Elephants and Tea - March 2023 - 14

Sexuality INTIMATE ISSUES WITH MARLOE
part of the sleep cycle we tend to wake up
after, hence why people often awake in the
morning with an erection.1
might derail the ability to get reliable erections.
Let's take a look.
This phenomenon
is all just a part of being a person with
a healthy penis!7
Not all of these cycles
of increased blood flow are sufficient to
achieve a full erection, and so they may go
unnoticed throughout the day.
ELUSIVE ERECTIONS
As far as trying to figure out the cause of
erection difficulties, the presence or absence
of these non-sexual erections can be helpful.
For example, if you are having trouble
attaining or maintaining an erection with
partnered sexual activity, but you wake
up with erections and/or you are able to
get an erection in other situations (such as
with masturbation), the cause is less likely
to be physical and more likely psychogenic
(related to feelings or emotions). Examples
include stress, worries or anxieties about
sexual performance, or problems with intimacy
or your relationships.
However, if you aren't able to achieve
an erection with sexual activity, and you
no longer notice erections when you wake
up or in other situations, the cause is more
likely to be physical. This could include
damage to blood vessels, nerves, or altered
hormone levels. A lot of the time,
it's a combination of both physical and
psychogenic causes (see The Brain-Body
Connection, below).
WHAT DOES CANCER HAVE TO
DO WITH MY PENIS, ANYWAYS?
Well . . . maybe a lot!
Studies show that problems with erections
are reported by young people dealing
with all different types of cancers, including
reproductive (testicular) and pelvic
(bladder, colorectal) cancers, as well as
brain and hematologic malignancies. 9,12,13
Erection challenges have been associated
with pelvic surgery and radiation, surgery
and radiation to the brain or spinal cord,
as well as chemotherapy and hematopoietic
stem cell transplants.3,6,10,13
Some sexual
problems may improve or even return to
baseline over time, while other sexual issues
can be long-term or worsen with time.6
As we have seen, getting and keeping an
erection is a surprisingly complex physiological
phenomenon, so it's no wonder
that the impacts of some cancer treatments
14
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MARCH 2023
* Chemotherapy
Because some chemotherapies lead to
nerve damage (like peripheral neuropathies),
it's possible that the nerve pathways
related to genital sensation and
erectile function could also be impacted.
However, the effects of chemotherapy on
* Surgery
Surgery for pelvic cancers (bladder, colorectal,
prostate) can cause damage to
the nerves and the blood vessel pathways
that are responsible for erections. Even
nerve-sparing surgeries are not 100 percent
effective at preserving erectile function
after cancer. Sometimes damaged
nerves can heal with time, so if a person
notices a loss of erections right away after a
surgery, they may be able to recover some
of that function as the nerves heal over the
next year or two. A process called erectile
rehabilitation (covered in more detail in
Part II) might help with this. 3
Brain and
spinal surgery have also been found to
be a risk factor for erection difficulties
after cancer, due to either disrupting the
brain's role in the production of hormones
associated with erectile function, or by
disrupting the nerve signal connections
from the brain to the genitals.13
* Radiation
In contrast to pelvic surgery, where
problems with erections are often immediate
but may improve with healing over
time; erection changes related to pelvic
radiation often progress gradually as the
affected tissues develop scarring with the
healing process.10
TRUE OR FALSE:
Orgasms Require
Erections?
This is one of my favorite factoids ever.
Turns out that the nerves responsible
for causing erections are separate
from the nerves responsible for
orgasming.2
This means that people
Scarring can occur in
the vessels that supply blood to the genitals,
causing a loss of elasticity and the
inability to accommodate the high volumes
of blood flow needed for erections
to occur. Fibrosis can also develop in the
spongy erectile tissues (corpora cavernosa),
inhibiting their capacity to stretch
enough to stiffen the tunica albuginea
and trap blood in the tissue. Further,
damaged nerves may lose their ability
to trigger tissue relaxation and vasodilation.
Radiation to certain parts of the
brain may also impact the production of
hormones needed for erections, as well.
don't need to have an erection in order
to experience an orgasm! Who knew?!
The reason I love busting this myth
is because knowledge is power, and
this little gem of knowledge sort of
feels like a huge middle finger to the
misguided cultural imperative that
penetration is somehow the best-if
not the only-kind of sex worth having.
I mean, using penis performance as
the measure of successful sex totally
undermines the sexual relevance of
all the penis-owners whose erection
equipment doesn't swell, but who are
still, obviously, sexual people with sexy
thoughts, feelings, and attractions, and
the ability to feel pleasure.
Thankfully, our bodies can experience
pleasure in so many ways that
don't require rock-hard penises or
penetration of any sort. No matter
where a penis lands on the spectrum
between soft and stiff, it can still
participate in sexual play and bring
sexual pleasure your way, if you are
willing to explore the possibilities.
For inspiration, consider checking
out the third episode of a threepart
podcast series by Death, Sex
& Money, called " Hard: Softening
Expectations. " The first two episodes
are great as well, but this one explores
sex beyond erections, and it's well
worth your time!
https://www.wnycstudios.org/podcasts/deathsexmoney/episodes/hard-softening-expectations-death-sex-money https://www.wnycstudios.org/podcasts/deathsexmoney/episodes/hard-softening-expectations-death-sex-money http://www.ELEPHANTSANDTEA.COM
Elephants and Tea - March 2023

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