The New Male Sexuality (64 page)

Disadvantages:

Some users complain that their erections are not as rigid as they want and somewhat wobbly at the base.

Some men experience side effects because of the constrictor band: pain in the penis, numbness and bruising, and painful ejaculation.

You can cause serious damage to the penis if you leave the band on for more than thirty minutes.

Injections of Prostaglandin and Other Drugs

Penile injections were introduced to American medicine in an unexpected and dramatic fashion. Because of his work with injections, British physiologist Giles Brindley was invited to present a paper at the meeting of the American Urological Association in Las Vegas in 1983. Knowing that
many American doctors were skeptical, Brindley injected himself before his talk. He gave his lecture, announced that he had injected himself, then dropped his trousers and invited the astonished audience to view the results. (For some reason, Brindley was not again asked to address this group.)

The procedure consists of injecting one or more drugs into the shaft of your penis, just as in the diagnostic test mentioned earlier. These drugs relax the smooth muscles and arteries in the penis, thereby increasing blood flow. I realize putting a needle into your penis sounds painful, but it usually is not. A very fine needle is used. In some men, however, the medicine itself, not the shot, does cause pain. This method requires a prescription after your doctor determines the correct dose and teaches you how to inject yourself. Within five to thirty minutes after giving yourself a shot, you’ll have a very stiff erection that will last from thirty minutes to an hour or longer. Injections have a very high success rate, higher even than Viagra, and often work for men for whom Viagra doesn’t. They work with many cases of performance anxiety and also with problems based on physical causes that in the past would have required a penile implant.

The drugs used for the injections can vary. If pure prostaglandin doesn’t work or causes pain, your doctor may try what’s called a tri-mix, a combination of prostaglandin, papaverine, and phentolamine. This is the mixture that has worked best for my clients.

Squeamishness about needles, especially in the penis, has been a tremendous obstacle to the acceptance of this effective therapy. There are two kinds of help available. One is a powerful technique called eye movement desensitization and reprocessing (EMDR). I’ve used this method with numerous clients to overcome fears of all kinds. Unfortunately, there is no way to do EMDR on yourself; you need a trained therapist.

Other clients have used a little gizmo called a Pen-Inject or Auto-Injector. This is a small plastic case in which you insert the syringe after you’ve loaded it with the dose of medicine you need. You then put the tip of the Auto-Injector where you want the injection to go, press a button, and it does the rest. Of course, you’re still getting a shot, but it’s amazing how much it helps to hide the syringe and needle. One client was so fearful of needles that he started to sweat whenever the topic was broached and was certain that his girlfriend, a nurse, would have to do the injecting. But at the urology consultation the doctor introduced him to the Pen-Inject. My client was so excited, he called me as soon as he got home: “It’s not a problem anymore. With this thing, it’s not like actually taking a needle. I can do it myself.”

Advantage:

The ability to have good, long-lasting, natural-looking and -feeling erections when you want without incurring the cost, pain, and risks of surgery. Injection may work even when Viagra doesn’t.

Disadvantages:

Many men don’t like to give themselves injections or even think about it. A very high percentage of men who start taking these shots soon discontinue them and seek other treatment. The Auto-Injector can help in this regard.

A small percentage of men experience pain in the penis not from the injection but from the injected agent. This can often be remedied by changing the agent or the mixture of agents used.

There is evidence that over time the injections form scar tissue in the penis in 5 to 10 percent of men, and sometimes cause Peyronie’s disease (serious curvature of the penis).

Most men continue to need these shots to get erections. It was once thought that many men would regain confidence after a few shots and be able to have erections without them. Unfortunately, this has proven to be true in less than 10 percent of cases.

Although the risk is small, a few men who inject themselves get priapism, an erection that won’t go down, almost always caused by injecting too much medicine. This can necessitate a trip to the doctor’s office or a hospital emergency room for treatment. Priapism was more common when papaverine was the drug of choice. With prostaglandin and tri-mix, the incidence of priapism is less than 2 percent.

Although the injections are effective with most cases of performance anxiety, they can be neutralized by massive anxiety.