Sex therapy and penectomy

A 65-year-old man, having undergone a penectomy operation that spared the ejaculatory apparatus and some erotically responsive areas, experienced a spontaneous orgasm, with ejaculation, upon being touched in the perineal area during a massage. Unable to duplicate the experience, he (and later his wife) entered sex therapy, which resulted in his being able to have orgasms during lovemaking. The course of the therapy is described, as are certain issues arising from the therapy. Regaining of the man's orgasmic ability was accompanied by a striking improvement in the intrapsychic and interpersonal functioning of the couple, and this is taken to be an example of the "ripple effect" of successful sex therapy. The implications for this therapeutic approach for the rehabilitation of other penectomy patients and their spouses are discussed. Finally the question of surgical penile reconstruction in such cases is explored.