THE SEX 101 QUIZ

CORRECT ANSWER: FALSE

FACT: This myth seems to have become even more wide-spread and believed more firmly since the introduction of Viagra and other impotence drugs. The fact is that sex involves a great deal of activities and most women and men report that the best sex involves creativity, fun, communication and partnership. Many men experience a lack of erection from time to time and this doesn't need to be a problem. In fact, being so goal-oriented about sex means that men can miss out on a lot of pleasure. There are many things you can do to satisfy a partner and experience sexual pleasure yourself. Putting pressure on yourself to get an erection only makes it less likely that you'll have one.

(Important information for men with Peyronie's disease, prostate cancer or for those recovering from prostate surgery).

CORRECT ANSWER: TRUE

FACT: Stress can absolutely undermine or sabotage the strength of the erection. During periods of significant stress, it is common to have difficulties getting and maintaining an erection. Stress and anxiety can interrupt how your brain sends messages to the penis to allow extra blood flow. In fact, blood flow is often redirected away from the genital region during stress.

Also, stress and anxiety about ED not only contribute to ED, but can in fact maintain a cycle of ongoing ED. Experiencing ED can lead to behavioral changes that contribute to anxiety and increase incidences of ED.

CORRECT ANSWER: FALSE

FACT: Yes, an orgasm can be great, but it’s definitely not the only pleasurable aspect of a sexual encounter. Even when sex doesn’t end in climax, it can still feel really good for both partners. Also, if orgasm is the only goal, it might not be as enjoyable.

The Orgasm Gap

How often do men orgasm during sex?

For men who had sex within a 12-month period, 90% of the time.

In the Vityl clinical sample, it useful to consider Q10 of the IIEF (included in the MSD preliminaries). Only 30% of men reported experiencing orgasm most if not always during intercourse and 24% of men reported experiencing orgasm more than 50% of the time. A total of 46% of men reach orgasm less than 50% of the time.

How often do women orgasm during sex?

On average, women said they reach orgasm 31-40% of the time in response to the question about intercourse in general. By contrast, women said they reached orgasm even more often with assisted intercourse (51-60% of the time), but less often with unassisted intercourse (21-30% of the time).

How many do not experience orgasm at all?

When asked about intercourse in general, 22% of women said they never experience orgasm and 37% of women never experience orgasm when specifically asked about “unassisted” intercourse (i.e., when clitoral stimulation was specifically excluded).

Side note:

On a side note, it’s worth mentioning that, as part of this study, approximately 1,500 men were asked to estimate how often women orgasm during both the unassisted and assisted forms. They estimated that women orgasm 61-70% of the time during assisted intercourse, compared to 41-50% of the time during unassisted intercourse.

These numbers suggest that while men do seem to recognize the important role clitoral stimulation plays with respect to the female orgasm, they tend to overestimate how often women are actually reaching orgasm. Why is that? According to the study’s authors, this “may reflect men’s difficulty in accurately detecting women’s orgasms, or alternatively, men’s difficulty in detecting when women fake orgasm.”

Shirazi, T., Renfro, K., Lloyd, E., & Wallen, K. (2017). Women’s Experience of Orgasm During Intercourse: Question Semantics Affect Women’s Reports and Men’s Estimates of Orgasm Occurrence. Archives of Sexual Behavior.

CORRECT ANSWER: FALSE

FACT: Penises and testicles come in a variety of sizes and shapes. When they're not erect, penises appear to be quite different in size, but when they're erect their sizes are much more similar. Since most men don't see each other's erect penises, they really have no way to realistically compare the size of their erect penis to that of other men. The myth, however, persists, and many men feel that they should be a certain size in order to “measure up.” This belief can often make men feel inadequate. The size of a man’s penis has nothing to do with how much pleasure he feels, and it has little predictive effect on the amount of pleasure his partner will feel as well.

Average penis length: 5.16 inches
According to the David Veale and his team, the average flaccid, pendulous penis is 9.16 cm (3.61 inches) in length; the average erect penis is 13.12 cm (5.16 inches) long. The corresponding girth measurements are 9.31 cm (3.66 inches) for a flaccid penis and 11.66 cm (4.59 inches) for an erect one.

Veale, D., Miles, S., Bramley, S., Muir, G., & Hodsoll, J. (2014). Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15 521 men. British Journal of Urology International.

CORRECT ANSWER: FALSE

FACT: There are lots of times when both women and men don’t feel like they want to have sex, and don’t want to get “in the mood.” Even though men may like sex, and even those men who like sex a lot, almost all of us, at one time or another, don’t really feel like being sexually active. However, this stereotype can operate to make men feel expected to perform even when they’d rather not, and put extra pressure on themselves in this way. They may feel like they can’t say that they don’t want to have sex. Men aren’t vehicles of sex and need to be okay with or willing to say no when they don’t want to. By learning how to say no, the sexual activity they do participate in can be that much more enjoyable – for both men and their partners.

CORRECT ANSWER: TRUE

FACT: Bike riders can experience pelvic blood vessel stasis as a result of the physicality of sitting for a long period of time.

According to a Harvard Special Health Report, Erectile Dysfunction: How medication, lifestyle changes, and other therapies can help you conquer this vexing problem, the Massachusetts Male Aging Study found that in certain circumstances, bike riding can damage nerves and compress arteries in the penis, which may lead to erectile problems. The risk was highest among men who cycled more than three hours a week.

The reason cycling may cause ED is that the seat puts constant pressure on the perineum—the area between the genitals and anus. This pressure can harm nerves and temporarily slow blood flow, which causes tingling or numbness in the penis and, eventually, ED.

CORRECT ANSWER: FALSE

FACT: A survey of sex partners of men with PE revealed that they are less affected by PE than the man who has it. There is also no evidence that people are more likely to break-up when one partner has premature ejaculation.

CORRECT ANSWER: TRUE - but not guaranteed.

FACT: Masturbating an hour or two before you have sex can delay the time you take to ejaculate during your intercourse, however there is no guarantee. 

CORRECT ANSWER: TRUE

FACT: Excessive porn use also leads to less gratifying orgasms.

According to the science, porn is a “supranormal” stimulus—it activates the normal reward mechanisms in our brains, but it does so at such a high level that we perceive it to be way more pleasurable than the average arousing stimulus.

But our brains become desensitized and develop a need for even more novel stimuli in order to reach the same level of arousal and excitement. Thus begins the spiral into more hardcore porn and higher quantities of it.

In some cases, men can develop a psychological addiction to pornography and it can begin to interfere with their sex and social lives. In rare cases, it can be debilitating in both.

Porn use has been found to result in anxiety, lower self-esteem and diminished identity, as well as feeling more isolated for the male addict. Not only this, it produces many of the same negative effects for their female partner and can lead to the latter suffering from feelings of shame and inadequacy.

Apart from the impact on the individual, porn use can lead to sexual problems in a relationship, a deterioration of trust and safety, a perception of rejection as well as a fundamental change in how the women view their addicted partner, from “good” to “inherently bad.”

When it comes to porn addiction, there is evidence suggesting porn addiction leads to structural changes in the brain and shares similar basic mechanisms with substance addiction.

CORRECT ANSWER: FALSE

FACT: Women are likely to compare the quality of the connection during sex, not the size of the penis. 

Even when a comparison is drawn, this does not affect their level of enjoyment. 

CORRECT ANSWER: FALSE

FACT: Your body actually maintains a surplus of sperm.

Your testicles make several million sperm per day — about 1,500 sperm are produced every second. This adds up to be around 129,600 000 sperm per day - There’s no way you could keep up at that rate!

This may seem like overkill, but you release anywhere from 20 to 300 million sperm cells in a single milliliter of semen.

You produce sperm every day, but a full sperm regeneration cycle (spermatogenesis) takes about 64 days.

CORRECT ANSWER: FALSE

FACT: Many people believe that masturbation affects a man's testosterone levels, but this is not necessarily true. Masturbation does not seem to have any long-lasting effects on testosterone levels. However, masturbation may have short-term effects on the levels of this hormone.

One study did find that abstaining from masturbation for one week increases testosterone by 45%.

CORRECT ANSWER: TRUE

FACT: Time to ejaculation or IELT ever so slightly decreases over the lifespan and for men over the age of 51 the median time is 4.3 minutes.

The overall median time to ejaculation across the lifespan is 5.4 minutes, and approximately 75% of the population also ejaculate in under 10-minutes.

For therapists: 4.3 minutes is not the average time to ejaculation, it is the median time. Since the mean (average) can be significantly affected by outliers, and given the skewed distribution of IELT, the median is often the best measure of central tendency.

CORRECT ANSWER: FALSE

FACT: Most people refer to ejaculation and orgasm as one in the same, but they are actually two separate physiological events.

Also, while orgasm and ejaculation often happen simultaneously, they’re actually two separate events that don’t necessarily have to happen at the same time.

Orgasm includes the pelvic contractions and intense pleasure and release you feel when you come.

Ejaculation is the expulsion of semen from the penis.

And, you don’t need to expel semen to have an orgasm.

Not everyone ejaculates with orgasm, and even those that do may not ejaculate every time.

This is referred to as a dry orgasm.

CORRECT ANSWER: FALSE

FACT: The root cause of ED and PE in men is psychological in up to 20% of men. It used to be the case that ED and PE were considered to be primarily psychological disorders. 

CORRECT ANSWER: FALSE

FACT: Psychological factors can cause low libido.

Irritability, mood changes, poor concentration, and feeling fatigued or having less energy are usually accompanied by a decrease of testosterone. And low testosterone associated with erectile dysfunction can also lead to anxiety and stress. Low testosterone can affect your sleep, which can then create further problems with moodiness out of sheer fatigue. The causes and consequences for low testosterone are intertwined, with depression, confusion, irritability and fatigue being known symptoms of low testosterone.

CORRECT ANSWER: TRUE

FACT: Overweight and obesity may increase the risk of erectile dysfunction (ED) by 30–90%. Obesity can lead to low testosterone because fat cells convert androgens (male hormones) to estrogen in both men and women.  Furthermore, people with ED tend to be heavier and with a greater waist than people without ED, and also are more likely to be hypertensive and hypercholesterolemic (Dr Margarida).

CORRECT ANSWER: TRUE

ED is linked to a web of closely related cardiovascular risk factors such as physical inactivity, obesity, hypertension, and metabolic syndrome. Regular exercise can help men with their erections. Exercise is also good for the circulatory system. It keeps blood flowing smoothly throughout the body (Dr Margarida).

CORRECT ANSWER: TRUE

FACT: This appears attributable mainly to the ratio of omega 3-6-9 in the diet as well as the liberal use of extra virgin olive oil. 

As an aside: More importantly, a summary of the literature reveals fat soluble vitamins such as AEDK (especially vitamin D) to be imperative for erectile function in addition to minerals such as zinc. Indeed men who were deficient in vitamin D were 32% more likely to have trouble with erections (Farag, 2016). There is also evidence to suggest natural remedies are also effective for ED. Some studies have shown that certain supplements (such as DHEA, red ginseng, L-arginine, L-carnitine, and yohimbe) may be helpful.

Furthermore, in a double-blind randomised control trial assessing efficacy of coenzyme Q10 supplementation in early chronic Peyronie's disease, mean plaque size and mean penile curvature degree were decreased in the CoQ10 group, whereas a slight increase was noted in the placebo group (both P=0.001). Therefore, In patients with early chronic PD, CoQ10 therapy leads plaque size and penile curvature reduction and improves Erectile Function.

CORRECT ANSWER: TRUE

FACT: True.

Anger and distrust in a relationship often indicate a lack of safety or a reduced feeling of security in a relationship which can undermine the ability to get and maintain an erection. Furthermore, repressed anger is likely to interfere with quality of the orgasm as well.

CORRECT ANSWER: FALSE

FACT: Whilst viagra can improve the strength of the erection, it does not necessarily improve the quality of the orgasm. The quality of the orgasm is often determined by psychological factors as well as one's emotional connection to their partner.

CORRECT ANSWER: TRUE

FACT: Some research suggests these pelvic floor-strengthening exercises may help restore bladder control after prostate surgery. For some men, they may also help treat erectile dysfunction and prevent premature ejaculation. They might even increase the intensity of your orgasms.

Research:

A team led by Dr Antonio Pastore (Sapienza University of Rome) took 40 men (aged 19-46) who were suffering from PE and trained them to exercise their pelvic floor muscles over a 12-week period. They also measured their time-to-orgasm over this period. Previously, the men had tried a variety of therapies, without any significant improvement. At the start of the trial the average ejaculation time was 31.7 seconds, but by the end of the 12-weeks of pelvic floor exercises this had risen to 146.2 seconds2– a more than 4-fold increase.

33 of the 40 men improved within 12 weeks. Only 5 men showed no significant improvement. 2 had dropped out of the trial early, after showing an improvement. 13 of the 33 patients continued the trial up to the 6 month mark, and they confirmed that they maintained their extended ejaculation time.

CORRECT ANSWER: TRUE

FACT: If stress can undermine the strength of the erection, relaxation can enhance the quality of the erection or facilitate a better sexuual experience. 

Breathing deeply with conscious awareness has been proven to significantly enhance the experience of sex and sexual satisfaction as well as contribute to longer orgasms.

CORRECT ANSWER: TRUE

From a physical health perspective, getting erections during maturbation, or during the night such as those which correspond with the sleep cycles, or even in the morning such as "morning wood" are good indication that cardio-metabolic or hormonal factors are not necessarily playing a causative role. 

CORRECT ANSWER: TRUE

FACT: When we are stressed or anxious, we can often be in a state of "fight or flight". This is when the sympathetic nervous system is activated. And sympathetic nervous system activation not only inhibits and or redirects blood flow away from the penis, it also triggers ejaculation.

CORRECT ANSWER: FALSE

Recreational drugs can include illegal drugs but also prescription drugs that are misused. Using drugs recreationally can alter the way your body functions and can sometimes cause serious damage.

Different drugs have different effects on sexual desire, sexual satisfaction, sexual arousal and orgasms.

Examples of recreational drugs that can contribute to ED include:

• Amphetamines, which can cause blood vessels to narrow, preventing enough blood from reaching the penis
• Barbiturates, which may decrease interest in sex
• Nicotine, which can decrease sexual desire
• Cocaine, which can cause blood vessels to narrow, preventing enough blood from reaching the penis
• Marijuana, which may increase sexual desire but prevent smooth muscle in your penis from relaxing to let enough blood flow in
• Heroin, which can decrease levels of testosterone and decrease your interest in sex

Speedball and cocaine abuse most frequently affect sexual pleasure, while they slightly affect sexual desire.

Cocaine users have very high sexual desire during peak periods of drug abuse.

Heroin, cocaine, alcohol and speedball use and abuse impair the quality and abiliy to reach orgasm.

MDMA use was found to moderately to profoundly increase sexual desire and satisfaction  in more than 90% of subjects. Orgasm was delayed but perceived as more intense. However, erection was impaired in 40% of the men. It seems that MDMA impairs sexual performance, in spite of enhancement of sexual desire and the perception of greater satisfaction.

Long term drug use and abuse increased the chances of ED, decreased sexual desire, and increased ejaculation latency.

ED and decreased sexual desire were most commonly seen in heroin, followed by amphetamine and MDMA mono-users.

Increased ejaculation latency occurred commonly in all of the abusers.

*speedball is a mixture of cocaine (a stimulant) with heroin or morphine (an opioid) taken intravenously or by nasal insufflation.

CORRECT ANSWER: FALSE

FACT: While one study reports that they may have some libido-boosting effects in rats, no actual study exists to to show that oysters can independently spark erotic desire in humans. 

However, oysters are extremely high in zinc, which is important in raising testosterone levels in men (although it's unlikely any testosterone-raising effect would be immediate). Oysters also contain varying levels of dopamine, a neurotransmitter that stimulates the 'arousal' centre in the brain (which governs among other things, sexual arousal) and this action could feasibly occur straight away. According to Nutrition Australia, "when we eat oysters we actually raise the level of that chemical in our system."

Side note:

One possible erection inducing food are pistachios which have a variety of health benefits, including helping lower blood pressure, weight management, and reducing the risk of heart disease.

They may also help reduce symptoms of erectile dysfunction.

CORRECT ANSWER: FALSE

FACT: Up to 3 drinks can enhance desire but more than 3 drinks dramatically reduces erectile function.

Alcohol has both short term and long term effects on men. These dramatic effects caused by drinking alcohol before sex are a real concern. The quality of sex a man has while intoxicated is significantly reduced compared to sex whilst sober.

Some of the physical effects of alcohol on men include: 

• Lowered testosterone levels– Excessive consumption has been known to lower the testosterone levels in the body. This, in turn, lowers libido and prevents physical arousal in men.
• Decreased pleasure and orgasm.
• Alcohol causes both short term and long term erectile dysfunction.

Alcohol is the drug which most affects sexual arousal (erectile capacity). In addition, researchers observed that men did not improve their sexual performance when they stopped drinking alcohol (even after years of abstinence). The study included 905 men of which 550 had been diagnosed with alcohol, cocaine, cocaine and alcohol, heroin, marijuana and speedball (cocaine and heroin) addiction.

CORRECT ANSWER: TRUE

This question is a deliberate attempt to prompt men who may be feeling shy or guilty or shame or even distress about a sexual fantasy to share (disclose) the fantasy in a safe space as a way to unburden themselves and examine the potential effect on ED and PE.

Ask the patient if they feel this is true of them or if this resonates with them.

CORRECT ANSWER: TRUE

FACT: While medication can be highly effective in treating physical causes for ED or PE, there are other underlying causes that are not directly addressed with medication. Even when there is a physical cause, psychological or emotional factors may make ED worse. For example, a physical problem that slows a man's sexual arousal can create anxiety, which in turn can worsen ED. Depression and past sexual traumas can also lead to ED. Counseling or "talk therapy" is one more way to manage ED for these exact reasons (Dr Margarida).