When erections are not possible

Despite the widespread availability of drugs to treat erectile dysfunction (ED), the reality is that there are many men (particularly those who have lost both nerve bundles, are on long-term hormone therapy, or have been surgically castrated) who will never respond adequately to have erections that are firm enough for sexual intercourse.

There are also those men who may choose not to use penile injections, vacuum pump devices, and urethral pellets to attempt to achieve erections, or do not want to undergo—or can’t afford—penile implants.

Many books, web sites, and prostate cancer forums recommend that couples turn to other forms of intimacy, such as cuddling, hugging, kissing, and fondling when erections are not possible. These are all wonderful suggestions (and may be helpful for many couples), but for other couples they may not be enough.

If you and your loved one fall into any of these categories, you may be wondering, “is there anything else we can do?” For that reason, we report about an interesting approach that has appeared in medical literature.

The approach involved the use of strap-on penile prosthesis (commonly called a dildo). An article written by Warkentin et al provides a detailed account of an impotent prostate cancer patient, who uses this device to achieve satisfying (orgasmic) sex for both himself and his partner.

At first, the man (who was completely impotent, due to androgen deprivation therapy) was very hesitant to try it. But once he did, he was surprised to find that in addition to satisfying his female partner through intercourse, he was also able to also achieve orgasm. He reported that the device gave him a new confidence, because he had no fear of losing his “erection.”

While his partner was also initially apprehensive, she reported that she was able (for the first time) to achieve orgasm through intercourse. The couple attributed this success to the fact that they were able to have intercourse for a much longer period of time than even before prostate cancer. It is important to note that the couple had no expectations the first time they tried this approach—they were simply experimenting. But they had such a positive experience that they continue to use the device with great success.

From a psychological perspective, the authors of the article suggest that part of the reason this approach was successful was because the device felt “real” to the man. It was strapped onto his hips (his penis was right below it), so he was able to use the same movements during lovemaking that he did before treatment for prostate cancer left him impotent. During lovemaking, the woman was stimulated directly with the device. The trick for the male was that his partner simultaneously stimulated his penis with her hand, allowing him to receive the direct stimulation he needed to achieve orgasm.

While this approach may not appeal to every couple struggling with impotence, we felt it was worth sharing. It is also important to note that only one couple that we know of has benefited from this approach. But if you have too, please let us know by using the form in the About this Site section of this web site.

Thanks to Richard Wassersug for his help in writing this article.


Always discuss everything you read on this web site with a qualified medical professional.

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Warkentin KM, Gray RE, Wassersug RJ. Restoration of satisfying sex for a castrated cancer patient with complete impotence: a case study. Journal of Sex & Marital Therapy. 2006; 32:389-399.

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