The Guide to Getting It On (170 page)

“If I were a woman who is preparing to have a hysterectomy, there are a few things I would want to be asked. First, I would like my physician to discuss the possibility of less aggressive/less invasive treatment alternatives—hysterectomy isn’t the only option for an increasing number of diseases. I would want my MD to check in with me about my general well-being in life at that moment, because the literature shows that depression and anxiety going in tend to predict poorer outcomes. I’d also want to know that my MD cared that I had the support of friends, family, and/or significant others; this is another thing that seems to influence outcomes. If my MD suggested that I should have my ovaries removed, I would want a very good reason for it. The idea that I should remove organs that I supposedly ‘won’t need anymore’ on that basis alone is preposterous!

“After hearing from many women about their hysterectomies, the main thing I have learned is that most of them just want information. Even if the MD can’t guarantee a particular outcome, they really want to know the pros and cons of all of the treatment options. Contrary to what some paternalistic doctors might tell you, they really can handle that information! Several studies have demonstrated that patients tend to want more information, sometimes a lot more, than their doctors think they want or need. The bottom line is that women want to CONSENT to every aspect of their treatment, and that means they understand why they’re taking one approach over the other, etc. Informed consent is not just ‘this is what you need, now sign the dotted line.’ It’s an agreement to a collaborative treatment decision (thus the word ‘informed’).

“The jury is still out on to what extent hysterectomy affects basic sexual physiology. I would guess that any given outcome is a combination of the surgical technique and the individual woman’s composition. I’ve heard some women say that they have lost some sensation after hysterectomy, or their orgasms aren’t as intense as they used to be, but there is no ‘typical’ hysterectomy experience as far as I can tell. Whether any woman would do it all over again given the chance depends on a lot of different factors. Women whose sex lives are disrupted because of huge, basically inoperable fibroids are likely to still be mostly satisfied when penetration no longer causes sharp pain, and I suspect that for many this would be true even if the cost were a slight change in sexual sensation or the intensity of orgasm. The thing is, though, we can’t KNOW what that potential trade-off would mean to any individual woman unless we actually ask her! So, if I were a doctor, I would say, “Look, these are side effects that some women have reported,” and summarize the latest research to give her an idea of how common the side effects actually are. It would be up to her to decide if the risk, however small, was worth the pot-ential gains associated with hysterectomy, which themselves are not 100% guaranteed either, of course! It’s a cost-benefit analysis, and even though there are a lot of women who want their physicians to make the final decision, I’ve never heard anyone claim that they got too much information about what might happen to them.

“I
have
heard from a few women who said that they put off their hysterectomies needlessly because of scare tactics, and this is the other side of the story. There are activist groups putting out some pretty wild claims. According to them, hysterectomy can cause asthma! They don’t do women any favors with their misinformation and pseudoscience. Ultimately it’s a hard decision to make, and women simply need the facts. I am fairly convinced at this point that, for an otherwise healthy, well-adjusted, well-supported woman who lives in a community or in a relationship that won’t see her as losing her femininity, hysterectomy is not necessarily a bad thing for sexual function and in some cases might be exactly what she needs. If less invasive treatment options have been ruled out and the main issue is painful intercourse caused by the disease. Otherwise, the picture can be more complex. One of the most consistent findings from past research is that the worse off you are to begin with, both sexually and emotionally, the less likely it is that your outcome will be a complete success. When women ask me about their treatment decisions, I ask them right out: are you emotionally, mentally, physically, and spiritually ready for this? You’d be surprised how seldom women get asked this question.

“No matter how healthy you are to begin with, losing the ovaries IS a big deal, especially for premenopausal women, as it changes the hormonal profile and forces further decision-making about hormone-replacement therapy and so forth. The choice to remove the ovaries should be carefully justified. The medical opinion on this issue has shifted back and forth over the years, but there are many experts who would tell you that, for healthy women with no significant risk factors for ovarian cancer, the cost of losing ovaries is greater than the potential benefits. Sometimes removal of the ovaries is an easy decision because of cancer or other factors, but more often than not it should be deliberated very carefully. This is a time to get second opinions.”

A Physician Gets Mad

A friend of
The Guide
from way back is one of the top sex researchers in the country. She is also a physician. Recently, she became so angry with her own private gynecologist that it appeared she was going to rip him a new—uh—vagina. She was diagnosed with cancer of the cervix, and she felt his handling of it was neither sensitive nor professional.

The reason for reporting this is not to dump on gynecologists. There are many excellent ones. It is to remind you that even an MD can become an angry and frustrated patient. So if you are feeling overwhelmed by your dealings with modern medicine, you are not alone. Don’t hesitate to get a second opinion. If it appears that you will need surgery and you don’t feel comfortable with your physician, find a university health center to get another opinion. That is what our physician friend recommends after her personal experience with hysterectomy.

A SPECIAL THANKS:
To Annie Bradford of the University of Texas at Austin for providing some of the best advice available on hysterectomy.

CHAPTER

87

Techno Breasts & Weenie Angst

P
eople who feel sexually inadequate sometimes focus their angst on body parts. For women, the focus is often on breast size or body shape; for men it is on the penis and sometimes height. Of course, it is silly to obsess about something that you had no say in getting, yet that is what many of us do.

When generating a physical balance sheet, it might be helpful to remember that even Man-O-War had his weaknesses. It might also help to remind yourself that sexual attractiveness is not like a steel chain, where one weak link makes the whole thing useless. All of us have weak links sexually, as part of our bodies and minds.

This offers little solace to people who are convinced that their body parts are deficient. They will keep telling themselves, “Everything would be better if I just had a bigger this or a smaller that.” To address such fears, this chapter offers a lengthy discourse on men’s genitals, then ruminates on breast implants and ends with a few suggestions about alternative strategies.

Body Concerns: Guys & How They’re Hung

While most books on sex say that penis size doesn’t matter, there are two groups of people to whom it does matter. One group includes almost every male alive. The second group includes every woman who derives sexual pleasure from intercourse.

In years past, women weren’t supposed to care about the size and shape of a man’s penis. That is because they weren’t supposed to be interested in sex. But wouldn’t you notice the size and shape of something that was about to get stuck into your body? As for how women respond to the actual dimensions of the thing, it clearly varies.

Some women regard the penis as a trophy—the bigger the better; others couldn’t care less. Some women prefer the feeling of fullness that a beefier penis has to offer; others prefer giving blowjobs to a partner who isn’t particularly well hung, and some even prefer a smaller penis for intercourse. Plenty of women get the bulk of their pleasure from what a man is able to do with his hands, heart, tongue and intellect. They view the penis as just another body part.

For some women, a lover’s penis becomes her penis or a part of her body when it’s inside of her. Does this mean that she necessarily wants the biggest one in town? Not usually. After all, when women buy dildos, they tend to select medium or smaller units. (Sorry, but they sometimes upsize later.)

This isn’t to say that women don’t have their favorites. Ask a woman to tell you which lover’s penis was her favorite, and she will probably be able to give a direct and clear-cut answer such as, “It was Alex’s” or “There are two or three that stand out, but I’d have to say Todd’s takes the prize.” However, if you ask about the men behind the penises and which ones she loved the most, Alex or Todd might not be at the top of the list. Maybe the guy she was happiest with didn’t have a memorable penis, but was able to put it together in other ways.

So while women might prefer one penis over the other, penis size usually isn’t a deal-breaker when it comes to choosing a man. It is sometimes disappointing, but usually not the deciding factor.

Irony:
While some guys grow up worrying if they are hung well enough, women sometimes grow up worrying that guys will be hung too well and might cause them pain. Maybe we humans were programmed to worry.

One More Thing Porn Has Changed...

Few women make it past age sixteen without having seen online porn. So most of the erect penises today’s young women have seen are in the top 1% to 10% as far as size is concerned. The good news about this is women probably don’t freak out nearly as much now as they did in the pre-porn days when a real-life lover pulls out a really big penis. The bad new is porn has upped the ante for what a lot of women assume is average. And this makes sense, given that porn doesn’t include warnings that say “The chances are slim that your man will be this big” or “You probably won’t get to try this at home.”

The Fear vs. The Reality

The Journal of Sexual Medicine
recently published a review of all of the studies that have been done on penis size.

One of the most fascinating findings is that out of 414 men who complained of having small penis size, 410 or 99% had penises that were normal sized. And while only 55% of men report being satisfied with their own penis size, 84% or women were satisfied with their partner’s penis size.

So, what’s average? Measuring from the pubic bone to the tip of the penis head, the average limp penis is about three-and-a-half inches and the average erect penis is about five inches. (This is the average of eight different studies that measured the penises of thousands of men.) The average circumference when erect is about four-and-a-half inches. When guys measure their own penises, they miraculously end up being almost an inch longer than when a researcher does it.

Weenie-Enhancement Techniques: Surgery That Makes Your Penis Fat

There used to be a surgical technique for penis plumping in which fat cells were harvested from the lower-stomach region and injected into the penis. The author of this book called three offices that advertised this procedure and was hit by a wave of sales pitches that he hadn’t encountered since joining a health club. The heavy sales pitch, which tried to capitalize on every sexual doubt known to man, made sense when you consider that these clinics were charging $3,000 to $7,000 for a simple outpatient procedure that takes half an hour.

One clinic in Beverly Hills refused to mail out information about the procedure. They claimed that a brochure had fallen into the hands of a child, resulting in great embarrassment. To prevent such a hideous event from ever occurring again, each caller had to make an office appointment where he could read the brochure and talk to a specialist. “Why an appointment?” “Because we process over forty men a day.” As it turned out, the dreaded brochure contained no pictures or drawings and was embarrassing only in how it insulted the consumer’s intelligence.

This fancy medical clinic insisted that it needed a social-security number and health-insurance information before discussing the procedure. Each visitor was required to fill out a separate page about his penis. The wording was designed to make a man feel sexually insecure and blame it all on the size of his weenie. It was the forerunner for today’s spam and TV commercials that promise a bigger dick with pills instead of surgery—with probably the same people being involved.