Manhood: The Rise and Fall of the Penis (30 page)

On the twenty-first day exactly, the first day of the next new moon, boil everything until the mixture thickens to a paste; then add four drops of crocodile seed and strain the mixture through a cloth.

After collecting the liquid in a bowl, you need only rub the parts of the impotent man with it, and he will perform wonders. This mixture is so effective that there have been cases where women have become pregnant simply through the intimate rubbing of the man.

Since crocodiles are quite rare in Europe and since obtaining the seed of this animal is extremely difficult, it may be replaced with the seed of various kinds of dog. Apparently that is possible because dogs are so strangely agile in eluding the eager jaws of a crocodile. On the banks of the Nile these dogs are very common. In any case, we are assured, the above experiment has been repeated several times and up to now it has always succeeded, with both dog and crocodile seed.

Medication

In the last century it was also believed that certain medicines could adversely affect potency. Roubaud described how in the treatment of tuberculosis with iodine vapour he saw four cases of impotence develop. Saltpetre also acquired a bad reputation. The use of bromide compounds mainly affected sexual desire. Camphor dulled the sensitivity of the genitalia.

Today it is mainly medication for lowering blood pressure and psycho active drugs that have a bad name. The same applies to a number of drugs to counter arrhythmia, Parkinson’s disease, certain medi -

cation prescribed for excessive stomach acid production and drugs used in treating prostate cancer. Some of the drugs mentioned adversely affect the desire for sex, others impede the stiffening of the erectile tissue compartments in the penis or lead to a ‘dry’ climax, meaning that sperm is forced into the bladder. Doctors call this phenomenon 155

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retrograde ejaculation. It is always worthwhile discussing with the prescribing doctor whether alternative medication is available.

Within the medical profession itself there is an ongoing debate about whether it is or is not advisable to point out possible unwelcome side-effects to patients before medication treatment starts, especially with side-effects of a sexual nature. It is desirable to ask about the patient’s sex life before starting treatment, so that the patient knows that the doctor is prepared to discuss the subject. Apart from that, it is a way of establishing whether or not the man has problems in this area. If it is necessary later to check whether there is a possible connection between sexual problems and the drug, this information can be useful.

On the other hand it is not fanciful to suggest that even the mention of, for instance, possible erection problems when using medication to counter high blood pressure, may become a self-fulfilling prophecy. These days, however, patients read the package inserts and ask questions on their own initiative about possible side-effects. In such a case the doctor will point out that these phenomena are quite rare, and it is impossible to predict who will suffer from them. As has been said, in the event of side-effects it is sensible to confer.

Yet it still happens that patients make a connection between their sexual problems and the drugs they are taking, but do not dare to raise the subject. They may even discontinue taking the medication without telling their doctor. Because, say, their blood pressure is not dropping sufficiently, they are prescribed a higher dosage or more medication, which they still do not take, and so on . . . Asking about sexual side-effects now and again in check-ups can provide an opening for a full discussion, and will undoubtedly benefit the patient’s adherence to the treatment.

Alcohol and drugs

Quite a few men believe that a steady intake of alcohol heightens potency – but this couldn’t be further from the truth. Chronic excessive alcohol consumption can lead to all kinds of sexual problems. Alcohol attacks the body in various ways: in the long run both the central and the peripheral nervous system can be affected. The substance also has a toxic effect on the testicles. Besides that less testosterone is produced and the liver is progressively less able to break down oestrogen (men also produce a small amount of this female hormone).

In the nineteenth century the effect of various kinds of wine was a serious object of study. The German physician V. G. Vecki believed that the heavier dark-red wines like Bordeaux, Dalmatian and Californian wines and some Spanish varieties have a positive effect on potency.

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Champagne was in his view pernicious, increasing the libido but harming the erectile apparatus.

The porter’s famous description of the effects of alcohol in
Macbeth
still rings true: ‘It provokes the desire, but it takes away the performance.’ Shakespeare’s point is still valid: excessive drinking is bad for the erection mechanism. It is sometimes said of impotence that it is a matter of wanting but not being able. In the case of excessive alcohol consumption, however, the reverse usually applies: one is able, but doesn’t want to.

Nicotine reduces potency through its vascular constrictive effect, meaning simply that the blood supply to the penis is reduced. Research with dogs, which were required to inhale a fixed quantity of nicotine, proved this beyond question. The effect of recreational drugs depends partly on the way in which they are used (smoking, snorting or intravenous injection) and the level of the dose. In addition, it is not exceptional for several drugs to be used simultaneously. Marijuana, methadone and heroin not only lower the testosterone level in the blood, but also result in a raised prolactin level. An excess of that hormone (which triggers milk production in nursing mothers) reduces the desire for sex.

Too high a prolactin level in the blood is fortunately only very rarely the result of a
prolactinoma
, a tumour affecting the hypophysis.

Depending on its size it must be treated by medication, radiotherapy or operation.

Congenital abnormalities

Some years ago there was a discussion about whether someone born with a serious disorder of the external sex organ could have a satisfactory sex life as an adult. When a survey was conducted among adult men with an ‘open’ bladder (
exstrofia vesicae
) and the accompanying seriously abnormal (short) penis, it was found that seven of the eleven were satisfied with the way they functioned sexually, though the other four were clearly not. There is very little research of this kind to be found in the scientific literature.

In his posthumously published diaries,
The Business of Living
, the Italian writer Cesare Pavese (1908–1950) describes his own life as a lost battle. Pavese was impotent because of a congenital defect in his sex organ. He talks of a struggle with his own character, which over the years he came to regard as an insurmountable fate. When Pavese put an end to his life in 1950, it was the culmination of something he had been heading towards for years. There has been much conjecture and much has been written about why he committed suicide: criticism and 157

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misunderstanding from the Communists, the fact that no woman was prepared to commit herself to him, but mainly his sexual problems.

A few fragments from the diaries:

7 December 1937: A man who has not come up against the barrier of some physical impossibility that affects his whole life (impotence, dyspepsia, asthma, imprisonment, etc.) does not know what suffering is. In fact, such causes bring him to a decision of renouncement: a despairing attempt to make a virtue out of what is, any case, inevitable. Could anything be more contemptible?

23 December 1937: The child who passes his days and nights among men and women, knowing vaguely but not believing that this is reality, troubled, in short, that sex should exist at all, does he not foreshadow the man who spends his time among men and women, knowing, believing this is the only reality, suffering atrociously from his own mutilation? This feeling that my heart is being torn out and plunged into the depths, this giddiness that rends my breast and shatters me, is something I did not experience even when I was befooled in April.

The fate reserved for me (like the rat, my boy!) was to let the scar heal over, and then (with a breath, a caress, a sigh) to have it torn open again and a new infection added.

Neither deception nor jealousy have ever given me this
vertigo of the blood
. It took impotence, the conviction that no woman ever finds pleasure with me, or ever would. We are as we are; hence this anguish. If nothing else, I can suffer without feeling ashamed: my pangs are no longer those of love. But this, in very truth, is pain that destroys all energy: if one is not really a man, if one must mix with women without being able to think of possessing them, how can one sustain one’s spirits and vital power? Could a suicide be better justified?

25 December 1937: If screwing was not the most important thing in life, Genesis would not have started with it.

Naturally everybody says to you ‘What does it matter?

That’s not the only thing. Life is full of variety. A man can be good for something else,’ but no one, not even the men, will look at you unless you radiate that power. And the women will say to you: ‘What does it matter,’ and so on, but they marry someone else. And to marry means building a whole life, a thing you will never do. Which shows you have remained a child too long.

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Spinal cord lesion

A spinal cord lesion is a catastrophic event. There is an abundance of therapies for this group of mostly young patients: physiotherapy, water therapy, psychotherapy, you name it. But sex therapy is not on the list.

Not only many professional helpers, but family members and others believe the patient will never again have a sex life. The unspoken question they are asking themselves is to what extent someone can love such a badly injured body.

The writer D. H. Lawrence (1885–1930) takes this as his theme in his once shocking but now classic novel
Lady Chatterley’s Lover
(1928). The main character’s husband is a war invalid, who at the age of 29 suffered a complete spinal cord lesion. His wife is six years younger. It so happens that the husband, Clifford, proved emotionally cold even before his injury. With great artistry Lawrence describes Lady Chatterley’s passionate relationships: first with Michaelis, whose

‘pathetic two-second spasms’ cannot ultimately satisfy her, and later with Mellors, the gamekeeper, the embodiment of the natural male element and the complete antithesis to her wheelchair-bound husband.

Particularly in the initial post-traumatic phase many spinal cord lesion patients see sex as a closed chapter, something that is no longer compatible with their badly damaged body image. At a later stage spas-ticity or stiff joints may hamper sexual activity, and there may also be involuntary loss of urine during sex, especially if the bladder is not emptied in advance. One positive aspect is that new erogenous zones may develop, such as nipples, neck, earlobes or the skin in the transitional area between those parts of the body with and without sensation.

Sexual need is particularly great among these patients without a partner. That need is catered for, for example, by the TLC Trust (www.tlc-trust.org.uk), which provides counselling and sexual services, and by discussion forums for the disabled like that at www.thesite.org.

A new technique, still in its infancy, is a neurological bypass. This involves an operation to redirect a nerve from the groin to the head of the penis, which requires the damage to the spinal cord to be below the point where the inguinal nerve branches off from the spinal cord, that is, below the first lumbar vertebra. The operation was first performed in the Netherlands with spina bifida patients. It often takes at least six months before any kind of sensation returns and it may take two years before it is possible to assess how pleasant that sensation is.

The brain has to learn that signals are no longer coming from the groin, since at the beginning a touch to the glans is registered in the groin.

The man himself has to begin to (re)associate the sensation in the penis with sex.

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If there is a partner and she is responsible for most of the care, that may be to the detriment of the sense of their being lovers. Friction between partners, one of whom is handicapped, often relates to that care. ‘If you have a row with your wife and half an hour later you have to ask her to put you on the toilet, it’s no joke,’ as one spinal cord lesion patient told me. Experts advise that the seriously handicapped are best cared for by a professional rather than by the partner, which is a way of preventing the carer–patient relationship from coming to replace love and friendship.

Partners wanting to end a relationship with a spinal cord lesion patient may feel a certain guilt, which can lead to the postponement of that decision. This may stem from a feeling of responsibility and concern about what will become of the invalid partner. It is important to distinguish love and pity: in the view of some psychologists staying with someone out of pity is a mistake. Others believe that love can develop into empathy: the sense of experiencing and sharing the other’s suffering.

That does not detract from the fact that it can be a very hard decision, especially if those around one take the side of the person left behind.

Lady Chatterley chose to leave after she become pregnant with Mellor’s child and her husband refused a divorce – and who can blame her?

Wedding-night impotence

One day I was rung up by a psychologist to ask if I would teach a patient to inject himself in the penis. The case was as follows: a young Turkish man was due to leave for his homeland to collect his wife. They had only been married for a few weeks, but unfortunately his bride had been taken back home because the poor bridegroom had been unable to achieve an erection on their wedding night. His wife remained a virgin, bringing shame on her family. On the principle of ‘now or never’, the unfortunate man was taught how to inject himself: if things didn’t work spontaneously, he would have some chemical backup. He left with needles, syringes and a number of ampules of vasodilatory fluid. A few weeks later we heard that fortunately everything worked without injections, and that the patient had been able to display the bloody sheet proudly to the family.