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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MAKING LOVE: SIDE-BY-SIDE POSITIONS 2
By slight alterations in movement, side-by-side positions can produce a wide variety of new sensations. By rolling backwards a woman opens up her vulva considerably and leaves her clitoris free for herself or her partner to caress. Drawing her legs upwards increases penetration. By changing the position of his legs and thighs, the man can achieve different movements and control the pressure that the root of the penis directs against his partner’s vulva.
Drawing her legs up along her partner’s back and sides can increase penetration, particularly if she presses with her legs and feet, coaxing him to thrust further into her
Changing the position of his legs and thighs can enable him to achieve different thrusting movements and new sensations for them both
1 The woman places her bent leg on top of her partner’s hip as he pushes his thigh between hers. Then she should lie back and her partner can lean into her, keeping his legs stretched out straight. One of his hands is free to caress her, while she has both free to attend to him. He has more freedom to attempt some active movements while bestowing some caresses.
2 By bringing his leg back up, the man can now make strong pushing movements. He can increase the pressure by using his hands to press his partner’s buttocks next to his hips.
Man
These positions provide plenty of body contact. The man has enough freedom to experiment with various movements to give new sensations. Movement is somewhat limited, but he is free to grasp his partner’s buttocks and pull her on to his penis.
Woman
These positions can supply plenty of pressure to the vulva for increased stimulation. They also are good in late pregnancy because they allow a woman plenty of space from her partner, and his penetrating and thrusting can be restricted.
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APHRODISIACS: FANTASIES
Everyone fantasizes. It would be very odd if we didn’t, because fantasy is a form of sexual rehearsal along paths that are familiar and also some that are entirely new and imaginary. We all respond to fantasies because the brain is the most important organ of sexual pleasure. As the seat of emotions, it can be responsible for turning us on or off sex. If we are full of resentment,
grief-stricken, angry, anxious or miserable, the most attractive person in the world will not seem so, and any amount of foreplay will not arouse us. On the other hand, being sexually aware, being interested in sex, thinking about it and fantasizing about it will all be arousing. In this sense, it would seem that the brain is the most crucial sex organ because it can override our sexual urges in any direction, either by turning them off, or by turning them on. Fantasies, therefore, are one of the cheapest and most effective sexual aids.
The best sexual fantasies, the ones that offer maximum pleasure, usually centre around ideal situations – ones that are, for practical purposes, unobtainable in “real life”. And, also unlike real life, they can be turned on and off at will, either to accelerate or calm sexual activity. Often, we use fantasy to concentrate our minds on what is actually happening to us during our own lovemaking. We “see” what is happening as well as experiencing it. This helps to focus our attention on our own sexual responses, and encourages the brain to respond even more enthusiastically to the signals of arousal it is receiving. It then sends out hormones that increase the excitement in our genital organs.
In rare cases, a person can become so fixed on a particular fantasy that they cannot become aroused without it. While a fantasy that exercises such a strong hold over your imagination can be very useful during masturbation, it can get in the way of shared sexual activities. Instead of concentrating on how your partner is reacting, and what you can do to please him or her, you can become fixed on bringing your fantasy to life, and thus seem remote and non-responsive.
Sharing fantasies is another way of personalizing your relationship, and can be introduced into a long-term sexual relationship to add new excitement and rekindle arousal. Some people are happy to join in a fantasy once it has been recounted; however, others may find that they cannot cope with the desires expressed, and may take their partner’s fantasy as a criticism of their lovemaking, which can put a considerable pressure on the relationship. If you are in doubt about what to share, bide your time until you see the situation more clearly.
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FOREPLAY: WHAT A WOMAN LIKES
One of the reasons why petting is so potent and so enjoyed by women is that it arouses and prepares them for sexual intercourse. For women, intercourse is welcome only when they have had enough stimulation so that the vagina lubricates and unfolds, ready to receive the penis. Without the chance to build up the level of sex hormones through kissing, caressing and petting, intercourse can be very uncomfortable for a woman. Most men underestimate how long this takes, since their own erections occur much more quickly.
Kissing should lead into and blend with caresses all over a woman’s body. Most women prefer initial caresses to be in areas other than the breasts and genitals, but once they have begun to feel aroused, they do enjoy having their breasts and bottoms stimulated. Breasts, however, need careful stroking until a woman is more highly aroused, then more passionate kissing, sucking and stroking are pleasurable. Most women like their buttocks caressed or squeezed; some enjoy gentle smacking. Only when a woman is sufficiently aroused does she want her partner to move on to genital caresses. Women differ in their tastes, but most prefer initial genital caresses to be gentle, with harder, more vigorous movements as they near orgasm.
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THE FIRST SEXUAL EXPERIENCE: INITIATING SEX
While a few individuals believe that one-night stands are one of the most satisfactory forms of human relationships, the majority of people feel that, in addition to physical attraction, there has to be love, and love involves knowing someone intimately. In fact, sex is the ultimate act of knowing. But in order to know someone, you have to show yourself to them. For the majority of people knowing is not easy; you feel vulnerable and open to the possibility of being rejected, which can be extremely painful. Sex can rarely be fulfilling without knowing your partner and showing yourself. No relationship can thrive where these two basic ingredients are missing. Right from the outset, you must tell the truth and nothing but the truth.
Becoming intimate Sex is our primary way of showing love. With a sympathetic, loving and open partner, it can be a magical voyage of discovery.
Any other form of behaviour is distancing and hypocritical; you must represent yourself honestly. In a loving relationship, even a white lie is an insult and extremely damaging. Honesty in itself is arousing; it can be a stimulant. Truth is probably the best aphrodisiac.
Everyone is vulnerable, both emotionally and romantically, so in a relationship that will involve love and sex, you should declare your vulnerability. Don’t forget that having sex is a decision as well as an impulse, and it doesn’t mean that you have to lose control. It means letting your partner know that the basic reason for your being there is that you are looking for love; you are looking for someone to bond with. When you decide to have sex with someone you are being intimate with all they are; so declare all you are.
The myth of romanticized women and eroticized men distorts the natural interaction that takes place between the two sexes. The infinite range of human experiences through holding, touching, feeling, stimulating, trusting, talking and listening to one another is involved in sexual interaction, and it is a distortion of the male and female personality to say that love and sex is the sole prerogative of either gender.
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ORGASM
Orgasm, the climax of sensation, is a uniquely human experience. For men, orgasm depends almost entirely on the stimulation of the penis, either by hand or mouth, as well as the vaginal walls, and is usually, though not always, accompanied by ejaculation of seminal fluid. For women, clitoral stimulation and movement of the penis within the vagina, prolonged through skill and experience, produce these intense feelings, although they can reach orgasm in other ways, for instance by manual or oral stimulation of the clitoris, vagina or “G” spot. About one woman in ten experiences the emission of fluid from the urethra with orgasm. It is thought that this fluid comes from the Skene’s glands, which run alongside the urethra, since it is not urine or vaginal mucus.
Orgasms vary: mood, level of energy or fatigue, amount and type of loveplay, the level of mutual trust, and what is happening in either partner’s life, all have their effects on the sensation. And not every sexual experience can, nor should, end in orgasm; there are times when orgasms are a natural outcome of sexual activities and others where lovers will have orgasms only if they really work at them.
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