Mr. Measuring Stick: Does Size Matter?

Dear Sexpert,

I’ve only recently started watching porn online, and I’ve seen countless advertisements about “guaranteed” ways to make my penis bigger. Also, the guys in the videos are usually longer than I am. I never really questioned my size before watching porn, and I’m starting to feel as if I won’t be able to please my partner if I don’t do something about my penis size. So I’m wondering: does size really matter?   

Thanks in advance,

Mr. Measuring Stick

Dear Mr. Measuring Stick,

Ah…the age old question that has dumbfounded people for decades — “does size matter?” Well, the answer isn’t as clear cut as yes or no. And we shouldn’t be surprised by that, since sex is rarely that simple and is very individual.

First, let’s clear the air about all the “10 tricks to make you grow 3 inches in 5 weeks” and other clickbait advertisements that taunt you as you browse porn sites – they’re a scam. Dr. Brian Christine, a urologist with the Urology Centers of Alabama, says: “There’s nothing topical you can put on your penis that will make it grow longer…same goes for pills—it’s a complete waste of money.” You’ll see these products marketed with penis-boosting vitamins, minerals, herbs, or hormones, but no controlled studies have shown they’ll provide any benefit. In fact some products might even produce harmful effects. For example, certain toys like cock rings or devices like penis pumps can increase the size of an erection minimally and temporarily. But using them for an extended period of time or producing great swelling can result in discomfort, bruising and even damage to penile tissue.

In fact, the constant debate over penis size can be traced to a deeper issue that permeates throughout our everyday language and popular media, such as music, TV shows, and movies. Often, the size and length of someone’s penis is linked to how powerful or successful someone is, or size comparisons are used to make others feel “less than”. We always hear that people believe that “bigger is better,” (from candy bars to body parts) and that leads to a horrible cycle of competition, where size-enhancing tips and tricks start to become appealing. But, truth is, your penis size doesn’t determine your sexual performance, or your overall worth. Also, odds are, you’re probably doing alright in the size department. The average penis measures somewhere between 3 and 5 inches when flaccid or not erect, and between 5 and 7 inches when erect.

So what DOES matter? Your confidence! And how you are respectful and attentive with your partner(s). If you’re still a little shy about your little guy, focus more on what you can do with your partner that doesn’t involve a penis. You can practice the craft of foreplay and oral sex, or forms of intimacy that don’t involve sex. There are many ways to please your partner without having a long penis. Size makes no difference at all as long as you and your partner are openly communicating, and happy and comfortable. That said, there are some ways to make your love muscle flex a little harder. If you’re hung up on size, trimming your pubic hair might make your penis appear larger and it may even increase sensitivity around the base of your penis. If you’re into that, be careful to avoid nicks and razor burn, which can increase risk of sexually transmitted infections (STI) transmission or a less-than pleasurable experience for you.

So, Mr. Measuring Stick, do not fear! The porn industry may feed you lies that claim size to be the end all be all of sexual happiness, but there’s so much more to it than a number on a ruler. So don’t be shy, and make the best of what you got!

Information about penis size retrieved from Men’s Journal, Healthline, Mayo Clinic and Zavamed.

 

Understanding Plan B

Dear Sexpert,

 My friend told me that she went to McCosh this morning to get Plan B after having unprotected sex with her boyfriend.  I am curious to find out more about how Plan B works.  Is it the same as an abortion?

–Plan A Preferred 

Dear Plan A Preferred,

I am happy to answer your questions about emergency contraception.  People may seek emergency contraceptive services for many reasons, including contraceptive failure (such as condom breakage) or forgetting to take birth control pills.  Options for emergency contraception include Plan B One-Step® or other generic progestin pills, ella® or other pills containing progesterone receptor modulators, some estrogen-progestin combination pills, and copper intrauterine devices (ParaGard® IUD).  Although there are sometimes stigmas around seeking emergency contraceptives, there should be no shame in seeking them when unexpected things go wrong.  As long as you are using non-emergency contraceptives regularly or as your primary form of contraception, it is useful to be knowledgeable about back-up options (hence the name “Plan B”).

I’ll now go into the physiological explanations about how these different methods work.  During the menstrual cycle, the pituitary gland in the brain releases the follicle-stimulating Hormone (FSH) which initiates the growth of follicles and a premature egg in the ovaries.  These follicles then release the hormone estrogen, which thickens the lining of the uterus and signals to the brain to release the luteinizing hormone (LH), which then triggers ovulation.  Birth control pills work by monitoring hormone levels; by increasing progestin levels, the pills decrease FSH and LH levels which prevent ovulation.  Plan B, or “the morning after pill,” works in essentially the same manner as birth control pills.  Plan B contains a higher dose of levonorgestrel, a synthetic form of progestin.  Therefore, it works to prevent ovulation just like birth control does.  Emergency contraceptive methods that prevent ovulation should be taken as soon as possible after unprotected sex to be most effective.  Levonorgestrel in Plan B thickens the mucosal lining of the uterus to create an environment where sperm will not survive.  Taken up to 3 days after sex, Plan B is able to prevent ovulation with an 89% success rate. Other emergency contraception methods can be effective when taken up to 5 days after sex.

Similar to Plan B, Ella also works to prevent ovulation.  Ella contains a progesterone receptor modulator, which actually has been shown to have a more direct inhibitory effect on ovulation.  Unlike Plan B, ella is only available by prescription. As opposed to preventing ovulation, the copper IUD prevents pregnancy after unprotected sex through impeding sperm function.  The copper IUD can be inserted up to 5 days after sex to prevent pregnancy at a 99% rate. Since the copper IUD is also a form of regular birth control (categorized as LARC or long-acting reversible contraception because it can remain in place for up to 10 years).  If you think long-term birth control could be right for you, you should talk to a healthcare provider at UHS. Also, emergency contraception is not the same as abortion because all methods only work pre-implantation (or the attaching of a fertilized egg to the uterine wall).  An implanted egg will not be affected by any emergency contraceptive method.

If you wish to obtain emergency contraception, or learn more about emergency contraceptive methods, you can make an appointment at McCosh Health Center via University Health Services.  To obtain emergency contraception, you do not need to make an appointment.  The morning after pill is available by appointment during regular hours and through the infirmary after business hours.  You can also go to the local Planned Parenthood, or get Plan B or the generic form from the local pharmacy in the family planning aisle (Call ahead to make sure they have it in stock!). I hope this article has cleared up your questions regarding emergency contraceptives.  Although they should under no circumstances be used as a primary form of contraception and do not protect against sexually transmitted infections, it is always useful to have a “plan b.”

Information regarding Plan B obtained from: The Emergency Contraception Website (Princeton), Planned Parenthood, American College of Obstetricians and Gynecologists (ACOG), AsapScience, and K. Gemzell-Danielsson et al. (2013).

 

 

Vape Lord: Does Juuling affect my erection?

Dear Sexpert,

Recently, my girlfriend and I have noticed that I’ve had trouble ‘performing’ in the bedroom, even if I haven’t been drinking. I thought these problems only happened to older people, but I heard that Juuling can cause problems with erections. Is this true?

Sincerely, Vape Lord

Dear Vape Lord,

Thank you for reaching out! Difficulty getting aroused and/or maintaining an erection can be a frustrating and embarrassing problem for many people, so there is nothing to be ashamed of. Luckily, for young people, this is often a fixable problem, too!

An erection occurs when hormone stimuli trigger blood flow into the spongy tissue of the penis. Thus, anything that interferes with these hormones or the blood flow can cause problems getting or maintaining an erection, otherwise known as erectile dysfunction, or ED. In young people, ED can be related to a variety of environmental causes, such as an unhealthy diet, medications, lack of sleep and exercise, and stress. It can also be due to the effects from chemicals or substances, as you note, including alcohol or other drugs.

Vaping – especially using a Juul device or ‘Juuling’ – is becoming increasingly popular because it is thought to be healthier than traditional cigarettes and often comes in a variety of flavors. However, vaping involves the ingestion of an aerosol that frequently contains nicotine and other chemicals and can be highly addictive. Most people do not believe that Juuls or other e-cigarettes contain nicotine, but in fact, a single Juul pod has the equivalent of twenty cigarettes’ worth of nicotine.

Nicotine alone has been shown to reduce sexual arousal in men and long-term studies reveal that the intensity of cigarette usage is correlated with greater degree of erectile dysfunction. Nicotine is a vasoconstrictor, meaning that it causes blood vessels to narrow and blood flow to be reduced. Since increased blood flow to the penis is what causes an erection, decreased blood flow creates more difficulty getting or maintaining them.  As long as nothing else has changed in your lifestyle and your stress levels have remained constant, it is possible that excessive nicotine consumption could be causing your ED.

This vasoconstriction can even cause permanent blood-vessel damage with prolonged, heavy use. As scary as ‘permanent damage’ sounds, there is good news! After smoking cessation, ED status improves quickly and significantly, especially in young people. Luckily, if your problem is nicotine-related, it will likely clear up if your nicotine consumption is curbed. If your ED persists, seeing a medical professional might be in order to discuss possible hormonal or lifestyle-related concerns. McCosh Health Center has Sexual Health and Wellness (SHAW) providers who would be able to help you get a diagnosis and treatment.

If you are a regular e-cigarette-user and have had problems with erections, it is definitely worth curbing your use to see if that nicotine consumption could be the root of your ED – it could be a simple and easy solution with the bonus of other health benefits, too.

– The Sexpert

Information regarding nicotine and erectile dysfunction provided by CNBC, Livestrong, National Institutes of Health, and BJU International peer-reviewed journal.

 

 

What is PrEP?: The Preventative HIV Drug

Dear Sexpert,

I’ve heard that more people are starting to use PrEP. What is it and should I start taking it?

-UnPrEPared

Hi UnPrEPared!

Thank you for your question! With acronyms flying here and there, it’s often hard to detangle what each one is and whether it is something to pay attention to. In 2012, the Food and Drug Administration (FDA) approved a first in class pre-exposure prophylaxis (PrEP) to prevent the transmission of human immunodeficiency virus (HIV), a sexually transmitted infection, in high-risk populations. (See, so many acronyms!) This simply means that the FDA approved a drug that can be taken on a daily basis to reduce the risk of contracting HIV. Only those that are higher risk for contracting HIV are encouraged to consult their doctor on whether PrEP is a good option for them.

PrEP (brand name Truvada ®), developed by Gilead Sciences, Inc., is a combination of two drugs, tenofovir and emtricitabine. These two drugs combine to provide the body the necessary fighting capabilities to attack the HIV virus once it enters the body and prevents the virus from multiplying and causing damage. Effectiveness of the medication is based on consistent and proper, daily use. For those who take PrEP every day, it is 92% effective at preventing sexually transmitted HIV infection and 70% effective at preventing HIV infection among people who inject drugs.

PrEP is only recommended for use among people at higher risk for HIV infection. This includes populations that engage in anal sex, engage with multiple sexual partners, engage with sex without a condom, or people that inject drugs and share needles. It is also recommended for people who are HIV-negative but in an on-going sexual relationship with an HIV-positive partner. Since PrEP is a preventative drug for people with on-going risk of HIV infection, it is not recommended for those who have had a single incidence of potential, high-risk exposure; a medication, called PEP, or post-exposure prophylaxis, is appropriate on that occasion.

Because it requires taking daily medication and regularly visiting a healthcare provider, PrEP is not right for everyone. Taking PrEP requires you to obtain regular lab tests and clinical visits every three months. Appointments for lab tests and clinical assessments for those required three month follow ups can be obtained at McCosh Health Center. Many private insurance companies and the University’s Student Health Plan (SHP) cover the cost of PrEP as long as the patient is considered “high risk” of contracting HIV. To figure out how much PrEP would cost, contact your personal health insurance provider, as different plans will vary in how much they require you to pay out of pocket. Gilead also may also provide helps with the cost of Truvada® through their medical assistance program.

Keep in mind that PrEP only protects against the transmission of HIV. To prevent the spread of other STI’s such as gonorrhea, syphilis, human papilloma virus (HPV), etc., PrEP should be used in tandem with condoms. If you believe that you are at a higher risk for getting HIV and can commit to taking PrEP daily, consult with a clinician at McCosh or your primary care provider to consider if you are a good candidate for PrEP. For more information, visit https://www.cdc.gov/hiv/basics/prep.html.

Best,

The Sexpert

Information regarding PrEP provided by the Centers for Disease https://www.cdc.gov/hiv/basics/prep.html Control and Prevention (CDC) and McCosh Health Center.

First-Year Virgin: How should I go about having sex for the first time?

Dear Sexpert,

Now that we’re a month into the school year, it seems like my friends have been hooking up or having sex more frequently than I am.  I feel insecure about my lack of sexual experiences and I would like to lose my virginity. How should I go about having sex for the first time?

–First-year virgin

image of sock on door

Hi first-year virgin,

Sexual debut can be a source of stress for many.  Sometimes, it may seem like everyone else is engaging in more sexual activity than us. Surveys of Princeton undergraduates tell us that about 61% of current Princeton undergrads have one or more sexual partners in the past year, while 39% have had none. Despite what your peers are doing, though, it is important to note that the decisions of when, how, and with whom to have sex are extremely personal ones. Whatever you choose, make sure it feels right for you!

The concept of virginity is a social construct (and a heteronormative one, too) that tends to place unnecessary pressure on those who abstain from engaging in sexual activities or those who abstain from sexual activity other than penile-vaginal intercourse.  Often, losing one’s virginity is considered to be a uniform, landmark event in one’s life; however, a first sexual experience can encompass a multitude of different forms and personal, cultural, or religious significance.  For some, the loss of virginity might include engaging in any form of sexual activity involving the genitals, engaging in new sexual experiences or activities with a current partner, engaging in sexual activities with a new partner, or having an orgasm. That being said, on your quest to expand your sexual experiences, I would encourage you to first think about and define what virginity means to you.  

In thinking about how you might find a potential sexual partner, many students meet people anywhere from their classes and organizations to parties, to dating apps like Tinder or Grindr, or through mutual friends.  When engaging in any sexual activity for the first time, it is important to be aware of boundaries and practice open communication with your partner because first sexual experiences may be nerve-wracking or uncomfortable.  For example, people with vaginas who wish to engage in penetrative sex may experience discomfort upon penetration due to insufficient lubrication and increased friction, stretching of the vaginal walls, or the breakage of the hymen, a membrane covering the opening of the vagina. (Note: breaking of the hymen can occur through other non-sexual activities [e.g., using tampons, exercise] and also may not occur during penetrative sex).  That said, using sufficient lubrication and focusing on foreplay to increase arousal can help ease physical discomfort.  Nerves or anxiety, which may be associated with first sexual encounters, can affect the sexual functions of penises and vaginas alike. For people with penises, nerves may make it hard to achieve or maintain a full erection. For people with vaginas, nerves can prevent natural lubrication of the vagina. Constant communication is another way to prevent nervousness or discomfort before and during sexual activity.

Before engaging in sexual activity for the first time, make sure that you are taking care of your health and safety. Using barrier methods can lower risk of transmission of sexually transmitted infections (STI) and, if relevant, contraceptive methods to prevent pregnancy (if you will be engaging in penile-vaginal sex).  It is important to talk to your partner. If the sexual activity of your choice involves penile penetration (of the vagina, anus or mouth), it is important to use an external (male) condom or internal (female) condom to prevent STI transmission.  If fingers will be used to stimulate the genital areas, a finger cot or condom can be used as a barrier.  If you wish to learn more about barrier methods or have further questions about sexual health, you can make an appointment online with a sexual health provider through MyUHS.

I hope this article has reinforced that choices regarding sex are personal, and sexual experiences need not be restricted to a timeline.  Whether you choose to explore sexual experiences with a partner immediately or far in the future, your choices are valid.

-The Sexpert

Information for this article was obtained from Kinsey Confidential and Go Ask Alice.

Handy: Is it bad if I masturbate every day?

Dear Sexpert,

calendar view

I masturbate every single day. I used to think this was completely normal, but after talking to my friends, it seems that I do it a lot more than others. I feel really embarrassed now. Is it dangerous to 

masturbate this frequently? Is there something terribly wrong with me? Please help!

-Handy

 

Dear Handy,

Rest assured, masturbation – the sexual stimulation of one’s own genitals— is a completely healthy and normal sexual activity. Unfortunately, society tends to treat the topic as a social taboo, making it unacceptable to discuss. Because of this, people often experience feelings of shame or embarrassment when their masturbation is brought to a public light.

Just as people have different food or movie preferences, people also have different preferences for how often they masturbate. Just because your friends report masturbating less frequently than you do does not mean that there is anything inherently wrong with your activities. Both men and women can find masturbation pleasurable, and it is a great way to explore and learn about your own body. Understanding your body’s likes and dislikes will improve all your sexual experiences – by yourself and with others.

Since masturbation is a solo act, there are no risks of becoming pregnant or contracting STIs. However, if you are using toys or objects while masturbating, be sure to clean them properly (wash with a gentle anti-bacterial soap and warm water) before and after use. And never transfer your sex toys from anus to vagina or penis without thoroughly cleaning them first. If you have an active infection (HPV (genital warts) or herpes lesions on the genitals) you may want to avoid touching lesions until they’ve healed.  If you do come into contact with any sores, wash your hands thoroughly. However, if you have a wart on your hand, you don’t need to worry about passing it to your genitals; genital warts are generally caused by different strains of HPV than warts on other parts of your body.

There do exist some prevalent notions that masturbating too frequently can affect things such as fertility, sexual ability and general health. Fortunately, these are all myths. However, just like any activity, it is possible to masturbate to excess. If you find yourself masturbating to the point where it’s interfering with the rest of your life – skipping classes to masturbate, for example – then you may be masturbating too much. In the event that this is the case, there are confidential counselors available in the McCosh Health Center with whom you can discuss your concerns.

I hope this overview of masturbation was helpful in quelling your fears. In short, masturbation is a healthy and safe way to enjoy sexual pleasure. Unless it’s interfering with your daily life, keep doing what feels good!

-Sexpert

Information retrieved from Go Ask Alice

Curious and Careful: About PrEP

Dear Sexpert,

Pill icon

I’ve seen a couple of ads for a drug for people at risk for HIV. What exactly qualifies as “at risk” and how safe/effective is this drug?

Signed,
Curious & Careful

Dear Curious & Careful,

You’re right, PrEP, or Pre-Exposure Prophylaxis, can be used in prevention of human immunodeficiency virus (HIV). PrEP is a prescription pill (commonly sold under the name Truvada®) designed for daily use by people who are HIV-negative and at substantial risk for HIV exposure. PrEP is a combination of two drugs, tenofovir and emtricitabine. If used correctly and consistently, it has been shown to reduce risk by up to 92%. Additionally, many health insurance plans cover PrEP.

There are several situations that can qualify a person to be considered at substantial risk. The Centers for Disease Control and Prevention (CDC) recommend PrEP for anyone who meets any of the following circumstances:

  • is in an ongoing relationship with an partner who is HIV-positive;
  • is not in a mutually monogamous relationship with a partner who recently tested HIV-negative;
  • is a gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the last six months;
  • is a heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status, who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners); and
  • has injected illicit drugs in the past 6 months and who has shared injection equipment or been in drug treatment for injection drug use in the past 6 months.”

If you fall into any one of these categories, or feel that you may benefit from PrEP, schedule an appointment at Sexual Health and Wellness (SHAW) or your primary health care office to discuss with a clinician whether this is an option for you. It’s important to keep in mind this is solely a preventative drug for people with on-going risk of being infected with HIV, and is not recommended for those who have had a single incidence of potential, high-risk exposure.  (There is a different medication, called PEP, or post-exposure prophylaxis, in those instances.)

Additionally, PrEP is a drug that needs to be taken on a daily basis. Like birth control or other daily-prescribed drugs, irregular use will decrease its effectiveness. Anyone prescribed PrEP should return

to their health care provider every three months for consistent HIV monitoring and follow up. PrEP is not 100% effective at preventing HIV acquisition and does not protect you from other sexually transmitted infections (STIs). Precautions should still be taken to reduce your risks, including using a condom with every intercourse, getting HIV tested with your partner(s), practicing less risky sexual behaviors (e.g., oral sex while using a barrier method), reducing your number of partners, and/or sterilizing injection equipment or joining a substance treatment program.

Best of luck and be safe,
The Sexpert

Information regarding PrEP retrieved from Centers for Disease Control and Prevention (CDC).

Not-Into-Intercourse: How can my partner and I be intimate with each other without having sex / what are different forms of outercourse?

Dear Sexpert,

I love my partner very much, but I am not sure that I am ready to have sex with my partner yet. Are there ways to be intimate without having sex?

–Not-Into-Intercourse

Continue reading Not-Into-Intercourse: How can my partner and I be intimate with each other without having sex / what are different forms of outercourse?

Curious Sub: How do I engage in BDSM without fear of losing equal status in my relationship?

Dear Sexpert,

I am thinking of trying out BDSM with my partner for the first time, but I am really curious about maintaining agency and empowerment when it comes to submissive roles in BDSM relationships. Will being in a submissive role negate my equal standing with my partner outside of the relationship? How should I engage in something like that without fear of being degraded by my partner?

–Curious Sub

Continue reading Curious Sub: How do I engage in BDSM without fear of losing equal status in my relationship?

Friends or More: Is the intimacy you have with a friend different than the intimacy you have with a romantic partner?

Dear Sexpert,

I wonder if you think that the emotional intimacy that you have with a friend versus a romantic partner is substantively different?

–Friends or More?

Continue reading Friends or More: Is the intimacy you have with a friend different than the intimacy you have with a romantic partner?

A Division of Peer Heath Advisers, Princeton University @princeton_pha

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