Sexual myths and misconceptions leading to anxiety are the most common sexual problems. The common myths relating to various aspects of sex and sexuality are handed down from one generation to another and many people imagine more problems than they actually have.

PENIS SIZE & SHAPE:

Q) What is the normal length of the erect penis to satisfy a woman?
A) Concern about penise size is as old as the human race. The width, length and erection of the penis vary from one male to another, as does the length of the nose, the depth and spacing of the eyes and the width of the forehead. The average sexual length of the vagina is about 15 cm. And only the outer third (5 cm) has the maximum nerve endings. The inner two-thirds (10 cm) is virtually insensitive. This leads to the conclusion that if a man wants to arouse his female partner he should concentrate on the area of maximum nerve endings i.e. the outer lips (labia majora) and the outer third i.e. the outer 5 cm of the vagina. Therefore, for female sexual gratification, the size of the erect penis could be anything from 5 cm plus. Penise size is unimportant for female satisfaction and the size of the penis seems important only to those women who harbor the myth that a man with a large penis can satisfy his woman better than a man with a smaller one!

Q) Is the width of the penis important?
A) Not really. The vagina is highly elastic. It can expand from the size of a little finger to that of a baby's head. The vagina distends according to the width and size of the inserted penis.

Q) Is there any relation between the size of the body and the size of the sex organs?
A) No.

Q) Can a smaller penis lead to conceptive inadequacy?
A) No.

Q) Is the penis usually inclined to the left?
A) Yes. This is true for a majority of men. This is so perhaps because the left testis is lower than the right. Therefore, while wearing under garments, most men adjust their penis on the left side as enough space exists on the left side as compared to the right.

Q) Does a slight curvature of the penis lead to any difficulty in penetration?
A) A slight curvature of the penis either to the left or to the right is common and does not affect penetration at all. It is a myth that an erect penis should always be at right angle.

SEMEN:

Q) Is semen vital? Does dissipation of semen devitalize a man and promotes aging?
A) Semen is being secreted day in and day out by the genital apparatus for erection and can not be stored indefinitely even if one wants to do so. Barring conception, semen is not vital. Moreover, sperms constitute less than one percent of the total seminal fluid and the rest is the secretion of the accessory sexual glands, prostate and seminal vesicles. The notion that one drop of semen is equal to a hundred drops of blood which in turn requires a lot of nourishing food is one of the most common sexual myths prevalent.

Q) Does conservation of semen lead to longevity and athletic excellence?
A) If this had been based on physiological facts, then all bachelors would have become athletes and lived longer!

Q) Does the reduced consistency of semen indicate sexual inadequacy?
A) No. The consistency of semen may vary as it depends upon several factors like the period of abstinence, the intensity of stimulation etc. However, as a man grows older, the consistency of semen does thin out, but this has nothing to do with the individual's sexuality.

Q) What is the 'Dhat' syndrome?
A) Sometimes men pass a whitish fluid with urine or whilst straining at stools. The belief that this fluid is semen/dhat is called the 'Dhat' syndrome. This is not a disease and it would not be inappropriate to say that  it exists only in the mind of the beholder. The physiological sphincter at the neck of the urinary bladder always remains closed and opens only when one is passing urine. Thus, it ensures that normally urine and semen do not mix i.e. normally one cannot pass semen and urine together. Sometimes, a physiological alteration in the urinary solution may change the appearance of urine, making it whitish which is mistaken to be semen by mistaken to be semen by misinformed individuals. In reality, the whitish discharge is largely the secretion of the urethral and prostate glands. When a man squats in the toilet and exerts a little pressure, the pressure is relayed from the rectum to the urethra and a few drops of sticky white secretion accumulate, coalesce and trickle down. The phenomenon is akin to there being ten drops of perspiration and on being joined by the eleventh trickle down . In my opinion, this misconception is prevalent in our country because of squatting toilet habits, as people tend to look down and see the sticky substance which they presume to be semen. In developed countries , most people use western style commodes, so they look straight ahead. Hence, what the eyes do not see, the mind does not perceive!

Q) Why do people feel weak after sleep emissions?
A) Post emission weakness is largely psychological. Right from childhood the idea has been drilled into our minds that the genitals are special and anything coming out of it is equally special. This misconception about the value of semen adds further anxiety in an individual leading to neurathenic symptoms. In fact, the calories lost during a sleep emission are equivalent to a glass of limejuice!

Q) Is sexual abstinence advantageous?
A) Prolonged sexual abstinence may be detrimental to mental and physical health. There are people who are under the impression that sexual abstinence is conductive to human health and happiness. Because of this misguided belief, they make an attempt to conserve their so-called 'energy' by sexual abstinence. The moment they are unable to do this, they get a feeling of guilt and anxiety that they have done something detrimental to their health. When this is repeated several times, the roots of the problem get deeper and deeper. Consistent suppression of the sex drive leads to emotional instability and evokes an abundance of sexual imagery. This usually leads to inability to concentrate, insomnia, irritability and extreme nervousness. The extent of the disturbance depends on the individual's own mental state and environment. At times, the consistent suppression and continued inactivity of the sex organ lead to diminished ability to function. One must remember it is the disuse that lead to atrophy and not the use!

Q) Mahatma Gandhi used to advocate this?
A) Yes, but Mahatma Gandhi was a politician and not a sexologist!

Q) What is Brahmacharya?
A) Brahma in Sanskrit means Atma or soul and charya means search, Brahmacharya is search of a soul.

Q) Is semen analysis necessary for a patient having impotence?
A) Absolutely not. The absence or deficiency of sperm does not indicate impotence. Sterility and virility are two entirely different things and depend upon different types of cells present in the testes. Absence or deficiency of sperm does not affect one's virility or potency. CIRCUMCISION:

Q) Would you advise circumcision for a newborn baby?
A) No. Certainly not. It is unfortunate that many baby boys are circumcised without anesthesia and a healthy and normal part of their body is cut off without their consent. Circumcised males are twice as likely to contact non-gonococcus arthritis as opposed to non-circumcised males. In fact, an intact foreskin would act as a shield for any irritating lesions on the glands following herpes or any other infections, by preventing external friction.

Q) Do circumcised males have orgasmic control than non-circumcised ones?
A) No. This is a myth.

VIRGINITY:

Q) What is virginity?
A) The word 'virgin' means one who has not had sexual intercourse, which can be verified by an intact hymen. However, a girl whose hymen is intact may have had intercourse; whereas a girl who has never had intercourse may not have an intact hymen. The idea of chastity and virginity needs to be clarified. There are virgin individuals who are not chaste and chaste individuals who are not physiologically virgin.

Q) Can a virgin becomes pregnant?
A) Yes. If the sperms are deposited near the vulva, they may pass through the small hole of an intact hymen and may travel up through the full length of the vagina and uterus and fertilize the ovum resulting in pregnancy. BREAST:

Q) Is breast size important?
A) No. Large breasts are not more sensitive to stimulation than smaller ones.

Q) Are there any medicines or creams to enlarge breasts?
A) No.

Q) Can breast size be increased?
A) Certain exercises do help develop the Pectorals Major muscles which could add a little bulk to the chest (but not the breasts themselves) and this may apparently increase the breast size. Plastic surgery may also prove beneficial.

Q) Do hairs on the breasts suggest any pathology?
A) It is not uncommon for women to have a little hair around the areola of the breast, which does not need any treatment. However, if a woman desires, she may get them removed permanently by electrolysis done by a qualified professional.

PREGNANCY:

Q) Is sex safe during pregnancy?
A) Usually, a healthy woman can safely indulge in sexual activity during pregnancy. However, coitus should be avoided if there is pain and/or bleeding at any stage. If a woman has had an abortion in the first three months in the past, coitus during the first trimester should be avoided. In the second trimester, coitus is contraindicated if the woman has a history of 'habitual abortion' because the incompetent cervical of the mouth of the uterus. In the last trimester i.e. from the seventh month to labour, one may safely indulge in sexual activity till the last day of delivery by altering the coital position so as to ensure that direct weight does not fall on the foetus. It must be remembered that if for any reason intercourse is forbidden during pregnancy, the woman must avoid reaching orgasm by any other means including masturbation. In fact, the contractions of the uterus following masturbation intercourse. An obstetrician may be consulted regarding indulgence in sexual activity during pregnancy, as each case needs to be evaluated individually in so far as any possible contraindication or modification needs to be made.

ORGASM:

Q) Are there any signs which indicate that a woman has reached orgasm?
A) When one reaches orgasm, one usually has gasping uncontrolled movements, or has a sense of suspension. But these are non-verbal communications to the partner that one has had an orgasm. In a majority of women, orgasm is generally accompanied by vaginal contractions. Later, after completion of the sex act, one appears calm and satisfied. The signs of having had an orgasm are quite fleeting. The best way of knowing is to ask the partner. Orgasm is like a sneeze , if a woman has had one, she knows about it, otherwise any attempt to explain it is akin to showing a rainbow to a blind man!

Q.) Is there a difference between 'clitoral orgasm' and 'vaginal orgasm'?
A) No, there is no difference. An orgasm may be more or less satisfying depending upon several factors, but whatever be the means of stimulation, ultimately ' all roads lead to Rome'.

TIME & FREQUENCY OF THE SEX ACT:

Q) What is the 'normal standard time' for an intercourse?
A) There is no normal standard time for an intercourse. It depends upon the partners. The act needs to be mutually satisfying. The notion that a prolonged intercourse gives more pleasure is a myth. What is important is not how long, but how satisfying and how blissful!

Q) How often should a couple have sexual intercourse?
A) Sexual intercourse is a means to an end, the end being pleasure. Therefore, a couple can have intercourse as often as it pleases them. Sex is a pleasure to be shared between partners and there is no need to keep a tally. How often to indulge in sex depends upon the individual couple. The best thing to do is to forget the number game and indulge in sex as often as is mutually pleasurable and satisfying. Moreover, the quality of sex is important and not the frequency!

Q) Is frequent intercourse harmful?
A) Present medical knowledge acknowledges the fact that as long as intercourse is indulged in amongst accepting partners and is not associated with any physical trauma or irritation, the act itself is not harmful irrespective to its frequency. SEXUAL POSITIONS:

Q) Are there different positions for sexual intercourse?
A) Yes. The human anatomy allows freedom for innumerable conjugal positions, which may be used depending on the practicability, and one's individual anatomy and preference.

Q) Are they useful?
A) Yes. Different positions offer different advantages in different situations with respect to accommodation, penetration and enhancement of pleasure. They also add a feature of novelty. In addition, a position like the female superior is often helpful in delaying the male's by side, rear entry and female superior positions are more comfortable in pregnancy. Penetration can be easy and deeper if the woman's thighs are wide open with a pillow beneath her buttocks. Positions in which her legs are closed after penetration enhance penile as well as clitoral stimulation. ORAL AND ANAL SEX:

Q) Is oral sex normal?
A) Yes. Oral sex can be an excellent variation.

Q) Why do some people prefers anal sex?
A) Due to the similarity in the neurological innervations of the vagina and the anal canal, the central neurological perception is likely to be similar in both, vaginal and anal sex. Further, the latter position allows freer access for manual stimulation of the breasts and the clitoris. Some experience a better grip whereas others enjoy the novelty. Thus, anal sex may be preferred for any one of the multitudes of reasons.

ALTERNATIVE ORIENTATION:

Q) What is an alternative orientation?
A) Any sexual inclination apart from the popular heterosexual indulgence can be termed as an alternative orientation. It is not necessarily an aberrant or deviant expression of one's sexuality but no one knows why some people develop such alternative preferences.

Q) What is homosexuality?
A) Sexual attraction towards, and/or indulgence in sexual activity with partners of the same biological sex as oneself is called homosexuality.

Q) Do you recommend homosexuality?
A) Neither do I recommend nor do I condemn! Nevertheless, if a homosexual is satisfying his relationship in a positive way, he is better off than not satisfying at all or being a destructive heterosexual one. SEX & AGEING:

Q) What are the common sexual misconceptions prevalent among middle age men and women?
A) Men harbor the misconception that misconception that increasing age and excessive use may lead to weakening of the genitals and end in 'seminal bankruptcy'. Because of this misguided belief, they observe sexual abstinence. One should remember that it is disuse which leads to atrophy and not the use. As a man grows older, he walks slow, he talks slow but he expects that his erection should not be slow! One needs to remember that this a normal phenomenon. Some are under the impression that 'one failure in making it means an end to sex life'. As a result, many men move from effective sexual functioning to various degrees of importance. I always emphasize that occasional failures are common and a failure does not mean an end. Women harbor the misconception that menopause marks the end of sex life. Menopause merely marks the end of a woman's reproductive career and not the conjugal career, which can continue up to the end of one's biological life. In fact, the maturity of the partner's end the relationship, along with guaranteed natural contraception many enhance the sex life. The misconception that 'sex after sixty is not possible' needs to be changed. Men and women can continue to remain sexually active till the last day of their lives provided they are in sound mental and physical health.

Q) Can a very active sex life in the early years affect one's sexual life later?
A) A very active sexual life in youth does not precipitate an early termination of the sex drive or capacity. On the contrary, persons having a strong sexual interest and capacity in the early years are more likely to retain the same in the later years. This has been confirmed by a longitudinal study on sexual behavior and old age.

Q) What are the most common conditions which could decrease sex drive later years?
A) The common reasons for a reduced sex drive in later years are: Monotony and loss of interest Changes in physical appearance Misconceptions about one's waning sexuality Lack of communication Depression

Q) Does female sexual desire increase or decrease at menopause? A) Some women report an increase while others report a decrease in sexual desire at menopause. Increase in sexual desire may be because of relative freedom from pregnancy and hence one may respond and perform with greater enthusiasm. Some women harbor the misconception that menopause marks the end of their sexual career and this fear increases their sexual drives as an affirmation of their femininity. During menopause (or even a few years earlier), a reduction in the secretion of the ovarian hormones may cause atrophy of the vaginal epithelium which leads to reduction in lubrication and hence pain at the time of sexual intercourse. This causes a decline in sexual desire and a woman tends to avoid sexual overtures.

ILL HEALTH:

Q) What are the most common sexual dysfunction among diabetics?
A) Sexual dysfunction is common amongst diabetics. The causes could be vascular, neurological or psychological. In diabetic impotence, the history is suggestive of presence of desire but decline in erectile ability at all times. Usually the onset of the problem is gradual. In some, the presenting symptom could be premature ejaculation and rarely retrograde ejaculation. Diabetic women sometimes complain of reduction in lubrication and difficulty in reaching orgasm. Monilial infection may further reduce lubrication and associated itching makes intercourse uncomfortable. Monilial infection often leads to Balanitis. A misconception that "all diabetics become impotent" may itself lead to psychogenic sexual dysfunction.

Q) How safe is a sexual activity in-patient with heart disease?
A) One must consult a cardiologist, because what is good for one person may not necessarily be good for another. Hellerstein and Friedman have studied cardio-pulmonary responses in middle-aged middle-class convalescent males engaging in sexual activity with their wives in the privacy in their bedrooms. From their studies, it was concluded that if a cardiac patient could walk on a treadmill at 3 miles per hour asymptomatically and without undue elevation of blood pressure or electrocardiograph changes, he could safely participate in sexual activity.

Q) What limits should one observe?
A) There is nothing like a limit in sex; either you indulge or you do not. The incidence of heart attacks during sexual activity, as per statistics, is 1 in 200. This could have happened even otherwise like while passing urine or going to toilet. However, the best person to advise you would be a cardiologist because the patient's regimen needs to be tailored according to individual needs.

The following precautions may be useful:
Avoid clandestine sexual activity as it tends to increase the heart rate even more than usual. Avoid elaborate meals and alcohol prior to the sex act as lot of energy and blood flow is being utilized for digestion. It is preferable to have sexual intercourse in the morning when one is not fatigued. It is advisable to do regular physical exercise need be an unaccustomed exertion. One may keep a nitroglycerine tablet handy or use nitroglycerine ointment if anticipating chest pain.

Q) Has blood pressure anything to do with sex?
A) There is a marked increase in blood pressure during sexual intercourse. Theoretically speaking, very high blood pressure does pose a danger of cerebral hemorrhage and myocardial infarction. A study recently conducted clearly showed that cerebral hemorrhage among patients with high blood pressure occurred as frequently during sleep defecation as during sexual intercourse. However it is desirable to control high blood pressure. Patients need to be informed very clearly that the danger of catastrophic events in negligible with the short term changes that occur during intercourse and other physical activities. It is equally if not more, important, to inform the patients about the likely side effects of anti-hypertensive drugs on sexual response.

Q) How does arthritis affect sexual relationships?
A) In arthritis, pain and deformity usually leads to disturbance in the sex act, especially where there is an involvement of hip, knees or the back. Factors like frustration, anger, dependency and low self image due to deformity, lead to depression. Steroid side effects e.g. obesity and moon like face complement this.

Q)When is sexual desire excessive?
A) The term 'excess' needs to be defined. In our culture, increased male sexual activity is considered as a sign of masculinity, while the similar behavior in a woman is considered a stigma or an illness --- nymphomania. Increase desire can be seen in mania where there is acceleration of activity in all spheres.