Bonk (17 page)

A voiceover puts the pelvic floor muscles through their paces. At one point, we hear “Tighten! Tighten! Tighten!” in a ringing exclamatory voice. My husband, in the kitchen, heard this as “Titan! Titan! Titan!” and comes in to check out what he assumed was some deliriously campy, low-budget sci-fi pic.

“Whoah,” says Ed upon encountering Dr. Foreman’s package.

“Notice the lifting of the scrotum,” the narration continues. Next the model demonstrates the exercises from a standing position, and here the camera zooms in dramatically. Ed and I lean back into the sofa cushions.

“Tighten! Tighten! Tighten!”

Part II was entitled “Post-Micturition Dribble.” “This is a dribble of urine that occurs after you’ve finished going to the toilet,” explains Dr. Foreman. The video cuts to a shot of a boxer-clad bottom backing away from a toilet. The skin tone situation has worsened, such that the man appears to be wearing a hot pink leotard under his boxers. The camera displays a close-up of a dampened blotch on the fly of the boxers. “It can be as much as an eggcup-ful and can be very embarrassing.” Is this an estimate, I wonder, or did Dr. Foreman recruit someone to dribble into an eggcup?

Given Foreman’s findings, why aren’t Kegel exercises the toast of the urological community? “That’s one study,” says American Urological Association spokesman Ira Sharlip when I ask him about it. Indeed, a search of the medical journal database PubMed unearthed no attempts to replicate the West England Kegeling study. Which seems like a shame. (A general Internet search did turn up a few self-help sites that mention Kegeling as a way to control premature ejaculation, something to which Dr. Foreman also alluded.)

Kegeling seems to me to belong in the same box with oat bran and prayer and vitamin pills, the big box that says
CAN’T HURT, MIGHT HELP
on the side of it. Certainly, it would be worth trying before moving on to the final frontier, the treatment of last resort: the artificial erection.

Re-Member Me

Transplants, Implants, and Other Penises of Last Resort

t
he AMS Malleable 650 Penile Prosthesis is a high-profit item with a steady demand. You could do worse, in life, than to be an AMS sales rep. On the downside, your sales patter would need to include the phrase “better concealment with less springback.” You would have to listen to yourself saying “The enhanced rigidity reduces the possibility of buckling during intercourse.” There would be days, perhaps even most days, when you would find yourself in a group of strangers, holding a silicone penile implant up to the fly of your chinos.

For the AMS sales rep visiting Dr. Hsu’s office at the Microsurgical Potency Reconstruction and Research Center, today is one of those days. Worse, it’s a day when the strangers are myself and Dr. Hsu’s wiseacre colleague Alice Wen. Alice is serving as my interpreter. The rep is demonstrating how you get erect with a set of 650s—one in each erectile chamber—inside your penis. It happens faster than the real deal. You just bend it into position like a gooseneck lamp.

There are also inflatable, rather than malleable, models. Here you don’t bend the penis, you pump it up. The surgeon implants a small bladder of saline
*
(or air) above the pubis bone. This gets pumped into the implant by means of a hollow, squeezable bulb implanted in the scrotum and attached to the prosthesis by a plastic tube. Inflatables are more popular because—unlike a malleable implant—they enlarge the girth of the penis, as would happen in an unaided erection. To many men, it seems more natural—except, of course, for the scrotum-squeezing aspect of the event.

“So who does the pumping?” Alice is making what psychologists call the distress face. “Anyone” is the answer. Whoever wants to. The guy, his date. Very occasionally, a visiting stranger. Sex researcher Cindy Meston tells a story about the time Irwin Goldstein, then at Boston University’s Center for Sexual Medicine, made her pump up one of his post-ops. “I was in Boston for a conference. I had the flu, I was throwing up all morning. Irwin was all excited about this new pump he’d installed: ‘You have to see this, Cindy!’ He drags me over to his office, and there’s this enormous man with no pants on. Irwin’s going, ‘Go on, Cindy, pump it up!’ And I’m going, ‘Oh, no, Irwin,
please
, not today….’”

Who would have this done? “It’s fairly popular,” says Goldstein, a urologist who is the editor of the
Journal of Sexual Medicine
. (The global total, to date, for AMS implantations is 250,000.) “But it’s a third-line therapy.” In other words, doctors try less radical treatments first. Implant surgery is intended for men whose erectile tissue is irreparably damaged and fibrous. Because if it wasn’t that way before the operation, it will be afterward. The prosthesis basically reams the erectile tissue on the way in.

Despite the reaming, an implant recipient can have orgasms and ejaculate. “The rigidity function—which is now being borne by the implants—has nothing to do with desire and orgasm,” explains Goldstein. Erection, orgasm, and ejaculation are independent events. A man can have an orgasm—or even multiple orgasms
*
—without ejaculation, and he can have an orgasm and/or ejaculation without an erection. An implant only affects erection. Goldstein: “If you can play the piano before the implant, you can play the piano after the implant.”

Most prosthesis patients are older men. In about twenty minutes, Dr. Hsu will be inserting the AMS 650 into a seventy-year-old man whom I will call Mr. Wang. The reason for the operation sits in the waiting room: the new wife. Mrs. Wang is forty.

t
he first time an implant—basically a strip of cartilage—was installed in the penis of an impotent man was 1952. The patient is described—this being the
Journal of the South Carolina Medical Association
—as “a 23-year-old Negro veteran of World War II.” Ironically, the young man became impotent as a result of being the opposite of impotent. Three months before, he had shown up at the veterans hospital with an erection that had refused to go down for two days and two nights. The doctors surgically drained the corpora cavernosa, and the operation resulted in a constricting scar in his erectile tissue, such that it was no longer living up to its name. Insult to injury, when he returned to complain about his impotence, the doctors refused to take him at his word. They had him masturbate in front of them. When this “failed to cause any visible or palpable erection of the penis,” Dr. Buford S. Chappell signed him up for the world’s first penile implant. Chappell does not specify who—or what—the cartilage came from. Nor does he mention whether the patient knew he was a guinea pig.

You got the sense that Chappell’s summation—“He has ejaculations although intercourse is not as pleasant as before”—wore a heavy sugar-coat. Chappell included an After drawing of the penis, which “now hung in a semi-erect position that allowed the comfortable wearing of clothing.” Based on the drawing, it was difficult to imagine wearing anything other than a caftan comfortably, and then only if you were comfortable with constantly appearing to have an erection, something that if I were a young African-American man in South Carolina in 1952, I might not be.

a
lice and I are joining Dr. Hsu in the operating room today. Mr. Wang is resting with his eyes closed. The operation is being done with local anesthesia, backed up by acupuncture. The penis is in good hands: Dr. Hsu has done more than a hundred prosthetic implantations. “Exactly one hundred eighteen,” he says, vigorously scrubbing his hands and forearms at the sink in the corner of the operating room. “Only two extrusions.” Alice raises her eyebrows above her surgical mask. “You mean it…”

Dr. Hsu holds his hands up in front of a nurse for gloving, a word I can no longer, since chapter 6, type happily. He nods. Meaning it pokes through the end of the penis. This tends to happen during vigorous sex in certain positions. “That’s why we tell patients: No woman on top.”

“Ohhh, no.” This from Alice.

Dr. Hsu makes a short incision where the pubic hair would be if the patient hadn’t been shaved. (This way the incision scar is hidden; implants can also be inserted through the tip of the penis.) He picks up a steel rod of approximately the same dimensions as the implant. This rod, called a Hegar’s dilator,
*
will be used to stretch each corpus cavernosum to ready it for the implant. It slides in fairly easily, though not as easily as I would have preferred, catching here and there and requiring a firm push.

Dr. Hsu’s nurse is unwrapping the second implant, for the other erectile chamber. This one does not go gently. The insertion is done in two stages. One end is submerged down to the pubis bone. That leaves several inches of implant sticking out of the incision like a flagpole upon conquered lands. Dr. Hsu hairpins the protruding part in half and then tries to feed the remaining end into the incision and push it toward the organ’s tip,
*
straightening it as it enters. It seems to be stuck. There’s a kinked inch of implant protruding from the fleshy incision. Dr. Hsu presses on the kinked rod. The novelist Martin Amis once described an impotent character’s attempts at intercourse as being like trying to feed an oyster into a parking meter. This is like trying to put a parking meter into an oyster.

Dr. Hsu pulls out the 650 and starts anew. Alice has stopped watching. Mr. Wang, incredibly, is napping. This time it goes in with minimal wrangle, and Dr. Hsu sews up the incision. It looks like a penis again, but longer and fatter than it was an hour ago. Dr. Hsu does a dry run, making sure the implant bends properly and holds its erect position. He bends it up into the familiar silhouette, and then lets go of it. It stays as he left it, a cooperative flesh Gumby limb. Then he pushes it down out of the way, like those exercise gizmos that can be stowed flat under the bed. Mr. Wang won’t
become
erect, he’ll just suddenly
be
erect. His hydraulics have been swapped for an
ON/OFF
toggle.

What Mr. Wang has sacrificed today is his organ’s natural retractability. The adjective
flaccid
will never again apply. In its place are the adjectives
bulky
and
conspicuous
. Mr. Wang will appear to be going through life at half-mast. Too bad he doesn’t have a pair of underwear that exerts significant inward retentive pressure. I am borrowing the wording of the team of inventors listed on the patent for Men’s Underwear with Penile Envelope.
*
The patent nowhere states that either of the inventors—who share a last name—had a semirigid penile implant that was causing embarrassing trouser bulge. Nor does it state that the other inventor exerted significant pressure to do something about it. I am, as they say, thinking outside the penile envelope. Just guessing.

Mr. Wang’s penis resembles a normal erection, but I find myself wondering if it feels that way. Does it feel like a blood-engorged penis, or does it feel like a penis with two silicone rods in it?

“May I squeeze it?”

Alice looks at Dr. Hsu. Dr. Hsu looks at the patient, whose head is hidden behind a green curtain of surgical sheeting. He is awake now, but he speaks no English and his crotch is still numb. He’ll never know. Dr. Hsu steps away from the operating table and pulls a pair of latex gloves from a box on a counter behind him.

“Mary, you have traveled a long way. You can do whatever you want.”

It does not feel entirely penislike, but at the same time, it does not feel inferior. It’s sort of bionic-seeming. Though the exterior lacks the steely
*
feel of a true erection, the interior is hard, harder even than a natural erection. And so it stays until everyone is finished. I can understand why, for someone who has exhausted all other possibilities, implants could be a welcome relief. So are they? And what do the ladies have to say?

In one study, 76 percent of the men were satisfied with the rigidity of their new, malleable organ. Another survey, of 350 men with inflatable implants, showed a satisfaction rate of 69 percent. In another, similarly sized study, 83 percent were satisfied—but only 70 percent of their partners were. (“Because they want to go on top,” surmises Alice Wen.) The most common complaints were that the implant caused pain or that it looked unnatural. Women occasionally complained that the head of the man’s penis was cold (a condition known as “cold glans syndrome”).

Obviously, satisfaction rates vary depending on the type and brand of implant. Less obviously, satisfaction rates vary depending on which one of a man’s wives is weighing in. In a study entitled “Satisfaction with the Malleable Penile Prosthesis Among Couples from the Middle East,” some of the men—who hailed from Libya, Egypt, Sudan, Yemen, Algeria, and Saudi Arabia—had either two or three wives. Table 4, a journal table quite unlike any other, lists the men’s and women’s assessments in separate columns, and is split crosswise into sections for “3-Wives Polygamy” and “2-Wives Polygamy.” While in six of the nine polygamous couples, the men basically agreed with their wives, three couples’ assessments bespoke stormy days in the marital tent.

Polygamy No. 4, for instance. The man reported being “satisfied,” as did one of his wives. The other two wives were, respectively, “dissatisfied” and “very dissatisfied” with the implant, “to the point of strong desire to remove it.” I pictured wives two and three whispering conspiratorially, kitchen knives hidden beneath their abayas. You may add to the general climate of marital discord the fact that 64 percent of the men had kept the operation a secret from their wives—possibly because 94 percent of the men hadn’t been told by their surgeon that their erections would be unnatural. The capper: A couple of years after the men’s surgeries, Viagra became available in most of these countries.

The careless reader might be tempted to draw a conclusion from the preceding paragraphs, and that is that polygamy causes erectile dysfunction.
Au contraire!
In 2005, anthropologist Ben Campbell traveled from Boston University to the far fringes of Kenya to chat with Ariaal tribesmen about their erectile function. One of the things he discovered was that men with multiple wives had lower rates of age-related erectile decline. Of course, this is not to say that an extra wife will prevent you from developing ED. It is far more plausible that a man whose penis is in working order is more likely to take on the sexual freight of multiple wives. Compared, that is, to an impotent man. Who would have to be mad, or maybe Libyan.