SEALING LEAKY VEINS SABOTAGE ERECTION
As you know, a man with leaky veins can find his erection sabotaged with amazing and disheartening efficiency. Until recently, leaky veins have been largely ignored by the medical profession, but now surgical solutions to this problem are receiving increased attention. One solution is to surgically tie off or remove the leaky veins, thus removing the source of the problem.
Belgian doctors have demonstrated just how effective vein surgery can be on certain patients. Out of 80 patients with potency problems, 20 were found to have impressive vein leaks.
Significantly, the leak involved the deep dorsal vein, a major source of blood flow out of the penis. The surgeons tied off the vein. Results were dramatic: 16 men found themselves with enough restored potency to allow intercourse. The 4 men who didn’t benefit from such improvement were found to have serious artery problems.
The best candidate for vein surgery has only his veins to blame for his potency difficulty; his arteries and nerves are normal. Usually the surgeon will make an incision somewhere on the penis, find the offending veins (which have previously been identified by a type of X-ray) and remove or tie them off, thus preventing them from carrying blood out of the penis. At the time of surgery the doctor can actually measure the extent of the leak by infusing fluid into the penis and measuring how fast it leaves. This way, he can gauge when enough veins have been tied off. Depending on where the veins are located, the procedure can be major or relatively minor surgery.
Unfortunately, no one knows how likely it is that a man with some leaky veins will develop others at some future time. Nevertheless, vein surgery holds the promise of a real advance in the treatment of some potency problems, making implants less necessary for some men.
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IMPOTENCE: THE DRUG MOST COMMONLY USED FOR THE SHOT
The drug most commonly used for the shot is papaverine, either by itself or in combination with another medication, phentolamine. The shot causes the arteries and sinuses to relax and allows increased blood flow into the penis. In some men, in fact, the blood flow produced by these shots may be somewhat greater than that which occurs during usual erections. Consequently, men whose nerves and blood vessels don’t work properly may be able to get an erection from a shot. After the shot, a small amount of pressure on the injection site is necessary to prevent bleeding.
If the shot works, results can be dramatic. In just a few minutes, a man who has had potency problems for years may find himself fully erect—and very happy. Jerry, a 50-year-old construction worker, had been unable to get an erection for ten years, ever since he fell on the job and suffered a painful and serious back injury. Jerry considered himself lucky to have recovered enough from the accident to be able to walk, but his potency did not return.
Jerry came to see a urologist, hoping that something new would be able to help his sex life. He had never heard about the shots, but was eager to try them. The first shot produced an erection—which surprised and pleased Jerry and his wife. The shots confirmed the doctor’s belief that Jerry’s erection problems were caused by nerves damaged in the fall. The shot, in effect, opened up the arteries and did the job the nerves were supposed to do. Subsequent shots resulted in the same reaction. After a decade without intercourse, this couple’s dry spell was over, Jerry ended up using the shots for regular treatment.
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AVOIDING ED AS A SIDE EFFECT: TAKING A DRUG “HOLIDAY”
Many of my patients who take antidepressant medications have adapted their sex lives to their use—a three-day medicine-free schedule, for example. Kirk was one such person. The thirty-eight-year-old, who had been under treatment for depression for several years, was overjoyed when he found that the regimen worked for him. “This is a
ED. The next step was to reintroduce the daily dose, but at lower levels terrific compromise,” he told me. “My depression is under control with Zoloft and I can enjoy my weekends. Life is good.”
I began using this alternative therapy after I read an intriguing 1995 study in the American Journal of Psychiatry by Dr. Anthony Rothschild. In his small sampling, Dr. Rothschild instructed the men to discontinue their SSRI drugs after their Thursday morning dose and restart them, at the same dosage, the following Sunday afternoon. After four weekends, Rothschild noted that there were no significant changes in the depression levels of those men who took the mini-drug vacations. However, there was definite improvement in both sexual functioning and satisfaction levels. According to him, antidepressant drug holidays worked best with men taking Paxil and Zoloft.
Note: Drug-free “holidays” are limited to non-life-threatening conditions where this option will work without risk to the patient. Discontinuing a beta-blocker, blood pressure medication, or diabetes drug can cause serious complications. If you take daily medication to manage conditions like hypertension, cardiovascular disorders, or asthma, don’t stop. Your most important job is to successfully treat your primary condition. Not taking a drug—even for a day—in order to achieve an erection is extremely dangerous to your health.
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ERECTION PROBLEMS: MULTIPLE SCLEROSIS (MS)
This disease, which seems to favor younger people as its victims, makes the nervous system degenerate. Small lesions attack the spinal cord and the brain and other parts of the nervous system which are essential to erection. Some male MS patients completely lose the ability to get an erection. Sometimes, men with MS can get erections, but they disappear before they can be enjoyed. Also, men with MS may find they can’t ejaculate, and for some, sexual desire also decreases or disappears. In some men, the disease causes numbness in the penis. Some researchers think that only one in four male MS patients develops erection problems from the disease; others think almost half of them do.
Sometimes, erection problems go hand-in-hand with other signs of the disease; at other times impotence is the first sign that something is wrong. For example, Brian, an engineer, was 43 years old when he first noticed a change. “I was unable to get an erection, even with candlelight, wine, a romantic setting, the whole bit. Sometimes it just wasn’t there. “Over a period of three years this distressing condition went from being an occasional problem to a chronic one.
At first, Brian couldn’t figure out what was wrong. He was filled with fear. “I just got very paranoid and embarrassed. I was afraid there was something wrong with me. I couldn’t tell anyone about it, except my wife. But mostly we avoided the subject. And I avoided being intimate with her. She knew that failure would just depress me more.”
After several months, Brian noticed he had problems walking. “I got very weak and collapsed. Finally I went to a doctor who suspected MS and confirmed the diagnosis. Actually, I felt relief at just knowing what was wrong.”
Brian was faced with the enormous challenge of coping and adjusting to the debilitating changes that go along with MS. But, although Brian made it plain to his doctors for several years that he also wanted help with his erection problem, he didn’t receive any, The doctors he consulted did not seem eager to deal with the issue. “Their attitude seemed to be ‘Sorry about that, Jack, the impotence is just a side effect of MS.’”
Luckily, Brian found out about penile implants and was able to have the operation. Although the MS has taken its toll, Brian is glad that once again, at least sometimes, he can make love with his wife.
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SEX AFTER THE MARRIAGE
During most of their marriage, William and Sharon have enjoyed sex together. But lately Sharon has wanted some changes in the bedroom. She’s been reading books about women’s sexual fulfillment, and wants her husband to read them—and try some of the suggestions. But William finds it difficult to read or talk about sex. Like many people his age, he received virtually no sex education as a child, and although he takes pride in the fact that he’s overcome the puritanical aspects of his background, the subject of sex still makes him uncomfortable. He secretly believes that sex shouldn’t be talked about unless there’s a problem, so if Sharon wants to talk, something must be wrong.
To make matters even more disturbing to William, what Sharon wants to talk about is orgasm. William “knows” that, as the man, he is supposed to “give” his wife an orgasm, and he fears that he has failed. And although he would deny it if asked, William has been influenced by what he sees in movies and on television: A “real” man is always ready to perform, eager for sex and able to satisfy any woman.
William believes he should always be ready to perform; his preoccupation with work, his health problems and his fatigue are irrelevant to this demand. These concerns just add to his anxiety and guilt. William is treating his body worse than one of the machines he designs—it’s never supposed to wear down, especially when it comes to sex, In William’s mind, the responsibility for fulfilling his desires, and his wife’s, rests squarely on him.
One Friday night, William comes home exhausted from a grueling day at the office and finds his wife taking a nap before dinner. He lies down beside her and falls asleep. When Sharon awakes, she wants to make love. As they cuddle and kiss, William gets excited, but a troubling conversation he had with his boss keeps popping into his mind. He loses his erection while making love and becomes embarrassed, angry and ashamed. He’s always been able to maintain an erection before. Sharon is clearly frustrated, although she tries to be understanding. She kisses him and murmurs a few words of encouragement. After a few minutes of lying quietly next to him, she asks him to please read the books on sex she has been mentioning for the last several weeks. William wants, more than anything, not to talk about his “failure.” He wants to escape into sleep, and he finally does.
During the next week, William and Sharon do not talk about what happened Friday night. But William thinks about it almost constantly and worries that it will happen again. He’s determined notto repeat his erection “failure.” So he plans a special night for the two of them.
The next Friday, William puts in a hard day at the office. He spends the morning feeling frustrated and angry over some problems at work, and to relieve his tension he smokes almost nonstop. In the afternoon he has a two-hour, unsatisfactory meeting with his boss, which just adds to his tension. Finally it’s time to leave, and William struggles to get home in rush-hour traffic. He barely has time to change his shirt before he and Sharon leave for dinner at theirfavorite restaurant. Atthe restaurant, William, worried about making love later, tries to relax with two martinis. Then, deciding it’s a special night and his diet doesn’t apply, he treats himself to a big steak with all the trimmings. After dinner the couple goes for a stroll. It’s after midnight by the time they get home.
By now, William has been looking forward for several hours to making love with his wife. Sharon undresses slowly, but William doesn’t waste anytime. Although it’s been a long day and he is tired, William has decided this is the night to make love, and he doesn’t want anything—even fatigue—to interfere. He strips and gets into bed. Lying there, he watches his wife get ready for bed, and feels himself becoming aroused. Sharon also has been anticipating the end of the evening. She is warm and willing, eager to have intercourse. William wants to make love, but he’s nervous, tired and afraid he will fail. His mind keeps returning to the last time, when he lost his erection. After several minutes of caressing his wife, he does not have an erection and begins to panic. Sharon is upset too. She asks if he still finds her attractive—what else could be the problem? William is tired, angry and discouraged. He snaps back that Sharon is not the problem, and stomps off to the kitchen, where he tries to console himself by drinking some Scotch.
Unfortunately, this isn’t an unusual example of sexual failure. It describes the experiences of many couples. Some overcome their problems in the early stages; others try to ignore the situation and find that their occasional difficulty turns into a chronic condition. It is important to realize that William set himself up for failure in a number of ways—many of them correctable. Here’s what’s wrong between William and Sharon, and how it could be set right.
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