Manhood: The Rise and Fall of the Penis (35 page)

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Coital training

apparatus

designed by

psychiatrists in

1947.

that certain men were not motivated to undergo any kind of talking therapy.

A different, but to some extent comparable solution is the artificial penis, to which some women have an aversion. The use of a dildo –

the exotic term for an artificial penis – is as old as mankind. In the nineteenth century they sold like hot cakes in all European capitals: clay, paper, wax – every kind of raw material was tried. In using such an aid one must of course observe strict hygiene, and the use of a lubricant is sensible. With an artificial penis full penetration is not necessary, and may even be undesirable.

High-tech: Old wine in new bottles

In the last decade urological interest in ed has increased spectacularly.

This is a positive development for various reasons: for instance, more attention has been paid to the sexual consequences of operations. It has also become apparent that physical abnormalities are more frequently involved than had been traditionally assumed by sexology.

In addition, both the diagnostic and therapeutic options in dealing with impotence have greatly increased.

On 25 June 1980 the French cardiovascular surgeon Ronald Virag discovered by accident that direct administration of papaverine into the penis could cause an erection, but he only published on the subject in
The Lancet
in 1982. Since the 1960s papaverine had been used in surgical procedures to keep the two blood vessels to be stitched together as wide open as possible: in other words, it is an established drug. Like opium, it is made from the poppyhead, but is completely non-addictive. During a cardiovascular surgical procedure Virag accidentally injected papaverine into the wrong vessel, inflicting an extremely long-lasting post-operative erection on the patient.

In fact, as long ago as the Second World War, the penis was used by military surgeons to transfuse large quantities of blood into soldiers 183

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in deep shock (because the relevant veins could no longer be seen or felt, it was sometimes impossible to insert a drip into the arm of patients in shock). However, if the blood flow was too fast, it resulted in an erection. Therefore injection therapy (in which the man injects himself in the penis with a vasodilatory drug) originates from the link established between a wartime procedure and a ‘slip’ during an operation.

In 1983 the world of urology was alarmed by a talk on this subject by the eccentric British professor Giles Brindley at the American Conference of Urologists in Las Vegas. He was conducting research into the effects of intrapenile administration of phentolamine, like papa verine a vasodilatory medication, but one that acted in a different way. Usually speakers at such a gathering are neatly dressed, that is, in suit and tie, but Professor Brindley appeared in shorts and sneakers.

He talked about the results of his research, but after a quarter of an hour he interrupted the talk by announcing that he was getting a hard-on. The audience were shocked, not least because he went on to drop his shorts giving those at the front a close-up view and inviting them to feel it . . . He told us that he had injected himself before giving his presentation. An unforgettable, penetrating performance!

A prostaglandin or a combination of papaverine and phentolamine can be used for self-injection. This combination was officially registered for intercavernosal use in 1992 under the brand name Androskat.

The dosage for treatment depends on the cause of the impotence. The effect is virtually immediate, or takes at most between fifteen minutes and half an hour. Depending on the firmness and duration of the erection, the dose should be adjusted step by step. A slow increase is preferable, and this is usually done in consultation with the urologist in charge of the case. In general the aim is to achieve an erection lasting between one and two hours. Injecting more than twice a week is not advisable, since this can cause sclerosis.

Penile injections can occasionally cause a long-lasting, usually painful erection (priapism). The blood is as it were trapped in the erectile tissue compartments, and is no longer replaced by new blood. As a result oxygen deficiency occurs and if action is not taken in time this is followed by morbidity in the erectile tissue. A faulty technique can result in a subcutaneous injection, and there will often be visible haemorrhaging; the same can occur in a patient taking blood-thinning medi -

cation. Caution must be used with patients suffering from cataracts or ailments in which an acute drop in blood pressure can be dangerous, for example shortly after a heart attack. Worldwide not only papaverine, phentolamine and prostaglandin ei, but also moxysylyte (especially in France), vasoactive intestinal polypeptide (vip), ketanserin, calci-tonin gene-related peptide and chlorpromazine are used.

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Intracavernosal

injection.

Papaverine was naturally also tested on women . . . Gynaecologists were keen to try injections into the labia minora (specifically, the bulbus vestibulum) with anorgasmic women, in the hope of producing at least some ‘moistening effect’. Attempts failed, and no orgasms resulted.

The vacuum pump

A more or less natural erection can be simulated not only by the implantation of an erection prosthesis, but also by the use of a so-called vacuum pump in combination with a penile constriction ring. Down the ages the constriction ring has been used a sex aid. Four hundred years ago in Japan penile rings belonged in so-called love boxes and Bedouins used the dried eyelashes of goats to make them. It was thought that the lashes would provide extra stimulus during intercourse and arouse the woman sexually. Such rings are still available in sex shops.

Vacuum apparatus has been on the market for almost a hundred years. Zabludowsky’s version is described in
Manual of the Sexual
Sciences
(1912) by the German psychiatrist Albert Moll. Until recently vacuum erection apparatus attracted almost no attention in medical circles, but plenty from the owners of sex shops, where it is on sale even today.

The modern vacuum apparatus consists of a cylinder, a pump and constriction band or ring. A true vacuum (with zero air pressure) is fortunately never achieved, since if it were the pump would be entirely filled with a bleeding penis. Actually a better name would be underpressure apparatus. The cylinder, closed at one end, is slid over the penis, open end first, and pushed against the pubic bone to form an 185

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A Zabludowsky

vacuum pump.

airtight seal. It is sometimes useful to cut away the pubic hair at the base of the penis. At the closed end the cylinder is connected to the pump, which creates underpressure in the cylinder, so that blood is sucked towards the erectile tissue and an erection is created. The required pressure is 120 millibars, which is the pressure in the erectile tissue compartments in erection. In reality, however, more is needed.

When the penis is sufficiently erect, the ring, which was previously placed round the base of the cylinder, is rolled down, so that the outflow of blood from the erectile tissue compartments is impeded.

At that moment some blood always leaks away, causing a proportionately large loss of pressure. This is why an underpressure of 200

millibars must be built up. Once the constriction ring is in place, blood can no longer leak out of the erectile tissue compartments. The ring has an indentation on its underside to avoid the urethra being squeezed completely shut, impeding ejaculation. The ring must remain in place no longer than 30 minutes and naturally one must not sleep with it on.

Because of the accumulation of blood the penis may turn slightly blue. Sometimes there are small pinpoint haemorrhages, and the penis may feel cold. ‘It was like making love to an iceberg,’ as one woman put it. The base of the penis may also wobble, thus sometimes complicat-ing insertion. It goes without saying that the use of a vacuum apparatus during intercourse stands or falls with the presence of a sympathetic and understanding woman, who does not make excessive aesthetic demands on the man’s phallus.

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The vacuum

pump with a

rubber constric-

tion ring at the

base.

Inspired by the penis bone

The first operation to insert a penis prosthesis took place in 1936. In order to reconstruct a male member amputated in a trauma, the plastic surgeon Bogoras implanted a section of rib cartilage, prompted by his observation of the presence of a penis bone in many male mammals.

The human penis is rather an odd man out, since that of numerous other mammals contains such a bone, called a
baculum
. These include the whale, the dolphin, the walrus, the otter, the bear, the marten, the badger, the squirrel, the wolf, the dog and the monkey. In some species, for example in the spider monkey, there is also a section of bone or cartilage in the clitoris.

In 1951 Bett wrote an extensive article on the penis bone. In the whale the bone is some 2 metres long, with a circumference of 40 cm at the base. Further up the evolutionary ladder it becomes smaller: in the walrus it is only just over 50 cm and in the monkey it measures only between 1 and 2 cm. Up to now there are no indications that homo sapiens ever possessed such a bone. The position and shape of the bone vary from animal to animal. In the dog, for example, it forms a channel for the urethra, while in the bear and the wolf the baculum is indispensable for mating. The baculum may have many different kinds 187

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of shape. In the racoon, for example, it is s-shaped and in the bat it is forked. In the squirrel there is a sharp hook attached, which according to some experts is designed to perforate the hymen. Others believe that the hook is designed to remove so-call mating plugs. A mating plug consists of a sticky residue of sperm allowing the vagina of the female squirrel to be temporarily ‘sealed’ in order to prevent sperm donation by another male. In the otter the penis bone is characterized by extreme hardness, though healed penis fractures have been observed in these creatures. When male otters fight each other, they target their opponent’s penis with their powerful jaws and sharp teeth, and often succeed in breaking the baculum!