The New Male Sexuality (65 page)

Muse

This consists of a prostaglandin pellet inserted with an applicator into the urethra. It was developed for men who didn’t want to take injections. Unfortunately, it also causes pain for some, and its effectiveness is somewhat less than that of the injections. However, because there are no injections, scar tissue is not formed in the penis. The maker of Muse has recently recommended that men use a constrictor ban around the base of the penis before inserting the pellet and during sexual activity; presumably this will raise the drug’s effectiveness.

Advantage:

A safe and modestly effective erection helper. Even though it uses the same agent as the injections, you don’t have to inject yourself.

Disadvantages:

Some men experience pain when using Muse.

The drug is effective for only about 25 percent of men.

As with injections, it can be neutralized by very strong anxiety.

Regarding vacuum devices, Muse, and injections, it’s well to keep in mind that they can cause some difficulties in the beginning. Most couples, after all, are not accustomed to stopping love play in order to do something special to attain erection, and many couples are not accustomed to talking openly about sex. There can be embarrassment, anxiety, and hesitation. One client didn’t have sex for weeks after he got his injection materials because he couldn’t figure out how to tell his partner that he wanted to go to another room to inject himself—this despite the fact that she had been to the urologist with him and knew full well about the shots. Some men, even though they now have a way to get an erection, still feel like failures because they can’t get “normal” erections. Such difficulties can usually be worked out easily if the partners are able to talk about them, but a few sessions with a sex therapist may be advisable.

Arterial and Venous Surgery

These are operations to repair or bypass clogged arteries and to seal leaky veins. Arterial surgery works very well for a very small group—young men whose blood flow problems are caused by accidents. Venous surgery, unfortunately, is not very effective in the long run. If your doctor recommends either type of surgery, find out what his or her results have been, especially on long-term follow-up, and insist on talking to several of the men who’ve had the operation. You might also want to ask for references in the medical literature regarding the effectiveness of these procedures.

Advantages:

Arterial surgery, called revascularization, is very effective in select cases, and the men function as they did before the surgery.

Both types of surgery are expensive but usually covered by insurance.

Disadvantage:

Venous surgery has a very high relapse rate and is therefore not very effective.

Penile Implants

Since as far back as the 1930s, surgeons have been experimenting with ways to produce artificial erections. By now the art of penile implants is highly advanced. Though there are a great many implant models, they can be conveniently put in two groups.

Nonhydraulic
(also called semirigid and malleable) implants consist of a pair of silicon rods placed inside the penis. With earlier models, the man always had an erection, and this obviously caused some embarrassment. Newer models are more flexible and can be bent down against the leg so the penis points toward the floor when the man is standing.

Hydraulic
, or inflatable, implants come in a variety of styles. Their distinguishing characteristic is that they mimic the action of a normal erection process. A pair of hollow cylinders is placed inside the erectile tissue of the penis, and a fluid-filled reservoir is inserted in the belly; when you want to have sex, you activate a pumping mechanism, implanted in the scrotum, that inflates the cylinders with the fluid from the reservoir. Some newer models have the complete mechanism inside the cylinders; when you want an erection, you simply bend or squeeze the head of the penis and presto—as if by magic—you have an erection.

Hydraulic models have the advantages of seeming more natural since they mimic what the body would do under normal circumstances. The penis is truly soft when it’s soft and only gets hard when you want it to. However, hydraulic models are also more complex than the nonhydraulic implants, and the chances of malfunction are greater. They are also more expensive and the surgery more involved.

These days, implant surgery is usually reserved for erection problems caused by severe vascular or neurological disease, pelvic trauma, and spinal cord injuries. Surveys show that a large majority of men with implants and their partners are satisfied with their devices, although many of them have various complaints. Nonetheless, the popularity of implant surgery has waned in recent years with the advent of less invasive tools such as penile injections and vacuum devices. Viagra will undoubtedly further reduce its popularity. But implant surgery remains an important last resort when other options do not work or lose their effectiveness over time.

Advantages:

The ability to have a usable erection whenever you want one without having to give yourself shots and without having to go through sex therapy.

Although implants are expensive (over several thousand dollars), they are covered by many insurance plans.