Penis size fixation — a growth industry.

Are you one of the hundreds of millions of men out there who worries about the size of his penis on a daily bases? If you are, then at least you have lots of historical and anthropological good company. Do not be fooled. Penile size fixation is as old as time itself and a male obsession that seems evenly spread across all cultures and civilizations down through the ages. Moreover, to judge by the number of contributions on the subject in these pages, it is an obsession showing very little sign of going away. Indeed it is, if you will pardon the pun, something of a growth industry even during these recessionary times.

The earliest written references to penis size obsession perhaps date back as far as 1400. When it came to sex and how it should be done, The Kamasutra of Vatsyayana was a right Jack the Lad. The illustrations that accompanied his writings show men with stallion sized phalluses performing feats of copulating gymnastics that would make even the editor of Playboy Magazine blush today. Pursuers of this medieval pornography could hardly have felt other than slightly inadequate as they thumbed their way feverishly through these pages.

But the Kamasutra was something of a late arrival in the art of how to make your fellow man feel inadequate through distorted images of penis size. Judging by some of the images left behind them on cave walls, our Stone Age ancestors were no shrinking violets either when it came to depicting penis size in man and animals! And so it goes on to this very day. Today, no self-respecting pornographic star would be found dead on stage sporting anything less than a shillelagh- sized erection. That this thing had been pumped up with inter-penile injection of alprostadil is hardy the point. No, in matters pornographic size does indeed matter, in fact it is all that matters. Thus, the myth is perpetuated for all time.

No religious sect, culture or ethnic group can escape. India’s holy men or Sadhus are known to attach weights to their penises in order to make them appear longer and fatter. This perhaps is understandable since they have a tendency to parade themselves around town wearing very little cloths from the waste down. The practise does make one wonder though if their holiness is very holistic. Ah well, it is not for us to judge now is it?

When it comes to tribal ingenuity in the penis-size-fixation department, the highland people of Papua New Guinea would be a hard act to follow. They still wear their beloved penis guards or Koteka as they are locally known. These cool little numbers, made from hollowed out dried gourds, are worn to cover the entire length of the penis and sometimes scrotum. The trick is to procure a Koteka that is about four sizes too big and it must be pointing upwards too of course. Into this, the wearer hides his flaccid penis while at the same time outwardly suggesting very generous endowment of a straight standing nature. It is hardly surprising that attempts to discourage this practise of wearing phallocrypts in Papua New Guinea have always fallen flat.

However, the surprising aspect to the small penis fixation industry is the fact that not one of the proffered remedies actually works. Vacuum pumps, weights, hand exercises, pills, herbs and potions are all of them a total waste of money and time. Not one of them would stand up to even the most cursory scientific scrutiny. However, does this deter men from lashing out their hard-earned money on these sham products? Not at all. When it comes to having a small penis, hope seems to spring eternal.

The sad reality though is that there are, as always, those waiting in the short grass ever eager to exploit the vulnerable and the weak. Men with small penis fixation are vulnerable and easy prey. You might as well try taking the Koteka from a New Guinean tribesman as expect some men to have a bit of sense. It is indeed a sad world we live in.

Dr Andrew Rynne.

www.andrewrynne.com

Erectile Dysfunction — An Overview.

Dr Andrew Rynne.
Irish Medical Times.
August 2009.

Funny the things you never forget. It was 1968 and we were gathered in the lecture hall of the Rotunda Hospital – the world’s oldest maternity hospital. The speaker was a then much loved character from the Dublin Obstetrical fraternity — Dr Raymond Cross. He was then, by default as it were, Ireland’s leading expert on Impotence as it was then called — the more politically correct term of Erectile Dysfunction had yet to be invented. His task was indeed a thankless one for there were, if you will forgive the pun, no tools for his trade.

The lecture was hilarious and a light relief from the more serious topics of Placenta Previa and Persistent Occiput Posterior. The fact of the matter is that forty years ago there was no effective treatment for ED and the subject was treated as a bit of a joke. I remember so well the lecturer holding up a kind of a wire splint that he had fashioned and into which the patient was supposed to place his penis before attempting intercourse. The thing had all the technological sophistication of a wire coat hanger except it was not as useful.

When this yoke failed to be effective, for one suspects it occasionally may have done, we were then quickly reduced to folk remedies. Chief among these of course were oysters. Oysters, Dr Raymond Cross told us were, according to the Dublin mythology of the day, capable of raising an erection on a dead Archbishop! More hilarity.

Now fast-forward ten years to the pioneering research of Masters and Johnson, with their classic work — Human Sexual Response. This was rapidly establishing itself as the foundation of all sex therapy as it remains to this day. Perhaps their greatest contribution was the recognition of Performance Anxiety as a major contributing factor in all ED but most particular to that which affects younger men. Sexual dysfunction had at last come of age and the laughing had stopped.

Now fast-forward another ten years and we have the Penile Injections. Papaverine, injected directly into the corpus cavernosum, as an inducer of erections, was discovered by accident but quickly established itself as a highly effective, if somewhat uncomfortable, remedy for most ED of whatever etiology. Combined with Phentolamine its efficacy was further increased. Now however, both Papaverine and Phentolamine have largely fallen into disfavour due to their propensity for inducing priapism and penile fibrosis.

Today, both these chemical have been replaced by alprostadil or PGE1 presented, in the main, as Caverject 5 to 20mcg. Where higher doses of 50 or even 100 mcg of PGE1 are indicated, you may have your local compounding pharmacy make them up for you. Suffice here to know that today 95% of all ED of whatever etiology can be successfully and safely managed by this modality of treatment.

Now fast-forward another ten years, to 1998 and, to a fanfare of global publicity that could hardly have escaped the attention of our neighbours on Jupiter, we get sildenafil or Viagra and the answer to a maiden’s prayer at long last. Well, maybe not a maiden’s prayer, but you know what I mean. For here finally was the ultimate aphrodisiac, the rhino horn and monkey gland all rolled into one little blue tablet, an oral preparation that could induce an erection in men. Utopia had indeed arrived.

Today its two first cousins Cialis and Levitra have joined Viagra and together these three oral preparations form the bulwark of pharmaceuticals in the management or treatment of erectile dysfunction. Unfortunately, with their easy and illegal availability on the Internet they are frequently abused as recreational drugs or pressed into service to treat ED when behavioural therapy might be more appropriate.

When it comes to diagnosing the cause and deciding on a treatment of any given case of ED it is worth remembering the results of the Massachusetts Longitudinal Ageing Study. Here they found that about a third of men with moderate to severe erectile dysfunction recovered full sexual potency over time without any treatment. I also use this rule of thumb: Between the ages of 20 and 40 75% of ED will have a psychogenic factor underscoring it while over the age of 50 years 75% of ED will be physiological. In all cases of ED performance anxiety must be address and explained even went it is often the last thing the patient wants to know about. Men often see performance anxiety as a weakness and as being somehow their own fault, hence the rejection.

A word about my old friend Testosterone Replacement Therapy or TRT. Recent peer-review published studies (Carruthers et al) have shown that when older men fail to respond adequately to the PDE-5 inhibitors alone the addition of testosterone, given as a transdermal gel (Testogel) or deep intramuscular injection (Nebido), will significantly improve their response to these medications. Do not give up on older men; they too disserve to be taken seriously.

The same researchers, Carruthers, Trinnick and Wheeler in a paper published in The Ageing Male Sep 2007 showed androgen blood assay to be a very poor marker for testosterone deficiency syndrome. And yet we still have practitioners adhering to this expensive and largely useless laboratory test.

Another consideration when dealing with older men with BPH and ED is the use of tadalafil 20mg taken daily. In an article published in last October’s Journal of Urology it was unequivocally shown that Cialis 20mg taken daily had equal efficacy to an alpha1 blocker also taken daily. And since we know that alpha1 blockers have no effect on erectile dysfunction and tadalafil has proven efficacy, then the latter as a treatment for BPH in the presence of coexisting ED might make sense.

Other pharmaceutical for ED are now in development. As to whether or not these will prove to be an advancement on our present repertoire of treatments remains to be seen. One thing is for certain though. In the space of a mere forty years, we have come an awfully long way from wire penile splints, oysters and dead Archbishops.

Andrew Rynne is Medical Director of The Clane Sexual Health Clinic and website www.testosterone.ie Appointments at 087 2455957.
Further information from: andrewrynne@eircom.net