photo via flickr

Every few weeks, Dr. Joe DeOrio, a urologist in Chicago, tackles questions about male sexuality here on EMandLO.com. To ask Dr. Joe your own question, click here.

Dear Dr. Joe,

Is it safe for me to enjoy receiving anal play if I have hemorrhoids?

– Backdoor Bob

Dear B.B.,

I guess the pertinent words here are “safe” and “enjoy.” If your definition of a safe and enjoyable sexual experience involves potential pain and bleeding, then we might be in business.

Okay, okay…maybe I’m exaggerating a bit, so let’s get into it. Surrounding the anal canal are plexuses of veins. In addition to performing the normal function of veins (returning blood to the heart), these plexuses may also contribute to fecal continence. A hemorrhoid is simply an abnormal dilation, or varicosity, of one of these veins. Since there are veins located both within the anal canal and at the level of the anus itself, one can develop both internal and external hemorrhoids.

Internal hemorrhoids are usually painless, and you might not even know that they are there. With irritation, however, they may bleed. Occasionally, they can prolapse, or stick out from the anus. Besides being a little unsightly, prolapsed hemorrhoids may become strangulated and lose their blood supply, which can be painful. External hemorrhoids, on the other hand, are often visible, appearing like a bulge at the anal verge. They are sometimes painful, they frequently itch or cause irritation, and they often bleed.

So what causes these little bundles of joy? Truth is, we don’t really know for sure. Hemorrhoids are associated with chronic constipation, occupations that involve prolonged sitting or standing, pregnancy, obesity, chronic diarrhea, and the abuse of laxatives — in essence, conditions that produce straining or increased intra-abdominal pressure or conditions that cause chronic irritation to the anal canal.

Does anal sex cause hemorrhoids? The jury is still out on that one. Undoubtedly, anal sex can increase anal pressure and cause some spasm. And it can also cause irritation, especially if you don’t use enough lubrication. Despite these facts, however, I suspect that anal sex, properly performed, will not result in hemorrhoids. In the presence of pre-existing hemorrhoids, however, anal sex can certainly irritate, inflame, or disrupt them, which can lead to pain, bleeding, and prolapse.

My recommendation? If you know you have hemorrhoids, treat them properly before attempting anal sex. Oftentimes, hemorrhoids will spontaneously resolve by increasing dietary fiber, maintaining good hydration, and moving about a bit during the workday. If that doesn’t do the trick, see a surgeon. There are a multitude of treatments that he or she can offer.

If you don’t know that you have hemorrhoids, if you are ignoring my advice and attempting anal sex anyway, or if you are just looking to prevent hemorrhoids, follow the common recommendations for healthy anal play: use plenty of lubrication, go slowly, and do not do anything painful. And don’t forget that the risk for acquiring STDs is higher with anal sex, so be safe.

– Dr. Joe

Dr. Joe earned his undergraduate degree in Molecular Biology from Princeton University. After attending the Loyola University Stritch School of Medicine, he completed his residency training in urological surgery at the Los Angeles County Medical Center. He lives and works in Chicago, IL. Keep an eye out for his upcoming blog at docjoe.net.

photo via Flickr

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions every few weeks on EMandLO.com. To ask her your own question, click here.

Dear Dr. Kate,

What does it feel like when a man’s penis hits the cervix during intercourse? I think it’s happened to me, but it doesn’t happen every time my partner and I have intercourse with deeper penetration. Can it hurt the cervix? How can this be avoided during sex while still allowing for deep penetration?

– Perplexed Cervix

Dear P.C.,

Deep penetration during intercourse can be immensely satisfying, and make you feel really connected to your partner….but sometimes has the less-satisfying effect of causing you pain. When the cervix is bumped, it can cause cramping in your uterus that ranges from mild to severe, or cause a dull aching or pressure-like feeling throughout your pelvis. Some women are more prone to cervical contact, if their uterus is tipped back towards their tailbone (or “retroverted”), bringing the cervix up and closer to the vaginal opening. The good news is that while cervical contact may hurt, it doesn’t hurt your cervix – no damage done. The best way to avoid it is to be maximally aroused before penetration – when the vagina is fully engorged, it gets longer and wider, and gives the penis more room to play, hopefully away from your cervix. Extra lubricant couldn’t hurt, as well.

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. She generously shares her medical wisdom with EM & LO readers every few weeks. Check out more of her advice and ask her a question at Gynotalk.com.

photo via Flickr

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions every few weeks on EMandLO.com. To ask her your own question, click here.

Dear Dr. Kate,

I sleep so much better after an orgasm! Sometimes when I’m having trouble sleeping I whip out my vibe and I just pass right out after I finish. Why is this and is it alright that I use orgasms as a sleep-aid?

– Bloody Mary

Dear Mary,

It’s a stereotype that only men want to pass out after coming – climax makes many people a little sleepy. Those muscle contractions aren’t just in your vagina – many women feel their orgasm through their pelvis and legs as well, and feel like they’ve had a work-out after they come. Add to the physical exertion the orgasmic mind-blowing that clears out much of the brain debris from the day…and I think you’ve found a great way to relax enough to fall asleep at night. Much better to get yourself off than to get yourself habituated to sleeping pills.

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. She generously shares her medical wisdom with EM & LO readers every few weeks. Check out more of her advice and ask her a question at Gynotalk.com.

photo via flickr

Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions on EMandLO.com. To ask her your own question, click here.

Dear Dr. Vanessa,

Is it possible to be on more than one contraceptive method at the same time? For example can I take the pill and also get an IUD? Or take the pill and get the shot or wear the patch?

– Backup Betty

Dear BB,

There’s a saying that too much of a good thing ain’t always good, and while some of us could certainly benefit by being more vigilant about using birth control, we also need to be careful not to put our health at risk when combining methods.

The main reason a woman might want to use two methods at once is to prevent pregnancy and sexually transmitted infections (STIs). The condom—male or female—is the best way to reduce your risk for an STI. Some women like to use other forms of birth control, such as spermicide, a diaphragm, an IUD, or implant along with condoms so they can have better protection against pregnancy than with a condom alone.

That said, you should never use male and female condoms together, neither should you use the female condom with the ring, because one can pull the other out of place or cause tearing. The diaphragm, cervical cap, and sponge are barrier methods that also provide some protection against STIs. But remember, these methods will only protect parts of the body that are covered—which in this case is the cervix. It all has to do with coverage, so if your bare skin comes in contact with active herpes sores or genital warts you are still at risk.

With regards to combining methods like the pill and patch or the birth control shot and the pill, each of these methods uses hormones to prevent pregnancy. You should not use multiple hormonal methods at the same time. Taking that much hormone places you at increased risk for serious blood clots—which are rare with hormonal contraceptives unless the doses are extremely high.

The IUD is a superb form of birth control, and it is highly unlikely that a provider would recommend using it in combination with any other method except a condom to prevent STIs.

Whatever your contraceptive choice, here’s to enjoying yourself, and best wishes for your good sexual health!

Vanessa
Planned Parenthood

Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America. She generously shares her medical wisdom with EM & LO readers every few weeks.

photo by greenchartreuse

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions every few weeks on EMandLO.com. To ask her your own question, click here.

Dear Dr. Kate,

Why is my period worse some months more than others?

– Bloody Mary

Dear Mary,

Blame normal fluctuations in your hormone levels. Sometimes your uterus is stimulated with more prostaglandins, the chemicals that cause cramping, so you’re hitting the Advil bottle more than usual. And if your lining is thicker one month than another, you’ll see heavier bleeding and sometimes even clots. Variations like these are normal, albeit a pain to deal with. The easiest way to get predictable periods (both in flow and comfort) each month? Most hormonal birth control methods, especially the vaginal ring and the progesterone IUD (Mirena). They’ll make your periods lighter, shorter, and less crampy.

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. She generously shares her medical wisdom with EM & LO readers every few weeks. Check out more of her advice and ask her a question at Gynotalk.com.

photo via Flickr

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions every few weeks on EMandLO.com. To ask her your own question, click here.

Dear Dr. Kate,

My boyfriend has 2 warts on his fingers. We have been trying to treat them to go away but in the meantime, is it possible to transmit these warts to my vagina? I have looked this up on various websites but can’t find a definite answer. One them has been there for almost 10 years (keeps regrowing) if that helps to clarify what type of HPV.

– Mrs. Toad

Dear Mrs. T.,

There are nearly 200 HPV virus types, and about 40 of them can infect the genitals. HPV viral strains tend to have a favorite vacation spot on your body, and don’t tend to travel outside of that area. Of course, there are exceptions; some high-risk genital wart strains can infect the mouth and throat during oral sex. But HPV 6 and 11, the two strains that together cause 90% of genital warts, don’t cause warts on other areas of the body. The reverse is also true; HPV on the fingers — most often from HPV 1 or 2 — is not likely to cause warts on his or your genitals. But to be even safer, cover up his warts with a Band-aid, finger cot or glove before he touches you.

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. She generously shares her medical wisdom with EM & LO readers every few weeks. Check out more of her advice and ask her a question at Gynotalk.com.

Every few weeks, Dr. Joe DeOrio, a urologist in Chicago, tackles questions about male sexuality here on EMandLO.com. To ask Dr. Joe your own question, click here.

Dear Dr. Joe,

What’s the deal with blue balls?

– The Indigo Boys

Dear T.I.B.,

“Blue balls” is a commonly used colloquialism describing pain or discomfort in the scrotum/testes that occurs after prolonged sexual stimulation without ejaculatory release. Despite your high school buddy’s arguments to the contrary, it is not a justification to demand sexual satisfaction. You’re not going to die, and you won’t damage anything.

Many men (and some medical professionals) consider this condition a myth, but any man that has experienced the dull ache appreciates its legitimacy. To be frank, I’m not sure what causes the pain. I’ve heard several hypotheses, most related to the epididymis, a small structure adjacent to the testes where sperm mature. The most commonly cited theories include the backup of blood in the epididymis or scrotum; swelling of the epididymis; and backup of sperm in the ejaculatory ducts, affectionately labeled “deadly sperm buildup.” Interestingly and for reasons that I cannot comprehend, the medical profession has not dedicated a great deal of effort into deciphering this medical conundrum.

Why not? Probably because it’s not dangerous, is self-limited, and has an easy fix. A fix you say? Yes. Pop one off. Huh? That’s right: ejaculate. To placate the more serious amongst you, I did do a proper medical search – even journeyed to the medical library to do so. No mention of blue balls in any of the major medical texts. An extensive literature review revealed only one mention of blue balls in the past 25 years. The October 2000 issue of Pediatrics reported a case study of a 14 year-old boy with recurring scrotal pain after messing around with his first girlfriend. The authors were happy to report that his condition promptly resolved once he started having intercourse – effective, but not my recommended remedy for a child.

Nonetheless, the treatment is valid. Ejaculation almost always “cures” the condition. This may be accomplished by any of the conventional methods. No partner? Opposed to masturbation? You could try a Valsalva manuever, which is forcefully attempting exhalation against a closed airway (imagine trying to “pop” your ears after air travel). One obscure reference from several decades ago even recommends trying to lift a car by its bumper. I guess whatever floats your boat, Superman – just don’t call me when you get a hernia.

Stay curious,

– Dr. Joe

Dr. Joe earned his undergraduate degree in Molecular Biology from Princeton University. After attending the Loyola University Stritch School of Medicine, he completed his residency training in urological surgery at the Los Angeles County Medical Center. He lives and works in Chicago, IL. Keep an eye out for his upcoming blog at docjoe.net.

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions every few weeks on EMandLO.com. To ask her your own question, click here.

Dear Dr. Kate,

Is there any way to prevent yeast infections?

– Itchy & Scratchy

Dear I.S.,

Not completely. The biggest risk factor for getting a yeast infection is having a vagina — not an easy risk factor to modify. But the more gently you treat your vulva and vagina, the less likely you are to get a yeast infection. This means three things: Limit your chemical exposure — no perfumed products like bubble baths and sprays, use simple soap in the shower, no daily pantiliners…and for god’s sake, no douching. Keep yourself dry, and let your vagina breathe — cotton underwear over nylon, no undies at night, get out of your workout clothes as soon as you’re done working out, change your tampons and pads frequently during your period. And limit your exposure to irritants — use just your fingers to clean yourself in the shower, no puffs or washcloths, and use a liquid clothes detergent over powder.

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. She generously shares her medical wisdom with EM & LO readers every few weeks. Check out more of her advice and ask her a question at Gynotalk.com.

Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions on EMandLO.com. To ask her your own question, click here.

Dear Dr. Vanessa,

Can obesity affect a woman’s ability to orgasm?

– California Queen

Dear CQ,

The science on this is less clear for women than it is for men. Obese men are more likely than other men to have erectile dysfunction, so they are definitely less likely to have orgasms than other men. This is true whether or not they are suffering from diabetes, heart disease, or other health conditions often associated with obesity and erectile dysfunction. Like other men with erectile dysfunction, obese men may use prescription medication such as Viagra in order to get and maintain an erection.

For women the evidence is less clear. Some studies have shown that obese women are just as capable of a satisfying sex life as other women. On the other hand, some studies have shown that obese women may have somewhat less capacity than other women for lubrication, orgasm, and sexual satisfaction.

Obese or not, there is another difference between women and men regarding orgasm and sexual satisfaction. Women’s attitudes about their bodies play a more important role in sexual satisfaction than men’s attitudes about their bodies. Women tend to be more concerned about their appearance than men. Women are also more likely to be self-conscious about their appearance during sexual activity than men, so they are more likely to be less sexually satisfied than men.

Women and men who are ashamed of their bodies for any reason are at risk for sexual dysfunction, including anorgasmia — lack of orgasm. Self-acceptance is the key to sexual satisfaction for both women and men. At a time in history when the media sets nearly impossible standards for attractiveness and vitality, it is very important for us to accept ourselves and each other for our own distinctive and individual beauty.

We’ll be healthier, happier, and able to take more pleasure in life when we are more self-accepting. Obese women and men can be very sexy, and they can get just as much sexual satisfaction as anyone else. Relationships help, too. Women and men in long-term relationships, obese or not, are likely to be less self-conscious about their bodies and more likely to enjoy them.

So whatever your body type, here’s to enjoying yourself, and best wishes for your good sexual health!

Vanessa
Planned Parenthood

Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America. She generously shares her medical wisdom with EM & LO readers every few weeks.

photo by applescruff

Other people’s dreams are never interesting…except when they’re about sex. Each week, our dream analyst Lauri Loewenberg tells one lucky reader what their dirty dream means. Got a dream you want Lauri to analyze? Click here to submit it) This week, a reader asks Lauri:

I have a slight crush on my boyfriend’s friend. I dreamt that I went to see him to tell him how I felt. He stopped watching the football for me, which is weird because he would never do that for anyone. Suddenly there was music and acting and laughing and he was acting out some scene where he was on top of me but holding himself up. He was about to kiss me but had tears in his eyes. He said he couldn’t because I had blood, acting out a scene of a vampire maybe?! He then said he needed to talk to me. He started off saying he didn’t want to hurt my feelings and then proceeded to say that I know what I want and I’m confident and believe I’m too good to be stuck here. He said it in a nicer way but that was the gist (I think this may be relevant to my boyfriend wanting to get a job interstate and take me with him, in which conversation with the friend, he said, jokingly, that I should stay and live with him). Continuing on with the dream, I said no I’m actually just very shy, which is true. He said I should make that clear to people. I then admitted I ‘kinda’ liked him. I wasn’t looking at his face in the dream but he just said ‘hmm’. I couldn’t tell if it was good or bad. Please help!!!!!!!!!

Lauri: Crushing on your BF’s BFF? Oh my, that’s an interesting situation you’ve got there and you can bet this dream is trying to help you with it.

All the music and laughing in the beginning of this dream reflects how you feel on the inside when you see him or think of him. He then acts out a scene and winds up on top of/over you. That’s probably connected to you “pretending” that you don’t have these feelings when you’re around him and your boyfriend. He is holding himself over you because you are holding him in a position in your mind where you look up to him. The tears in his eyes are most likely your own inner tears. Deep down you know this revelation – were it ever to be found out – would bring tears and heartache with it. That’s also why he tells you he can’t kiss you. This is a no no. It would break up a friendship and a relationship.

What he continues to tell you in the dream is super important to pay attention to because that is really coming from your wiser, intuitive self. Long story short, it seems you are telling yourself that you are better than this, crushing on your BF’s BFF and that you need to move on from it rather than allowing yourself to be stuck in that torn mindset. Listen to thy inner self and thou shalt never be steered wrong!

Got a dream you want Lauri to analyze? Click here to submit it. Anonymity guaranteed! Don’t forget: you can get access to Lauri’s Instant Dream Decoding Dictionary on her site. And check out Lauri’s new book Dream On It, available everywhere!