The New Male Sexuality (63 page)

DIAGNOSTIC TESTS

If you see a physician, there are a number of procedures that may be employed to determine the exact nature of your problem. First a complete history of the problem should be taken. Some of the important questions are: Exactly what is the problem (don’t get erections, get them but lose them quickly, penis is full but not rigid)? Under what circumstances do you get and not get erections? When did the problem start, and how has it changed since then? How is your general health, and what medications are you taking? What about alcohol, nicotine, and recreational drugs? Have you ever had pelvic trauma (being kicked in the balls, falling on the top tube of your bicycle)? These questions are the ones you should address yourself before seeing the doctor or therapist.

Typically a physical examination is also done. This usually includes tests to determine the state of your arteries and blood pressure, since blood flow difficulties may well be responsible for your erection complaints. The physician may conduct a rectal exam to check your prostate gland, since an inflamed or painful prostate can disrupt blood flow or sensation in the penis; a check for anatomical abnormalities of the penis, such as Peyronie’s disease (a curved and sometimes painful erection), that can impede blood flow; and a determination of whether the nerves in the penis are functioning normally.

Blood tests are usually taken to determine your level of testosterone. Your blood sugar may also be checked for diabetes, a frequent contributor to erection problems.

Several other tests may be given. One of them is the RigiScan, a device attached to your penis that records its activity while you sleep. Since men usually have erections during rapid eye movement sleep, the stage of sleep when we dream, this is a way of determining if the problem is physical or not. The RigiScan is painless and typically done for two consecutive nights either at home or at a sleep laboratory. Most other tests have the goal of determining if enough blood is getting into and staying in the penis. These
require the doctor to inject your penis with a drug, usually prostaglandin, that causes the smooth muscles to relax and the arteries to open, thereby allowing increased blood flow into the penis. (Giving yourself such injections is also used as a treatment, which I cover later in this chapter.) By using X rays, blood pressure cuffs, and ultrasound, important information is collected about what might be getting in the way of you getting and keeping erections. If these tests don’t reveal significant pathology, the problem clearly lies elsewhere.

WHAT MEDICAL OPTIONS CAN AND CANNOT DO

Each of the medical interventions that I describe below can do one thing and one thing only: give you a usable erection when you want it. That’s it—nothing more. Compared to what was available twenty-five years ago, that’s miraculous enough, but some people have let their expectations get out of control. The resources we have—Viagra, penile injections, penile implants, vacuum devices, and so on—will change only the stiffness of your penis, but not your personality, behavior, or lovemaking technique.

Some couples are doing fine even without an erection but would like to have intercourse. All they want from the medical tool is what it can offer. Simone and Paul were such a couple. Even though Paul had developed an erection problem, they still had a wonderful relationship and sex life. They had sex frequently and did all sorts of lovely things with their hands and mouths and a vibrator. Nonetheless, they both missed intercourse. After a few sessions with me and some medical tests, it seemed to be the case that Paul’s problem with erections was caused by his long-standing diabetes. They tried a vacuum device for several weeks before deciding it wasn’t for them. The penile injections they tried next worked very well for them. They tried Viagra as soon as it came on the market, but it was not as reliable as the shots, to which they returned. Because Simone and Paul only needed erections and found a medical tool that provided that for them, they are doing very well.

The situation for some other couples is different. Yes, there’s an erection problem, but there are also other issues. Despite what many people think, these resources are not aphrodisiacs and in themselves will not make you desire sex more. (There is one exception. There are some men who have turned away from sex because of their erection problem. Because of the problem, sex was so full of tension and humiliation that they suppressed
their desire. With the erection problem resolved, these men become more willing to have sex. But this is the only way in which it can be said that using any of the following tools creates more desire for sex.)

These tools will not help you to talk or listen to your partner or be more sensitive, will not make you a better lover, will not improve sensation or give you a better orgasm, will not resolve relationship tension, and most certainly will not save a failing relationship. All of these considerations may seem too obvious to be worth stating, but strange things happen. A client of mine in his fifties got Viagra, tried it by himself, and found that it worked. His wife was very angry that in the weeks after that discovery he didn’t approach her. So he agreed that he would take a pill immediately after our session and make love with her that night. But he didn’t. After he took the pill, they made out on the couch, but before things got too interesting he told her he wanted to watch “a few minutes” of the first game of the 1998 NBA playoffs. She went into the bedroom, and two hours later—when he had still not come to bed—she called me in a state of great distress. We interrupted his game watching and got him on the phone as well. He didn’t have an explanation for what had happened, but it was clear that despite knowing that the Viagra he had taken would give him a good erection, despite knowing that his wife was expecting and wanting to make love with him, he chose Michael Jordan over his wife. Urologists and sex therapists, including myself, have talked with men who have gotten prescriptions for Viagra or vacuum devices which they never filled; others got the drug or pump and never used it. Some men have had surgery to have a penile prosthesis implanted and then never again had sex; some men have had sex only a few times in the years after surgery. Obviously, there is more to many men’s “erection problems” than simply not having erections.

There is another issue to consider as well. In some relationships the woman likes not having sex and is actually grateful for the erection problem, perhaps because she didn’t get much out of sex when they had it or because she feels estranged from her partner. So she isn’t receptive, and may even be horrified, when he presents himself ready for action.

Unless your problem is a very simple one, like Simone and Paul’s, consider a few sessions of sex therapy along with your new medical erection helper
.

If you have refrained from sex for a long time because of your problem, it may be difficult to get started again after you have the pill, pump, or shot. Even though you know you can now get erect, there may be some shyness or hesitation on your part and perhaps your partner’s as well. This
is especially true if there were bad feelings and ugly words exchanged about not having sex. You may need professional help to get past the bad feelings and deal with the anxieties and hesitations still present.

Another reason to see a sex therapist is that most doctors today simply don’t have the time to deal with all the concerns you may have. They may also lack the training or skill to deal with the relationship issues, anxiety, and other feelings that accompany erection difficulties. In addition, the partner may need to spend anywhere from a few minutes to several hours expressing how angry she is about all the rejections she endured before her man became willing to deal with the problem.

Don’t kid yourself into thinking these are small matters. The partner is typically the key to whether any intervention will succeed. If your partner continually complains about the medical option the two of you have selected—it doesn’t feel natural, it interferes with spontaneity, why can’t you get erect without it, and so on—chances are good that there are still feelings of hurt and anger that need to be dealt with.

MEDICAL TREATMENTS

I start with the options available before the advent of Viagra that are still useful today, and then take a detailed look at the drug we’ve heard so much about. All of these therapies are FDA approved, but of course this discussion is not intended as a substitute for an in-depth conversation with your physician.

Yohimbine

A drug in pill form that comes from the bark of an African tree, yohimbine was, until recently, often the first intervention suggested by physicians for erection problems. It is being used less frequently now because its results have not been impressive: Only about 20 percent of patients received significant benefit. However, side effects—anxiety, headache, and a small increase in blood pressure—are infrequent and generally mild. Yohimbine may be worth a trial if your doctor suggests it. If it helps, fine; if not, look at other options.

Advantage:

Yohimbine is safe, relatively inexpensive, and noninvasive.

Disadvantage:

It is effective for only a small number of men.

Vacuum Devices

Vacuum pump devices and constriction rings are now available without prescription. The typical device consists of a plastic cylinder that fits over the penis. You then repeatedly press a lever that pumps the air out of the cylinder. This creates a vacuum, which draws blood into the penis, resulting in an erection. When you have a satisfactory erection, you remove the cylinder after placing a specially designed constrictor band at the base of your penis; this holds the blood in and keeps the penis erect during sex. The constrictor band should not be kept in place longer than thirty minutes. Vacuum devices work well almost regardless of the cause of the erection problems. A plus for some men is that they are entirely mechanical and noninvasive. Surveys indicate that the majority of men who’ve tried these devices like them and so do their partners, especially in established relationships. They are a bit cumbersome for the dating game.

Advantages:

These devices, which can be used effectively by most men with erection difficulties, produce serviceable erections when you want them.

Vacuum devices are inexpensive—a one-time fee of $150 to $450—and have few side effects.