Very few topics can elicit the number of wide-ranging emotions and spark as many debates as sex. But how has a topic that is essential to the human experience become so taboo? Mainstream television portrays sex casually, and pornography has become so prevalent it’s almost commonplace. At the same time, politicians are still fighting about access to birth control and whether to continue funding Planned Parenthood, an organization that provides healthcare services and information on sexual health.
Honest discussions about real-life sex and all its pros and cons are critical, but good questions are often asked in secret while the louder voices project perspectives that are sometimes unrealistic and even untrue.
Fortunately, there are resources available right here at UH, one of which is the Counseling and Psychological Services (CAPS) directed by licensed clinical psychologists and AASECT certified sex therapist, Dr. Norma Ngo. As a sex therapist, Ngo deals with multiple facets of sexuality ranging from abnormal sexual behaviors to gender identity, and she stresses the importance of communication and individuality of sexual expression.
Cooglife recently gathered questions from students for Dr. Ngo’s professional point of view to not only satisfy our curiosity, but to continue the effort to destigmatize sex talk.
How do you become a sex therapist?
Keep in mind to become a sex therapist, you will need to be post-degree and licensed (at the master or doctoral level). It is equivalent to doing a 2-year postdoctoral fellowship or residency. https://www.aasect.org/aasect-requirements-sex-therapist-certification
What lead you to this role?
NN: My interest in promoting sexual health and sex-positive information about sexuality. What is communicated about sexuality in our culture tends to be more sex negative, e.g., preventing unwanted pregnancy, sexually transmitted infections, sexual assault. Individuals are not encouraged to have open and honest communication about their sexuality, to explore and communicate what they find pleasurable, or acknowledge the existence of a wide range of sexual behaviors and attitudes. There are a lot of sexual myths that can be clarified if we have more open and honest conversations about sex. I also wanted to practice sex therapy to give people the space and opportunity to process their sexual concerns and attitudes without the fear of shame and judgment.
Is it normal to have a harder time getting “wet” (vaginally lubricated) when you’ve been in a long relationship?
NN: There could be a variety of factors that may contribute to a woman experiencing less vaginal lubrication. The degree of lubrication depends on the woman’s arousal and hormone levels, which may be an issue in a short or long term relationship. One of the most important factors may be the quality of the couple’s communication about what they each find arousing and pleasurable and their on-going efforts to communicate to each other when changes occur or when sexual activity becomes less desirable. It’s also important to note that women tend to require more time to become aroused then men. This gap narrows as men age. Insufficient lubrication may be caused by psychological or physical factors. Psychological factors such as anxiety, guilt, or fear during sexual activity may result in less lubrication. Conflict between the woman and her sexual partner may also contribute to inadequate lubrication. Too much stress, focus on performance and less on what is pleasurable are all possible psychological contributors to less vaginal lubrication. Physical factors may include medical illness/condition, post-menopause, drug abuse, or side effects of various medications, may all impede sexual arousal and inhibit lubrication.
What positions do you recommend for men with larger than average penises to avoid causing their partner any pain?
NN: Let me first preface my response by saying it depends on the specific man and his sexual partner. But generally, the level of arousal, lubrication, and position of the woman can really make a difference in lessening or avoiding pain during penetrative intercourse. This is true regardless of penis size. The vagina is capable of stretching and expansion. After all, it can accommodate birthing a baby. The more time spent on foreplay will help build arousal and increase lubrication levels which expands the vagina, creating a tenting or ballooning effect that can accommodate a larger size penis. Specifically, sensual touching, kissing, and inserting the man’s fingers and using them to stretch the vaginal opening (gradually increasing the number of fingers) can help build arousal and relax the vaginal opening. In some cases (as may be the case when the woman experiences more pain), a gradual stretching process may be necessary and she can do this on her own with the use of vaginal dilators (as there are a variety of sizes). Regarding positions, trying out different sexual positions is unique to each couple. Generally, those that allow the woman to have control over penetration and movement (e.g., being on top) are recommended. A second option might be for each person to lie on their side facing each other. The woman will lift her top leg while the man attempts to penetrate her. Once he has penetrated, she can lower her leg and rest her ankle on top of his. This position is good because it allows for eye-contact and kissing, similar to the missionary position. The man can angle his body so that the base of his shaft rubs against her clitoris, which can be a magical combination. I want to emphasize that the best position will depend on the uniqueness of each couple and the arousal level of the woman. Communication is critical as the couple experiments with what works best for them. It is important to talk to your partner and let them know what feels good and what is uncomfortable. Understanding ahead of time that honest communication will help you to ultimately achieve more pleasure and comfort versus not saying anything because you are afraid of hurting your partner’s feelings.
Should swallowing be avoided?
NN: It depends. If you perform oral sex on a man who has a sexually transmitted infection-STI (e.g., chlamydia, gonorrhea, syphilis), you are at increased risk of contracting the STI, whether you swallow or not because the risk stems from having the ejaculate in your mouth. If you are not absolutely certain about the man’s STI status, you should use a condom during oral sex to prevent contact with his semen. If the thought of performing oral sex with a condom is not appealing, you might want to try the many flavored condoms available out there, which is a better alternative than contracting an STI. If you are absolutely certain the man does not have an STI, there are very few risks associated with having his ejaculate in your mouth or swallowing it.
What is a healthy amount of masturbation?
NN: A healthy sexual life includes masturbation across the lifespan. The amount is different for each person, and hard to quantify given the uniqueness of an individual’s sexuality. Masturbation isn’t like medication where there’s a recommended dosage. Generally speaking, however, there may be a sign of problems if the individual’s masturbation is causing them distress or is disruptive to their life. To help assess if your masturbation is problematic, ask yourself the following questions:
- Is your masturbation getting in the way of your life in undesired ways?
- Are you using masturbating to avoid something?
- Is your masturbation causing (undesired) physical pain or damage to your genitalia?
- Do you have any problems with orgasm or ejaculation alone or with your partner?
- Do you find yourself literally unable to stop masturbating?
If you answered yes to any of these questions, you may consider talking to a professional to determine if there should be reason for concern. However, I do want to stress again, that there may be times in your life when it feels perfectly fine and not disruptive to masturbate daily or even more than once a day. Remember, there isn’t a magic number because we all have a different sexual template.
How should one properly prepare for anal sex?
NN: Let me first preface by saying that anal sex can be incredibly hot but it can be intimidating, and not for everyone. If you have no desire to try anal sex, then don’t. Just like with any other sexual activity, you should never feel pressured into doing something that you aren’t comfortable with.
- Before having anal sex, you want to make sure you’re clean to enhance the experience for yourself and your partner and to reduce some of the feelings of self-consciousness you may have. Showering with your partner can even be an erotic prelude to anal sex.
- Investing a lot of time in foreplay is critical to heighten arousal and relaxation. This may involve kissing, sensual touching, oral sex, partner masturbation, and vaginal penetration.
- Relaxation is key. If you’re the one being penetrated, you will want to try to relax your sphincter muscle. It’ll take a little time to relax it, so you may want to prepare yourself in advance. To relax this muscle, you may try to insert a lubed finger in your anus and hold it in there for a couple minutes. You’ll feel it naturally loosen up. For some, experimenting with butt plugs is another way to prepare for anal sex. You can either insert it yourself or have your partner insert it as form of foreplay. There are various shapes, sizes and materials, so have some fun finding the perfect fit for you. Just remember to take it slow and don’t pressure yourself into anything.
- Slowly massaging the anus is important before inserting anything in there. The anus is naturally meant to dispel, so you don’t want to rush or it will tighten up. You need to use a lot of lube. Everyone needs some kind of lubricant for anal sex. Water-based ones are best. While the vagina self-lubricates, the anus does not, making lube a requirement.
- Using a condom is a critical factor in safe and enjoyable anal sex. What is absolutely important to keep in mind is that you should not switch from anal to vaginal sex without changing the condom because you will introduce bacteria into your vagina.
- Anal sex is even better when partners are communicating openly and honestly with each other. If something is uncomfortable or hurts, you need to tell your partner and pause to reposition, add more lube, or figure out what’s going on. Pay attention to your body, and don’t hesitate to stop and try it again at a later time. This reduces any pressure and increases your chance of potentially enjoying this on a different occasion.
What is the clitoris, and what is its function?
NN: It is the female sex organ purely for no other purpose than pleasure. According to the Museum of Sex, the outer part of the clitoris contains roughly 8,000 sensory nerve fibers. This makes it not only the most sensitive part of a woman’s body, but also much more sensitive than the penis, which contains around half as many nerves. It is more than a nub that resides under a hood at the top of the vagina. That top part is just the glans, while the internal clitoris consists of two corpora cavernosa, which also form two legs that extend up to nine centimeters and is a wishbone-like shape. The clitoris is the key ingredient to a woman’s orgasms. Most sex researchers would say that the majority of women need clitoral stimulation to orgasm, and that approximately 75% of women are unable to have an orgasm during intercourse without some sort of clitoral stimulation.
If your partner is wearing a condom, should they still pull out?
NN: Again, I am not a medical doctor, so it is best to check with one for accuracy. However, according to Planned Parenthood, if a condom is used perfectly it has about 98% effective at preventing pregnancy, but because people are not perfect and may not always use them correctly, the effective rate is probably lower. Using condoms and another form of birth control such as the pill or IUD may be an even better way of preventing pregnancy and STIs. Withdrawal and condom use may also do the same. However, the decision is an individual one because some are comfortable with using one or two forms of birth control without feeling the need to withdraw.
What are effective ways to communicate with a partner if you are uncomfortable before, during, or after sex?
NN: Communication about sex with your partner is very important and can contribute to the overall quality of your relationship. Unfortunately, our culture does not promote open communication about sexuality and sexual behaviors. Many individuals report feeling uncomfortable because of social stigma and because they do not have the tools to communicate about sex, resulting in misunderstanding and engaging in sexual activities they don’t really desire or enjoy. Being able to honestly communicate about what arouses or interests you can increase your overall sexual satisfaction. Unfortunately, I often hear from individuals that they are hesitant to communicate with their partners about sex because they are uncomfortable or embarrassed about expressing their desires for fear of feeling judged or hurting their partner’s feelings. What is also common is that we assume our partners will magically know what we like in the bedroom and we are less cognizant that each person brings unique desires and arousal patterns to each relationship. I also hear that one partner will not tell the other about something they disliked in the bedroom because they are afraid of making their partner feel inadequate as a lover. The unfortunate result is that the partner continues to engage in the same sexual behavior not knowing otherwise that it is not pleasurable or is uncomfortable to their partner. This can result in sex that is repetitive, undesirable, or even unwanted. One of the best ways to make sexual communication easier is to start the conversation out of the bedroom. Here are a few tips:
- Communicate that you want to discuss what you desire and want to hear from what your partner what they desire.
- Express appreciation to your partner for the things they are currently doing in the bedroom that you do like and want more of.
- Communicate to your partner what is definitely off limits, what is sometimes okay, and what you might be open to trying. Have your partner do the same.
- Each individual has a unique sexual template, your own sexual fingerprint of sorts. Respect these differences by expressing an interest to learn more about your partner. This does not mean you have to know all of their deepest, darkest fantasies or that you have to agree to do any particular activity, but do discuss what you are/are not open to in a nonjudgmental way. At the same time, do not hesitate to be clear about what you are not comfortable engaging in.
- Remember that no matter what you start out agreeing to do sexually, you can change your mind at any time during the process. This should be clearly communicated as an option between you and your sexual partner before you enter the sexual encounter. Consensual sexual engagement is vital for sexual pleasure, so don’t hesitate to agree on a safe word that communicates you do not want to proceed any further.
- Lastly, non-verbal communication via touch can be viewed as less threatening for some individuals. Ask if you can touch your partner and allow them to offer you feedback by directing your hand (e.g. to a different area, applying pressure or varying the type of touch, etc.). Switch roles so each partner has an opportunity to explore and learn more about what is pleasurable for the other.
By continuing to communicate with your partner about your sexual needs, you are building the trust in your relationship, which will enhance the overall quality of your interactions with each other, in and outside of the bedroom.
Why does the female orgasm seem to be so elusive?
NN: In general, we are not a culture that encourages open, positive communication about sex. There is stigma surrounding female sexuality. Not surprisingly, due to less communication and cultural sanction, many women report they have not really examined their own genitals nor have thorough understanding of their own bodies. They may not know what kind of stimulation feels best for them, so they are less able to guide a partner. For a lot of women, they are hesitant to ask questions because they feel if it’s not obvious, it must be because there is something wrong with them that keeps them from being able to orgasm. The reality is often that there isn’t anything wrong with them or how their genitals function, but they have internalized enough doubt which can discourage them from a desire to continue to explore and learn about their own sexuality. There tends to be more of a “culture of acceptance” and perception of power surrounding male sexuality, including the procreative power of the male penis, its size and the general power associated with having it. A male penis is out in the open from birth, encouraging touch and creating a more obvious connection to orgasm. Women’s genitalia is less discussed and understood. Due to mainstream messages, many women are taught to be ashamed of their bodies or they are objectified rather than respected or encouraged to learn what brings them pleasure. There is growing attention and understanding about a woman’s clitoris and its pivotal role in achieving orgasm. Historically, there has been more focus on vaginal intercourse and the expectation that women orgasm via this manner. No wonder so many women feel inadequate and frustrated when they are unable to reach orgasm from vaginal penetration alone. In fact, via penis-in-vagina intercourse, approximately 70% of women do not. However, the likelihood of a female orgasm increases as she moves from intercourse, to receiving oral stimulation, to receiving manual stimulation from a partner, and, finally, to engaging in masturbation (reaching rates of orgasm similar to that of males). The reason is connected to the amount of clitoral stimulation that occurs across these sexual activities (with vaginal penetration having the least amount of clitoral stimulation). While a lot of women do know this, it is still overlooked when she is engaging in partner sex due to lack of knowledge by the (male) sexual partner and lack of communication between the couple.
The following questions were submitted anonymously for a student-organized sex education event
Q: Are HIV/STD tests free? How is HIV transferred?
NN: I believe there are some places in Houston that offer free HIV and STI testing, but I cannot provide you with specific names. I am aware that the Health Center does offer HIV testing a couple of times a year, but you will need to confirm with them if their testing is free.
According to AIDS.gov, most commonly, people get or transmit HIV through sexual behaviors and needle or syringe use. Only certain body fluids from a person who has HIV can transmit HIV such as blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk. These body fluids must come into contact with a mucous membrane or damaged tissue or be directly injected into your bloodstream (by a needle or syringe) for transmission to occur. Mucous membranes are found inside the rectum, vagina, penis, and mouth.
Q: Does the vagina return to its pre-birth state after giving birth?
NN: I am not an OB-GYN, so you may need to check with one for accuracy. My understanding is that it may come close to your pre-birth state but not exactly the same. It depends on how much your vagina was stretched and if you experience any tearing, such as a third or fourth degree tear to your outer vagina. The great thing about the vagina is that it has the capacity to expand and recoil. Given enough time and pelvic floor exercises, you and your partner may not notice much of a difference. Pelvic muscle rehabilitation specialist will often recommend Kegel exercises during pregnancy to keep the muscles toned and taut as possible. After delivery, resuming the Kegels when you are feeling comfortable is one of the best ways to get your vagina back as close to its pre-birth shape and size. Kegels are also good for helping with postpartum urinary incontinence and helps make sex more pleasurable.
Q: When should women start getting a pap smear or mammogram?
NN: Again, I am not a medical doctor so it is best to check with an OB-GYN on this question.