Sexual health care must deal directly with issues of sexual pleasure if there is going to be total sexual healing. Men need new messages to replace the old ones learned over a lifetime. Suggested messages include the following:
- Ejaculation and orgasm are not the same thing.
- It is not necessary to ejaculate everytime you have sex.
- Orgasm is possible without ejaculation.
- Sexual activity without orgasm or ejaculation is still sex and is a viable alternative to having no sexual contact at all.
- There are many ways to receive and to give sexual satisfaction without penile-vaginal intercourse.
- Sexual pleasure and even orgasm is possible through touching, kissing, hugging, masturbation, oral, and anal sexual activities.
- Good sex does not have to be spontaneous--talking about sex and planning sex can lead to good sex.
Simply sending messages will not be enough, though. Assuming a man desires to be sexually active again, and assuming excitement problems of attaining and maintaining an erection are organically based and managed with one of the options for erectile dysfunction, or assuming he decides to have sex without an erection, he will need guidance in finding out his optimal conditions for arousal. Common conditions men have reported as necessary to enjoy good sex and that lead to increased arousal include being more open to the experience, more confident, more rested, and more relaxed (Zilbergeld, 1992). Achieving these conditions subsequent to acquiring a disability is not a quick and easy path and will require implementation of the forementioned treatment suggestions.
A man will also need guidance in relearning about his body and what types of stimulation bring him pleasure. There are commonly used techniques to help increase awareness to areas of our body where sensation is still intact and where we may be open to sexual stimulation. Sensate focus exercises described by Masters and Johnson (1970), pleasure mapping described by Stubbs (1988), and charting your personal extragenital matrix described by Whipple and Ogden (1989) are three options for increasing sexual communication and sexual pleasure. Some of these sexual exercises may be performed alone while others will require the help of a partner or sexual surrogate.