Manhood: The Rise and Fall of the Penis (38 page)

‘Juno-esque’ lady of amazing beauty. The man has been impotent for twenty years. To begin with he still had erections, but these invariably disappeared the moment his wife approached. For the last ten years he has had no erections at all, not even in the mornings. In addition he suffers from nocturnal panic attacks, and is afraid of developing a heart complaint. The man’s behaviour is unpredictable and he often loses his self-control. These days his wife is only happy when he is away. He blames his wife:

Do you know, doctor, even when I was young I often couldn’t perform normal intercourse. There always has to be an element 198

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of danger for me to perform well. You may laugh! I’ve never really been potent in bed, only with my wife when we were first married. But if I could throw some girl into a corner, on the floor or onto the sofa, then it was always terrific.

His wife had fallen in love with him because she admired his paintings so much. She was his pupil, but gave up painting when they got married.

When she took up painting again, he realized that he really didn’t care for her mediocre work. Subsequently his wife began criticizing his paintings, and took the side of an art critic who had attacked his work:

‘Was that before your impotence?’ asks Stekel.

‘Wait a moment, I remember the exact date of the exhibition. And the date of my first disgrace, it was my wife’s birth-day, and we were in Semmering . . . Of course. The disgrace befell me a few months later.’

During the course of psychoanalysis his wife died. Two weeks later he raped his hunchbacked cook. A few months later he dismissed the cook and fell in love with a young pupil, who idolized him, and with whom he proves quite potent enough to be able to make love in the normal way in bed . . . .

Stekel regards this case as an example of the dichotomy between animal and ‘spiritualized’ love The man undoubtedly harboured brutal and possessive sexual desires from an early age, but his sexual potency failed him when his wife denied him her ‘spiritual’ admiration, thus turning into a ‘bit of skirt’, whom he would most like to fling onto the sofa.

Priapism

Priapism is a totally different affliction of the penis. It is the medical term for a usually painful erection lasting longer than three hours, with a complete absence of any sexual arousal.

In Graeco-Roman mythology Priapus is one of the lesser gods, of fertility, viticulture, gardening, beekeeping, etc. He is usually depicted with a gigantic phallus, and originated from Asia Minor. In the eyes of more educated Romans, Priapus was a figure of fun. He was imported from Greece in the first century by Roman practitioners of lighter verse.

Almost always he is pictured as a scarecrow and a deterrent to thieves keeping watch over a patch of land growing some vegetables and fruit and his coloured image is carved from a rough piece of wood.

He is considered to be a connoisseur of the erotic, whose rough appearance is echoed in his forthright language, and who is immensely proud 199

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of his phallus. The
Carmina Priapea
, a collection of nearly a hundred obscene erotic poems from ad 100, are quite explicit about Priapus’

life and works.

The Priapus of the
Priapea
is a sexual glutton, a genuine Roman macho, who penetrates wherever he can. His sexuality is violent and unfeeling and some people have seen this as typical of the Roman male from the time of Nero:

Take heed: a boy behind, a girl in front I’ll take.

For bearded men who steal, remains a third ordeal.

Briefly summarized, that is the standard penalty for theft from Priapus’

garden or orchard. Depending on whether the offender is a woman, a man or a boy, they are threatened with vaginal, oral or anal rape.

Priapus is also offered sacrifices in the poems, which are not only about crude sex. In one a dancer dedicates her tambourine and castanets to Priapus, expressing the hope that her audience will stay as enthusiastic as Priapus himself. Another promiscuous woman offers a generous number of wooden penises, one for every man she has ‘serviced’ the night before.

Priapism may occur as a side-effect of self-injection in the penis, but can also be the result of leukaemia, malignant tumours in the lower abdomen, the use of certain drugs and also sickle-cell anaemia, a here -

ditary disease affecting mainly non-white populations living in or originating historically from tropical or subtropical malarial regions. In this condition the red blood cells are more or less deformed, assuming a sickle shape, so that blood-clotting can quite easily occur, particularly when the flow speed is reduced. An instance of reduced flow is the state of erection, especially in sometimes 50-minute-long nocturnal erections.

Young men with sickle-cell anaemia are prone to priapism. Treatment consists of the injection of a vascular constrictive medication directly into the penis. If that doesn’t help, an operation is necessary, in which a kind of bypass is constructed from the penis to an inguinal vein, allowing the accumulated blood to drain away uninterrupted. There are many variants: if an operation also fails to bring about flaccidity the erectile tissue compartments will fill up with connective tissue, giving them a wooden feel.

This happened to one of our patients not so long ago: after taking medication for depression a man, not yet 40, developed priapism.

Unfortunately it emerged that that not all doctors are equally up to date on the treatment of priapism: it is necessary to act as soon as possible after such an erection, which is often very painful, and preferably within six hours. He was dismissed by his doctor, who did not take the 200

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trouble to consult a specialist. Eventually the patient submitted a claim to his gp’s insurance company. However, damages had never been paid in the Netherlands in such a case, so that the patient’s lawyer sought advice from colleagues abroad. He found that in the United States about 200,000 euros would be paid out. The patient received less than a tenth of that . . .

The crooked penis

The name of Marquis François Gigot de la Peyronie, personal physican to King Louis xv, is linked to a most unusual abnormality of the penis.

Peyronie’s disease indicates a crooked erect penis caused by excessive connective tissue formation in the wall of the erectile tissue compartment. At the point affected a hardening develops and elasticity is lost, hence causing crookedness in the erect position. The ailment is common, affecting an estimated 3.6 per cent of all adult males, and in most cases the onset is around the age of fifty. Approximately 20 per cent also suffer from connective tissue formation in and around tendon sheaths in the palm (Dupuytren’s disease), and the occasional one has problems on the sole of the foot. The cause of Peyronie’s disease is an abnormal inflammatory reaction in and under the capsule around the erectile tissue compartments, virtually always on the top, which means that the crooked position in the vast majority of cases is towards the abdomen.

A crooked penis may also be the result of a congenital asymmetry of the erectile tissue compartments, in which case the bend is towards the ground or sideways. The estimated incidence of congenital crookedness is six per thousand male babies.

Peyronie’s disease is not an easy ailment to go public with, or a suitable conversation topic at parties. Consequently the patient often thinks that he has a ‘unique’ malady, whereas it is something run-of-the-mill. Its manifestations are pain, insufficient hardness of erection or an awkward
intromissio vaginalis
, in which the penis can be inserted only with great difficulty. Above all a member shaped like a boomerang can make sex very painful for the woman, though many women appeared to be intrigued by a crooked penis.

The cause of Peyronie’s disease is still unknown. Mainly on the basis of the existence of related ailments thinking tends to favour abnormal genes, for which scientists are at present searching. As regards treatment, the Marquis de la Peyronie sent his patients to Barega, a spa in the Pyrenees. Not such a bad cure, when one knows that 40 per cent of patients will show some improvement in due course. However, the restoration of a ramrod-stiff penis will be out of the question for the patient concerned. Over the years more than a hundred non-operative 201

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Crooked position

in Peyronie’s

disease.

treatments have been described in the literature. That in itself says enough: not a single one has been convincingly proved to produce a cure.

If a year after the onset of the disease there is still serious crookedness, then provided the complaints of pain have ceased, there is good reason for an operation to correct the crookedness. Problems of rigid-ity are not solved by an operation, but problems with intercourse can be alleviated. The most frequently mentioned problem is that the penis regularly ‘flops out’ while the patient is thrusting. There are two different operations. In one the hard area is cut away and the defect created is covered with tissue taken from elsewhere or with synthetic material. In the other surgical technique the hard area is left untouched, and instead the operation takes place on the healthy side, where the penis is pulled back into line by the cutting out of small elliptical sections of wall or by a series of so-called reef knots. The main snag is that the penis may be shortened slightly, in addition to the shortening caused by the disease. The advantage is that there is no chance of dev elop ing ed. In contrast to the first operation, where the diseased tissue is removed, the malady is here treated with stitches on the healthy side.

Hypospadia

Hypospadia is a condition in which the opening of the urethra – which is normally at the top of the glans – is located on the underside, the shaft of the penis or even in the scrotum. In addition the foreskin on the underside of the glans is missing, and the erect penis is sometimes also bent. Approximately 1 in 300 males is born with this abnormality. The 202

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cause of hypospadia is very probably a relative testosterone deficiency between the sixth and thirteenth week of pregnancy.

To enable a patient to urinate standing up and function normally sexually, the end of the urethra must be reconstructed and the penis stretched. In the past children with this condition were not operated on until they were older, but today urologists prefer to perform the operation before the child enters its third year, thus limiting the psychological trauma of hospital admission as far as possible. For the manufacture of a new section of urethra use is made of the inner leaf of the foreskin. If the foreskin has already been removed, one can also use mucous membrane from the cheek or lip. Scars, the relatively short penis length and the abnormal shape of the glans mean that some boys, particularly in their adolescence, are not really satisfied with the result of the operation. The urologists who operated on them usually are, but they know that their options will always be limited. Doctors can’t really improve on the existing organ. It is important to make it quite clear to patients that correction of hypospadia will not lengthen the penis.

Adolescents or adults complaining of too small a penis in particular should be offered help by a sexologist.

A very special form of hypospadia is
mika.
As an initiation ritual at the onset of puberty, the male inhabitants of the island of Mangaia in the Pacific have their urethra split open from the tip to the scrotum with a narrow incision. It is no accident that
mika
means ‘the terrible ritual’. The procedure prevents semen from finding its way into the vagina during intercourse – a crude form of contraception! Australian Aborigines, as it happens, once had the same custom.

As a last resort in the event of several failed urethra operations, uro logists sometimes go a step further by relocating the outlet of the urethra between the scrotum and the anus. Men who have had this treatment are therefore obliged to urinate in female fashion, namely squatting.

Phimosis and circumcision

A completely different but common ailment of the penis is phimosis, contraction of the foreskin. The only reason for operating on the foreskin is a lasting contraction that leads to problems. Virtually all newborn baby boys have a slight degree of phimosis with some adhesion, which almost always disappears spontaneously. Actually the term adhesion is incorrect: what is actually meant is that in the prenatal development of the sex organ the separation of the foreskin is not yet complete, and continues after birth. In only 4 per cent of newborn males can the foreskin be fully retracted, after six months the figure is 15 per cent, and at one year approximately half.

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