Women have gynaecologists to go to, sex tips in Cosmo and Femina, girls seem to have a whole industry that has been built around sexual health and advice about sex. What do men do? Does that awkward conversation while watching porn with your friend count? Or that drunk conversation? Or that random boasting? Or being told to be a ‘mard’ or a ‘man’? Probably not. If you are like most of us you probably have a lot of questions and you don’t know who to ask.
I am a physician specializing in public health, and work with HIV and Sexually Transmitted Diseases. Five years ago, along with my partner Gautam Ivatury, I started a service called ‘MeraDoctor’.
MeraDoctor is one of India’s largest online health services that gives you access to instant medical advice from highly trained family doctors, nutritionists and counselors. Although we built the service to answer all kinds of primary health queries and advise people on medical conditions, nutrition and mental health issues over 50% of the questions that we get from young men are about sex or sexual health. Many of these are very basic, such as questions about penis size or masturbation. If people didn’t lack good quality and reliable information, they would not need to pay someone to answer these for them. But other queries like problems with urination, or erection could be serious medical conditions for which a doctor’s advice is invaluable. Often this help is not sought out maybe due to a lack of awareness or awkwardness, but also because of an attitudinal barrier. People believe that if you do not know something or if there is a problem with something connected to your “manhood”, it makes you less of a man.
Sex, shame and fear
As a young boy when you start exploring sex, what you first learn is that sex is associated with shame, that it is dirty. Then you hear myths about your manhood – and how precious it is. Someone probably told you that you masturbate (“hasth maithun”, “muth marna”, “hilana”) too much and you won’t grow tall or that night fall (nocturnal emissions or “dhat”) will leave you with no sperm left.
You were also probably told that size matters, that some boys are pansies or “guud” and therefore abnormal, that you need to dress in a certain way, women need to be ‘dealt with’ in a certain way. You were also taught that sex is mostly about YOUR pleasure. What all of this does is confuse you as a young adult.
All of the above are obviously wrong. In the chaos of myths being pushed as facts, and things that do not need fixing being propagated as problems, the very important information gets lost. Because of course there are also serious sexual health issues that men should worry about and get help for.
The most important thing that we need to be able to understand first is what IS and what IS NOT a problem – and that is what I hope to help you figure out in this handy guide.
Things that most likely are not a problem
- Penis Size
Don’t worry about this at all, you are fine! The average size of the erect/aroused penis ranges from 3.2 inches to 6.5 inches, but even lower sizes don’t make a difference to the ability to have sex, please one’s partner or have children. The aroused female vagina only extends between 3 to 4 inches, and even here, the most sensitive parts are towards the outside.
Girth (thickness) is a little more important, but most important is how you use it. So please focus on the person you are with and make sure your partner enjoys the experience – there is really nothing more important than that in sex. Anyone who tells you that size is important doesn’t really know what they are talking about. The only way to increase penis size or girth (thickness) is through surgery, but this is painful and risky. None of the pills and creams that are marketed for increasing penis size have been shown to work… We don’t recommend surgery or any medicines.
Masturbation is often the first sexual act experienced by most men and women. In children, masturbation is a normal aspect of the growing child’s exploration of his or her body. Most people continue to masturbate into adulthood.
For more masturbation myth busters, click here.
The medical community considers masturbation to be a natural and harmless expression of sexuality for both men and women. It neither causes any physical injury nor any harm to the body, and can be performed in moderation throughout a person’s life as a part of normal sexual behaviour. It will not affect you or your ability to have children in the future. So go ahead and masturbate 🙂
- Night fall
Most young men know what this means – sometimes waking up with moist underpants or a drying patch. This fluid coming out of your penis at night is semen. Semen, also known as seminal fluid, is a body fluid that contains sperms. It is secreted by the sexual glands and this phenomenon is called ‘Night fall’ or nocturnal emission or wet dreams or ‘swapna dosh’ in Hindi.
It is normal and nothing to be worried about. It is not an illness but a natural process by which old sperms come out and make space for new sperms. New sperms are produced continuously in our body and old ones are pushed out. It does not cause any physical harm or weakness.
- Being attracted to boys or being attracted both boys and girls
You might be a man attracted to other men. Or you might find yourself attracted to men and women. You might also find that you are born as male but don’t quite feel comfortable with that. Perhaps you don’t physically or emotionally identify with your body or your sex. Perhaps you feel more like a woman – or you don’t feel like either man or woman but some of both. Sexual orientation or sexual identity can be multiple and varied. None of these are medical problems that need “fixing”. It might be helpful to get community support and visit a good counselor to understand your choices and needs better.
Things that could be problematic are of two types
I. Problems with sexual function
1. Premature Ejaculation
Premature ejaculation (PE) occurs when a man experiences orgasm and expels semen soon after sexual activity and with minimal stimulation. It has also been called early ejaculation, rapid ejaculation, rapid or premature climax or “pani jaldi girna” in Hindi. This can be psychological or can be caused by disease. If this continues to be a problem then you should seek help.
The ideal first port of call should be a General Physician. Do not worry, most good doctors should be able to give you very useful advice. Only if you are not able to resolve the matter with your General Physician or do not have one you are comfortable talking to, you could visit a trained sexologist.
2. Erectile dysfunction
Erectile dysfunction is when you can’t achieve or maintain an erection during sex. This can have many causes – some of them can happen to anyone. For example stress, anxiety or alcohol consumption can lead to problems with erection. However, this can also be caused by medical conditions like diabetes or heart disease. Either way – if this persists for weeks or months this can be a big problem and it is best to seek help.
Again a General Physician or a sexologist will be the best people to help you.
II. Sexually transmitted diseases and other male genital problems
Safe sex is an important protection against a large range of sexually transmitted infections, some of them very deadly. Practicing safe sex (using condoms) significantly decreases your chance of contracting STDs.
If you are sexually active and not in a long term mutually monogamous relationship it makes sense to get screened for STDs. Your General Physician should be able to help you decide what tests to get and when.
There are a wide range of STD’s with varying symptoms, some of them can be easily cured, but many of them can also be fatal if they are addressed soon enough.
These are some top signs that should not be ignored:
- Pain/burning during urination
- Feeling like urinating often
- Pain during ejaculation
- Abnormal discharge from penis
- Swelling of testicles
- Blisters, boils or sores on the penis.
Your family doctor is the best person to help with these.
The key is to get the right kind of help. Usually it is best practice to speak to your General Physician first, who can examine and guide you to a good sexologist and/or andrologist if needed. However, sometimes the General Physician is someone known to the family and you might not be comfortable discussing this with them. In this case you can also approach sexologists directly, but ensure that they are have an MBBS degree in addition to their qualifications in sexual health and sexual medicine. We also have a range of qualified doctors on our MeraDoctor app who can guide you too.
Male sexual health does not have a one stop shop, but the first steps to getting help is to understand what needs fixing, what the warning signs look like and getting to know your body better. The next step is not feel awkward, embarrassed or panicked if something does go wrong – but to just reach out to the correct type of doctor and get help. Women go to gynecologists, and I hope you now know where men go to.
Dr. Ajay Nair is a trained physician who graduated with an MBBS from Grant Medical College, Mumbai and an MPH from Harvard University. He is also the the co-founder of MeraDoctor, one of the largest and fastest growing digital health platforms in India. He has also worked with Acumen Fund in New York and Nairobi, the Avahan HIV-AIDS program, ICICI Bank and the Government of Maharashtra.