Sex Advice: "I haven't had sex in two years. I'm meeting a girl and I'm torn between natural sex and continuing with Viagra."

Here's a new installment of the sex advice column, one of the 20minutos services available to help readers. These are this week's answers from our expert, Santiago Frago, director of the AMALTEA Institute of Sexology in Zaragoza .

Menopause and (little) sex

QUESTION: My girlfriend hasn't felt like having sex for a few months now. She says it's because of menopause. Is there a solution? Augusto. Does menopause lower libido? Merche

EXPERT ANSWER Hello Augusto and Merche. Since your question relates to the same topic, I'll answer both of you. There are no homogeneous menopause processes; that is, in some women, the hormonal decline in estrogen, typical of menopause, has little impact on their erotic and intimate life; and for other women, whose sexuality is closely linked to the hormonal system, it can cause a marked decline in the erotic sphere. When you mention that your girlfriend has gradually lost sexual interest, and she attributes it to her menopause, you're probably right. If her body has stopped "emitting signals" of desire, it would be advisable to perform a hormonal study to verify the degree of hormonal decline that has occurred.

If the hormonal pattern is compatible with normal development, a sexual history would be advisable to analyze your past and present erotic life, assess individual eroticism, lifestyle, presence or absence of discomfort during sexual intercourse, current illnesses, medication use or not, and a detailed analysis of your relationship as a couple in the relational sphere.

All of these elements will allow you to assess your situation and initiate sexual therapy with a sexologist. The goal will be to remove obstacles to your desire and activate it with personalized therapeutic strategies.

And if your hormonal pattern has suffered a sudden decline and is affecting not only your desire but also other areas of your health—insomnia, hot flashes, low vitality—then it would be advisable for your regular gynecologist to suggest a temporary pharmacological approach.

Not even the slightest erection

QUESTION: Is it normal for a man to not have the slightest erection after kissing and caressing a girl, and then performing oral sex on her? I'd like to know if there's any explanation. This is the first time it's happened to me, twice with the same guy, and I feel like it might be my fault, because I'm not doing enough to excite him. But with other guys, always after kissing and some contact, I find that they already have an erection, allowing me to go further. Almudena

EXPERT ANSWER Hello Almudena. There are three male sexual difficulties that a woman, in a heterosexual, intimate relationship, experiences with concern: 1st: her partner's lack of desire; 2nd: her partner's lack of erection for unjustified reasons; 3rd: her partner's inability to ejaculate. These realities often cause her to question her role as a lover or to interpret that her partner doesn't like her.

You also mention that when your partner performs oral sex on you, he doesn't respond with an erection. This usually occurs when a man stops feeling and focuses on thinking, trying to make you enjoy himself. In the erotic realm, you have to be "selfish," and that means you have to focus not on making your partner feel, but on feeling WITH your partner.

I don't know your lifestyle, age, health status, or length of relationship. These are important details to give you a sufficiently clear answer. All erectile dysfunction has a psychogenic component, regardless of whether there is a possible organic cause. If your partner has erections when he masturbates and has erections upon waking, it could almost be deduced that there is no organic cause or side effect of any medication to explain his erection difficulties.

It's likely that, after initial, difficult erotic encounters, two conflicting elements have been set in motion: desire and the fear of a repeat of the difficulty. In this duel, fear always wins, a fear that translates into anxiety and triggers a logical response of vascular emptying, which translates into a loss of erection. In your case, simple sexological counseling combined with initial pharmacological support will allow him to gain confidence and gradually wean himself off the medication, while simultaneously restoring tranquility and trust to the intimate level of your relationship.

Since I was 19, I've been on pills.

QUESTION My question is about using Viagra and Cialis every time I have sex. I'm currently 35 years old and started using them when I was 19. During this period, I only stopped using them during six sexual encounters with different women: in four of them, the erections were weak, very difficult to achieve and maintain; in the remaining two, they were nonexistent.

An organic cause has been ruled out because I still have erections upon waking and when I masturbate. I also went to psychotherapy, but the erection problems continued without medication. I haven't had sex for two years now, and in the last month I've met a girl I like, and I'm torn between trying to have natural sex or continuing to take pills as I have in the past. A.

EXPERT RESPONSE Hello A. I'd like to add the following to the previous questioner's response: once an organic cause of your erectile difficulty has been ruled out, in your case, the psychosexual cause is very clear. Since you've entered into a relationship where sexual insecurity is evident, my suggestion is the following: at the beginning of a relationship where the relationship's complicity is not yet consolidated, provide temporary pharmacological support with Tadalafil 20 mg to ensure your erection and gradually begin a de-escalation at doses of 15, 10, and 5 mg. This will give you time to build trust and for the relationship to stabilize (calm down). Relational tranquility will lower your anxiety levels, restore your erection, and allow you to gradually stop taking the medication.

I enjoy it but I don't get there

QUESTION : I'm a woman. I've been in a stable relationship for years, where I enjoy sex like never before and more and more, but I can't reach orgasm. I've been to a sexologist and have also undergone tests to see if I have a physical or psychological problem, but I haven't found a solution. What could be the cause? B.

EXPERT RESPONSE Hello B. We define “anorgasmia” as the inability to reach orgasm after “appropriate” erotic play and in a “reasonable” relational context (Amaltea Institute). Orgasm is a subjective experience of pleasure with an objective physical expression.

Pleasure and orgasm are not synonymous; metaphorically, I would say that pleasure is a good movie and orgasm is an interesting scene in it. With these considerations in mind, I'll tell you: "I interpret your question as meaning that you do reach orgasm in an individual context (masturbation). It's relatively easy to reach orgasm through masturbation (individual eroticism), although this ease isn't always present in a relationship context. Orgasm is very shy, and sometimes revealing itself to others requires certain conditions: bonds of trust, love, complicity, sexual communication... and everything so that you can "let yourself go" and feel it. Another element to consider is how you reach orgasm in your individual eroticism.

Regarding your difficulty reaching orgasm with your partner, you may have entered a vicious cycle. One day, you didn't reach orgasm, he was surprised, and you didn't give it much thought. The second time, the situation repeated itself, he became concerned, and you were surprised. From that day on, your subsequent erotic relationships had a warning: "How will things go this time?" I recommend professional sexological counseling to clarify the specific cause of your difficulty in your relationship and thus design a therapeutic strategy that allows your orgasm to express itself.

Transplants and sex

QUESTION: Eight months ago, I received my third kidney transplant. With the previous transplants, I had little desire for sex, but with this latest one, I have none. I'm married, and although my husband understands and respects my situation, I know he needs it, and I just "put him off." We don't want to go to couples therapy because "we're so self-centered" and we're embarrassed. What can we do to improve our relationships?

EXPERT ANSWER Hello Maria José. A high percentage of transplant recipients experience sexual difficulties during the underlying illness and after the transplant. Being a transplant candidate means you have a serious underlying illness that will have led to clinical symptoms, hormonal disturbances, and medication use: antihypertensives, alpha- and beta-blockers, analgesics, anxiolytics, antidepressants, hormonal agents, and immunosuppressants.

The erotic and romantic experience in transplant recipients is more difficult, and "blocks" can occur during erotic encounters. The combination of kidney disease and medication use causes a lack of genital vascularization and, consequently, erotic dysfunction. After surgery, your previous erotic history, general health, age, lifestyle, and the side effects of the medications you are taking will need to be assessed.

Once you've completed your sexual history, I suggest you keep these guidelines in mind:  Give yourself permission not to have desire.  Create a friendly atmosphere as a couple and find time and space.  Look at each other, kiss, and caress each other every day, without letting the kisses confuse you.  Listen to music associated with good memories.  Have a sincere conversation about your new sexual reality.  Engage your senses: dancing, going to the movies, traveling, playing sports, etc.  Plan intimate play for times when you're not tired.  Expand your erotic range, if necessary.  Read erotic literature.  Do pelvic floor exercises. And don't rule out consulting a sexologist to suggest a sexological strategy to energize your intimate life and taking a natural product to help awaken your sexual desire.

Don't forget to ask your questions about sexology. Our expert will help you.