What to do sexual problem

Do some simple tests such as urine sugar and culture to exclude diabetes or infections.

For impotence:

• explain that this is a common problem and that it is usually short-lived;

• advise against cigarette smoking and drinking alcohol before having sex;

• discuss possible reasons why the man may be tense or worried and explain the links between these emotions and impotence;

• advise the man to avoid sexual intercourse for two weeks, but during this time to practise pleasurable physical contact and social activities that do not involve intercourse;

• counsel the partner and encourage her to be part of this therapy.

For premature ejaculation, explain that this is a common problem and is most often caused by tension. Ejaculation can be delayed by the squeeze technique or the stop–start technique. The person is asked to recognise the sensation that he is soon going to ejaculate. The moment he feels

this way, he should stop sexual movements immediately. Then, he must wait until that sensation has gone before starting sexual movements again. In the squeeze technique, just as the man begins to feel he is going to ejaculate, he squeezes his penis with his fingers .

This reduces the urge to ejaculate and helps prevent it. These techniques help the man feel more confident that he can control his ejaculation.

For women who have pain during intercourse:

• explain that this is common and most often due to tension or because she is not sexually excited;

• if she agrees, counsel the man to explain the need to stimulate the woman so that she feels sexually excited and her vagina is wet, and explain to him the need to have sex when both of them want to have sex;

• recommend the use of vaginal lubricants such as butter or oil.

A lack of sexual desire is usually a problem when one partner has less desire than the other.

Counsel both separately and together, if possible. Reassure both that this problem is often a result of marital problems rather than a physical problem with the sexual organs. Explore marital

problems between the partners. Encourage them to discuss their feelings and concerns. Identify activities that both used to enjoy doing together (for example meeting friends). Suggest that they should do such activities more often (section 10.7 gives guidance on helping with marital

problems). Suggest masturbation as a way of sexual release for the partner whose sexual desire is greater.

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