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Honeymoon impotence: Fears about first time sex
When you're newlywed and getting intimate for the first time, experiencing jitters and nervousness goes with the territory.
Wedding night stress about first time sex can be enough to make the bridegroom's erection droop and the bride's vagina squeeze tight shut, according to Dr Hussein Ghanem.
Honeymoon impotence is more common in conservative societies where access to sexual health information is limited and sex before marriage is rare, the Cairo University sexologist says.
According to him, the young couples who come to his clinic have no previous sexual experience and hardly any knowledge about sex.
Family
"They don't even know what a normal sexual position is. So fear on the part of the wife and anxiety on the part of the husband can lead to a loss of erection."
To make matters worse, the couple can feel like the whole family is breathing down their necks on their big night. "In certain societies, it becomes a big problem because families get involved and everyone wants to know whether the wedding night was successful or not."
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An emergency
All this attention ramps up the pressure on the couple and can lead to a cycle of impotence. The more the guy is desperate to perform, the more his erection withers.
"We see it as a medical and social emergency and try to resolve it quickly before things get out of hand. It can be a reason for the marriage to be annulled," says Dr Ghanem.
When couples don't manage to have penetrative sex on the first try, it's usually either because the man fails to get an erection, or the woman gets vaginismus, says Dr Ghanem. This is when the vaginal muscles involuntarily contract because the woman is tense and scared. It locks the vagina, so penetration just isn't possible.
Conservative outlook
The problem is most common in countries where attitudes to sex are the most conservative. "In my practice in Egypt, eight percent of the visitors to our centre have problems with honeymoon impotence," Dr Ghanem says.
"A colleague in Saudi Arabia reported a figure of 17 percent. And another study from Turkey suggests that one quarter of cases referred to sexual dysfunction clinic were about wedding night impotence."
Positions
Luckily Dr Ghanem has had great success treating couples in this situation, he says.
The first step is education. "We show the couple illustrations of male and female genitals, and explain some easy sex positions, usually with the man on top."
Mutual stimulation
After that it's about slowing things down, and concentrating on lovemaking and pleasure, instead of obsessing about penetration.
"We advise them to stop trying intercourse for a couple of weeks. I suggest mutual stimulation -- masturbating each other -- and just introducing the glans or the penis at the entrance of the vagina.
Pleasure
"This relieves the anxiety on the part of the wife that she's going to be subjected to a lot of pain. She can get used to the feeling of the penis. At the same time, it relieves the man's performance anxiety, because an erection isn't needed. This first step is just about pleasure and mutual stimulation."
"If it's needed, we prescribe an erection-enhancing medication. This in combination with the mutual stimulation works very well. In over 90 percent of our cases, honeymoon impotence is resolved in this way."
For women
There's also help out there for women with vaginismus. "We can show her how to use a vaginal dilator. We start with a small size and teach her to increase the diameter of the dilator until she reaches a size close to the penis."
"There are also reports about doctors advising women to use a vibrator," says Dr Ghanem. "They advise the wife to stimulate herself externally with the vibrator and then put it in her vagina herself, so she feels in control."
"The next step is to ask the husband to hold the vibrator while she's holding his hand and controlling his movement. When she's feeling confident enough, she'll give her husband the vibrator and he can do the act himself. And then they can go ahead after that."
Evening to remember
Patience is the key, says Dr Ghanem. "If you try to rush things she'll just get scared and involuntarily the muscles will contract."
The same is true for men. Take your time. Talk about it. A few simple steps can turn your first time fears into an evening you'll remember with pleasure.