Fred was a big, hulking 62 year old contractor with a salty sense of humor who had been my patient for many years. On his most recent visit when I examined him, his penis was black and blue, and there were several small tears of the skin on the shaft. "What happened?" I asked?

"It looks bad, doesn't it?" he said with a grin. "This is Nature's way of demonstrating the laws of physics. We're talking about shear forces here, doc."

"What are you talking about?" I asked.

"Immovable object meets irresistible force," he went on. "Except that the coverage of the irresistible force is only a thin layer of delicate skin."

Fred has diabetes, and due to poor nerve function, he also has trouble having an orgasm. Diabetes is also a major risk factor for erectile dysfunction (ED), and this had been a problem for Fred for even a longer period of time. The oral medications, such as Viagra, Cialis, and Levitra, often aren't effective in men with diabetes, and this was the case for Fred. So, for sex Fred used our usual "next step" in the urologist's armamentarium for ED, namely injections of medication into the penis itself to create an erection. Not painful (I'm serious!), these injections have a feature which can be very useful for men, namely that the erection often lasts for a very long time, even after a man ejaculates. Which means that a man can keep going for a long time, whether or not he is still excited.

So, what happened to Fred with his "immovable objects" and "irresistible forces?" Well, three days earlier, Fred's wife, Selma, took it upon herself to give Fred an orgasm. She was so determined, that she kept working and working at it until Fred was raw, and sore. And bruised and torn a bit, as it turned out.

"Did her efforts work?" I asked.

"I couldn't come, but I pretended I did," he said. "I couldn't take it anymore, and I wanted to live for another day. Selma and I used to have a lot of sex, and even though I almost never come anymore, it's important for Selma. She still loves it, and likes to think she's the hottest thing going. She would have gotten so down on herself if she knew she hadn't been able to get me off after all that work she put into it."

Although Fred's penile injections allowed him to keep going like the Energizer Bunny despite diabetes and ED, his reduced sensation made it difficult to have an orgasm. And because Selma was determined to give Fred the satisfaction of a bone-shaking climax, they had just kept going and going until Fred was suffering from his physics experiment. "Doc, you've got to help me. I can't go through that again."

An easy solution helped Fred and Selma- lubrication. Selma was post-menopausal, and thus had relatively little vaginal lubrication of her own. Some of the over-the-counter lubricants are great at increasing sensation for both men and women, and can avoid the "shear forces" of too much friction. As the old Brylcreem ads used to say (and if you remember this, you're showing your age, as I guess I'm showing mine)- " A little dab will do ya!"

What I like about Fred's story is how it shows up some of the complex, relational aspects of sex. The tired story line that men are just interested in sex to satisfy their primitive urges is shown the lie by Fred's behavior. In his case, sex is largely for the pleasure of his wife. And faking his own orgasm, as strange as it may sound, was another example of his concern for her sense of sexual self-worth. And in this case, for self-preservation too!

Men, Sex, and Testosterone

A urologist's view on men and sexuality.
Abraham Morgentaler, MD

Abraham Morgentaler, M.D. specializes in male reproductive and sexual health, and is a professor of urology at Harvard Medical.

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