Thanks, Hollywood, for making sex look so easy. In real bedrooms, the rest of us must wrangle with some not-so-sexy issues: unsatisfactory erections, untimely ejaculation, pain, low libido, and more. Yet tending to a problem might save not only a relationship but also your life. "Sexual health problems are very often the first sign of underlying serious medical issues," says Michael Krychman, medical director of sexual medicine at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif.

In women, for example, dulled desire may signal thyroid dysfunction or other hormonal troubles; painful sex could even be an early symptom of pelvic cancer. And erectile dysfunction is now recognized as an early whiff of looming cardiovascular disease. "Your problems shouldn't be ignored," he says.

Of course, they are ignored, jammed deeply into back corners of brains, denied. Patients and doctors, it's clear, have trouble talking sex. Many adults would like to discuss sexual problems, research indicates, but don't--for fear that doctors will dismiss their concerns, or worse. Women appear especially likely to stay mum, says Anita Clayton, a professor of psychiatry at the University of Virginia and coauthor of Satisfaction: Women, Sex, and the Quest for Intimacy. "Everyone has the right to a satisfying sex life."

Satisfying sex has been linked to increased longevity, better immunity, better stress-coping abilities, and enhanced connectivity with a partner, says Krychman. So, if you're sinking, not sailing, between the sheets, help can come in many forms, from sex therapy to various pharmacological options. Most important, if you're not getting the answers that you're looking for, "keep seeking," says Irwin Goldstein, director of sexual medicine at San Diego's Alvarado Hospital. Your sex life--and health--will thank you. Here are a few places to start:

More Than Just an Erectile Problem

Men, you may not realize it, but you've got a canary in your pants. Doctors now recognize that the penis functions as an exquisitely simple gauge for detecting impending heart problems. That's one reason flagging erections, which affect more than a third of men over the age of 40, should not be ignored. Another: Drugs like Viagra, which celebrated its 10th birthday this year, are just one set--among several--of time-tested treatments.

A decade into the medical revolution that turned erectile dysfunction into a household term, a shift in thinking is afoot. There's ample evidence that Viagra, Levitra, and Cialis can revitalize a man's sex life; in trials, Viagra enabled 83 percent of men struggling with ED to have intercourse at least once compared with 45 percent of those taking a placebo. Still, other drugs may be necessary to deal with vascular disease or diabetes, which often accompany ED. And long-impotent men may want to consider options like penile implants because, as vascular disease progresses, the usefulness of Viagra and its kin often wanes.

ED heralds heart trouble because arteries in the penis have about a quarter the diameter of coronary arteries. When plaque builds up, the slender vessels reach the strangling point first--but cardiac problems are often just around the corner. "In many cases, erectile dysfunction is quite literally vascular disease under the belt," says Randy Fagin, a urologist and director of the Prostate Center of Austin. Symptoms often occur three to four years before cardiac problems, such as chest pain or heart attack, begin to crop up, says Robert Kloner, a cardiologist at the University of Southern California. New guidelines in 2006 advised physicians to consider a man with erectile dysfunction and no cardiac symptoms a cardiac patient until proved otherwise.

In addition to any treatment they may need for vascular disease or diabetes, men have options for fixing ED. Eating better and exercising regularly can not only stave off plaque buildup in arteries but reverse it, research has shown. A 2004 study of obese men with erectile dysfunction found, for example, that erectile function improved in a third of men who adopted healthful behaviors and lost about 30 pounds.

Among medical options, doctors say, one of the best is to inject a medication such as alprostadil into the base or side of the penis. A quick, relatively painless shot, which can produce an erection within 10 minutes, costs about twice as much as a dose of an oral ED drug.

Other ED fixes are made to last. Vacuum pumps put negative pressure on the penis, creating an erection that can be maintained for about 30 minutes by placing an elastic band around its base. Studies report success rates of 70 to 94 percent with the devices, but side effects can include pain, numbness, bruising, and obstructed ejaculation. Surgical implants are pricier but have upsides. Men can inflate the implants at will, using a pump placed in the scrotum. Satisfaction rates are high.

Yet despite the availability of solutions, many harried doctors are not as aggressive as they could be about sleuthing out sexual problems. That puts the burden of speaking up on men.

Pacing Performance

Is premature ejaculation the most common form of male sexual dysfunction? The answer is debated, but one thing is clear: For men who have the problem, it can be a showstopper. "I see young guys who simply cannot establish a relationship with a woman because of this," says Ira Sharlip, a spokesperson for the American Urological Association.

The past few years have brought a surge of interest from pharmaceutical researchers aiming to relieve the problem with a pill. So far, no medication has been approved for the purpose; the Food and Drug Administration turned down a drug called dapoxetine in 2005. Yet doctors can and often do prescribe drugs that are approved for other conditions, such as the antidepressants paroxetine (Paxil) and fluoxetine (Prozac), which have been shown to lengthen intercourse by a few minutes. Potential downsides, experts say, include diminished intensity of a man's orgasm and libido and a hampered ability to maintain an erection.

Creams and gels that numb the sensitivity of the penis are another option. They usually contain lidocaine or prilocaine. Studies have shown them to be effective, but some couples find them difficult to use. They generally involve a messy application within a condom and can numb a partner.

A man's mind-set can play a role. "It's pretty unusual to see premature ejaculation without some degree of psychological component," says Fagin, the Prostate Center of Austin urologist. Therapists can work with men to address anxiety, stress, guilt, and depression--and can impart techniques like the "stop and go" method or the "squeeze" method to help men slow down. Honest partner-to-partner communication is also critical, says Barry McCarthy, coauthor of Coping With Premature Ejaculation. For example, he says, some women simply can't achieve orgasm through vaginal penetration, yet a partner might blame himself unless the couple discusses how the woman can reach a climax.

More often than not, the only real problem may be outsize hopes. In various surveys, between 20 and 40 percent of men complain about the short duration of intercourse. But fewer than 5 percent have a sustained disorder in which they consistently ejaculate in a minute or less, estimates Marcel Waldinger, associate professor in sexual psychopharmacology at the Hague Leyenburg Hospital in the Netherlands.

"Nobody really knows how long is normal. It's very subjective," says Martin Miner, a clinical assistant professor of family medicine at Brown University Medical School. In a recent survey, sex therapists typically said satisfactory intercourse should last three to 13 minutes. That's a far cry from the 30-plus minutes that many men say they want.