the inside of his.

You can probably feel gravity pulling you towards his feet. You can position your breasts nicely between his thighs on the slide down stroke, then slide back up to his face and do it again. Maybe lick his balls.

Get up on your knees and rotate to straddle his stomach now, on your knees again, his eyes facing your ass. Pour or squirt some oil into your palm and hold it for, oh, ten seconds. Then cup your hand with it up under his balls, and drag the liquid up to his belly button.

Massage his entire scrotum sack, gently fondling each of his balls as you go.

Finally, drip a bit of oil over his cock tip, then use an open palm to very gently rub just his glans, the top cap of his cock.

Add some more oil on his cock tip, and sensually spread the oil down his entire cock shaft.

 Ooh, all slippery, all of a sudden. Grasp his cock below the head and slide your hand back down again, and massage his balls some more, It’s amazing if the sack is trimmed or shaven.

Put your thumb and forefinger in an ‘okay’ circle position around the base of his cock, above the balls, and squeeze. Draw your hand up a little and see that cock head bulge; every nerve ending standing at attention. You can hold the tight grasp about 15 seconds, then release him now, because it’s time for the cock ring.

I prefer and recommend the simple stretchy rubber O ring that leaves his balls free. Have him take a deep breathe in, then have him completely relax his body as he exhales. While he exhales, roll the cock ring on down his oily shaft, right to the base. Now maybe give him a minute to cool down first if you have to. While your ass is in his face, rub your labia and anus slowly, some more, then crawl back down between his thighs and look at his eyes.

 This is the slow, grueling handjob. It’s going to be very tasty indeed. I have a big smile on my face, perched inside his spread knees, looking into his eyes and licking my teeth.

What a view he has: my face, my hair, tits, neck, bare shoulders, and his big, helpless cock wrapped in my slick fingers. A nice little exclamation point.

With the cock ring on properly, his cock is; hard. Don’t forget it. The cock ring is a must-have for 90% of the time. The cock ring’s doing some work for you in keeping his penis bigger, harder, more sensitive and for longer. It also prolongs cumming, which is nice. Would you like to prolong cumming?

Anyway, back to the matter at hand. I’d say for now stay at his knees. Have one hand by his stomach and the other around his dick. Tickle, rub, caress and massage the head. Your fingertips have a little texture and it’s good for this.

Make a fist above the head and slide the cock through your liberally lubricated hand, and then the next above it. Keep one hand working his balls while the other is up and down the shaft, getting just high enough to touch the head.

But this isn’t really a handjob guide; it’s up to you to know how to get him real worked up in your hands, but just shy of cumming. Pay very close attention to his facial expressions. You should have learned these clues from all the previous sex you’ve had with your lover.

And I mean real just shy of cumming. Don’t take any chances if he’s looking ready bust a nut 'cause game’s over if he does, unless you’re both into a little Post orgasmic torture.

After the third or fourth almost-orgasm, just stop. Release his cock (I didn’t say take the ring off) and take a break.

Lie down next to him, ask him how he’s doing. He’s probably a mess already.

If he’s been talking a lot and annoying you, feel free to gag him. Ball gags are best. You can also shut him up with some tongue and a little gravity-biased spit swapping. Reach down and stroke his cock. I say gag him. If he doesn’t he’s never getting out. Hehe, look at those eyes. You need him to be able to breathe freely, because it’s one of the clues of his impending ejaculation.

Get back on top of him, looking away. Sit on his chest; or his neck. Don’t worry, he can breathe. Get out your oil. He’s likely to groan at the click of the bottle closing. That’s right, slow grueling handjob part two. Drip some lube on his cock and get busy again. It should take less than five minutes to get him to orgasm, so go for four and a half. Give it a couple minutes cool down period each time.

Take off his gag for a minute. Don’t worry, you’ll get it back on. Lie flat on top of his body, with your cunt barely rubbing the side of his cock shaft. Kiss him on the lips, and tell him you’re going to suck his cock a little; maybe a lot?  See the slightly pained expression.

Tell him you’re going to eat him alive. I like to tell him; “Kiss me if you want to cum, suck my lips off.”

Save your saliva, put the gag back and reverse yourself. Apply some fresh oil and get into the 69 position. Depending on how tall you both are your thighs may be right past his face, but likely not (unless on purpose). Licky licky, sucky sucky.

Ooh, the blowjob, about the most vindictive instrument of torture at your disposal; pleasure-torture, of course, but torturous none the less.

Have your hands intertwined around his balls and the base of his cock, and point the thing at your lips. Tell him it’s just inches away. He can feel your hands, your breath and your tits on his stomach, but is looking at your spread ass. Told you a blindfold wasn’t necessary. That said, presentation isn’t as important now, either.

Press his cock against his stomach and give his balls a lick. In fact, give his balls the whole hog all over again. Lap away like a dog on peanut butter.

Tongue, tongue, tongue. Not the best from this angle though, so back to the shaft. Do a sloppy harmonica slide kiss up its length and back down the other side. Do it again; then let the tip of your tongue wander along the base of the head, all around; you’ll probably have been introduced to precum by now. Precum is the bomb. In fact, precum is a reward, and you want more of it. And god knows his dick wants more of your saliva.

Yes, saliva, the wonderful renewable fluid of many useful and interesting applications. Put it on his dick. Lots of it. Big, long, flat licks are good for applying the stuff. So is outright drooling. It’s also recyclable; anyway, coat it.

Purse your lips in the Marilyn Monroe “prune” shape and plant them on the head. Lower your own head, slowly, keeping them pressed, sliding your lips over the head so he breaks firmly through your kiss. I like to call this move “crowning” the dick.

Mmm, cocksucking. In this context of extremely erotic tease and denial, this is where the head of his cock gets a good workout. Get both hands around the shaft and your mouth on the head for the full engulfing effect, or take him to your tonsils while he’s gasping. He should be gasping.

He’s definitely feeling the restraints, for he really wants his hands on your ass. Or your head, or something, anything. Helpless as a little duckling.

So employ to whatever effect you choose. Your lips, tongue, teeth, the cavity at the back of your mouth…the roof of your mouth, cheeks, did I say lips? Teeth are special. The mouth’s real power, there to tease and delight, nibble and horrify, perhaps making a gentle introduction as his cock glides past your cool, wet lips for the umpteenth time.

His cock, still, sealed inside the tight, wet and very hot prison of your mouth, with your tongue the interrogator and no escape in sight. I’m sure it’s ecstasy, and ecstasy should last. For a real treat, squirt some (edible) oil in your mouth, let it sit for a moment, and suck him in. Loudly. Unseal your lips to allow some of the goo to dribble out. They call cum-swapping snowballing because of the accumulation; keep slurping. No need for lip gloss with this kind of action.

Instead of popping him out of your mouth when he’s about to cum again, if you think he can handle it just keep him there, suspended in your mouth (oxygen free). In the 69 position your mouth and throat are positioned excellently for sucking cock. Deepthroat him if you can. You want him to really feel and experience the depth and unrelenting cock-ministering power of your body.

Give him a real tour of the orgasm factory, so to speak. With the cock ring, one merely needs a hand and the lightest touch at the base of his cock in order to point it about.

You are his queen tonight, so continue to make the most of it. Give him the most lascivious tongue lashing of his life. Snake it up, down and around the shaft, his belly button, his thighs (no substitute for tits though), and all over the head.

Pointed tongue, flat tongue, slurpy dripping loving tongue; he can feel your every taste bud. Stop intermittently of course. One thing you’ll have to get used to is the sound of breathless disappointment.

I’ve described so far you being flat on his stomach, like a half of 69. If you are, after a good bit of luxury cocksucking, flip around, get your ass in the air, and; continue it. If you thought there was some spit content before, well. Give him a real working over all over again.

Noticed you haven’t used any artificial lubricant in a while? Yeah. Look into his eyes, stick your tongue out all the way, and give him a big snail trail from under his balls to the tip of his cock. You probably know how to swish your tongue around with your mouth closed to stimulate more production.

Have him watch you do this. Then, leave his cock flat on his stomach, lean over and, slowly, let a big fat string drip down past your lips and all over his cock and balls. Drool it. You’ll probably have to break it off at your chin, afterwards. Rub it in (to his dick, I mean), run your tongue up to the head again, hold it vertical, and do your best to make him squeal.

“What, you don’t want your dick sucked?”

You should be at least an hour in. That cock’s been wet for a while. It’s had quite a bit of tongue. If you’re good at blowjobs, he’ll have done some work. And having been licked all over, he ain’t nothing but cock now.

Reapply some oil and remind him. He’s probably moaning, panting, and unsure. Give his balls a scratch. The gag in his mouth will have been suppressing his complaints nicely, to say nothing of the feeling of helplessness it contributes. If this is his first time he’ll have never wanted to cum so badly in his life.

Slow, drawn out, deliberate and agonizing tease and denial is a kind of extreme erotic frustration that in the process of inducing is, well, quite delicious.

You can give your mouth a break now. Sit back at his knees, facing him, and produce your feather, fur, or strip of silk. Wiggle the point of the feather under and around his balls, maliciously target the head, and run it up to his neck. Aw, it’s just a little feather. Drape your piece of fabric on his dick and trace it over and around, or hold it at length and have it dance around his balls.

Set them aside. Did you bring some condoms? I hope so. Oil him up again and slip one on. Dribble a little oil on top, and put another one on! And one or two more, depending on their thickness (you probably don’t need to lube up the last one). Hoo boy. You’re going to fuck him like this. He’ll feel the heat but not your pussy.

So with a glint in your eye, release his leg restraints and have him slide his thighs together, then climb on cowgirl facing him.. Take him right to the hilt; I don’t want to know the noises he’s making. Grind away your clot on his pelvis, but keep the vertical strokes to a minimum. Is it unbearable? Of course not. So let’s turn the torture up to 11.

After you’ve had enough of this, take the condoms off, all at once, release his cock, and have your pussy sit at the base of his shaft. Tell him you want to polish his lovely shaft, and ‘this is gonna suck.’ Put your hands down on the bed beside him, and slide your pussy up the length of the shaft, till your clit is just past the head. Slide back down. Groaning, muffled moaning and heavy breathing are all to be expected. He’s not penetrating your cunt, but your labia & clit are enjoying his shaft.

Be agonizing. Wet pussy sliding on a cock in this state is a deadly, twisted move. You can be a little bit sadistic. Make his cock shine. I needn’t point out it’s the more sensitive underside of his cock you’re working with. So go extra slowly and ignore the whimpering. After a few minutes of this, get off, stand his cock up and plunge the whole thing deep into your pussy. Not too fast though. If you think he can keep still and you aren’t reverse cowgirl, lean forward and kiss his neck. Lick some of the sweat off your victim’s face. Then lean back, keeping his dick confined the whole time. Then crawl up and bury his face in your ass, and purr while he struggles, his cock twitching, getting nothing but air.

“What now? You want some cum soon?”

 That can be obliged, if he isn’t ready for another slow, grueling handjob or getting sucked again. But he probably is; and how he gets off is, of course, up to you. Should he orgasm deep in your pussy? I say no. Having him cum all over somewhere visible is more rewarding. You could take the gag off now too, but he might bite you. Get your tongue at the ready, and prepare for an extra large spoonful of hot, sticky cum.

You know how to get him there; when he’s finally ready. I recommend the sloppy cum in mouth finish. Work him. This should be at least the 15th time he approaches a volcanic cum pop.

So either get a hand on there and tongue him to the first squirt, or jerk him with Oily Hand. A hand around his balls either way. Right when he starts ejaculating, pop that bulging cock head in your mouth and get on the receiving end. Smile while it oozes past your lips and down to his balls, like so much spit before it. Cum play is where it’s at. I’d say make sure to get all the cum out, for a giggle during cleanup.

By alf_2712

• Art and texts from ancient Greece and Rome show physical pain being used as an erotic stimulus, per the book An Illustrated History of the Rod, by William M. Cooper, first published in 1868.
• The Kama Sutra, the revered Sanskrit text on sexuality written in India about 2,000 years ago, describes six appropriate places to strike a person with passion and four ways to do it. It also has chapters titled “Scratching,” “Biting,” and “Reversing Roles.”
• The Marquis de Sade, a French aristocrat who lived from 1740 to 1814, wrote a variety of erotic novels and short stories involving being beaten and beating others. Eventually the author’s name gave rise to the term “sadism.”
• Similarly, the term “masochism” is derived from the name of Austrian nobleman and author Leopold von Sacher-Masoch, whose 1870 novel Venus in Furs describes a dominant-submissive relationship.
• Back in 1953, a Kinsey Institute study found that 55 percent of women and 50 percent of men were aroused by being bitten.
• And even pre-Fifty Shades of Grey, 36 percent of U.S. adults reported having had sex using masks, blindfolds, or other forms of bondage.

• Kidnapper and victim
• Law enforcement and prisoner
• Owner and pet
• Royal and commoner

• Bondage (restraint or restriction)
• Wax (dripping hot wax on the skin)
• Impact (spanking, slapping, caning, flogging)
• Sensation (using tools such as feathers, a paddle, burlap, on the skin)
• Sensory deprivation (blindfolds, earmuffs, ear plugs)

• Red
• Pineapple
• Banana
• Peach

• Bondage and discipline
• Dominance and submission
• Male dominance
• Male submission
• Female dominance
• Female submission
• Sadism and masochism

Curious about BDSM? Here’s the lowdown on the vocabulary you’ll need to ask questions and learn about it.

By Julie Lynn Marks

BDSM enthusiasts have created an entire vocabulary around their lifestyle.

If you’re interested in exploring BDSM (bondage/discipline, domination/submission, sadism/masochism), you’ll need to understand BDSM terms. The glossary below will make it easier for you to parse the technical terminology as well as the not-so-scientific vernacular — aka, slang — you’ll need to speak BDSM.

Aftercare

When a scene is over, aftercare is the emotional and physical care that’s administered, usually by a top. Proper aftercare may be used to prevent a drop.

Age Play

When participants take on an older or younger role.

BDSM

An umbrella term used to describe a sexual practice that involves the use of physical control, psychological power, or pain. It typically includes the components of bondage and discipline, domination and submission, or sadism or masochism.

Bondage and Discipline

A type of BDSM practice that incorporates bondage (tying, binding, or restraining someone) and discipline (punishing a submissive partner when they break a rule).

Bottom

The person in a scene who follows the orders and receives the sensations.

Breath Play

A form of play when one participant controls their breath. This may include choking or holding the breath.

Consent

Agreeing to certain acts in a BDSM scene or relationship. Practitioners believe that consent is what separates BDSM from assault.

Contract

An arrangement that outlines the rules and structures of a BDSM relationship. It may be written or oral.

Dom

A dominant role, often referring to a male.

Domina

A dominant who is female and embraces a feminine gender role — sometimes called a Domme or Dominatrix.

Dominance and Submission (D/S)

A term for the behaviors or rituals that a submissive person follows in a BDSM relationship. In D/S, one person usually has power over another.

Dominant

A person who has the authority in a BDSM relationship or scene.

Drop

The physical or emotional exhaustion that takes place after a scene. Both tops and bottoms may experience a drop. Crying, feeling sad, and physical shaking are all signs of a drop.

Dungeon

A location where BDSM play takes place (usually in a person’s home or at a club).

Dungeon Monitor

A person (or group of people) who supervises BDSM activities at a club or play party to make sure the acts are safe and consensual.

Edge Play

BDSM acts that are considered more intense or dangerous, such as breath play.

Female Dominance

When a woman takes the dominant role in a BDSM relationship or scene.

Female Submission

BDSM activity in which a woman submits to a sexual partner.

Fetish

An obsession with a specific experience, body part, or object.

Fetish Wear

The clothing worn by those who practice BDSM (usually leather attire or other role-playing costumes).

Gender Play

A type of BDSM play when an individual in a scene takes on the role of the opposite gender.

Hard Limits

An activity that a person in a BDSM relationship absolutely won’t do. A hard limit can’t be negotiated.

Impact Play

A type of BDSM play that involves striking the body. This can be done with a hand, paddle, cane, whip, flogger, or other instrument.

Kink

Nonconventional sexual practices. BDSM is often referred to as kink.

Master

The person who has control over a slave in a consensual master-slave relationship.

Male Dominance

BDSM acts when the dominant partner is a man, also called maledom.

Male Submission

BDSM activities when the submissive participant is a man, also referred to as malesub.

Masochist

An individual who likes or becomes sexually gratified by their own pain or humiliation.

Munch

An informal meeting or party, often at a public place, where people interested in BDSM can mingle.

Play

A term used to describe the BDSM acts themselves.

Play Party

A social gathering where guests can engage in BDSM activity.

Pro Domme

A woman who is a professional top and dominant.

Protocol

A rule or rules that people practicing BDSM agree to follow.

Role Play

When one or more people take on a different identity during a scene. Examples may include teacher-student, doctor-patient, or boss-employee role plays.

Sadism and Masochism

This subset of BDSM involves inflicting pain or humiliation for the purpose of pleasure or sexual gratification.

Sadist

A person who enjoys or becomes sexually aroused by inflicting pain or humiliation on someone else.

Safe, Sane, and Consensual (SSC)

This phrase describes what the BDSM community considers ethical behavior. Kink enthusiasts stress that activities must always be safe, sane, and consensual.

Safe Word

An agreed upon word or phrase that a bottom, sub, or slave can say during a scene to stop the activity or session immediately. Some common safe words are “red,” “red light,” “pineapple,” and “banana.”

Soft Limits

A limit that’s more flexible than a hard limit. It might be an act that a person is hesitant to perform but may be willing to try.

Scene

The actual BDSM activities or encounters that take place.

Slave

A person who gives up total control of one or more parts of their life to a master.

Submissive

Someone who submits to a dominant person in a BDSM relationship or scene. Submissive can be shortened to sub.

Switch

A person who sometimes plays a top and sometimes plays a bottom in a BDSM scene.

Top

The person who performs the BDSM acts in a scene.

Topping From the Bottom

When a bottom tries to control a scene even though it was agreed that the top would be in charge.

24-7s

When individuals in a relationship engage in some form of BDSM at all times (24 hours a day, 7 days a week).

Vanilla Sex

 Used by people in the BDSM community to label sexual behavior that doesn’t involve kink.
 

This post is part of the How To Sex podcast. Subscribe in your favorite apps.

Chronic medical conditions become more common as a person ages. Many of these can interfere with an older person's sex life.

Arthritis and Chronic Pain

Arthritis and other chronic pain conditions are common among older adults and can make sex very difficult. Depending on the cause, doctors may recommend physical therapy to strengthen muscles and improve flexibility.

Nonsteroidal anti-inflammatory drugs (NSAIDs), both over-the-counter and prescription, can be taken before sex to help ease the pain. Opioid drugs, while effective as a pain reliever, can cause a drop in testosterone and contribute to ED.

If the pain only occurs in certain sexual positions, let your partner know and try different positions. Bolstering your bodies with pillows and cushions can also help.

Best Positions for Sex With Back Pain

Diabetes

In the United States, almost one-third of adults over 65 have diabetes. Approximately half of these are undiagnosed.

Diabetes can cause sexual dysfunction in both men and women. This can be due to circulation problems, medication side effects, or nerve damage. Problems include: 

• Low libido
• Difficulty with arousal
• Erectile dysfunction
• Painful intercourse
• Reduced genital sensation
• Urinary tract infections
• Yeast infections

The best way to reduce the impact of diabetes is to gain control of your blood sugar. Speak with your doctor if you have difficulty managing your blood sugar, and be sure to mention any sexual health problems you may be having. It's important for your doctor to know.

Heart Disease

Older age is the greatest risk factor for heart disease. Heart disease causes problems as arteries start to narrow and harden (referred to as atherosclerosis). This reduces blood flow throughout the body, including the pelvis and genitals, resulting in sexual dysfunction in both men and women.

Heart disease is one of the leading causes of erectile dysfunction in men. It can also cause women to have difficulty achieving orgasm due to the decreased blood flow to the genitals.

There is no one way to resolve these issues, but there is evidence that statin drugs used to reduce the risk of heart disease can improve erectile dysfunction in some men.19 Some studies suggest that similar approaches may improve sexual function in women with heart disease.

People with heart disease may also be nervous about sex due to fear of a heart attack. While sexual activity is generally safe, talk to your health provider if you are concerned.

Navigating Sex After a Heart Attack

Obesity

Today, more than 40% of adults over 65 meet the definition of obesity. Research shows that women who are obese are more likely to experience sexual dysfunction than non-obese women. In addition, obesity increases the odds of erectile dysfunction in men.

These issues may be directly related to higher rates of diabetes among people who are obese as well as reduced blood circulation due to atherosclerosis.

Weight loss, achieved with a healthy diet and routine exercise, is considered the best strategy to overcome obesity. It may also improve a person's self-image and sense of well-being while making sex easier to navigate.

Urinary Incontinence

Urinary incontinence is the loss of bladder control. This becomes more common with age, especially in women.

Incontinence can be embarrassing and make sex awkward. Women who experience stress incontinence may be afraid to orgasm. Extra pressure on the abdomen during intercourse can also cause urinary leakage.

If you have incontinence, empty your bladder before sex. Changing sexual positions can help prevent urinary leakage by avoiding the compression of the bladder. Pelvic floor exercises can also help strengthen the muscles that aid with urine control.

Medications

Some medications used in older adults can cause sexual dysfunction in both men and women. These include:

•  Antidepressants
• Antihistamines
• Chemotherapy
• Diuretics ("water pills")
• High blood pressure medicines
• Opioid painkillers

If you are having sexual difficulties, let your doctor know and advise them of any drugs you are taking, including over-the-counter, prescription, or recreational.

Lifestyle and Mental Health

Lifestyle and mental health issues can also contribute to sexual problems in older adults. These issues can be just as difficult—and sometimes even more difficult—to overcome than physical ones. If you are faced with any of these issues, there are things you can do to turn them around.

Alcohol

For some people, drinking a glass of wine helps them relax and get in the mood. However, too much alcohol can end up impairing sexual function. According to the National Institute on Drug Abuse, alcohol is the most-used drug among older adults, with 65% of people 65 and older reporting high-risk drinking.

Alcohol can impair a man's ability to get an erection, cause premature ejaculation, or delay orgasm. In women, too much alcohol can make it difficult to climax.

Reducing the amount you drink can help, but if you are unable to control your alcohol use, speak to your doctor about treatment options.

Depression

In the United States, between 5% and 10% of adults over 65 are estimated to be depressed. This can lead to many health concerns, including sexual dysfunction.

In people with depression, neurotransmitters—chemical messengers that send signals between the brain and body—are out of balance. This can affect sexual desire, arousal, and orgasm. Ironically, medications used to treat depression can have the same effects.

While the benefits of antidepressants often outweigh the risks, therapy and counseling may offer a reasonable option for those with mild depression.

Stress

Stress can be a contributing factor to sexual dysfunction. Financial worries and health concerns are just some of the common stresses affecting older adults.

To relieve stress (and the effect it has on your sex life), consider stress management techniques like mindful breathing, tai chi, yoga, and meditation. Research shows practicing mindfulness and meditation can ease the effects of stress and improve overall feelings of well-being. This alone may help improve sex.

In addition, seek professional assistance from financial advisors, health advocates, and social workers to help better deal with the other stresses in your life.

Relationship Issues

Lack of sexual intimacy is often related to relationship problems. If you are and your partner are not connecting emotionally, it can lessen your desire to be intimate.

On the flip side, studies show that older couples who engage in sexual intercourse with their partner are likely to share a closer relationship. Moreover, closeness to one’s partner has been shown to increase overall well-being.

While this issue is not unique to older couples, many people find talking to a marriage counselor can help them work through relationship issues and rekindle sexual feelings and attraction.

Self-Image

With age can come weight gain and other body changes that may affect one's sense of physical attractiveness. Self-consciousness can spill over into the bedroom and affect a person's confidence during sex.

A 2019 study among older women found that those who were self-conscious about their bodies reported less sexual satisfaction. By contrast, those who had greater self-acceptance of their bodies irrespective of weight or aging-related changes had a more satisfying sex life.

Self-acceptance is ultimately the key. Working with a therapist, either alone or as a couple, can help you discuss your feelings openly and find a way to embrace a more positive self-image.

The benefits of maintaining your sex life as you age are physical and emotional. Being sexually active is associated with a lower risk of medical conditions and a longer life. It's also associated with a greater sense of happiness and overall well-being.

If your sex life has become stagnant and you'd like to rev it back up, here are a few things you can do.

Communicate

Good sex begins with good communication. Couples who have been together a long time often think they know what the other is thinking. But no one is a mind reader.

Talk to your partner about any concerns you have. You may feel as though your mate is no longer attracted to you because sex has become infrequent, when in fact they are experiencing a decline in sexual interest.

In addition, as sex organs change with age, what felt good before may no longer feel good or may even be painful. Be open with your partner about these changes.

Communicating about sex can be challenging at any age, however. If you and your partner struggle to talk about sex, consider seeing a sex therapist.

Redefine Sex

Sex, as you get older, may need to change. But different can still be good, if not better. With an empty nest and possibly retirement, there’s more time and privacy to explore.

Research shows older adults have a broader definition of sexual activity than younger adults. In other words, they better understand that there is more to sex than just intercourse. Foreplay on its own can be quite satisfying.

Be creative and willing to try new things.

Rethink Intimacy

Sex isn't just physical. It’s an emotional expression of intimacy. As you grow older, sexual intimacy changes. What this means to you and your partner may need to be redefined.

Emotional intimacy can be expressed through non-sexual physical touch. Examples of non-sexual physical touch include: 

• Back rubs
• Cuddling
• Holding hands
• Hugging
• Placing your hand on your partner's shoulder or arm
• Playful nudges
• Sitting next to each other
• Touching feet under the table

Another non-sexual way to build emotional intimacy is spending quality time together. Things you can do:

• Go out on dates with other couples.
• Look through old photos and reminisce.
• Play cards, board games, or word games.
• Read aloud to each other.
• Play music together.
• Travel, explore new places.
• Visit with friends or family.

Just Do It

Instead of waiting for the desire to strike, experts recommend that older adults just go for it. This is because sex has physical and emotional benefits. Orgasms release oxytocin, a hormone that induces a state of calm and improves sleep.

Even if you’re not in the mood, having sex can set the stage for more sex in the future. This is especially true for women. Having sex regularly helps increase natural lubrication and vaginal elasticity. It may also improve erections in men.

Summary

Older age can lead to sexual problems in different ways. Age alone increases the risk of erectile dysfunction, delayed ejaculation, low libido, vaginal dryness, and pelvic organ prolapse. Medical conditions like arthritis, diabetes, heart disease, obesity, and incontinence can also directly or indirectly interfere with sex.

Lifestyle and emotional issues that can impair sexual function in all ages can become even more profound in adults 65 years and older. These include stress, depression, negative self-image, relationship problems, and alcohol abuse.

By working with a doctor or therapist, you can overcome many of these concerns and improve not only your quality of life but your sex life as well. Keeping open lines of communication and embracing change as a natural part of life can also help keep your sex life fresh as you approach your later years.

By Mark Stibich, PhD for Very Well Health 

This post is part of the How To Sex podcast. Subscribe in your favorite apps.