Sexual Healing

by Barbara Keesling

  The flaccid insertion exercise can be done in other positions besides the scissors position. It generally does not work well in the female-superior position, but it works very well in the butterfly position. If you decide to use the butterfly position for this exercise, you rather than your partner will be in charge of inserting your penis. Have your partner lie on her back with her legs up and spread. Kneel between her legs and caress your penis and her vagina with a lot of lubricant. Line your penis up so that it runs along her vaginal opening with the head near her clitoris and the base at the bottom end of her vagina. To insert your penis, gently push on the base. Then hold your partner’s hips and move her toward you in order to get inside her vagina as far as you can.

  Exercise 48. NONDEMAND PENETRATION

  There are two forms of nondemand intercourse: the “quick dip” and the longer version.

  The Quick Dip

  For the quick-dip version of the exercise, you add a quick episode of intercourse (no more than a few strokes) to the end of a manual or oral peaking exercise. Start with focusing caresses. Do a front caress, a genital caress, or oral sex with your partner. Next, she should begin a manual or oral peaking exercise while you remain passive. Peak using arousal levels rather than erection levels. See if you can peak all the way up to level 7 or 8. When you have reached a fairly high arousal level and when your partner thinks you are hard enough for intercourse, instead of doing another manual or oral peak, your partner can climb on top of you, insert your penis into her vagina, and thrust for a few strokes. If you become more aroused and ejaculate during this short bit of intercourse, fine. If not, your partner will climb off and finish the exercise using manual and oral peaking.

  The purpose of this version of the exercise is to teach you that intercourse doesn’t have to end with ejaculation, and if you feel your erection going down during intercourse, you can always switch to some other activity that you find stimulating and with which you are comfortable.

  Longer Version

  In the longer version of nondemand penetration, you use the female-superior position. This exercise is very similar to the flaccid insertion exercise. The difference is that you stay totally passive while your partner does all the thrusting. To begin, exchange focusing caresses with your partner. Then give her a front caress, a genital caress, or oral sex. Next, lie on your back and have your partner caress you. She can stimulate you either manually or orally, as long as she is doing it for her own pleasure. During this exercise you are totally passive, meaning that you don’t even have to pay attention to your arousal levels or give your partner any feedback about them.

  If your partner feels you are erect enough for intercourse, she will climb on top of you and thrust for a few strokes. Then she’ll climb off and stimulate you manually or orally again. Your partner will be in charge of this exercise; that is, she will decide when to have intercourse and how many strokes to do at a time. She will have to monitor whether you are erect enough to keep going with intercourse. The first time you do this exercise, you may feel frustrated because you are not in charge of deciding when you will stop and start intercourse. You may feel that your partner is stopping and starting on a whim. Her instructions are to start intercourse if she thinks it would feel good and to stop temporarily if it doesn’t feel good any more and go back to a caress that did feel good.

  During this exercise, remember to breathe and to keep all of your muscles relaxed, especially your PC muscle. Focus as much of your attention as you can on the feelings in your penis, no matter what kind of stimulation you are receiving from your partner. If you want to, finish the exercise by having an orgasm and ejaculating, with either intercourse, oral sex, or manual stimulation.

  This exercise can result in an important change in your thinking about intercourse. It reinforces the idea that you don’t have to be rock-hard in order to start intercourse. It also helps you learn to appreciate the unique sensations of intercourse instead of looking forward to intercourse as the “main event” and seeing every other kind of stimulation as second-best. You will learn what you are supposed to from this exercise if you can truly say that you were able to focus so intently on the sensations themselves that you really couldn’t tell which type of stimulation your partner was giving you at any particular time.

  Exercise 49. PHONE IT IN

  Do you own a phone with a vibration setting or a beeper? If so, you can use it to train yourself to have erections. Figure out how to set a phone or beeper to go off at random times during the day—say, maybe ten times a day. Whenever the vibrator or beeper goes off, stop what you are doing, find a private place, sit down, relax, and give yourself a short sensate-focus genital caress, whether you get an erection or not. Reset the beeper or phone every day so that it goes off at different times. Do this for about two weeks. From this point on, whenever you feel the vibrator or hear the beeper, you’ll start to get an erection.

  Physical, Behavioral, and Psychological Issues in Erection Problems

  Specific aspects of the mind-body connection may be getting in the way of your ability to have satisfying erections. Let’s look at some potential physical, behavioral, and psychological issues that could be at play here.

  Health Habits

  Take a look at your health habits. Are you overweight? Do you smoke, drink alcohol, or use illegal drugs? As I mentioned in Chapter 17, all of these habits can cause severe erection problems. Quitting these practices will cause dramatic changes in your erections as well as in your sexual fulfillment, your ability to savor sensations, and ultimately your sexual self-esteem.

  Medical Conditions

  Do you have any chronic medical conditions that might be affecting your erections? Diabetes, prostate problems, and circulatory problems are among the medical conditions that can interfere with erections. In addition, many prescription medications, such as those given for high blood pressure and ulcers, can have a negative effect on erections.

  Pelvic-Steal Syndrome

  In addition to all of the physical and emotional problems that can affect your erections, it is also possible that you may be doing something during lovemaking that prevents you from having an erection (a behavioral issue). As discussed earlier in the chapter, unconsciously or consciously squeezing your PC muscle during arousal can actually prevent erection. As you become aroused, you may also unconsciously tighten the muscles in your legs, abdomen, or buttocks. Some men do this because they think it helps them get an erection. In fact, it does the opposite, because the blood that could be available for your erection is diverted to the muscles that are tightening up. This phenomenon is called pelvic-steal syndrome because the blood that could be used for your erection is literally being stolen for use by your body’s long muscles. To deal with these possible issues, try the exercise for relaxing the PC muscle (Exercise 37) and the “get-and-lose” exercise (Exercise 39).

  Attitude

  When discussing psychological causes of erection problems, the first place to start is by taking a look at your attitude and sexual awareness. Never pressure yourself to have an erection during any exercise described in this book or during any sexual activity. You can do every exercise in this book, up to and including sexual intercourse, without an erection. While going through the exercises, try to pay more attention to your arousal levels (i.e., how close you feel to ejaculation) than you do to your erections.

  Erection problems occur when men expect their bodies to perform like machines. It’s unrealistic to expect to get an erection if you’re angry, exhausted, stressed out, or have just eaten a huge meal. On the other hand, try to be satisfied with the erection you have. It doesn’t do any good to wait for the perfect erection that’s somewhere out there on the horizon. Start some sensual contact with your partner and enjoy the level of erection you do have.

  Attributions

  An attribution is an explanation for a behavior. How you explain your erection abilities to yourself can have an impact on those abilities. There are two basic types
of attributions: internal and external. In an internal attribution, you attribute the cause of your behavior to something inside yourself, for example, your personality or your character. In an external attribution, you attribute your behavior to something outside yourself, for example, bad luck or the behavior of another person.

  When it comes to erections, you should always attribute your erections to something internal (“I had an erection because I allowed myself to relax,” or, “I had an erection because I was horny”). Conversely, you should always attribute situations in which you did not have an erection to something external (“I didn’t get very hard because I had just eaten” or “I didn’t get hard because the noise from the television set was distracting”). Make lists of both internal and external attributions for your erections, and start using them often.

  Spectatoring and Performance Anxiety

  Finally, are you spectatoring? This is a term coined by Masters and Johnson that refers to watching and worrying about whether you are getting an erection. You can read more about spectatoring in Chapter 3, on the role of anxiety in sexual problems. A watched pot never boils ... and a watched penis never hardens.

  Medical Solutions for Erection Problems

  We live in an age when men are very concerned about erections. A number of medical solutions have been developed over the years to help with erections. They all have downsides. If a perfect erection enhancer existed, everyone would use it.

  I list these medical solutions in order from cheapest, easiest, and safest to most expensive, most painful, and most dangerous. When describing drugs, I obtained my information from the product packaging.

  Over-the-Counter Erection Enhancers

  Go to any health-food store or supplement/vitamin store and you will find a whole wall of products that purport to help erections. Some of these products are herbal remedies, and some are precursors of testosterone or other hormones that help erections. Do they work?

  To my knowledge, the only one of these substances that has been clinically tested is yohimbine. Yohimbine is a stimulant made from the bark of the yohimbe tree. It used to be sold by prescription only, but now it is sold over the counter. Yohimbine has been found to enhance erection in some men because it is a stimulant. This means it causes your heart to beat faster and your blood pressure to rise. For some men this translates into a quicker or harder erection. You should not take yohimbine if you have anxiety problems or are on heart medications. Some men report that yohimbine gives them heart palpitations.

  Regarding most other herbal products that claim to enhance erections, in general I would steer clear of them. Most of them contain stimulants that are not clearly labeled as such and can make anxiety symptoms worse.

  I know many men who have taken supplements like DHEA (a precursor of testosterone) and arginine, because they supposedly enhance erections. Sometimes these supplements appear to work for a couple of sessions. I believe these results are probably due to the placebo effect, which can occur when someone expects a medication to work. (You’ll read more about the placebo effect in Chapter 32.)

  Vacuum Erection Device

  The vacuum erection device (VED or penis pump) is not a drug and is not invasive. It consists of a plastic cylinder that fits over the penis. You put lubrication and a surgical rubber band on one end of the cylinder and fit it over your penis. The cylinder is attached to a pump, which is either batterypowered or operated by hand. The device pumps air out of the cylinder, creating a vacuum, which causes blood to literally be sucked into the penis. When you have pumped your penis up to a full erection, you slide the rubber band down to the base of your penis in order to hold the blood in.

  The upside: This device is inexpensive. If you buy it as a medical device, insurance plans will often cover it. You can also buy cheaper versions of it in adult stores or through adult-product catalogs. The device is very good for men whose PC muscle is in bad shape or men who have difficulty maintaining an erection. The downside: Because the rubber band acts as a tourniquet around the penis, you really shouldn’t use it for more than twenty minutes. If the rubber band is too tight, in some cases it can rupture a blood vessel in the penis, which can cause bruising and bleeding. Furthermore, it kind of breaks the mood of a sexual encounter if you have to stop and pump up your penis. You need to have erectile tissue to use this device; in other words, men with advanced Peyronie’s disease (a buildup of scarring in the erectile tissue) can’t use it. The men whom I have seen use this device successfully have been in their seventies and eighties and really had no other options other than a penile implant.

  MUSE

  MUSE stands for male urethral suppository for erections. It is the brand name for a drug called alprostadil that is administered in a pellet form that is inserted directly into the urethra. This is painless; the pellet is very small. Once the medication is inserted, the user is instructed to walk around for about ten minutes while stroking his penis firmly from head to base to get the medication into his erectile tissue.

  MUSE is easy to use and doesn’t go through the digestive system, so it doesn’t cause stomach problems. In my experience, however, it just doesn’t work very well. It is too dependent on the vagaries of individuals’ metabolism. Plus, if receiving oral sex is a big part of your sexual repertoire, you definitely don’t want to use this drug. A woman can’t go down on you right after you insert the pellet because she will suck it right out of your penis. Besides, it tastes terrible and probably doesn’t do her any good, either.

  Viagra, Levitra, and Cialis

  When Viagra was first introduced in 1998, it caused quite a controversy. Most of the hoopla seems to have died down, and many men are using it successfully on a regular basis. In general, Viagra works by relaxing the smooth muscle at the base of the penis (the PC muscle), thereby allowing blood to flow into the penis more easily following direct stimulation.

  Viagra comes in doses of 25 milligrams, 50 milligrams, or 100 milligrams. You take it half an hour to an hour before you want to have sex. Viagra cannot be used if you are taking nitroglycerin heart drugs; this combination can be fatal. Since it is taken orally, it has to go through the digestive system and thus can cause indigestion. If you take it with food, it takes longer to work. It can also cause nasal congestion and facial flushing.

  I have seen Viagra work really well for many men. It tends to work well for men in their forties, fifties, and sixties who have psychological erection problems, although I have also seen it work for men following prostate cancer and surgery. In my experience, it has not worked well for men in their seventies and eighties. This is probably because the smooth muscle at the base of the penis is in such bad shape.

  The newer drugs Levitra and Cialis work on the same principle as Viagra: They relax the smooth muscle, allowing blood to flow into the penis more easily with stimulation. The advantage of Levitra and Cialis over Viagra is that they are purported to work faster and to last for a longer time. Versions of these drugs are available that can be inserted under the tongue so you don’t have to digest them.

  Injection Therapy

  There are several substances that can be injected directly into the penis to cause erections. Two of them are papaverine and regitine, which are fast-acting vasodilators that literally draw blood into the erectile tissue of the penis. Using a fine-gauge needle, you inject the drug into the corpus cavernosum on one side of your penis. Prostaglandin (or alprostadil), a hormone that also promotes erection, is another substance that can be injected directly into the penis.

  Obviously, the downside of injection therapy is the discomfort or pain of injecting something directly into the penis. If you are uncomfortable with the idea of filling a syringe, the manufacturers market a version called Caverject, which comes already filled with a quick-action injection device like the ones used for flu shots. A problem with injection therapy is that if you inject at the same site over and over, you can develop scar tissue that can change the appearance of your penis or further compromise y
our ability to get an erection. Sometimes the use of penile injections can cause bruising or bleeding. Finally, users have to be careful to make sure they are injecting into the erectile tissue rather than into some other area.

  Penile Implants

  Penile implants are mechanical devices that are surgically inserted into the penis. They are a last resort for men with serious medical problems who have no other way to obtain an erection. The most likely candidates for penile implants are men who have had their prostate removed and men with diabetes who no longer have nerve supply to the penis.

  There are two kinds of penile implants: the semirigid rod and the threepart inflatable implant. The semirigid rod is a silicone-covered rod that is inserted alongside the urethra. It has no moving parts. It makes the penis semihard all the time. When you’re not having sex, you just bend it down so it rests against your leg. When you want to have sex, you bend it up. Obviously, having a semirigid rod inserted in the penis will interfere with ejaculation. But a man with advanced diabetes or prostate problems can’t ejaculate anyway. He can still have an orgasm.

  I believe that the semirigid rod is no longer used very much. The threepart hydraulic implant is now the implant of choice. The three parts of this implant are comprised of a hollow cylinder that is implanted in the penis alongside the urethra, a reservoir of fluid placed in the abdomen, and a valve implanted under the skin of the scrotum. When the user wants to have an erection, he turns the valve, causing fluid to flow from the reservoir into the cylinder located in the penis, making the penis erect. A man with this type of implant can have an orgasm but not an ejaculation. When he’s finished having intercourse, he just pumps the implant back down.