Sexual Healing by Dr. Margarita Kressin

Because of what I do, I am definitely pro-sex. But a caveat I should say is that this be done between consenting adults and be done safely. I went to a recent conference where there was a lecture on oral and throat cancers. In the past, oral and throat cancer’s greatest risk is smoking. However, recently there has been a change in the leading cause of this cancer. This was actually brought up in my colleague Dr. Bruce Campbell's blog, Reflections in a Head Mirror. He writes about the relationship of oral cancer and oral sex.

Some facts about Human Papilloma Virus (HPV):

• HPV – most common cause of cervical cancer, now also in vulvar cancer (50 percent of pre-cancerous lesions now seen in 20-39 years of age)
• HPV – now seen in 72 percent of oral tumors (D’Souza 2007)
• Smokers have a 3x increased risk
• Heavy alcohol use a 2.5x increased risk
• Greater than 6 oral partners an 8.6x increased risk
• HPV 6 and 11 are the strains that cause benign genital warts. HPV 16 and 18 cause 70 percent of cervical cancer
• 1,700 new cases of HPV-associated head and neck cancers are diagnosed in women and nearly 5,700 are diagnosed in men each year in the United States (Ryerson, 2008)

What caught the attention of the room is the statistic of having more than six oral partners increases your risk more than smoking. We do know that it has been reported that oral sex among teens is often viewed so casually that it needn't even occur within the confines of a relationship. A study published in 1999 in the Journal of the American Medical Association examines the definition of sex based on a 1991 random sample of 599 college students from 29 states. Sixty percent said oral-genital contact did not constitute having sex. And ...

• According to a Centers for Disease Control and Prevention survey, 28 percent of males age 15-17 reported giving oral sex to a female and 40 percent reported receiving oral sex from a female.
• Among females aged 15-17, 30 percent report giving oral sex to a male, and 38 percent report receiving oral sex from a male.
• Some teens reported having oral sex but not vaginal sex (13 percent of males and 11 percent of females aged 15-17).

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.