Joe and his wife consider the choices they have. The easiest being the pills, the PDE-5 inhibitors — sildenafil, verdenafil, tadalafil (brand names: Viagra, Levitra, Cialis). Joe gets excited of the prospect of getting an erection. Then he paused and asked: How is my orgasm going to be?
I assured him that it will remain the same.
But how can it be, my erections will be affected, how can my orgasm stay the same?
Like many men out there, Joe doesn’t know that each sexual function actually is independent of itself. What that means is one can have an erection without orgasm (the sensation of sexual peak) or ejaculating (the actual muscle contraction of the pelvic floor of men) or emission (movement of semen outside of the penis). One can orgasm therefore without erection. In post-prostatectomy men (men who have had their prostate removed because of prostate cancer), there is orgasm and ejaculation but erection may not happen and they do not have emission because their seminal vesicle and prostate are gone. Spinal cord patients sometimes can’t have erection on command but they can orgasm but not ejaculate and may or may not have emission.
So I can still have an orgasm even if the penis isn’t very hard? Absolutely! Let’s say you want to use other things; tongue, fingers, other senses — a practice called
sensate focus, you can do this and still ejaculate without getting hard.
This piqued his wife’s interest because she, like Joe, is herself changing sexually and would like to explore more about their sensuality than just focus on the genitals.
I gave them the handout for sensate focus and our sex therapist’s contact. I gave a prescription for one of the PDE-5 inhibitors. They felt that it was good to hear that their intimacy could be preserved and that sex is more than the genitals. But also relieved that if Joe did want to use his penis he still has the option to do this.