Sex Therapist Dr. Zuckerman Answers Your Questions

Sexual dysfunction can be incredibly embarrassing for some. Dr. Zuckerman is here to provide some answers.

Many of us will suffer from sexual dysfunction, but not everyone will have the courage to actually seek help. According to data released by the European Association of Urology in 2013, only 25% of men sought treatment for their erectile dysfunction—and it is believed that these figures are similar for other sexual dysfunctions. For those who may be suffering but are too shy to seek help, we have sex therapist Dr. Zuckerman from the Between Us Clinic to answer readers’ questions.

Coitus Interruptus
I am a college student, 19 years old. Due to a medical problem, I cannot take the pill and my boyfriend cannot use condoms. As a contraceptive method we use coitus interruptus. I have noticed that during foreplay there are a few drops coming out of my boyfriend’s penis. Are those drops secreted during penetration before the actual ejaculation, and can they cause unintended pregnancy?

Dr. Zvi Zuckerman: During sexual stimulation, about 50% of men will have a few drops of transparent fluid at the tip of the penis, and when this is secreted in a large quantity, it might even be troublesome. This secretion originates in the Cowper’s glands, and basically it is meant to neutralize the acidity in the urethra so that the semen can flow easily and safely during orgasm.

There has been some information in scientific literature, though it is not conclusive, regarding whether some of these drops contain semen that might lead to unwanted pregnancy. When I was working in obstetrics and gynecology at the Rabin Medical Center, we have had concerns about this as well. So in order to find out once and for all what those drops contain, we conducted a study in which participants (in particular those who had complained that the secretion interferes with their lovemaking) were asked to provide samples of the fluid so that it could be examined under a microscope. Dozens of examinations revealed that the dried samples did not contain even a single sperm cell. It is clear that the pre-ejaculate fluid does not contain semen, and this completely contradicts the theory that it might cause unintended pregnancy in sexual relations.

However, when the only contraceptive method is coitus interruptus and the man withdraws from the vagina when the ejaculation spasms have already begun, a few drops of semen in the vagina are enough to cause pregnancy, even with a quick withdrawal. Every semen drop contains a large quantity of sperm. Sometimes, the man won’t even feel the first drops ejaculated. The efficiency of coitus interruptus is relatively low. Between 10% and 18% of the women who rely on this method will become pregnant within one year.

To conclude, pre-ejaculate fluid does not contain semen—so it is impossible to get pregnant from it—but you might get pregnant by practicing coitus interruptus. In your situation, I would recommend also using the rhythm method. On the days of ovulation, avoid penetration in order to prevent the mis-timing of coitus interruptus.

What Can You Do If the Penis Is Too Thick?
I am 26 years old and the perimeter of my penis, when erect, is 13 centimeters. The issue is that the head of the penis is thicker than usual, and my girlfriend, 24 years old, cannot take it. Only the tip enters the vagina, and the rest remains outside. Am I different than others? Can this issue be treated?

Dr. Zvi Zuckerman: If the glans penis perimeter is 16 cm (more or less) during erection, there may be difficulties in penetration, especially if the vagina is relatively narrow. The situation you describe requires measurement and examination of the penis, especially where it is thickest. In addition, your partner should consult a gynecologist with expertise in sexual function. You may need to use a lubricant during penetration so that the penis will succeed in penetrating the vagina with greater ease. You do not say whether your girlfriend experiences pain, but if she does not, it is likely that you reach only the opening of her vagina, without actual penetration. There is no doubt that you should each make an appointment to see a clinician.

No More Morning Erection
I am 42 and do not suffer from any special medical conditions. I have regular sexual intercourse and am generally satisfied with it. Yet lately when I wake up, I notice that I do not have a morning erection. This bothers me greatly, since I am used to having a rather strong morning erection. What should I do?

Dr. Zvi Zuckerman: The belief that one’s morning erection is “gone” is not always objectively the case. At the moment, it may not mean much, since you say that you are satisfied with your sexual performance. You may simply be experiencing a bit of a decrease in the frequency of your morning or night erections. Physiologically, four to five erections occur during REM sleep, which are quite lengthy—up to 30 minutes. It is possible to determine whether the erections and their hardness are physiologically correct by using a device that examines the erections during the night. This device (RigiScan) examines the number and quality of the erections that occur during sleep by means of sensors attached to your sexual organ before you go to bed. The sensors register the information, which can then be examined in a clinic that deals with sexual treatment or in a sleep lab.

The age of 42 is relatively young for morning erections to disappear. It might have future implications for your ability to reach a healthy erection. Stress and anxieties, which are common phenomena these days due to the financial and marital issues of many people, could lead to psychological erectile dysfunction, but there are also medications that affect erections, all of which have medical significance. These include medicine for blood pressure and other issues.

If you experience erection-related problems in the future, you should seek a thorough medical examination. You may have an illness that you are unaware of and that might cause other serious issues. If a doctor discovers any medical issues, you should take care of them as early as possible, in order to prevent future complications.

About Dr. Zuckerman
Dr. Zvi Zuckerman is a medical doctor and certified sex therapist. He is a professional consultant for the Between Us Clinic, which offers the PE Program, an online home exercise program for treating premature ejaculation.