Sexuality and life as a couple: how to find serenity. The expert's answers to your questions!

Sexual disorders are much more frequent than one might think. Often, however, the silence and embarrassment with which these situations are accepted only exaggerate problems that in fact have a solution. Communicating discomfort, especially if it concerns the intimate sphere of a couple, is undoubtedly the first step to face and bring to light issues that in the long run could wear down the relationship. A good dialogue and a clear relationship without misunderstandings in fact facilitate a peaceful sex life, for this reason it would be good to educate couples to dialogue and confrontation in order to try to understand and heal any misunderstandings and encourage greater understanding even under the covers.

There are many questions that spring to mind when you have problems of a sexual nature, but often you do not have the courage to submit them to the competent people who could solve them in a short time, showing us a quick way to find serenity in the life of two. Below you can find a series of questions on the matter posed by people who participated in our discussion on the forum, followed by the respective answers of the expert, Dr. Emmanuele A. Jannini, Professor of Endocrinology and Sexology - University of Rome Tor Vergata - President of the Italian Society of Andrology and Sexual Medicine, who tried to clarify doubts and indicate specific solutions to help find a satisfying and worry-free sex life.

Doctor Hello, I kindly wanted to ask you if you can help me with my problem. I am 22 years old and I have never had problems with erection, on the contrary, with my girlfriend everything has always been fine. In the last 2/3 months I have noticed that I find it difficult to maintain an erection compared to a few years ago. In your opinion is it a physical or psychological problem? Thanks Lupino991

Dear Lupino991, in the course of a couple's life there may be moments in which you are faced with small problems, such as a defect in the erection. In this case it is important to focus on what has changed during this period, in order to better evaluate the possible causes and reach a resolution of the problem as soon as possible. If the difficulty in maintaining an erection persists, I recommend that you contact an andrologist who will provide you with the necessary support in defining your problem. In fact, there are several pharmacological solutions that must be adapted, as a good tailor does, to the real needs of the couple.We call it "sartorial sexology" and it is based on 4 different "clothes" available to the doctor: the first is the "blue" pill (technically: Sildenafil), the well-known first-born, with a strong ability to intervene on vascular problems; it currently exists in an orodispersible form, which dissolves immediately on the tongue. The weekend pill (or Tadalafil) starts working much later than the other molecules, but it helps improve erections for 36 hours. In low doses, but taken every day (it is a rather expensive solution), it is used when along with impotence there is prostate hypertrophy. The third child is Vardenafil, similar to Sildenafil, which owes the name by which it is known as "Mint of love" to the mint flavor of the orodispersible formulation. It is a solution whose strength is discretion. The most modern of the formulations is Havanafil, which my patients have dubbed the "worry-free pill". This is because it removes the thought that it does not work (the effectiveness is at least equal to the other molecules), which removes the worry that it does not work in time (it is the fastest of all, to the benefit of spontaneity: fasting already works in 15 minutes and, above all, it removes the thought that it hurts, that side effects appear (skin redness, stomach ache, headache, painful back pain, etc.), typical of the predecessors. The "thoughtless pill" is in fact the one with fewer side effects, the safest. And there is a fourth reason, in times of crisis, to define it this way: it reduces the economic worry: they are all expensive pills, but this, being produced by an Italian company, is the most And, you know, the adage says: "sex doesn't want thoughts".

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Bye! My partner and I have been together for a couple of years, everything has always been perfect, complicity and intimacy are the basis of our relationship. In recent months we have had some problems not only under the covers but also in the relationship. Honestly, I don't know which of the two is the cause and which is the effect, the fact is that everything has become colder and more complicated. So I wonder how pathological or how psychosomatic the cause can be? If pathological can it be momentary? Does age affect this problem (my partner and I are 10 years apart)? Thank you very much, Innamorata1979

Dear lover1979, it is important to understand that the problems in the love relationship are often accompanied by some sexual difficulties, which act as an alarm signal for the two-way street. In the presence of these problems, the first reaction that often each member of the couple has is that of closure, cooling the relationships with the partner and avoiding any type of speech that can open old and new wounds. Regardless of the age difference (which can certainly affect the relationship) it is important to understand the causes and reasons for this coldness. The first step you can take is certainly aimed at opening a space for comparison, clear and open to the other, so that you can understand your mutual difficulties. If this is not enough to solve your problem, an andrological consultation will certainly be of benefit to you, if among the various problems you are encountering there is an erectile difficulty or in the ejaculation of your partner or of a psychosexological nature, to work thoroughly, together , on the moment that your love and sexual relationship is going through.

Doctor good evening, I am 23 and he is 28, we have been together for 4 years. There has always been a problem between us, which we have talked about and talked about again: he never tries to make love with me, I am always looking for him and almost always avoids me. I don't know what to do anymore: I have tried everything even to tell him if maybe he does not want me or if he feels something for the other sex but nothing ... he always tells me that he is made so I repeat to him that it is not normal. In a month we do it once, only two minutes, he has no other, I know for sure. He fills me with attention, he loves me madly but something is missing that is becoming a really serious problem for me. Thanks Pasqualina71

Dear Pasqualina71, I imagine that, despite the many attentions that her partner gives her, it is frustrating to hear that something is always missing to make this relationship of love complete. Certainly her partner with these refusals is trying to communicate to her a difficulty in approaching sexually, perhaps due to a difficulty in achieving and / or maintaining an erection or ejaculating in a time that is not considered sufficient. As difficult as it may be for your partner to be able to fully open up and reveal his real difficulty, it is good that you, in the least judgmental way possible, can guide him towards the valid help of a specialist, such as the medical andrologist, who can help the patient. his partner to understand his problem, accept it but above all have the confidence that sexual problems have a solution. It is up to the specialist to define the specific gravity of the various sexual symptoms he tells me: reduced sexual desire (in general or towards him ?, reduced virile potency (is it a real erectile dysfunction or just lack of interest in sex?), And / or premature ejaculation , the most frequent, but also one of the most easily treatable (there is a specific drug for this), of male sexual disorders. As you see sexuality and its disorders it often manifests itself in a complex and multifaceted form. For this it is useful to find professional help I advise you to contact a Public Center Accredited by the Italian Society of Andrology and Sexuality Medicine (www.siams.info) where you can find the expertise you both need.

Dear Professor Jannini, after a few days of uncertainty I decided to write my comment on this topic. I have been married for 6 years and have a son. After the first few months in which sex was great, we were a close-knit and eager couple. Then our son arrived and if our sexuality was more than enveloping during pregnancy, after his birth there was a decrease in desire, but for reasons of force majeure. Today I am almost forty years old and desire is as if he was gone. I noticed it but I pretended nothing had happened, giving me answers that could justify the fact that we had stopped making love, for example the arrival of Peter. This is not the first time this has happened to me. I lived together for four years even though I no longer had sex with my partner, except on rare occasions. Now I find myself in the same situation. I have found and read many reasonable answers about a man losing desire and equally reasonable explanations about the fact that at any moment a woman feels that she is no longer wanted by her partner.

Suddenly you skip twenty or thirty years of relationship and find yourself in the shoes of old spouses in bed. Did it happen that the dream shattered before our eyes? Or am I the one who can no longer play with my wife? Do I feel pressure from my son in the other room and can't be more engaging with my wife? Sometimes I get stuck in the sense that I can't maintain the relationship and this happened to me twice during a special evening just me and her and after drinking wine and looking for the right atmosphere. Sometimes I think our relationship is over, other times I think I'm the one who's in trouble. Should I try to take something to feel manly? Yet if I see other women I don't seem to have problems. I'm waiting for your answer because not even I understand what is happening to me

Dear Luca Pietrino, the birth of a child imposes on the new parents many inevitable and necessary changes, even in the relationship itself. Moving from couple to family also implies living not only as a partner but also as parents. It is good that you know that the months following childbirth are always accompanied by a reduction in sexual desire, especially in women, both from a hormonal point of view (prolactin, which is the hormone that allows breastfeeding, is one of the more bitter enemies of sexual desire) than psychological, as his partner has the possibility of living as a mother by establishing an almost symbiotic relationship with the child in this first phase. What is good to always keep in mind is that the birth of a child does not force the couple to take off the clothes of the love relationship to wear exclusively those of parents: it is important in fact, that both of you constantly strive to feed not only yours. small, but also your love relationship, creating spaces and times dedicated only to you, sharing interests, fantasies and pleasures that go beyond the daily parenting. Having put this dress aside for a long time implies a whole series of complications that you and your partner are experiencing with a lot of suffering. Her sexual appetite complications also seem to be limited to the relationship with her partner. In light of the above, I can reassure you by telling you that restoring the pleasure of being together is certainly possible: if you both have the right motivation to resume your experience as a couple, you can certainly rely on the help of a valid couple therapist with certified experience in the field of sexuality, building a new space precisely starting from therapy where one can truly re-enter an authentic contact with his partner.

I would like to ask you about a situation in which a dear friend of mine found herself. She recently got involved with an interesting guy. They have been together for a year and he does not often feel the need to have sex with her, despite the fact that they love each other a lot (according to them). Also often before he gets aroused, he needs constant stimulation ... Also sometimes it stops because ... just can't keep everything stable (I mean badly for the embarrassment, but I think you understand). In the morning, then, he never has the phenomenon that normally characterizes the awakening of boys ... When she takes the initiative, he has a lot of difficulty, when instead she does nothing, it can happen that he does it and that everything is fine. . She always tells me to justify it that he is different from the others and that he feels he wants a relationship with her made up of love and not just a physical relationship, but is it possible? I don't know, in my opinion she doesn't even believe it ... I ask you, what do you say? I think he is impotent, thank you. Lacombeb

Dear Lacombeb, in the light of the information you have provided me, I agree with your preliminary analysis. However, it should be emphasized that a diagnosis of this type needs clear clinical evidence: an andrological consultation is therefore necessary that will be able to dissolve the doubts of your dear friend. It is a question of understanding whether it is really a problem of maintaining an erection (impotence is not only the inability to get an erection, but also to maintain it, in fact), or if it is a problem of reduced desire.From the few, fragmentary indications he has given me, I would lean towards the first hypothesis. If the specialist confirms my impression, invite your friend to consider that erectile dysfunction affects about 1 in 5 males, so it is not uncommon to encounter cases like the one you described to me. This is why it is important for her friend to know in order to be able to face the problem with determination together with her partner (it is often women who take care of their partner's health). It is equally important to know that there are both psychotherapeutic and pharmacological solutions to the problem. The ideal would be the integration of both: being able to exploit the power and effectiveness of the famous phosphodiesterase 5 inhibitors, the love pills, with a review of the intrapsychic and relational aspects is certainly the most correct approach, but also more effective.

Dear Professor Jannini, I hope you can help me solve this dilemma. My current Him, due to 10 years separating us, is unable to have a complete sexual act with me. He says it's the first time this has happened to him. At least, according to him. I told him that it is also my choice and that I am not a minor. I tried to make him feel comfortable in several ways, but nothing. We continue to live only on foreplay and as soon as I propose him to do the actual act he pulls back with various excuses. Now I would like to know: Why does this happen? And how can I do to overcome his / our block? Thank you. Fedea88

Dear, really the possible causes are many, many. And it will not be trivial to find them. An experienced psychosexologist is able, through a sincere but thorough interview, to understand if the obstacles are of a relational nature (ie if the problem is the couple itself, and the interaction between the two partners) or of an "intrapsychic" nature, that is due to particular problems internal to his partner. An example comes from a patient who looks a lot like the story he tells me. After some interviews we realized that he was a "crypto-homosexual", that is a person who does not have the courage to admit, often not even to himself, his homosexuality. But his case can simply be explained in terms of insecurity, uncertainty. It happens that you give up sex, a bit like the fox does with grapes, simply because you are afraid of not being able to reach it. In this case it is necessary to understand why there is fear and if the fear is founded and where is the "breaking point" of the body-mind system and the couple system. But fear not: with patience the solution is found and the problems are solved!