Sex and Sexual Operations
There are two major operations affecting the sexual apparatus which are, or seem to be, becoming increasingly common. One affects the man - prostatectomy; the other affects the woman, hysterectomy, with or without ovarian section.
Prostatectomy
Let me run over briefly what I have already said about the prostate.
The prostate is a large walnut-shaped gland which surrounds the neck of the bladder in males. It produces the prostatic fluid, which mixes with the fluid produced by the seminal vesicles, into which the semen has moved from the testicles. Together seminal fluid, prostatic fluid and sperms make semen.
As well as being a gland, the prostate also has the qualities of a muscle. When the man begins his orgasm, the muscle-like prostate begins to contract and relax, and forces the semen along the urethra, where it is then taken over by the muscles surrounding the bulb of the penis - that part which lies inside the body - and forces it out of the penis. It is because this occurs by contractions of the various muscles that the semen leaves the penis in spurts.
The necessity to have this operation, in which a large part of the prostate is removed, is brought about by the fact that as it grows larger it closes the outlet of the bladder, making urinating very difficult, setting up all kinds of inflammation in the bladder and ducts, and can become so serious that sooner or later, if not attended to, it could prevent the passing of urine altogether.
The operation is a major one, and has various after-effects, many men being anxious that after the operation they will be unable to have any further sexual experience. This is quite wrong. Men report that they achieve orgasm just as easily as ever and the sensations of orgasm are unchanged. In some cases, no semen is ejaculated from the man's penis. In other cases, nerve damage through total prostatectomy means that it is impossible for the man to get an erection after the operation. Modern surgical techniques, which are designed to spare the nerves running through and around the prostate, can help maintain erectile capacity.
The lack of visible semen after the operation in some men is caused by the fact that although the seminal vesicles continue to produce their fluid, as does the remainder of the prostate, the muscle quality of the prostate is weakened to the extent that though it in no way interferes with the orgasm sensations, it cannot force the semen down the urethra, and it flows back into the bladder. If you urinate just after coming, you will see semen floating in the urine, if you use a glass receptacle. This is retrograde ejaculation.
Loss of fertility should not worry any man, because as a rule you are in your late fifties or middle sixties before a prostate operation becomes necessary, by which time you will probably have had all the children you have planned. Some men find the absence of visible semen requires psychological readjustment; but this is not difficult; and it may even be a good thing because it allows one to have all the fun of sex without any of the mess!
Any irritation of the urethra and difficulty in urinating should send you hurrying to the doctor. If caught in time, a large number of malignant prostate growths can be dealt with successfully. If the whole prostate has to be removed, impotence will follow more likely than not.
Hysterectomy is the removal by surgery of the uterus, which may or may not be accompanied by the removal of one or both ovaries. The ovaries have a tendency to develop cysts and other irregularities which give rise to great discomforts and complaints. This usually happens in the five to ten years preceding the menopause and during the menopause. If an operation is necessary to remove either one or both of the ovaries to eliminate the cyst trouble, most surgeons also remove the uterus. Most surgeons, too, even in cases requiring surgery on both ovaries, try to leave part of one ovary at least, so that the woman's sex hormone continues to be manufactured naturally.
This is possible in the majority of cases, so her sex-drive will in no way be affected, and she will be as capable of reaching orgasm after it as she was before, if not more so. Even when both ovaries have to be completely removed, hormone replacement therapy can replace the lack of natural production and she will still experience the desire for sex and orgasm.
So no woman need fear that either ovarian section or hysterectomy spells the end of her sex life.
The uterus may also develop tumors and other obstructions which require the removal of the whole organ. If the ovaries are found to be perfectly healthy they will be left. Then there is no impairment of the enjoyment of sex at all. Removal of the uterus may have the effect of shortening the vagina. First sexual intercourse after the operation should therefore be undertaken with the greatest care. If the penis, which before could be accommodated with complete comfort, now causes pain, then shortening has taken place. After a time it may return to its former elasticity and length.
Throughout this book I have referred to impotence, the man's inability to achieve an erection and so be unable to have sexual intercourse. There is no doubt that so far as most men are concerned, this is his greatest fear, from the moment that he becomes aware of the delights his erect phallus will bring him, as well as the means of fulfilling his manhood in reproduction, to the day he dies, or for some other reason gives up all interest in sex, though this is very rare.
As I have remarked before, as a man grows older, his sex drive loses some of its urgency, and his capacity for strong and sustained erection becomes slightly impaired. It is when he notices that this is taking place that he begins to fear the worst, though in the vast majority of cases his fear is groundless. Certainly, by far the larger number of cases of erectile problems occur in older men, but miracles have been performed with the help of Viagra and male hormone replacement therapy
It is, however, temporary dysfunction which is the main cause of the fear, and fear always feeds impotence whether the primary cause is psychological or physical. So, at the first sign of repeated inability to achieve erection, see a doctor. If he finds there is nothing physically wrong with your penis, testes and prostate, then the causes are psychological and are capable of being treated.
Again, as I have pointed out earlier, in quite a number of cases temporary erectile dysfunction has psychological causes which stem from the fact that in later life it is sometimes the woman who has the stronger sex-drive. And this may be the direct cause of a man's failure to get an erection. Many men, finding they are no longer in control of an aspect of their lives which has been so important to them, build up an unconscious resentment, frustration and anger against their new role. This can be enough to take away all interest in sex. If it does not do this, then it leads to temporary erection problems.
In order to attain the greatest heights of sexual pleasure the mind must be free of distracting influences. The uppermost thing in the man's mind when he becomes sexually active must be his desire for the other person involved. Every successful act of sex and intercourse requires a complex set of responses from men: all of his powers - psychological, emotional, nervous, glandular and muscular - have a role to play, and failure of any one of these functions will diminish or destroy potency. In particular, a wide variety of strong emotional reactions such as animosity, fear, anger, disgust or anxiety can destroy his erection. One of the greatest tragedies of impotence is that of a man, having 'failed' once, is thereafter always anxious about failing again - and, more often than not, he does just that. It is ironical that the fear of impotence is the most frequent cause of erectile failure.
Another common cause of fear lies in the superstition that the 'change' - the andropause, the reduction in male sex hormones around forty five to fifty five - means the end of sex.
And let the angle of a man's erection decline by so much as a few degrees and he may be thrown into a panic, foreseeing the end of his potency.
The problem is simply that the middle-aged man who becomes unduly conscious of his waning sexual capacity creates his own emotional crisis. When he reaches the years of less frequent love-making, he views his youthful potency with nostalgia. But what is he measuring himself against, against what standards of performance? The youth of eighteen who was capable of coming eighteen times a week? But this is a fairy-tale picture he is evoking. If he recalls those years correctly they were likely to be years of trigger happy sex. The years of luscious, long drawn out sex with his woman were still in the future. There was nothing enriching about his attempts at sex in those years...wham, bang, thank you ma'm, as the saying has it.....
In a more rational frame of mind there is no reason why he cannot have a rich and fulfilling sexual life for many years to come. And a determination to go on being interested in love and love-making and to do both for as long as possible is a major step on the way to long-lasting sexual happiness in later years. Deeply satisfying emotional relationships store up a positive charge of energy which our bodies continue to draw on for many years. Erotic experiences in early and middle years can form the basis of happiness in later years. If the earlier erotic experience of the partners has been good, desire and love-making continue far beyond the average.
If any of my readers has the misfortune to be suffering from psychological impotence, may I plead with him to try to cure himself quickly, and if he does not succeed within a fairly short time to seek psychiatric advice. I make this plea because his state will have repercussions in every sphere of his life. Not only will he suffer, but also those about him, and his work. It does, perhaps, require a degree of determination and will-power, but the results will justify any trouble to which he is put.
And after all, this suffering is so unnecessary.