How to Do It is Slate’s sex advice column. Have a question? Send it to Stoya and Rich here. It’s anonymous!
Dear How to Do It,
I’m a 75-year-old male who married the love of my life four years ago. My problem is that for the past two years at least, I’ve had a difficult time coming. I have no trouble getting an erection and can go for a long time, but I often just can’t seem to “get there.” It doesn’t matter if it’s PIV, oral, or masturbation. I can’t remember the last time I came from a blowjob. I do have orgasms but they’re infrequent. And many times it takes 45 minutes of various stimulation to finally climax. I’m not on SSRI and haven’t been since 2021. My penis just doesn’t seem to be as sensitive as before. My wife is incredibly attractive so it isn’t that. When we have sex, most of my pleasure comes from pleasuring her. We have sex usually three times a day, almost every day. We love it. I just wish I could come more easily. Not every time; I know better than that. But twice a week would be nice, especially if it didn’t take forever. I’ve already been checked by a urologist and don’t have any obvious deficiencies. I’m at a loss as to what to do.
—Frustrated
Dear Frustrated,
What you describe sounds like a condition often referred to as delayed orgasm, which is notoriously difficult to treat. (Definitions/terminology vary and others might call what you are experiencing delayed ejaculation or even anorgasmia, which generally refers to an absence of orgasm but sometimes is used when orgasms are “delayed, infrequent, or [lacking] intensity despite being aroused.”) A 2024 paper in the International Journal of Impotence Research that reviewed the literature on DO broke down the the common causes for the condition like so: SSRIs (42 percent), psychogenic (28 percent), low testosterone (21 percent), abnormal penile sensation (7 percent) and penile hyperstimulation (2 percent). I recommend reading that paper, as it’s teeming with useful information and may actually provide some hope.
Though DO is hard to treat, it is possible. “Common treatments plans are often multidisciplinary and may include adjustment of offending medications and sex therapy,” report the paper’s authors. You mention that your levels were checked, by which I’m sure you’re referring to your testosterone. You might want to make double sure that your thyroid stimulating hormone levels have been checked as well, as the paper reports that hypothyroid patients often experience DO.
Causes of psychogenic DO can include “feelings of fear, anxiety, hostility, relationship difficulties associated with sexual intercourse and encounters,” while some common triggers are “childhood sexual abuse, sexual trauma, repressive sexual education or religious beliefs, general anxiety, and history of being widowed or divorced.” If any of this stuff resonates with you, working through it in therapy should be your priority. Hyperstimulation of the penis is another factor, as DO is “significantly associated” with higher masturbatory activity, among other things.
The treatment approach will depend on the source of the DO, and may be multi-pronged, including medical interventions and sex therapy. The latter “involves enhancing psychological arousal by using a vibrator or vigorous pelvic thrusting and addressing psychological factors that may be contributing to DO.” If there is decreased penile sensation (which additional tests may elucidate—you may want to ask your urologist about biothesiometry or pudendal somatosensory-evoked potential, since you say, “My penis doesn’t seem to be as sensitive as before”), penile vibratory stimulation, in which a vibrator is placed on the frenulum of the penis for up to 10 minutes, may be useful. The authors cite a small study from 2006 that found that 72 percent of men who were classified as anorgasmic and underwent PVS had a restoration of orgasm on at least some occasions.
A therapist might also direct you to things like “erogenous zone stimulation, altering pressure and pace of penile stimulatory techniques, using vibrators, or incorporating roleplay.” You might also change your sexual practices/positions to maximize pleasure.
In terms of medication, there are no FDA-approved drugs for DO, but some drugs for other uses have shown promise, namely cabergoline, bupropion, oxytocin, and amphetamine/dextroamphetamine (Adderall). You can talk to your urologist about off-label prescriptions if this is a road you want to go down, though be aware that they may come with side effects, particularly because they’ve all been formulated to treat other conditions.
So, treating this is something that may require a lot of trial and error. I’m going to suggest taking the pressure off yourself entirely. Don’t worry that it’s taking you 45 minutes to come—enjoy that time. Also keep in mind that you are, by any measure, extremely sexually active. Three times a day, almost everyday, means you’re putting the “busy” in getting busy. It sounds like you might already be doing some version of this, but maybe if you shift your priorities to edging the majority of the time (that is, stimulating your penis without the intention of orgasm), you might build up more excitement so that in a few sessions, orgasm is more easily achieved. That’s something you can toy with now, before pursuing further medical/therapeutic solutions.
If that doesn’t work, maybe try no stimulation of your penis for a period of time (maybe a few days to a week) in case a contributing factor is hyperstimulation. I’m not saying to have less sex, just focus entirely on her—or parts of your body beyond your dick—and see if that moves the needle. Regardless, look: You’re having oodles of sex with the love of your life. You have learned to get pleasure through giving it. “We love it,” you report. If nothing ever improves with your orgasmic functioning, you still have a lot to be grateful for sexually. Cherish that.
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Dear How to Do It,
I’m a bi male and have two questions about Grindr, hookup apps, and sexual health. I am a super horny guy, and 90 percent of the time, I engage in bareback sex. However despite my high risk tendencies, I still want to stay healthy. I get tested usually around every 6 weeks and I take PrEP and Doxy PEP.
Having said all this, there are two groups of guys that I’m debating whether to engage with: (1) HIV undetectable and (2) guys who say they want me to poop on them or guys who are eager to suck my bareback dick after it’s been inside a dirty hole. FYI, I’m cool with fucking bottoms who don’t clean out. Sex is sometimes messy and spontaneous, and I just roll with it.
My real questions are about the health concerns both for myself and the bottom. As far as I can tell from my STI doctor and ChatGPT, bareback sex between someone who’s HIV undetectable and someone on PreP should have effectively zero risk, right? I’d still like to ask you because I admire the extensive research that goes into your answers.
And regarding the guys who are into poop, what’s the health risk both to myself and them? Part of my hangup is that I’m not comfortable with being responsible for a bottom who enjoys getting fecal matter in their mouth. They insist it’s perfectly healthy, but how could it be? I respect their kinks—and the simple answer obviously is for me to just fuck someone else—but some of these bottoms are seriously hot and the submissive aspect also appeals to me as a top. Do you have any thoughts on this?
—Tempted but Unsure
Dear Tempted but Unsure,
You are right—having sex with an undetectable partner while you fully adhere to your PrEP regimen, as prescribed, comes with virtually zero risk for contracting HIV. The great thing about PrEP is that it’s about 99 percent effective (says the CDC) regardless of your partner’s status/viral load. That alone should instill confidence. But yes, adding on top of that a partner’s suppressed viral load means the chances of HIV transmission are as close to nil as it gets (while still leaving a margin for the extremely unlikely).
What gave me full faith in U=U (undetectable equals untransmittable) was robust data deriving from the PARTNER study. The first part of that two-year study found that, among its hundreds of participating mixed-status couples—who had more than 44,000 combined instances of sex—there were no transmissions of HIV from the undetectable HIV-positive partner to the HIV-negative one. A follow-up study of only gay couples who logged even more sex acts found the same thing. Antiretrovirals work. However, not everyone who is HIV positive maintains consistent blood levels (for example, HIV can go from undetectable to detectable), which is why PrEP is a great additional layer to one’s sexual health regimen. It’s like wearing two condoms but it actually works and doesn’t actually involve wearing condoms.
Regarding your other query, I think it’s important to distinguish between eating poop and engaging in ass-to-mouth. There’s a difference between being OK with getting some fecal matter in one’s mouth and chowing down. I realize there’s a spectrum, and that a lack of douching can really change the color (and flavor) here, but while ass-to-mouth carries some risk, it’s relatively small according to a VICE exploration of this matter. According to one epidemiologist, “the transfer in the same body of NORMAL enteric (intestinal) pathogens—those that cause gastroenteritis—we wouldn’t expect to see an increase in risk. If you have enterohemorrhagic E. coli (that’s E. coli that can cause diarrhea or coliti) or Campylobacter (a type of bacteria that causes food poisoning) in your gut, adding some more at the top end doesn’t noticeably change things in the alimentary canal.” Note “same body” in that quote—the risk goes up if the dick in your mouth is coming from someone else’s ass. Norovirus, which is surging right now, can be spread via feces, which heightens the stakes for rimming and ass-to-mouth, at least for the moment.
To be clear, bacteria, viruses, and parasites are found in poop. There are a number of diarrheal infections that are somewhat common in men who have sex with men. To say that play that involves various configurations of asses and mouths is “perfectly healthy” is a stretch, and the more poop you ingest, the bigger risk you take. However, given our cultural taboos about eating poop, said risk is widely understood and it’s safe to assume that someone who engages in this behavior is aware of this. If someone wants to suck your dick after it came out of his butt, you don’t need to stop everything to deliver a teachable moment. It’s really not your responsibility to school people on the obvious. You have to decide whether it’s more important to overlook this for the sake of banging a seriously hot dude, or to move on to a seriously hot dude who isn’t into this thing that makes you somewhat uneasy. There are a lot of seriously hot dudes and it’s widely accepted within gay culture that there’s a shortage of tops, so it sounds like you can really have your pick.
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Dear How to Do It,
I’m a gay, recently single guy in my late 50s. A few months ago they found prostate cancer and I had a full prostatectomy. The cancer is gone (yay) but I’m dealing with the aftermath of ED (I’m on Cialis but it doesn’t work). I miss the splooge more than I ever thought. In the “God laughs” category, I have suddenly been presented with multiple guys a month (always younger) who try to get me into the sack. (I’m not on the apps.) That’s not something I’m used to, but I am horny all the time. I have dry orgasms and fun new mini orgasms if a guy really gets me turned on with kissing, etc.
My question is when and how to tell a guy who’s coming on strong that I’d love to be with him but he shouldn’t expect an erection or cum from me. My medical history (beyond HIV status) is a lot to unload for a hookup. Do I owe guys a heads up before they commit? The ED could resolve itself in 1-2 years but that seems like forever.
—Limp Dick Daddy
Dear Limp Dick Daddy,
“Commit” is an awfully strong word for likely no-strings-attached sex. Given your situation and that you’re asking this question at all, I’m assuming that you’re bottoming/sucking. If that’s the case, and there’s no expectation of your erection making or breaking the session ahead of time, I don’t think you need to reveal this upfront. There’s no guarantee a bottom will stay hard during penetration (look at how many Reddit threads there are about this). Guys who are experienced at topping know that a bottom may or may not be hard while getting plowed, but as long as he’s having fun, that’s really all that matters. You may encounter guys who get really turned on by bottoms with hard dicks, but if that’s their thing, the onus is on them to state it ahead of time and make sure you are carrying the kind of wood they’re looking for. (If I’ve misread you and you are actually being approached to top or get head, absolutely share this information upfront with whatever alternatives to a hard dick you will provide–i.e. toys/a strap-on or assurances that you enjoy getting sucked while soft.)
I agree that your medical history is a lot to unload to someone that you may never see again. While I don’t imagine your limp dick would be a deal breaker to most seasoned tops, it might be and you’ve been through enough to not be stigmatized for something that is virtually cosmetic. Of course, not disclosing ahead of time means you may be asked about your plumbing in the moment. As long as you don’t find that too awkward, this is something that’s worth reserving as a topic of discussion until it comes up (and hopefully a brief, “I had a procedure recently,” will suffice for your hook-up). You could also try experimenting with a chastity cage, which could take some pressure off as it may be harder to determine whether you’re erect or not while wearing one. It could be something to lean into, in fact, if you’re at all submissive or kinky.
One final thing: You may want to ask your doctor about switching you to sildenafil (Viagra) as you recover. Your results may be as lackluster as they have been with tadalafil, but different meds work differently on different people and switching is likely worth a try.
—Rich
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