Shattered

Friday, May 27, 2016

Question

Dear Patrick: I am one of about 2,000 American veterans whose genitals were injured by an IED (improvised explosive device). In my case, a roadside bomb also took off my legs and one of my arms. Soldiers and Marines like me are waiting for medical research to come through for us that would allow transplants to repair our bodies. I have thought about a phalloplasty, but this surgery is very expensive, and I am not sure that it would give me what I want. In the meantime, I have a wife who wanted to celebrate my homecoming. She still wants to be with me, but our old way of being intimate is gone forever. She says to me, “Use your imagination.” I’m afraid my imagination hasn’t gotten us very far. So I guess now I am turning to you to ask to use your imagination instead of my own. What about it, can you help me to rescue my marriage and our sex life?

Answer

Dear Shattered: No pressure, huh? Unfortunately, veterans’ services has not kept pace with emergency medicine. It is harsh to say this, but a decade ago, you probably would have died of such catastrophic injuries. The agencies that deal with veterans have not kept pace with providing all the social services needed by men and women who come home with genital injuries, most of whom are also trying to adjust to life as amputees who must use artificial limbs or a wheelchair. For example, the U.S. Senate Republicans have blocked attempts to fund “artificial” reproductive technology that would allow veterans with your injuries to have a family. According to a series of articles done by the Huffington Post in 2016, about half of veterans with genital injuries are married, and their average age was 24, so it’s crucial for the issue of having children through a sperm donor or adoption to become part of the benefits for male and female veterans who lost their reproductive capabilities in the service of their country.

The good news is that these types of injuries have catapulted Western medicine forward in two ways that night help you. One is in the field of transplants and the second is in the development of replacement organs. Surgeons in South America began researching penis transplants because so many young men there were suffering from mutilation or complete loss of their genitals after botched circumcisions. Young men in the Xhosa tribe must undergo a radical circumcision ritual, conducted by tribal ritual specialists, to be considered men. But the circumcisions are often carried out in such a way that the injured penis is bound too tightly, cutting off blood supply and causing gangrene. The young men are also isolated after the ritual, forbidden to eat or drink water, and their poor physical condition contributes to a bad outcome. It’s not known exactly how many young men commit suicide each year because of castration due to the circumcision ritual; some also live as outcasts from their tribe once they realize the healer’s promise that their penis will grow back will not materialize. It has only recently become possible for some young African men to speak out and try to hold ceremonial practitioners and tribal elders accountable for what has happened to them.

The man who received the first penis transplant was told that he might need two years to regain sensitivity. Instead, he was able to be sexually active after two months, and even impregnated his girlfriend. He must take immunosuppressive drugs for the rest of his life, which isn’t pleasant. But he is able to once more feel whole as a man and as part of his community.

Other research uses stem cells from the patient’s body like seeds to grow a new penis on a scaffold of a neutral substance that his body will not reject. The goal is to grow a replacement penis that can be surgically attached without the need for the patient to also take immunosuppressive drugs.

Johns Hopkins University School of Medicine plans to begin doing penis transplants for American veterans in the near future. They will do the transplants for a group of 60 men, then study their results to see if this treatment can be viable for a larger number of veterans. The physicians there have received criticism for being willing to do a complex surgical procedure that is not necessary to save a patient’s life, but Johns Hopkins defends these transplants on the grounds that they are vital for quality of life and for a patient’s identity and sense of self.

If you are not one of the 60 pilot subjects, what can I tell you to do in the meantime? Well, you are in the situation of using what you’ve got. I want to reassure you that there are a lot of people in this world who manage to have really good sex without a penis. It can be done. The goal of making love with your wife remains the same as it was before your injuries: releasing tension, experiencing mutual pleasure, affirming your bond with one another, and feeling close.

Don’t avoid physical contact with your spouse. One of the most harmful things you can do is keep her at arm’s length because you feel stress and disassociation about the changes in your own body. Start feeling more centered and full of acceptance instead of anger or fear by being physically close to her. Express your affection in a physical way. Touch her, hug her, kiss her, stroke her hair, tell her you love her. Smile at her. Listen to music together. Do things that make the two of you laugh. This surrounds her in a net or an aura of your affection and attention, and is a constant reassurance to her that she is valued and needed.

When you can be alone together, passionate embraces begin with kissing and with touching one another. Don’t stop her from seeing or touching your body. If you need to take it one step at a time, that’s okay, but gradually let her explore the body that you occupy, your physical reality. This body is strong, it got you home, it survived, and your body needs affection and pleasure as much as it ever did. Your body doesn’t want to be shut off from human contact, ignored, or treated like it did something wrong. Your body didn’t do anything wrong.

You may need to use new positions because of the loss of limbs and mobility. Get help if you need to be positioned in bed so you can be with your wife. Undress each other and hold each other. If she needs to come, there are a lot of ways for you to help her do that and enjoy being with her while she does. You can go down on her, maybe exploring her inside with your fingers, if she likes or needs penetration. You can also use a vibrator to tease her and give her orgasms. Some women like vibrating toys that can be used for penetration; others prefer toys that are only good for clitoral stimulation. So you might want to buy a couple of different toys. Looking at catalogs or websites that sell these items can be a way to flirt with one another and anticipate having a fun date in the future. It’s also a big risk to take, and can make you both tense as hell, so if you have a fight about something else, understand why that’s happening, and just try to reconnect and forgive each other for only being human.

The two of you are trying something very hard, and you don’t have any role models. You are brave loving people, and you need to go as easy as you can on yourselves and on each other.

If you want to try having intercourse, there are ways to do that by using a prosthetic penis and a harness. I know that this may be a difficult decision to make. It’s something you and your spouse should discuss together, looking at the options that are available. I just want to reassure you that it’s okay to try something in bed that you might not like. That’s still important information. You can always just say, “Well, that didn’t work,” and move on to something that does work. And it’s always possible that you will say, “Hello, this is fun, I like this a lot!”

There are many different types of harnesses. I recommend one that goes around the waist and between your legs to hold the prosthetic in place. Make sure you can remove the ring that holds the dildo steady, so you can wash it. Purchase a phallic device that seems a little too small, rather than one that seems big. People have a tendency to buy dildos that are too big to really be practical. She is probably going to be riding the toy, sitting on it, rather than using the missionary position. That means a deeper degree of penetration. And so you need to account for that and get a toy that won’t be painful for her.

There are many different types of dildos. I recommend the softer types that are made of cyberskin or its relatives. These toys get warm as they are in contact with the human body, and they are not rigid to the touch. Dildos that have balls or some other base are best for use with a harness, because you need that structure to keep it from slipping out of the ring.

Using a harness and prosthetic allows you to hold your wife while you are inside of her. It reproduces a style of intimacy that you were able to enjoy before your accident. Some men find that they really like that; others do not. But I wanted to mention it as an option so you could decide. For some men, using their real body parts is more important, so they would rather go down on their wife and stroke her with their hand than use a toy. Others don’t care whether it’s a toy or their hand that pleasures her as long as she feels good. And some guys wind up running off with the vibrator because it creates some pleasure for them as well. It can’t hurt to try that, too. You may have some nerve endings that respond to a vibrator.

I hope these ideas give you a starting place. If you need extra help, you can always seek out a sex therapist who will work with the two of you to help you develop a new sexual style that will enhance your relationship. I hope very much that the two of you can preserve your love and stay together.

I don’t know if you are in therapy. If you were, a counselor would probably mention that you need some time to grieve. You might suddenly get hit by a wave of intense sadness, even if the two of you are having fun in bed. It’s clear that the kind of sex you and your wife can have now is not the same as what you had before. I can’t offer you that. But I can offer you some ways to be physically close that feel very intense and are quite satisfying for her, if she is willing to let go of the past and try something new. Mourning the past doesn’t mean you can’t adapt to the present and even learn to be very happy in it. It just feels like hell when you are in those sad, bitter times when all you can feel is how very much you wish you did not have to cope with such a serious medical problem.

I hope the doctors are soon able to restore your body to a facsimile of how it was before military service. In the meantime, I hope you and your wife will be able to remain partners and friends. Please feel free to write as often as you like.

 

P.S. For my other readers, a phalloplasty is a surgery to construct a phallus. It requires a large donation of tissue from another site—usually the patient’s forearm or thigh. This means considerable scarring at the donation site. Phalloplasties are risky because there is always the danger of inadequate blood circulation, which can cause the phallus to be lost. It takes a separate surgery to create the facsimile of a scrotum. This surgery does not provide any sexual sensation or the ability to get an erection. Some doctors promise to provide sensation by transplanting nerves. A plastic rod can be inserted into the urethra to create enough rigidity for intercourse. Or a reservoir of fluid can be implanted near the hip with a tiny pump that will push the fluid into the neophallus to create an erection. This is obviously a very problematic procedure, and I can see why you are reluctant to allocate tens of thousands of dollars to get it done.

 

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