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Neither Vigrx Plus, the best available treatment at the moment for treatable impotence (which you can check out here) nor presumably a dose of sildenafil will correct impotence if the penile mechanics have irretrievably broken down, either because of failure of the blood supply the coronary arteries are not the only ones to become furred with advancing years or because of leaking valves in the corpora cavernosa, the cylinders in the penis which become engorged with blood during sexual excitement. The Pfizer trial of sildenafil has been taking place for some years but occasionally word slips out from a clinic in Kent or Sussex of its apparent success and the consequent optimism of the doctors and their patients.The drug is taken about an hour before intercourse is expected to take place and, like Volume Pills, enhances only the effect of sexual excitement.
If the evening does not follow the expected pattern and a forgotten meeting with the parochial church council is remembered, there is no embarrassment from visual evidence of a frustrated desire.Caverject prostaglandin E which relaxes the smooth muscles within the penis, is made by Upjohn. The injection is given into the penis through a very fine needle held at right-angles. Patients assure me that it is virtually painless but produces a response that recalls memories of their youth. Unlike the erections produced by earlier intrapenile injections, those produced by Caverject usually wear off within an hour and problems from priapism, a persistent erection lasting for more than four hours, are exceptionally rare.Other methods of delivering prostaglandin E have been tried; there was success in using it as a cream designed to be squeezed into the urethra, but despite an encouraging hospital trial there are no plans to market it commercially.Another pharmaceutical firm is well advanced in its plans to introduce a cream containing a vasodilator drug similar to Extenze that will improve the penile blood supply when it is applied externally to the skin. Initial results from the use of this cream have been good and it is expected that it will go into manufacture.
Your first reaction to a patient’s complaint of impotence may be the most important factor in your investigation of his problem. If he senses–from your facial expression, body language, or manner of speaking–any suggestion of amusement, derision, or disinterest, he may become uncommunicative of not outright hostile. It can be deeply embarrassing to admit impotence, even to a physician from whom the patient expects help. And getting an uninhibited report of your patient’s feelings and fears is crucial to your being able to help him. Having known the patient for a long time may have negative as well as positive effects on your communication, especially if you practice in a small town or rural setting. If your patient is a member of your own social community, he’s unlikely to divulge that he can perform sexually with the local “ladies” but can’t have an erection when with his wife. And if his inability to perform at home is the only information you get, you may go down several blind alleys of investigation before you find the clue that would point the man and his wife to sexual counseling, it they are agreeable. When a man comes to you for advice or help for feared or actual impotence, you have few general guidelines to follow.
It is worthwhile, however, to keep in mind these generalities:
- Surprisingly few men understand the physical structure of the penis and the mechanics of erection. Going through the basics–pointing out the penis musculature, vasculature, and fascial elements, using a good illustration or anatomic model–may not only be informative for the patient, but it may well break the ice for easy communication, giving you an opportunity to discuss all facets of the patient’s fears.
- Still fewer men understand the effect of aging on sexual prowess; knowing they are in the same league with others their age may be all the help they need. When you see the need for patient education in this area, explain–conversationally–that practically all men start, somewhere around age 45-50, to experience a little time lag between perceiving sexual opportunity and full erection. From that age, too, the size and rigidity of the penis at full erection diminish somewhat, while the time interval to ejaculation increases; many men find the delay in ejaculation to be a benefit.
Gradually, too, the nature of ejaculation changes somewhat, with less spurting and at same time, the period between ejaculation and flaccidity shortens, while the “recycling” interval–the time span to the next reaction to sexual stimulation–increases. Understanding these physical limitations can alleviate many of the patient’s concerns.