Many of our male patients desire clarification about certain sexual issues that may be giving them significant concern and leading to a perception of inadequacy. Here are the answers to a few of the questions you may be too embarrassed to ask your doctor:

1. How long should intercourse last?

Intercourse length is generally defined as acceptable if it is around three to five minutes. Penn State researchers published an interesting study in the May issue of the Journal of Sexual Medicine that looked at length of intercourse and sexual satisfaction. The article states that the average sex therapist believes sexual intercourse that lasts three to 13 minutes is normal and not of clinical concern.

Basically, a good rule of thumb is that if both people are satisfied with the sexual intimacy in the relationship, then there are probably no problems. If one or both are dissatisfied, then the issue is worth pursuing.

2. When is intercourse too brief?

Premature ejaculation is generally believed to exist if intercourse lasts less than 1.5 minutes. If this is happening regularly, you may want to see your doctor or a urologist for further evaluation.

3. When is intercourse too long?

Ummm — we will leave that for each couple to determine. The Penn State study found that somewhere around 30 minutes was too long for the majority of couples.

4. How often is normal?

Statistics show the average frequency of intercourse to be around 60 to 120 times a year. That averages out to once or twice a week for most couples. This number does decrease with the advancing age of the couple — dropping quite a bit after 70.

5. I am never in the mood. Why?

A decrease in libido can arise from a variety of factors, including low hormone levels, high stress, poor health, decreased emotional intimacy and marital stressors.

6. When should I see a doctor?

If you have difficulty getting an erection, a persistent lack of sexual desire, a difficulty reaching orgasm or premature ejaculation, your doctor is a good starting point for discussion of these issues. A therapist might be needed to explore marital and psychological issues that could be contributing to the problem.

7. What is the holistic approach to sexual issues?

Sexual expression is a manifestation of the emotional health of both the individual and the couple. Enhancing self-esteem and self-love, optimizing communication, and resolving life stressors are important ingredients to a vibrant sexual life. There is a hormonal decline that will impact both men and women, especially after age 50. And health issues may certainly impact sexual functioning. These are issues that may or may not be reversible and should be addressed with your doctor. However, some things can certainly get better with age, sex included — and we would hope that you aim for a passionate sex life at any age.

Drs. Kay Judge and Maxine Barish-Wreden are medical directors of Sutter Downtown Integrative Medicine program in Sacramento, Calif.