38 UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE JUMPING THE RIVER - ORGASMS WITHOUT ERECTIONS Helen Shaw runs a men's health physiotherapy practise in Wynberg Cape Town. She qualied as a physiotherapist in 1981 and has worked in various towns and cities in South Africa and Namibia. She has completed numerous courses in men's health and is now on the course planning committee for the Pelvic and Women's Health Physiotherapy Group. Her practice is focused on assisting prostatectomy patients with continence and sexual function issues A SHORT CUT TO SEXUAL REHABILITATION Many men suffer with partial or full erectile dysfunction post-prostatectomy. The level of erectile dysfunction is dependent on the advancement of the cancer and the subsequent nerve sparing results. Where both nerve bundles surrounding the prostate are spared, it is realistic to encourage the patient to regain an active sex life which will include erection capability. If a man has had a non-nerve sparing procedure, he will be unable to obtain an erection without external help (medication does not help). Where one nerve is spared, full erection capacity can be obtained with medication, patience, and lots of 'jumping the river'. JUMPING THE RIVER conjures up an image of a short cut. With some simple but clever intervention techniques, men can use their capacity to rehabilitate their own erection function. This will hugely help with the excitation and neuro-muscular repair of all structures involved in the erection process. The four phases of men's sexual intimacy are; foreplay, erection, orgasm and ejaculation/climax. (Ejaculation is not possible post prostatectomy, and a climax is experienced.) These four phases work separately but the brain and spinal cord interaction allow them to work together to create the whole sexual experience. I often challenge men to consider how much thought, words, jokes and anxiety go into erections (and later in life, ejaculation), yet minimal thought and mindfulness go into the orgasm phase…… Hardly any men are aware that an erection is not needed for an orgasm. The erection is needed for penetration and procreation. The orgasm is needed for ejaculation, which can be external and therefore attainable with a accid penis. It is also a huge part of the pleasurable aspect of sexual activity. So where are we heading………. OUTERCOURSE. Or as my 74 year old patient said, turning to his 72 year old wife….”well my darling - it's all that stuff we did before the ring was on the nger.” It is hand work, oral sex and positional sex. A combination of 2 out of the 3 enhances effectiveness. HAND WORK. Done with self or partner stimulation. It is done on a accid penis – with lube or in the shower or combined with oral sex. Gentle gliding Helen Shaw Dip. Physiotherapy (Pretoria) Men's Health Physiotherapy Practice, Wynberg Cape Town
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