Have you little or no desire for sex either in general or with your current partner?

Yes
(Lack of sexual desire often reduces a man's ability to get or maintain an erection)
No
Q Do you fail to get an erection only occasionally?

Yes
Q Does this usually happen at the start of a relationship?

Yes
(Nervousness and anxiety at the through of intercourse with a new partner, and perhaps about your performance, may cause a temporary inability to have an erection. this is quite normal and as the relationship develops it usually becomes less of a problem.
Self-help: Discuss the problems with your partner. You may well find that she does not feel that enjoyable sex depends on your having an erection immediately and that she also forms of sexual contact other than sexual intercourse, such as oral sex and simulation by hand. As you find it easier to relax you will probably find that your ability to have erection gradually returns. Occasional inability to have an erection is quite normal. This may occur if you are not in the mood for intercourse, perhaps because you are tired or under stress for some other reason. This only becomes a problem if you are afraid that it may happen again. If your erection difficulty starts to occur more frequently, discuss the problems with your doctor. You may also find the advice on reducing sexual anxiety helpful.)

No
Q Do you sometimes wake with an erection?

Yes
Q Are you worried about having sexual intercourse?

Yes
(Anxiety is fairly common cause of erection difficulties and the fact that you sometimes wake with an erection means that there is no physical problem. Worry about premature ejaculation, making your partner pregnant, or catching a sexual anxiety. In the majority of cases it is only a temporary difficulty.
Self-help: Discuss your feelings with your partner. You may well find that your partner's reassurances are sufficient to help overcome your difficulty. Meanwhile, try other forms of sexual contact such as mutual stimulation or oral sex. An erection may follow on from this when you begin to feel less anxious. Try also the advice given in reducing sexual anxiety. If the problem persists and interferes with sexual enjoyment, consult your doctor, who may recommend sex counseling.
No
Q Are you being treated for a long-starting illness?

Yes
(Impotence may be caused by some diseases such as diabetes mellitus; it may also be side-effect of certain drug, including diuretics, antidepressants and anti-anxiety drugs. Discuss with your doctor for a proper diagnosis of your problem.)

Q Have you just started your first sexual relationship?

Yes
(Sexual inexperience is a very common cause of premature ejaculation. Nearly all men have difficulty controlling orgasm when they are beginning to have sex. This usually becomes less of problem with time and more experience.
Self-help: Try to get another erection another erection about 15-30 minutes after you have your first orgasm and have intercourse again. You will probably be able to last longer once the edge has been taken off your sexual excitement. Alternatively, you may find it helpful to masturbate shortly before you have intercourse to reduce sexual tension, which will help you to delay orgasm.
No
Q Are you just beginning a new relationship?

Yes
(Excitement and anxiety when you have intercourse with a new partner are common causes of premature ejaculation. As the relationship develops it is likely to become less of a problem.
Self-help: You and your partner should try to relax, perhaps by having one or two alcoholic drinks, before having intercourse. Using a sheath may help to dull the sensitivity of your penis and so delay ejaculation.)
No
Q Were your early sexual experiences hurried or marred by fear of discovery ?

Yes
(Hurried or furtive sexual experiences, carried out in an atmosphere of guilt or fear of being discovered by parents or passers-by, may have caused the problem.
Self-help: Discuss the difficulty with your partner so that you both can develop an understanding of the problem. You can also try the squeeze technique.
No
Q Are you worried about your ability to satisfy your partner ?

Yes
(Anxiety about sexual performance is fairly common cause of premature ejaculation.
Self-help: Discuss the problem with your partner. You may very well find that she does not feel that enjoyable sex depends on your delaying ejaculation indefinitely or having a long-lasting erection. she may enjoy other forms of stimulation such as oral sex. Once you understand what your that your partner enjoy and vice-versa, you will find it easier to have intercourse without feeling anxious and you will gradually learn to delay ejaculation as matter of course. Also read reducing sexual and try squeeze technique described right. If so that it interferes with your sexual enjoyment, you seek specialist advice.
No
Q Are you worried about your ability to satisfy your partner?

Yes
(Performance anxiety during intercourse may be making you so tense that you are unable to ejaculate. To reach orgasm, it is helpful to be relaxed and confident.
Self-help: Discuss your worries with your partner; you will probably find that you have no need to be concerned and that she is quite happy with your lovemaking technique.
No
Q Are you over 50 ?

Yes
(An occasional inability to ejaculate is a natural occurrence as you get older)
No
Q Are you taking any medicines ?

Yes
(Certain drugs, particularly antidepressants and anti-anxiety drugs, may interfere with ejaculation process.)
No
Suggestion: (Anxiety about sex and a lack of sexual confidence may cause this problem.
Self-help: Discuss the problem with your partner so that she understands that it in no way implies a rejection of her. Follow the advice on reducing sexual anxiety and try self-help the problem, or if you feel that the relationship between you and your partner is in danger, consult your doctor, who may recommend that you receive some professional counselling. You may also discuss the problem with your doctor if you are unable to make a diagnosis from this chart.)

3. Low sex drive

Male sexual arousal is governed by both psychological factors and the male sex hormone testosterone. If a man has a very low level of testosterone, he is unlikely to have a great interest in sex and may find it difficult to become sexually aroused. However, Most cases of reduced sex drive have non-hormonal causes, including physical illness, stress, sexual difficulties, boredom and discontent with a current relationship. In rare cases low sex drive may be a symptom of a deficiency of the male sex Hormone testosterone. This Type of hormone deficiency always causes additional symptoms such as loss of body hair and unusually small testes. If your lack of interest in sex is accompanied by such additional symptoms, consult your doctor. For self-diagnosis, follow this chart:

Q Have you always had little interest in sex?

Yes
(A naturally low level of interest in sex is normal part of personality of some men. This is unlikely to be cause for concern if you and your partner are happy with your present level of sexual activity. However, if your low sex drive is causing difficulties within your relationship, consult your doctor, who may recommend sex counselling.)
No
Q Have you been overtired AND/OR under stress recently?

Yes
(Fatigue and stress are very common reasons for making a man lose interest in sex.
Self-help: Discuss the problem with your partner and explain to her why you are feeling the way you do. This will help her to understand that it is not because you find her unattractive in any way. You will probably find that she agrees that there is little satisfaction for either of you from sex attempted out of duty. When you feel better, the desire for sex will almost certainly return.)
No
Q Have you been feeling in low spirits recently?

Yes
(Depression is a possible cause of interest in sex.)
No
Q Have you been drinking heavily in recent weeks?

Yes
(Regular consumption of large amount of alcohol is common cause of loss of interest in sex and in some cases, may lead to impotence. There is also the possibility of other health problems. Self-help: Cutting out alcohol altogether should help to restore your interest in sex. If you find it difficult to cut down on your alcohol intake or your enthusiasm for sex does not return, consult doctors.
No
Q Do you or your partner have a specific sexual difficulty?

Yes
(A sexual problem may unconsciously make you feel that you do not desire sex. When such an underlying problem is dealt with, sex drive usually returns to normal.
No
Q Do you only fail to get aroused by your regular partner ?

Yes
Q Do you have any other causes for discontent in your relationship?

Yes
(Generalised antagonism or specific disagreements can lead to tension in a relationship that also affects your sexual feelings for each other. there may also be some lack of communication so that you do not fully understand each other's feeling and attitudes towards sex and other matters; and this may produce conflict, and damage your sexual relationship.
Self-help: Talk to your partner and explain how the problems with explain how the problems with your relationship are affecting your feelings. If you find that things do not improve after full and frank discussion, consult your doctor, who will examine you to find out if there is an underlying physical problem. If there is no physical disorder he or she may suggest that you and your partner seek marriage guidance about your general difficulties and possibly sex counselling for specific problem you may have.
No
Q Are you taking any medicines?

Yes
(Certain drugs, particularly diuretics, antidepressants, anti-ulcer and anti-anxiety drugs, may interfere with your sex drive. The problem is usually only temporary, but discuss it with your doctor.)
No
Q Are you over 50 ?

Yes
(A need for less frequent sex is common as men grow older, although this does not mean that your enjoyment of lovemaking is necessarily reduced.

No
Q Do you fail to be aroused by women, but find you are sexually attracted to men ?

Yes
(Homosexuality - being sexually aroused only by someone of the same sex- is a normal sexual preference for as many as 5 percent of the population. While many homosexual are aware of their sexual orientation from adolescence, some do not recognise their homosexuality until much later.)
No
(Loss of interest in a sexual relationship once the excitement and novelty has worn off is a common cause of loss of sexual desire.
Self-help: It may help to talk openly with your partner about how you feel so that there is no misunderstanding of the situation. If the relationship is a long-standing one, and sound in every other way, try to inject new life into it, for example, by going away for a weekend together or co-operating in some new venture. You may find trying new approaches to lovemaking helpful.)

Treatment for hormonal deficiency: If tests confirm the diagnosis, hormone treatment will be prescribed by your doctor; this is usually successful in increasing sex drive and reversing such physical changes. Loss of sex drive that is not accompanied by the physical symptoms described here is not caused by lack of testosterone, and hormone supplements will have no beneficial effect.

REDUCING SEXUAL ANXIETY

Many sexual difficulties arise out of anxiety in one or both partners, and most forms of Sex Counselling involve advice on reducing such anxiety as a basis for improving sexual enjoyment as a basis for improving sexual enjoyment. The following technique, called sensate focus, is often successfully in heightening sexual responsiveness without provoking anxiety about performance, and may help you overcome inhibitions and tensions that can mar sexual relationship. Usually the first step is for both partners to agree to abstain from sexual intercourse for, say, 3 weeks.

Ensate focus
Set aside at least 3 evenings (or a period at another time of day) in a week when you can be alone with your partner without fear of interruption for at least 2 hours. Try to create an atmosphere in which you both feel relaxed-for example, by playing some favourite music. During the time when you are trying this therapy you and your partner must stick to your agreement to refrain from full sexual intercourse.

Stage 1: On the first evening, each partner should take it in turns to gently massage and caress the other for a period of about 20 minutes. This is best carried out when you are both naked, and you can use body lotion or oil, if you like. The massage should involve a gentle exploration of all part of the body except the genital, breast, and anal areas. The partner being caressed should concentrate on finding pleasure from being touched, and the partner giving the caresses should concentrate on his or her own pleasure from contact with the partner's body. Once you have got over any awkwardness and finding enjoyment from the experience-this may take several session-go to stage 2.

Stage 2: Stage 2 is similar to stage 1, but this time body massage may include genital, anal, and breast areas. Remember, however to continue to include other parts of the body in your caresses, so that direct sexual stimulation can be felt in context with other body sensations.

Stage 3: Most couples find that soon after reaching stage 2 they are ready to resume sexual intercourse; and in most cases they find that they are more relaxed and are more able to enjoy a full range of physical and emotional sexual feelings.

SEX COUNSELLING

Sex counselling can take many different forms. Most Family doctors have experience in dealing with the more common types of sexual difficulty and so, if you have a problem you should first consult your own doctor for advice. Depending on the nature of the problem and his or her experience in this field, your doctor may either suggest treatment him or herself or may refer you to a specialist sex counsellor. Such counsellors may or may not be medically qualified-often they are specialists in psychology. Some large medical practice have sex counsellors attached to them. In other cases you may be referred to a clinic or hospital outpatient department.

Treatment for all types of sexual difficulty has greater chance of success if both partners attend counselling sessions. Usually a course of counselling starts with a discussion with the counsellor about the nature of the problem. In many cases this provides a couple with their first experience of talking together frankly about their sexual feelings, this is often in itself of great help in clearing up misunderstandings and reducing anxiety. The counsellor may later suggest techniques for overcoming specific difficulties - for example the squeeze technique if premature ejaculation is a problem. Or he or she may give more generalised advice on sexual techniques. The counsellor will also, if necessary guide you through a prolonged therapy programme to be carried out at home, such as the sensate focus technique. The success rate for couples who overcome their embarrassment sufficiently to seek sex counselling is high. So Even if you feel that your problem is insoluble it is worthwhile to seek your doctor's advice.

THE SQUEEZE TECHNIQUE

The squeeze technique is one of the most widely accepted methods for helping a man to delay and control orgasm. It teaches both partners to recognise the sensations that immediately precede ejaculation, so increasing control. Many couples find that it helps to try the technique of sensate focus before undertaking the squeeze technique.

Stage 1: Adopt a position that is comfortable for both you and your partner. Many couples find the best position is one in which the woman sits with her back to head board of the bed, her legs spread out in front and the man lies facing her, with his body between her legs over here. Your partner should then caress your penis to full erection and continue until you are close to orgasm. When you feel ready to ejaculate, signal to your partner, who then stops stimulating you and grips the penis firmly just below the glans-penis until your erection subsides. After about the half a minute, she can start simulating your penis again. Repeat this 2 to 3 times before allowing yourself to ejaculate. With practice, Your partner will begin to sense without signal when you are near to orgasm. After a few sessions, when you both have gained confidence about controlling ejaculation, it is possible to move on to the next stage.

Stage 2: Lie on your back with your partner astride you and your erect penis inside her vagina. Practice holding this position without moving for as long as possible, if you feel you are about to ejaculate, signal to your partner. She then lifts herself away and applies the squeeze grip as before. Repeat this 2 to 3 times. If your erection begins to subside, stimulation of the penis will restore it so that it can be once again inserted into your partner's vagina. After a few sessions, When you feel control has improved, normal full intercourse can be attempted so that both partners can reach orgasm. You may find that positions in which your partner is on top allow you to control orgasm most easily. If at any time you feel ready to ejaculate before your partner is ready, she can use the squeeze technique.

SEXUAL ORIENTATION

Sexual orientation- that is, whether you are homosexual (attracted to people of the opposite sex), homosexual (attracted to people of same sex) or bisexual (attracted to people of both sexes) is probably determined by a combination of inborn personality traits, upbringing and family relationships. Some researchers have suggested that there may be hormonal sexual orientation, but these findings have not been generally accepted. Few people are wholly heterosexual or homosexual. In particular, it is common for adolescents to go through a phase of experiencing homosexual feeling before becoming attracted to people of the opposite sex. Some people however, remain homosexual in their sexual preferences.

Homosexuality: This variation from the mainly heterosexual orientation of the majority is no cause for medical concern as long as individual is happy with his homosexuality. Treatment to change sexual orientation is unlikely to be effective and is seldom recommended unless the individual is very determined to make the attempt and has at least some interest in the opposite sex. However, society's often intolerant attitude towards homosexuality frequently causes homosexuals to feel guilty and abnormal, and therefore leads them to repress their sexual feelings. This can be psychologically damaging. If you think that you are homosexual and are experiencing such problems, consult your doctor, who may be able to offer helpful advice and/or refer you to one of the voluntary organisations that specializes in advising homosexuals.

Being a homosexual man, and having sex with other men, is no more hazardous to health than sex between heterosexuals. People of either sexual orientation who have many sexual partners but who take no precautions against sexually transmitted diseases are likely to have repeated infection. Infection with one sexually transmitted disease seems to increase the sexual partner are at high risk of the more serious diseases such as hepatitis and AIDS. Homosexual men who have multiple sexual partners should practice safe sex and use a condom for these symptoms :

inexplicable tiredness
yellow of the skin
unexplained rashes or sores
abnormally frequent and persistent respiratory and/or digestive-tract infections
persistent swelling of the glands

If you notice of any of the symptoms, consult your doctor without delay. It is advisable to avoid sexual contact until the cause of the symptoms has been diagnosed and treated.