Sex can be enormously satisfying, but perhaps never so much as when it feels like an accomplishment or an adventure. Your first time with a new partner can be traumatic or tremendous, but your first time after an illness is always a triumph. Surviving cancer, sexual difficulties, or reproductive health problems may make you feel like dwelling on what you've lost, but in fact you may have gained much more than you've lost. The changes you've been through, the inner strength you've gained, the appreciation for life itself-all can make sex seem new and exciting again. Treatments for sexual dysfunction can make an enormous difference in the quality of people's lives. Whether it's major surgery, a little blue pill, a change of diet, or even an understanding ear, improving your sexual health can really pay off in enhancing your sex life and your quality of life as a whole.

It takes two to tango...and it takes two to make a baby. Every time a man and woman decide to have vaginal intercourse, there is a chance, so long as the woman is not postmenopausal, that they will conceive a new life.

Contraception is the responsibility of both men and women. But women need to be especially cautious because they bear the brunt of the burden of pregnancy, and because the majority of contraceptive methods are controlled by them. To date, the only effective male-controlled methods of birth control are condoms and vasectomy.

Vasectomy is a type of permanent surgical steril- ization that can be performed in less than half an hour, usually as an outpatient procedure. During the procedure, the vas deferens are cut and either clipped, tied back, or cauterized. Healing is generally complete within four to five days. Couples still need to use another form of birth control for two to three months while the sperm still present in the man's body are expelled. For people who follow that instruction, vasectomy is a highly effective procedure with relatively few side effects.

The equivalent procedure in women, tubal ligation, is actually much more invasive. The basic procedure is almost identical; what makes things more complicated is access. Men's vas deferens can be accessed by making a tiny incision in their scrotum, and there are even scalpel-free surgery options available. In contrast, the fallopian tubes are located well inside a woman's abdomen, and even with laparoscopic surgery, accessing them is a riskier procedure.

Condoms fall into the category of barrier methods. They are unique in that they are the only form of contraception that also protects against most STDs. Male condoms work by covering the penis and containing the ejaculate. When used correctly, they are the most effective over-the-counter form of birth control available. The important phrase in that sentence is "used correctly." Reservoir-tip condoms were probably invented because too few people knew that they were supposed to leave room at the condom's tip to contain the ejaculate, and it's important to remember that any type of oil—including oil used for lubrication—can cause a condom to break.

There are many types of condoms, but only latex and polyurethane condoms should be used for protection against STDs. The pores in natural skin condoms are so big that viruses can pass right through them, and novelty condoms were never intended as anything other than gag gifts. Although many men have preferences in condom brand, "large" and "extra large” condoms are mostly a matter of vanity. Most standard condoms will stretch easily over a large combat boot, and if the item being covered is bigger than that...maybe it shouldn't be going anywhere inside anyone! Not that this is any news to condom manufacturers-at least one company's XXL condoms are exactly the same size as their standard condoms, and that information is clearly visible on the company's website. Ironically, some men actually could benefit from petite condoms—condoms do no good if they fall off mid-act—but there doesn't seem to be much market demand for them.

Women have a lot of options when it comes to contraception, but most of their choices are just different sides of the same coin. Female contraceptives are categorized into three main types: hormonal, mechanical, and chemical. Hormonal contraceptives alter a woman's body chemistry so that it either produces no eggs or is otherwise unreceptive to pregnancy. Mechanical contraceptives block the cervix so that sperm can't enter the uterus. Chemical contraceptives kill the sperm before they can cause pregnancy. IUDs, however, don't fit neatly into any of these three categories. They primarily work by making it more difficult for sperm to reach the egg, providing a mechanical barrier as well as thickening the cervical mucus, but they may also mechanically irritate the uterus to make it unreceptive to implantation.

These methods all can work, it's just a question of whether or not they do work.

Whether a contraceptive works or not has to do with the difference between perfect use and actual use. Perfect use describes how well the contraceptive would work if a woman used it correctly every time she had sex, and ranges from 0.1 percent to 20 percent chance of pregnancy within a year. Actual, or typical, use describes how well the contraceptive works in the real world, and takes into account how well and how often women use the product as well as its basic efficacy. This is the true estimate of contraceptive efficacy, and ranges from 0.1 percent to 40 percent chance of pregnancy in a year.

Premature ejaculation is defined as uncontrolled ejaculation that happens before a man wishes, before or slightly after sexual penetration. It has many causes, including oversensitivity of the penile glans and injury, and it can also be a side effect of some medications. In some men, premature ejaculation is related to psychological issues, and the lack of control over ejaculation can lead to further anxiety-increasing the problem in an unfortunate vicious cycle.

Although in many men premature ejaculation resolves on its own, there are also numerous pharmaceutical treatments for the disorder. SSRIs, a class of drugs used for the treatment of depression, have the side effect of inhibiting orgasms. For men who suffer from premature ejaculation, that's actually considered to be a positive and can lead to off-label use. Inhibition of orgasm allows them to maintain an erection longer than they could without the drugs. PDE 5 inhibitors, which are prescribed for erectile dysfunction, are also useful for premature ejaculation, since they help to prolong erection as well as achieve it. Finally, topical creams and condoms can be used to reduce sensation in individuals whose premature ejaculation is caused by hypersensitivity of the glans.

Behavioral therapy is often the remedy of choice for treatment of premature ejaculation in men who have no obvious underlying cause. The squeeze technique, for example, uses pressure applied to the base of the glans to force blood out of the penis, reduce the size of erection, and delay ejaculation. It can be used multiple times to prolong the sexual experience. Relaxation therapy is also recommended, as is paying attention to the specific stimuli that encourage ejaculation and moderating them during the sexual experience.

After the nervous system, the circulatory system plays the most important role in maintaining sexual function. In order for a man to have an erection, blood must pour into the penile arteries and be successfully contained by the penile veins. In order for a woman to lubricate, blood pressure must increase to high-enough levels in her vaginal walls to cause fluid to start to seep through. All of this requires circulatory flexibility, so that blood vessels can dilate and contract on demand and blood pressure can rise and fall as needed.

When individuals have problems with their cardiovascular health, their sexual function can be affected not only by their disease, but by its treatment.

Drugs prescribed to control blood pressure may have sexual side effects in both men and women. Simply by successfully fulfilling their purpose and controlling hypertension, they can make it difficult for men to attain an erection or ejaculate. Since vasocongestion is important not only in erection, but in all phases of arousal, tightly controlled blood pressure can also reduce overall sexual response. Unfortunately, since hypertension is mostly without symptoms, sexual side effects can cause people to stop taking their medication and risk their overall health. But there is hope. Certain classes of anti-hypertensive drugs are far more likely to cause sexual dysfunction than others, so people with high blood pressure should be able to work with their doctor to find medication that will preserve both their life and their sex life.

STDs are commonly grouped into two categories: curable and incurable. The curable STDs are caused by bacteria and protozoa, organisms that can be killed by antibiotics. The incurable STDs are caused by viruses—which are not alive and which can be treated but not destroyed. Antibiotics work in many ways, but they are all selective poisons that are designed to kill bacteria without harming you. They may prevent the bacteria from growing a new cell wall, or stop them from being able to use glucose for energy. However they work, their basic function is to stop the bacteria from reproducing and send them to their doom.

Antibiotic resistance, where bacteria have become immune to the effects of a particular antibiotic, is an increasing problem in this and other countries. Diseases that were once simple to treat now require more and more expensive and complex drugs—if they can be combated at all. There are two simple ways to avoid contributing to this worldwide problem. First, take antibiotics only if they are prescribed by your doctor, and don't pressure your doctor to prescribe antibiotics if you haven't been diagnosed with a bacterial infection. Second, when you are prescribed a course of antibiotics, take every single pill as prescribed, even if you feel better halfway through therapy. If you don't allow the drugs time to kill all the bacteria in your system, the strongest or most adaptable ones will survive. The next time you take the drug, it will be harder for it to kill these bacteria.

Unlike antibiotics, antiviral medications don't work by killing viruses, because viruses aren't alive and cannot be killed. Viruses use a person's own cellular machinery in order to make copies of themselves, so antiviral medications must target the interaction with the host cell somewhere in the infection process. They can prevent the virus from entering the cell, stop its replication, or prevent it from leaving the cell. But because they can't destroy the virus, their effectiveness is usually limited. Antiretroviral therapies for HIV primarily target the replication process, although the newest drug classes also affect cell entry.

The newest development in the fight against viral STDs is the HPV vaccine. Vaccines are an artificial way of stimulating your immune system to fight a microorganism that it has not encountered. Vaccines prevent disease by preparing your body to fight in the event that it is exposed to the virus, or bacteria, the vaccine is designed to protect against. STD vaccines are relatively recent innovations. The first such vaccines were against hepatitis; now, vaccines for different types of HPV are in the pipeline. We can only hope that perhaps a herpes or HIV vaccine will be next.

There are essentially four types of treatment for cancer: surgery, chemotherapy, radiation, and drugs or vaccines. Which methods are used in any individual depends on the location of the cancer, how invasive it is, and whether it has spread, or metastasized. Most cancers are treated with a combination of procedures.

Prostate cancer is a difficult cancer to treat, because sometimes it's not easy for physicians to determine whether it should be treated at all. New technology has given doctors the ability to diagnose cases of prostate cancer that are not only asymptomatic, but that could possibly have no effect on the patient's health during the remainder of his lifespan. However, it is difficult for many men to understand that not treating their cancer may be the best course of action. Lack of treatment has no sexual side effects, does not require surgery, and will not affect a man's quality of life. In cases when treatment is necessary, early cancers are usually treated by complete or partial removal of the prostate, and more advanced cancers with removal of the testicles or other testosterone-lowering therapies. Both procedures can have serious sexual consequences, and testosterone replacement therapy may not be an option if there is a chance of cancer recurrence.

Testicular cancer, in contrast, is usually treated immediately with removal of the affected testicle followed by chemotherapy or radiation. In order to preserve fertility, a device is used to protect the unaffected testicle from radiation damage. Removal of one or both testicles usually has no effect on sexual function, although occasionally retrograde ejaculation, where sperm are ejaculated backwards into the bladder, may occur. This does not affect potency in any way; only ejaculation. Many men choose to have a prosthetic testicle implanted after surgery. Although these devices have no function, they restore the appearance of normality, and can make men more comfortable about reşuming their sexual life.

Cancers of the female genital tract have relatively similar treatments, depending on the stage of disease. Ovarian cancer is usually treated with surgical removal of the ovaries, fallopian tubes, uterus, and any sections of affected intestine, as well as intensive chemotherapy. Treatment for endometrial cancer is comparable, but also may include radiation therapy and hormone therapy depending on the nature of the tumor. Cervical cancer, if caught early, does not require such major surgery, and only the affected tissue needs to be removed. However, if allowed to progress to an advanced stage, hysterectomy and chemotherapy or radiation may become necessary. Fortunately, most women with cervical cancer are able to keep their ovaries, which means that hormone therapy isn't necessary to avoid a sudden reduction in levels of hormones, which could cause them to go into early menopause.

Breast cancer treatment is constantly in flux. Whereas for many years mastectomy, removal of the breast, was the standard treatment, more recently lumpectomy along with radiation has been gaining approval. New drugs have also been developed that can bind to hormone receptors in the tumor and actually prevent or arrest the cancerous growth. In stark contrast to the growing trend for less invasive therapies, some women with a family history of breast cancer are actually choosing to have their breasts removed prophylactically—before there is any sign of disease. Finally, although men are far less likely to be diagnosed with breast cancer than women, when they are, their treatment options are essentially the same.

One of the most common treatments for a benign testicular cyst is...no treatment at all. Due to recent advances in ultrasound technology, it is possible to easily monitor cysts for any changes that could lead to cancer formation, making it unnecessary to attempt removal if the cyst isn't causing any symptoms. Other treatments for testicular cysts range from excision of the cyst to removal of the entire affected testicle. The last, known as orchidectomy, was once the most frequent treatment for testicular lesions, since it was straightforward to perform and removed the risk of the cyst recurring or becoming cancerous.

One of the major concerns in the diagnosis and treatment of ovarian cysts is the possibility that they may be cancerous. Ovarian cancer is rare, but deadly, and doctors want to make certain not to miss any chance for diagnosis. Fortunately, most cysts are non-cancerous, and they can be examined using sonography—a noninvasive procedure that uses sound waves to see inside the abdomen. Benign cysts in premenopausal women who are still having their periods usually don't even need to be treated, since they are a natural, if unpleasant, consequence of ovulation. However, if the cysts become painful, or continue to grow over a period of several months, they can be removed by surgery. Surgery is also almost always recommended for women who are no longer menstruating, since they should not be forming benign cysts. Removal allows for biopsy of the cyst and removal of the ovary in case it might be cancerous. Today, many cysts don't need to be treated at all, because they can be prevented. In young women prone to ovarian cysts, oral contraceptives are used to stop their formation by preventing ovulation.

Until relatively recently, the only two treatment options for uterine fibroids were surgical: hysterectomy—removal of the uterus, and myomectomy—excision of the fibroid tumors. For women who did not need to preserve their fertility, hysterectomy was usually the recommendation, as it was an easier procedure to perform and there is no risk of recurrence.

Fortunately, a new procedure was developed for the treatment of fibroids that does not require surgery: uterine artery embolization (UAE). During this procedure, small particles are injected into the arteries supplying the fibroid tumors. This blocks their blood supply and causes them to eventually regress into the uterine wall. It's still a relatively new technique, but data seems to suggest that it's as safe and effective as hysterectomy while, theoretically at least, preserving a woman's ability to bear children. As time goes on, and women having fertility problems because of fibroids are treated with UAE, scientists will begin to develop a clearer idea of this technique's place in the treatment lexicon.

Although the process of menopause is universal, each woman's experience of it is unique, and there may be a cultural component as well. Western women have far more negative experiences of "the change” than their Eastern counterparts, and debate has long raged over how much of the difference is cultural and how much biological. Over the past ten years, however, an increasing amount of research has suggested that a diet rich in consumption of soy, with its phytoestrogenic (plant-estrogen) compounds, can actually ease the transition into menopause.

Estrogen replacement therapy in menopausal women, despite the controversy over its general health effects, does lead to definite improvements in sexual response, particularly by increasing vaginal lubrication and wall thickness. It is available in many forms, from pills and injections to skin patches and vaginal suppositories, gels, and rings. Some of these treatment regimens increase hormone levels throughout the body. Others have a more localized response that can be an advantage for women who are worried about systemic side effects or increase in cancer risk. In general, the recommendations for hormone replacement therapy in men and women are similar. Use them, doctors say, if the symptoms require it, but if you don't need them, it's best to let your body have its way. Many individuals maintain healthy sexual function long after the onset of menopause, but for those who don't, hormone replacement therapy can help to improve the quality of their sexual life.

Hormones are the building blocks of sexual function. When levels of hormones are low, sexual desire may be absent, and sexual arousal may be difficult or impossible to experience. Although for many years decreasing levels of sex hormones were thought to be a natural part of aging, recently more and more scientists have accepted that the changes in lifestyle that follow their loss can be not only disheartening, but dangerous. For many individuals, the lack of an enjoyable sex life can lead to depression and an overall decrease in physical well-being.

Testosterone therapy helps to maintain sexual interest and function in both men and women. In addition, it appears to help both mood and body composition in men, although as with estrogen replacement therapy in women, the non-sexual benefits of testosterone replacement therapy are still controversial, since there is no detailed understanding of its risks when used in men with low levels of testosterone.

There is one use of testosterone where the risks are well understood. Most men think of steroids as something that bodybuilders take to help them develop big muscles. What they forget is that those drugs are mostly synthetic forms of testosterone. It's the well-known side effects of steroid use in young men that have made many physicians leery of prescribing testosterone replacement therapy in men with low androgen production.

Such a worry is, however, probably unfounded. The goal of testosterone replacement therapy is to maintain hormones at a healthy level, not pump them up to achieve unrealistic goals. A healthy amount of testosterone acts almost as a fountain of youth, improving not only sexual function, but overall fitness levels and quality of life.

For individuals with sexual disorders who either aren't responsive to or don't want to pursue pharmaceutical treatment, it may be possible to use other methods to increase blood flow to the genital region. There are currently vacuum devices available which stimulate the penis or clitoris by, essentially, sucking enough blood into the area to cause an erection. In women, clitoral therapy devices have been shown to improve all facets of arousal, from desire to sensitivity and lubrication. In men, vacuum therapy has been a long-accepted treatment for erectile dysfunction.

Where the presence of a vacuum device is too intrusive during the sexual experience, researchers have explored the use of vasodilating creams and gels to achieve the same effect. These solutions contain compounds, such as the capsaicinoids found in hot peppers, which increase blood flow to the areas where they are applied. In both men and women, such topical agents have been shown to promote arousal in preliminary studies, and in the future these creams might become an effective, minimally invasive form of treatment for sexual dysfunction.

In men for whom medication or external devices are not effective, there are also numerous surgical treatment options for erectile dysfunction. Penile prostheses, for example, can be an effective and permanent way of treating erectile dysfunction. These devices come in two types, semi-rigid and inflatable. Inflatable implants work by allowing a man to manually pump fluid into tubes inserted along the corpus cavernosa. Different designs either expand only the girth of the penis, or both girth and length, and they require sufficient manual dexterity and flexibility to operate the pump. Semi-rigid implants are either rod-shaped or flexible like a gooseneck lamp. They are less expensive than inflatable implants and require less expensive surgery; however, they are less adjustable once inserted.

Other types of surgery for erectile dysfunction generally focus on improving or restoring blood flow within the penis. Crural ligation, for example, helps to reduce the amount of blood leakage from the penile veins, which, when present in abnormal amounts, can make it impossible to achieve or maintain erection. In contrast, penile revascularization improves the amount of blood flow into the penis, providing sufficient blood volume for erectile function in men with damaged or insufficient arteries.

The future of treatments for sexual dysfunction is potentially as varied as the sex act itself. As researchers gain new insights into how sex works, they are developing treatments that affect sexual performance at all levels. Testosterone replacement therapy, in new and unique forms, not only may be used to enhance the sexual desire of men and women, but also may someday be used as a form of male contraception. Novel psychoactive drugs, or gene therapies, may be developed to directly alter the pathways of arousal and response. Innovative suppositories and topical creams could encourage erection in men, increase lubrication in women, and redefine the role of lubricants in sex.

Sex in the future will be safer as well. Microbicidal creams are being developed that kill not only sperm, but STD pathogens on contact. Other scientists are inventing ways to produce and deliver anti-STD antibodies directly into the vagina. These little bullets may finally provide women with a way to protect against disease without also preventing pregnancy. With a vaccine in the pipeline to prevent cervical cancer, and many of these products in clinical trials, it seems like tomorrow is already today.