Dear Dr. Milrod:

I am a happy guy in my 20’s. I have a great job and now an awesome girlfriend for the past four months. I try to do my best to satisfy her sexually – I like paying attention to all her body parts and making sure she doesn’t get bored in bed. Recently, however, we had a big fight about how she says I’m always hurting her in some way. The final straw was when I accidentally pulled on her hair extensions and she had to go get them fixed. I was in the dog house for days! What am I doing wrong?

Garren in Playa Vista

Dear Garren:

I can understand why this is becoming a sore spot in your otherwise happy relationship! There is a fine line between pain and pleasure, and sometimes, it takes some time to figure out what makes a woman tick. Here are some of the worse offenses in the bedroom – please try to avoid engaging in them as best as you can:

1. “Motorboating”
Usually done between the breasts, i.e. painfully squeezing two breasts together, pushing your face in between and making revving engine noises, in the belief that this is funny, or worse, even sexy; it is mostly painful, the sound is distracting and it activates pain neurons instead of pleasure centers in a woman’s brain. This is the evil cousin of:

2. “Vacuum cleaning” or “plungering”
Imagining that the clitoris needs massive stimulation and sucking onto it like a bat in heat, or worse, a toilet that’s clogged and needs to be fixed. Don’t believe the oafs claiming that it brings women to ecstasy – it usually has them sprinting out of bed and screaming for dear life.

Both of these offenses are the directly opposite behavior of “speaking slowly but carrying a big stick.” In other words, be gentle with your tongue and lips unless told otherwise.

3. Indiana Bones and Raiders of the Lost G-Spot
Someone told you to make that “come here” motion with your one crooked finger, and you went looking for the G-spot with half your hand. Do not put in more than one finger and go speed wiggling – it hurts. Even worse, it can give a woman a nasty urinary tract infection (UTI) if your fingers aren’t scrupulously clean or begin to irritate the spongy tissue surrounding the urethra. Let her take your hand, gently extend the finger that is most comfortable for you, and let her guide you.

4. Pump up the volume?
No, your penis is not a pump, nor is your woman’s head with the mouth somewhere in her face. Holding her head and jamming it up and down your penis while you dream of impersonating the latest male porn star may look sexy from your angle, but hey – wonder why she’s gasping for breath? That’s because you are unintentionally stopping her from enjoying your love pump! Take your hands off her head, stop pushing and enjoy the gentleness of a slow and sexy blow job.

5. No “rapunzeling” the hair please!
A lot of women have pricey and beautiful hair extensions these days, and while in the heat of passion hair pulling is not unusual, proceed with caution. Many sexual experiences (and relationships!) have come to a screeching halt because a guy ended up with a woman’s weave or a clump of extensions in his hand. If you really want to know, start by gently touching her locks. If she pulls her head away, be discreet and understanding, and leave Rapunzel alone. In time, you will be let in on all her secrets – for now, only the hair dresser knows for sure.

6. Avoid the Hershey Highway unless she gave you explicit directions
This is mostly for your own good (and that of hers, of course). Sometimes the desire to “try something new” is overpowering, in this case engaging in insertive anal sex without having gone through some necessary preparations. Make sure she says it’s OK, and then has the time and the tools necessary to cleanse and prepare for a pleasant experience. Because even if it’s pleasurable for both of you in the moment, withdrawing a brown penis can cause a bit of a visual shock and put a damper on any future experiences – for both of you.

Christine Milrod, PhD

Dear Dr. Milrod:

I am an IT professional, divorced since 15 years ago, no kids (don’t want them), with a really unusual problem on my hands. Four months ago, I went on line and found photos of a beautiful escort. After some thinking, I called her and we met – at a Nevada brothel, where she works. It went very well – you could say that it was almost fate! Because now I am really in love with her and want to be in a committed relationship with her. There are some issue that we need to work out, or even possibly “red flags,” if you will. I’m 48, she is 24. She has been an escort for most of her young adult life, but she hasn’t had any long-term relationships for free so this is her first deep one (I don’t pay her for sex anymore). She is also very interested in me and I firmly believe she is in love too. I’m  also becoming jealous, which I think is natural. She has a certified massage therapist “degree”, but hasn’t actually had a real job yet. When I sit down to think lucidly and clearly about this, I see all sorts of problems. But when I am with her, they magically disappear and I just want to put a ring on her finger. Meanwhile, she is worried she won’t have any voice in the relationship if she becomes financially dependent on me. So what should I be including in my admittedly confused analysis?

Unix-Dan

Dear Unix-Dan:

There are several factors to include in your assessment of your relationship and your situation. For one, the significant age difference (which happens both in and out of the P4P world, of course). Many middle-aged men who wouldn’t normally meet younger women encounter them in these situations. In terms of adult development, you’ve got “an adoption” on your hands, at least metaphorically. From a lifespan perspective, she still has some things to experience while you may have been where she was 24 years ago. Depending on her life history (not much dating in the “civvie” world, you say), she may have some “catching up” to do. She may also eventually be ready to settle down and have children, while you don’t want them. Getting involved with a woman 24 years your junior carries its own psychological short-term perks but can become problematic as the relationship goes on. Four months tells me you are right in the thick of an eroto-sexual stew; fast forward a few years and there may be many unforeseen issues of maturity, physical health and general philosophical differences. She may “find herself” and want to fulfill some goals in life that are way past your interests or preferences, or she may find you a stick-in-the mud or unwilling to go along with her likes and dislikes as they befit a person 24 years younger. And of course, psychologically she will be in a relationship that contains different dynamics than may be encountered in a client-provider relationship.

One thing that is very important to understand is that to a sex worker, having sex with clients is first and foremost WORK. Sometimes it means having an orgasm, and sometimes it means just going with the motions to service the client – for a good example of this, watch Jane Fonda’s award winning performance in “Klute.” It does not mean that a provider is disgusted or feel forced –  it’s very much like any other job, good days and bad days. This is very difficult for the average male to comprehend, since a man needs to generate enough attraction toward his sex partner to maintain an erection, while for a provider [that’s another term, in addition to sex worker], no such need is necessary. Hence, men will project their aversion toward having sex with someone unattractive or unappealing onto their provider girlfriend. You may vacillate between having pity on her or simply feel disgusted on her presumed behalf. In addition, there is the evolutionary adaptation of sexual jealousy, which serves to make you angry when thinking about her and other men. For some men, this tends to be a problem that goes away with time. For others, it’s a complete deal-breaker and an insurmountable obstacle to a long-term relationship. Hence, even if it is difficult to bring up  – talk about it, process it, detoxify it. The more you process it, the more you’ll elicit and will be able  to resolve or compromise.

But perhaps the biggest concern in all this is not emotional – it’s financial. Women planning their exit strategies from sex work have a very difficult time making it work, unless they have a solid education or savings that can last them for a few years. Brothels are very “orderly” places – you get a check, taxes are taken out (if you are in Nevada). To transition from such a place to “real life” takes some serious wherewithal. In addition, she may find that it is much more difficult to earn a living in the “civvie” world – after all, she will be competing in the certified massage therapist marketplace, where earnings in general are lower than in the sexwork business. Does she have a financial cushion or is she expecting you to “buy her out?” Are you going to support her, have her move in with you, marry her, become somewhat financially responsible for her? In addition, you may be so afraid she will go back to sex work, that you might extend yourself financially just to make sure she isn’t going to abandon her civilian life if no money is coming in. Since she “can’t feel she has ‘any voice’ in the relationship if she is dependent on you financially,” she will truly benefit from working out a real budget and stick to it. The financial transition is every bit as stressful as the emotional work that goes on between the two parties and this is where the relationship can really fracture. She is moving into a completely different role, while you are staying in the same.

I understand that you are both deeply in love; I would, however, focus on some very mundane things like finances, budgets, schools, real-life nuts-and-bolts issues, so that you can feel the “realness” of the situation. Oftentimes, it becomes much easier to hang your emotions on concrete real-life solutions rather than metaphors and fantasies. There is so much unspoken “mystery” in sex work and people often fear what they don’t know. If you can discuss every day issues, detoxify the experience and normalize the work by talking about it, demystifying it, and engage in some every-day strategies and ways to “recouple” at the end of her work day, it may feel a little easier for you to trust that you are the only one who matters to her. And then see an accountant, attorney, and therapist before you take the plunge.

Christine Milrod, PhD

Dear Dr. Milrod:

I am a woman in my mid 40s with a fraternal twin brother. We live in Los Angeles not too far from each other. I am very close to my brother and his wife. Recently, she confided in me that my brother dresses like a woman and that it keeps happening more and more. It started just in the bedroom but has now escalated to the point of him talking about taking hormones off-and-on. His wife confided in me that he acts like a woman during their love making (I found this very disturbing to hear), and that he prances around afterwards in a robe around the house. She is confused by this but she loves my brother, so she is trying to go along with whatever is happening. He has said absolutely nothing to me about it. To me, he has always been fairly manly. Why is he acting like a woman sexually? Thank you for your help in clarifying this!

Eileen F.

Dear Eileen F:

I no longer use the word “cross dresser,” as I find it inadequate in its description of gender variance. Rarely does an individual dress only because s/he likes clothes or lingerie of the opposite gender; instead, the individual is expressing his/her degree of gender variance that resides deeply within the person and generally escalates as the years go on. What may have begun as an eroticizing of the individual’s female self in younger years when testosterone levels were high and sexual expression was at the forefront, often begins to take on a much deeper sense of significance post-andropausally. The individual may be “partially transgendered” (a term I use to detoxify and neutralize the often derogatory “cross dresser” label) and moving toward a more internally bi-gendered self or even fully transgendered persona. This is very frequent among individuals in my practice. Someone who in his pre-40s used the female self for primarily erotic purposes may wish to integrate more and more of an unrepressed female identity beyond sexuality after 40. The individual begins to seek gender comfort which includes both sexual behavior components and also selfhood in the opposite gender.

Some of my clients endeavor to live a bi-gendered life; their wish is to live in a work role as male, but slip into a female role at home. This includes engaging sexually as a female – passive intromission with dildos or vibrators, the other partner becoming the sexual aggressor, etc. For these men (usually they are male), this becomes an impossibility unless the wife accepts and can integrate the two personas. For others, transitioning is the only way out. I do have my own theories regarding brain chemicals and the influence of gonadal hormones – I believe there is a reason for why the degree of physical gender dysphoria increases substantially during or post-andropause in these men. Suppression of the female gender works as long as there are sufficient androgens to fight against the need for estrogen in the brain – this is why there seems to be so much comfort and real internal peace once the individual is put on weak non-transitioning levels of estrogen or androgen suppressors.

In any event, I believe it would be useful to pursue the meaning of your brother’s gender rather than just make this into a sexuo-behavioral problem. It is entirely possible that he is moving toward transition and is not able to fully express this without fear or trepidation. Even if he is going toward bi-genderedness, dressing in private is no longer an option, since one lives life at home “in private.” Home IS private and hence s/he probably feels the need to express his/her true self unrestrictedly in this environment. As to his wife, yes, it is an arduous road toward acceptance, if that is what she will end up doing. Gender issues don’t go away – they become stronger and stronger as the years go on. If she forbids her husband’s expression, he will just take it somewhere else. I believe sex is the least of their problems – it is their open realization that he is part female, at least to himself. They need to investigate what this brings to their mutual relationship, and how they will negotiate it in the end. It will surely never go away.

Christine Milrod, PhD

Dear Dr. Milrod:

A 30-year old acquaintance of mine from northern Europe is getting married to his American girlfriend. She is Jewish, he is a Scandinavian atheist. She is now demanding that he undergo circumcision before marriage, or else her parents will not accept him as her husband. He is mostly afraid that he will lose all sensation in his penis, and that “sex will become worthless.”  From what I have read – everything from Masters and Johnson, to discussing this with urologists, colleagues and friends – circumcision does not seem to affect the sexual experience at all. Some reports I have read have even stated that sex is more enjoyable after circumcision. Above all, women seem to prefer circumcised partners, but maybe that is just in the United States. In addition, new research has shown that circumcision reduces HIV infection by over 50%. In short, I have told him that he need not worry, and that my recommendation is that he should undergo circumcision and become happily married. His fiancée is fantastic and they love each other. Nevertheless – what is your opinion on the matter?

Dr. B in Beverly Hills

Dear Dr. B:

There are many factors to consider in this case. My response is informed by formal studies, anecdotal evidence, personal bias and knowledge of Judaism and its practices, including my experience in counseling Orthodox as well as secular Jews. First of all, it is important to ascertain the particular affiliation/branch of the fiancée’s Judaism. This has a bearing on the type of circumcision that will be accepted, should this man consider going through with the procedure. If she is Orthodox or Conservadox/Conservative, a proper bris will be necessary, complete with removal of a substantial amount of foreskin. If she is Modern Reform, the Rabbinical Council (or just the rabbi) may be satisfied with a symbolic bris, drawing blood from the penis but leaving the foreskin intact. This is something that needs to be discussed with the Rabbi, as I am assuming this man is also converting? Without his religious conversion, there is no sense in circumcision, as a mere procedure will not make him a Jew in any fashion.

The family needs to abide by the rabbinical edict or counsel in this matter. If the family is insisting on this procedure without guidance from a rabbi, then the procedure is questionable. Most likely, the procedure will be performed in a hospital by a physician, although if these people are really frum, i.e. highly Orthodox, there may be a mohel involved. If the surgery is successful, he will not lose complete sensation, but his sensation will surely be diminished. As the glans continues to be exposed to air, rubbing of fabric, etc., it will slowly keratinize. In addition, he will lose some ability to self-lubricate. This will have consequences on his technique and style of intercourse. He will no longer be able to use the same technique in terms of intromissive intercourse. Since he is no longer self-lubricating, they will need to rely on her ability to lubricate from excitement. In view of the fact that some women’s lubrication diminishes due to lack of sexual excitement throughout years of accommodation and habituation to the same individual (i.e., it may take her longer to get excited), in addition to hormonal changes, they may now become steady consumers of lubricants. In addition – and this is probably the worst aspect for a woman – the penis will no longer be “screwing” itself into the vaginal cavity with the help of the prepuce and the natural lubrication. He will need considerably more friction, which, in slang terms means that he will “bang” rather than “screw.” This can cause considerable dryness if the sex act is prolonged, and may give her pain after some minutes of intromissive sex.

If the surgery is less than optimal, he could experience a variety of issues as the penis heals. The loss of frenulum where there are extreme nerve endings responding to pleasure cannot be overstated. There are no guarantees except one – he will lose some sensation.

Dear Dr Milrod:

My issue is one of being turned on more by the hunt/chase of the opposite sex rather than the actual act of sex. I have a hard time getting into serious long-term relationships, not because I don’t want to be in them, but for a reason I can’t quite understand. When people initially meet and begin to date, there is that mutual attraction between them with the flirting, the teasing, and the posibility of the unknown. A few dates go by and things become more and more physical – you finally have sex. Say the two of you decide that this is the beginning of a relationship that neither of you expected, but you feel like it could be something you both could enjoy, so you go for it. For me this is where the problem begins. Things start to go sour, and the whole thing eventually implodes and you both go your separate ways. It’s a rut I can’t get out of; there is nothing else for me. Should I start over with someone else? It sure feels like it.

Geoff, 42

Dear Geoff,

I would suspect that many, many people in the Western world share your feelings and your concerns. In today’s day and age, what is really required from all of us in the relationship arena? We definitely don’t need each other to have children – you can fix that with adoption, inseminations, single biological parenthood, etc. We also don’t need to stay together for financial reasons. The subsistence farms are long gone, women have their own financial resources, and theoretically, you could stay inside of your own four walls 24 hours/day and still be a functioning member of society, should you so desire.

In agrarian civilizations, people still depend on extended families to survive. We don’t even depend on the nuclear family to stay alive. And that’s my point. Our impetus for “banding together” is gone. Now being partnered is called “a choice.” So the push isn’t quite there. I believe that whole skewing toward singlehood, at least in the larger metropolitan areas, has profoundly changed our relationship dynamics. Yes, we still have our sex drives to contend with and satisfy, but the ‘cost’ to do so in terms of financial and emotional sacrifices has greatly lessened. Imagine the post-war 1950s: frequently, heterosexuals got married right out of high school or during the first years of college. Women often dropped out to support their husbands through graduation. Divorce really didn’t come around until after the launch of the Pill in the 1960s. Hence, the ‘value’ of a relationship was high and real. But what does it mean in terms of cost-benefit ratio to you?

Perhaps what you need to assess within yourself is your motivation to have a lasting relationship at all. Is it necessary for you emotionally? Financially? What are your views of women? And finally and most importantly: Are you willing to make the sacrifices and compromises required to make a relationship work?

From a purely biological standpoint, our bodies are constructed in a most ingenious way. We are designed to procreate, and neurotransmitters and hormones are built into our systems to ensure precisely that. So when you first meet someone, your dopamine receptors act in certain ways – interestingly, if you really ‘fall’ for someone, you experience a dopamine deficiency when you’re not together – the levels of phenylethylalanine (PEA) rise in your brain, inducing all sorts of pleasurable, lust-filled feelings…and that goes on for about a year to 18 months. And suddenly it’s gone! One of the reasons for the presence of these brain chemicals is to induce us to engage in sexual procreative activities as much as possible so that an impregnation will take place, and a little consequence will pop out in due time. But when the brain chemicals are gone – and they will be, even in the most determined, love-crazed human being – then reality sets in. And reality is frequently boring and uninteresting. Your partner smells sometimes. Your partner has nothing to say, or even says irritating things. S/he used to sound so cute, remember? Now the person snores, has PMS, bad breath, bad taste, you name it. That is the “sour” part. And that’s when most ‘in-love’ junkies check out. Why should they stay on if there’s no real need? Now, those who can tolerate the pain and disappointment of realizing that their partner is human and still stick with him/her, their reward is the experience of reciprocated, deepened human emotion. It’s not “sex,” but it may be “love.”

Love is comprised of many conscious acts – many sacrifices, many compromises, many decisions that are not fun, or remotely have to do with what we popularly think of as “love.” And in that sense, it is work. But if you plug away at it with dedication and belief, you may glimpse “lifelong intimacy” and enjoy a lasting bond with another human being.

Many of these existential questions start showing up on the radar screen when we reach middle age and begin to take stock of our lives. There are also studies that consistently show that married men live longer, are healthier and generally more pleased with their lives than unmarried ones. For some older men, the reality of being unattached can bring on unexpected issues. Once those levels of testosterone die down, once the thrill is gone, the chase is over, some experience emptiness inside. Perhaps it is the missing intimacy that shines through. This does not necessarily represent a major tragedy – it becomes more like a lingering melancholy and wistfulness over long lost conquests or The One That Got Away. This is when many men either throw themselves frantically into a last stab at being swinging bachelors, or, they bite the bullet and try to live with some realistic choices. So you need to ask yourself some questions and then give yourself some honest answers.

Christine Milrod, PhD

Dear Dr. Milrod:

I have two children, a son 11, and a daughter in elementary school. My daughter has a developmental disability whereas my son’s child development has been normal. He is a bright boy, athletic, active and happy. He plays computer games and does the usual boy things with his friends from school. At night, my wife puts our children to bed – ours. She has been doing that for as far back as I can remember. This has resulted in no private sex life for us as a couple. While it’s been so long that I’m no longer upset about it and have accepted it as fact, I’m beginning to wonder if it’s normal to have an 11-year-old boy in bed with his mother.  He is beginning to sprout hair on his legs and he is tall for his age. I have raised the issue with my wife but she refuses to listen, claiming that it’s natural and healthy for the kids to sleep next to her. Is this really so?

Henrik, 50

Dear Henrik:

You are correct in assuming that it is neither recommended nor psychologically healthy for your son to sleep in his mother’s bed at the age of 11. While longitudinal research has shown that children up to 6 years of age have had no psychological or developmental consequences from parental co-sleeping, a boy of 11 years is another matter. From a biopsychosocial perspective, he is entering puberty and adolescence. Not only will his secondary sex characteristics such as hair on his legs and face begin to manifest, he is also going to experience an increased frequency of erections, both during waking and sleeping and also nocturnal emissions, i.e. “wet dreams.” From a social perspective, he will begin to establish his independence from his mother while there will be a simultaneous need for increased peer interaction. There will also be an increased need for privacy, in which he can become familiar with his sexual impulses, his preferred way of masturbating and sexual fantasizing. It is highly inappropriate that he experience this with his mother next to him, as it could needlessly stimulate him, confuse him and even make him feel guilty and somewhat “wrong” about doing what is otherwise developmentally healthy. In addition, the possible erotic stimulation of being near his mother could set him on an atypical sexual scripting path that might discourage him from eventually engaging in healthy sexual interaction with his peers, be they of opposite or same-sex orientation.

You will need to discuss this with your wife; after all, it is possible that she is having some abandonment or attachment issues that have influenced her to seek comfort in an affectionate relationship with her children. Even your daughter, regardless of her disability, needs to learn how to sleep in her own bed. For now, the behavior must be stopped and some in-depth communication must occur so that your wife understands the inappropriate and possibly damaging effects of her preference.

Christine Milrod, Ph.D.

Dear Dr. Milrod:

I’m a single Dad in my early 40s with a pre-teen daughter. In our sessions, we’ve mostly been discussing my issues, but I really want to know – what is your philosophy on sex education of children?

Paul D, West LA

Dear Paul:

It is my belief that while parents who came of age in the 1980s are more informed about sexuality than any previous generation, their offspring are receiving conflicting messages about sexuality, ranging from polyamory to abstinence. On one hand, parents of young children worry incessantly about sexual predators and deviants lurking not only in the streets, but also on the ever-present Internet on various sites targeted toward the young. On the other, children are living in a heavily sexualized culture where eroticized dolls and new mutations of adolescent singers of both genders are out to sell the message of seduction. In addition, sex play/erotic relations between ever-younger children are taking shape in cyberspace, via text messaging, chatting and in playing games where no physical contact is needed. Against this background, I believe that children are struggling to make sense of their growing bodies, their sexual responses and the evolution of their own desires. Sexual role modeling comes less and less from parents and more from the media, intent on selling and promoting a specific type of desirable sexuality which is more void of intimacy and emotional connection than ever. More than ever before, American society has become extremely polarized and I believe that sex education needs to incorporate various non-judgmental presentations of both physical and emotional components of sexuality, particularly directed at young people.

Christine Milrod, Ph.D.

Dear Dr. Milrod:

I am a 30 year old normal, average guy. Recently I come to find out that there  is this fat girl at my job who wants to date me. I am not attracted to her, mainly because she is about 5’7” but weighs at least 140 pounds. I told a co-worker that I wasn’t attracted to her, and she said I shouldn’t judge. Am I a bad person for not wanting to be with someone that I dont find attractive? What am I supposed to do? Feel sorry for her? If you have a pretty face, and you let yourself go, that is your problem, not mine!

Rick T.

Dear Rick T:

First of all, there is no official directive that tells you that you are “supposed to feel sorry for fat women.” Women come in all sorts of permutations – in fact, there doesn’t even seem to be an agreement of what is considered “a fat woman.” Granted, there is the governmental definition of obese, so if you are talking about obese people, then you can feel both sorry and alarmed, since it’s a medical condition that qualifies for help. But if you are talking the movie star definition of what’s fat, then 99% of the American population will qualify as fat, in comparison to the seriously anorexic movie and television star ideal that presently reigns in mass media. Fatness is culturally determined, don’t forget that. What we think is “fat” qualifies as erotic and attractive in some other cultures. Also, some men are genuinely attracted to women who are considered “fat” in the dominant culture; however, you may not be one of them – and that’s fine. Evolution has selected for traits in men that prefer women that are somewhere in the middle – not too fat, not too skinny. The key is the WHR, the waist-to-hip ratio which is a reliable indicator of fertility. Thus, a woman can be plump rather than skinny – as long as she has a small waist, men will find her attractive. It is only in a culture of overabundance such as ours that preferences for skinny women have evolved, mainly as a resistance to the fertility difficulties that obese women face. Men are hardwired to breed, breed and breed, so that’s pretty much a no-brainer. But certainly, things have gotten out of hand and now visual images are filled with anorexics who are not necessarily healthy or fertile, judging from all the assisted reproduction going on, even with young women who under normal circumstances would never have problems conceiving.

Now, back to your specific dilemma. You are entitled to your opinion and preference, but why discuss it with people at work? This is bound to cause controversy, not only because it’s the workplace and such things should NOT be discussed in a professional environment, but also because you chose to open up to the girl’s friend. That was a mistake. In doing so, you triggered her friend’s defenses. You denigrated, however subtly, the woman by indicating your lack of attraction for her. Her friend defended her and now you feel slighted in turn.You are not “a bad guy” and you are not supposed to go out with someone you don’t feel attracted to – that would be disingenuous. But by the same token, you also need to examine your belief that fat women “let themselves go,” or even that this particular woman of above average height is “fat” at 140 lbs. It is true that many people lack the discipline that staying within recommended weight ranges demand in our society. But the problem is multi-factorial; to blame it on some kind of moral failing or laziness is just not intelligent. In fact, to me, this represents another kind of laziness, meaning one who is not really interested in finding out medical facts but simply looks at the superfice of it all and assumes that all fat women are lazy and don’t go to the gym.

Hence:

1. Quit discussing personal matters at work, no matter how boring it gets;

2. Get on line and begin reading up on the root causes of obesity. You will see that in our society where genes conflict with our lack of mobility, many people – not just women – will have weight problems;

3. Try to engage your thinking on a deeper level – ask yourself what is it that triggers these emotions in you? Oftentimes, when we displace anger on a particular group of people, it’s because we are dissatisfied with something in ourselves, whether it be appearance or abilities. Do you look like a perfect movie star? Are you flawless, in your mind?

4. And finally, realize that there are preferences for everything and anything. There are so many more important things to worry about. For now, just count your blessings if you don’t have to concern yourself with body weight, even if you can’t “feel sorry” for those who are less fortunate, no matter what their gender.

Christine Milrod, Ph.D.

Dear Dr. Milrod:

I am 28 years old and in a great relationship with a girl I’m planning to marry. Recently, we’ve had some sexual difficulties and we want to get them resolved. It turns out that my girlfriend complains about my super hard-on. She says it’s really painful. Is this really possible?

Carter

Dear Carter:

It may not be the erection itself that hurts your female partner – it’s the propulsion with which you force the rock hard object into the vaginal cavity. If she is not sufficiently lubricated, then it’s going to hurt having something go in and out with some pressure and force. Another possibility is that if you are in a position where you penetrate her deeply, you may be bumping into her cervix, which can also cause pain. Lastly, one issue may be if you are taking meds for erectile dysfunction. Oftentimes, this can turn an erection into a very hard penis; in fact, some men report feelings of near numbness or a “woody” penis, which can reduce sensation and cause you to push too hard to experience excitement and orgasm. Please take it very slow and make sure you excite her so that she will lubricate naturally (use extra waterbased lube if you are wearing a condom), and that her vagina will expand naturally and make room for the penile propulsion.

Christine Milrod, PhD

Dear Dr. Milrod:

My wife and I just found out that we are expecting a boy. Needless to say, we are overjoyed, however, we have this nagging issue of circumcision to deal with. I’m Jewish and my wife is Latina and Catholic. Neither one of us really care about religious traditions, but both sets of in-laws are now pestering us about the whole circumcision issue. Her parents don’t want it, while mine insist on a bris with all the trimmings.There is some controversy regarding circumcised vs uncircumcised penises. I heard about some studies that showed circumcision to reduce the risk of HIV. My question to you is, are there any substantiated health benefits to having a circumcised penis?

Harvey in the Hamptons

Dear Harvey in the Hamptons:

Adult male circumcision has been found to reduce the risk of acquiring HIV in men by around 55-60% in three randomized trial studies in Uganda, South Africa and Kenya, where HIV/AIDS is endemic. Heterosexual vaginal intercourse is the predominant mode of HIV transmission in these countries.
The studies found that circumcision did not provide complete protection against HIV, however the researchers concluded that circumcision reduced the risk of HIV acquisition in the study groups. While there were high rates of HIV acquisition in both arms of these studies – the circumcised and the uncircumcised – rates were lower in the former group. The results of the studies do suggest that widespread circumcision in Africa could reduce HIV transmission by hundreds of thousands. And while consideration is being given to implementing such programs in African countries, relying mainly on circumcision to prevent HIV presents some problems:

If more men decide not to use condoms because they have been circumcised, HIV transmission may increase.
Male circumcision has no effect on women’s HIV risk.
Circumcision may reduce women’s ability to negotiate condom use.
Circumcision is a complex cultural practice, with identity and religious connotations in many cultures.

Now I believe that parents in the US should NOT consider the results of these studies as a reason to have their child circumcised. Looking at heterosexual transmission in the United States, the protective factor for the male partner is very low (and again, male circumcision has no direct effect on female partners’ risk). An American male heterosexual, non-injecting drug user’s risk of HIV infection is very low. These low rates of transmission and risk do not justify widespread circumcision in the general population of the United States.

Circumcision for men who have sex with men is slightly more controversial. HIV risk is highest for the receptive partner during male-to-male anal intercourse, and research shows that most men who have sex with men will be both a receptive and insertive partner. For the realtively small number of men who are only insertive partners and who engage in unprotected anal intercourse with casual partners, circumcision may have a protective effect.
Circumcision does not prevent HIV; further, male circumcision has been shown to have no effect on transmission through receptive anal sex, which is the most common SEXUAL risk activity for HIV transmission in the US. Circumcision has no significant impact for heterosexual or homosexual transmission of HIV in the United States. Finally, condoms are still the most effective means of preventing sexual transmission of HIV and other STDs.

Christine Milrod, Ph.D.