Dear Ms. Queen,

I am a 44 year old man with an unfortunate story. When I was 19 years old, I ruptured my penis during masturbation. Most unfortunately for me, I never saw a doctor, even though there was tremendous pain and some blood from the urethra. Weeks later after the pain had dissapeared, I resumed masturbation (very gingerly). At one point, while ejaculating, to be specific, the head of my penis became numb, and I experienced almost no pleasure. I have been the same ever since. I experience little pleasure, and worst of all, I go through cycles of very uncomfortable pain (which makes me crazy) in the head of the penis. I have been seen by several doctors, in the late 1980s and more recently also.

One doctor did a sensitivity test which determined abnormality in the head of the penis. This was just this last December. Last month, I saw a doctor who told me that the nerves in the penis were likely damaged, and that had they been able to repair, they would have started to do so about two years after the injury. Both physicians gave me viagra and cialis. I haven't tried them yet. I am a little afraid of how they will affect my body. Over the years, when I have seen physicians for this, they have either pooh-poohed my story or they have simply told me that the damage was done and can't be undone. My sex life is a total disaster, and my mental state has been tenuous.

I have never spoken with a sex therapist about this. I would say that in some ways, I am typically North American and male, meaning this is something better kept secret. But I go through real despair over it. I was diagnosed at the UCLA pain clinic as suffering from PTSD, post tramatic stress disorder. Even now, 25 years later, I go through horrible periods (I'm in one now) in which I continuously go over the events that led to the injury, and the aftermath of it (the fact that I didn't seek medical attention, and the results of that. Physicians have told me that had I done so, the damage might have been avoided). I wonder if there is anything that you could say that would be helpful to me.

--In Pain

Dear IP,

First I want to commend you for not giving up, especially given how long you have been living with this distressing situation. That you are still looking for positive sexual experience and some sort of resolution to your injuries *will* make a difference. You are making the effort to take care of yourself and to learn all you can about your situation, and that's a really positive step. Please remember that when you get depressed: you
*are* taking action.

I am all too familiar with stories that are similar to yours in terms of doctors not taking sexual complaints and issues seriously. Most MDs, no matter what their specialty, get little training and information about sexual functioning. This combines with the very common discomfort about sexual communication that's so pervasive in this culture (you feel it, and so, probably, do many of your doctors; sad but true!). The result is that docs frequently have no real answers and don't want to talk about their patients' sexual concerns. Since you already feel distress and shame over the accident, this just makes matters worse. It's very important that you be able to communicate as comfortably as possible with the physicians who are trying to help you figure this out.

For example, I am wondering whether you actually asked your most recent doctor what effects Viagra or Cialis might have on you. If you weren't comfortable enough to ask, or they could not satisfactorily answer, no wonder you're nervous about taking it. I'm not sure, given the information you've shared with me, whether it's likely that your corpora cavernosa have been injured. If they have, that might indeed affect how you respond to Viagra and similar chemicals. If it's just nerve tissue that is still damaged, I don't think there's any harm using the Viagra; but it would be good to have a real diagnosis (at least a doctor's educated guess) before you use yourself as a guinea pig.

I don't know if you are using a health plan that pays for outside experts, but I would like to suggest you seek out a local doctor who specializes in urology and sexual functioning. An organization like AASECT (the American Association of Sex Educators, Counselors and Therapists) or SSSS (Society for the Scientific Study of Sexuality) can help you track down the best person to see. Visiting a neurologist is good, but a urologist with a specialty in sexual issues may be even better. He or she will be more accustomed to talking about erotic functioning and more informed about it than most doctors. Also, I have a book to recommend to you: Dr. Charles Moser's Health Care Without Shame, which talks about the medical field's problems addressing sex and helps you get the most out of talking to any doctor about sexual issues. You might find it useful. You can get it at Good Vibrations.

Your story is a sad but clear example of the damage that can occur from our society's discomfort about sexuality. You felt unable to get help when the injury originally occurred, and that had its own problematic repercussions. There's no way of knowing *for sure* what might have been done at that time, so it's hard to say if your long-term injury could have been prevented or minimized. Since we don't know, there's no real point in dwelling on this. But not being able to talk about it has hurt, not helped, and that's not really your fault. Many, many people (maybe most
people) still have a real block when it comes to communicating easily about sex. In your case it has affected your search for care, but I am guessing it also affects your sex life and possibilities.

So I *would* encourage you to see a sex therapist, partly because, besides your physical injury, you have a substantial emotional injury too. A sex therapist can help you work through this, and possibly open your eyes to sources of intimate pleasure that don't center on your penis or that minimize any pain still associated with it. Plus they can help you learn to communicate about it (and sex in general) more comfortably, which will have positive effects in your current or future relationships. If you find a new doctor, he or she might be a good source of referral to a therapist. If possible, see someone who has some experience working with people who have had to deal with sexual trauma or injury. And make sure you feel comfortable with this person. If you don't, learning to feel comfortable about communication will be that much harder.

By the way, ask your physicians what's new in pain relief that deals specifically with nerve pain. Perhaps one of the new medications might make a difference for you.

I encourage you to continue your quest to deal with your situation. Physical pain aside (which of course you want to minimize and control), you *can*, with help, overcome some of the traumatic effects of your injury. Best of luck.