For men–and the women who love them–sexual-performance problems are so embarrassing that most would prefer to keep them under the covers. But at some point, most sexually active men will have trouble getting an erection or keeping it. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), between 15 million and 30 million American men suffer from erectile dysfunction, a sexual-performance problem that almost always has a physiological basis. No one knows how many men experience “performance anxiety,” defined as premature ejaculation or other sexual difficulties due to both emotional and physical issues. But now that drugs to treat problems with erection are available (see “The Little Blue Pill: Facts You Need to Know”), men–brothers included–are asking their doctors for prescriptions. They’re also buying and trading them over the Internet, in hopes of boosting their sexual performance. What’s going on?WHEN HEALTH PROBLEMS INTERFERE WITH SEXMen of all ages sometimes experience difficulty getting or maintaining an erection or may ejaculate too quickly. But doctors classify sexual-performance problems into a few different categories. Erectile dysfunction (ED), formerly called impotence, develops and worsens over months or years and is chronic. While it is more common among older men, ED is not a natural consequence of aging. In fact, it can strike brothers in their late twenties. About 70 percent of the time, ED is caused by serious ailments such as heart disease and diabetes, which impede blood circulation to the penis, making it more difficult for it to get and stay hard. Sometimes ED is a man’s first warning that he has a serious health issue.

Studies show that ED can often be corrected by stopping smoking, shedding pounds, eating fewer fatty foods, and exercising. Gerald Hoke, M.D., chief of urology at New York’s Harlem Hospital Center, warns, “You have to give up smoking or eventually give up sex.” The same with excess weight. “If a guy comes in with belly obesity, if he doesn’t have erectile-dysfunction problems now, he’s going to later,” he says. If left untreated, ED symptoms worsen and can eventually stop his penis from getting hard at all.

TOO QUICK ON THE DRAW

More common than ED is premature ejaculation, in which a man can’t control the amount of time between getting hard and ejaculating, says Los Angeles sex therapist Gail E. Wyatt, Ph.D. A man may come while whispering sweet nothings or during foreplay, leaving his partner surprised that the sex is over just as it was starting, she says. It’s common among men of all ages, and the causes vary. For example, men often worry about satisfying their partners, and this anxiety can trigger the condition. “If he’s having problems maintaining an erection but they’re intermittent, it’s usually anxiety-related,” Hoke says.

GETTING TO THE HEART OF THE MATTER

Consistent problems can cause a man’s self-esteem to plummet. But they’re also problematic for women, making some sisters worry that their man is cheating or has lost interest. The bottom line, says Wyatt, is that you and he have to find out what’s going on. If your partner repeatedly experiences problems that don’t improve with rest and avoiding drinking or drugs, he probably needs a full medical exam to test for physical causes. “You need to rule those out before asking, ‘What do we need to do to work together?’ “Wyatt says.

What to Do If He Has a Problem

If your man is experiencing problems with his erection, how you handle the situation can help–or contribute to his difficulties. Los Angeles sex therapist Gall Wyatt, Ph.D., coauthor of No More Clueless Sex: Ten Secrets to a Sex Life That Works (Wiley), provides these do’s and don’t’s:

DO SKIP THE APPETIZERS. Wining and dining followed by sex may look romantic in the movies, but don’t try it at home. particularly if your man has a problem. Heavy meals, fatty food and alcohol make sex more difficult for him. “Don’t set yourself up for a problem,” Wyatt suggests. Eat and drink later.

DON’T LET HIM PUSH YOU AWAY. Many men who struggle with erectile difficulties will do anything to avoid the shame of not being able to satisfy their partner–such as picking fights or going to bed early or very late. If this happens, have a nonsexual conversation about getting some help together and try to take the focus off sex by cuddling instead.

DO TRY A LITTLE TENDERNESS. “Sometimes women can be insensitive about penis size, erectile dysfunction and premature ejaculation, and that can contribute to the problem,” says Wyatt. “Find out how he’s feeling, and either say something nice and honest, or don’t say anything at all.”

DO BE A GOOD LISTENER. “Men have had trauma, failure and successes and you need to hear about it,” Wyatt says. “All those ingredients go into your partner’s performance.”

DO BE HANDS ON. Ask “What can I do to help you become more aroused?” And be prepared to suggest sexual activities you’re willing to engage in. –H.B.

The Little Blue Pill: Facts You Need to Know

It’s almost impossible to turn on a TV without seeing commercials for viagra, Levitra or Cialis. But are the drugs really the wonder pills their ads make them out to be? We asked the experts.

What do these drugs do?

According to the American Urological Association, all three medicines improve blood flow to the penis, helping about 80 percent of erectile-dysfunction sufferers have sex. The drugs will make his erection harder and may allow him to have multiple erections. But contrary to urban legends, they won’t make him last all night.

Do they work for young men?

Myths touting sensational sexual performance make ED meds valuable on the street, where younger brothers, who may or may not need them, buy from older men with prescriptions. Theoretically, men who don’t have ED won’t benefit from the drugs, but there is an important caveat: the placebo effect. Even when men don’t need the meds, says James Bennett, M.D., an Atlanta urologist, they may believe that taking the drugs will help them perform better. And since so much of sexual performance is psychological, that belief can be powerful.

How soon before you see results?

Viagra and Levitra, which can be taken once daily, require up to 60 minutes to work and help men have erections for four to six hours. Cialis takes up to two hours to kick in and keeps him erect for up to 36 hours. The drugs must be prescribed by a doctor. –H.B.

Hilary Beard is a freelance writer living in Philadelphia.

COPYRIGHT 2004 Essence Communications, Inc.
COPYRIGHT 2004 Gale Group

SO YOU MET the dawn in full salute. Maybe you attributed it to your partner’s snuggling up extra close, or even to a full bladder. Could be, but “healthy males of all ages have three to five erections every night for reasons that have nothing to do with sexual arousal or the need to urinate,” says J. Catesby Ware, Ph.D., chief of the division of sleep medicine at Eastern Virginia Medical School in Norfolk and director of the Sleep Disorder Center at Sentara Norfolk General Hospital.NOCTURNAL ERECTIONS are actually a form of exercise. When the penis is flaccid, Ware explains, it receives little blood flow, which hinders the oxygenation and removal of waste products from penile cells.

WHILE YOU’RE awake and moving, the penis receives a healthy flow of blood. But during sleep, the body responds to the hematic slowdown with a genital workout roughly every 90 minutes. This usually occurs during rapid-eye-movement sleep–the time in which you also happen to be dreaming. REM periods grow longer as the night progresses, increasing the likelihood of a stiff wakeup call.

IF YOU REGULARLY rise sporting a pup tent, chances are that any occasional erectile difficulty is not physiological. If your plumbing works in the a.m., your p.m. shortfalls are probably psychological.

COPYRIGHT 2003 Weider Publications
COPYRIGHT 2003 Gale Group

Q: I hate the idea of scalpels you-know-where, but I wouldn’t mind more bulk in my briefs. What’s the lowdown on penis enlargement?A: Given his druthers, the average guy would prefer a penis different from the one he’s got: longer, bigger around, straighter, even smaller–you name it. There is no more sensitive subject.

Unfortunately, we don’t really know what qualifies as “small” or “big.” Only Kinsey’s 1948 study looked at an ample number of men (3,500) and used thorough statistical methods. That work found an average penis length of 3.89 inches flaccid and 6.21 inches erect. Average circumference was 3.75 inches flaccid and 4.85 inches erect.

What is too small? I could offer a statistical definition based on the above numbers, but I doubt that it would sway anyone. Basically, too small is whatever a man thinks is too small. After all, we’re not talking function here. Size has nothing to do with satisfying a partner or producing offspring. At one of the most prolific surgical practices for penile augmentation, four out of five patients choose surgery because of “self-image.” This probably has more to do with the locker room than the bedroom.

I won’t try to talk you out of wanting a different penis. Instead, I’ll tell you about the various methods that attempt to deliver one.

STRETCHING THE TRUTH

The penis is not a muscle; you cannot build it up through exercise. But it certainly can be stretched. The problem is keeping it stretched.

One method of stretching is the vacuum pump. By placing the penis inside a cylinder and sealing it against the abdomen, pressure can be reduced around the penis, helping it to inflate with blood. A constriction ring applied to the base of the penis keeps the blood in once the pump is removed. Constriction rings, a.k.a. cock rings, should be left in place no longer than 30 minutes. After that, you risk damaging delicate tissue, which could lead to permanent damage.

Over the decades, hundreds of my patients have used vacuum pumps to achieve erections. When used appropriately, they are safe and effective, so much so that the FDA approved them–for treating erectile dysfunction, that is, not for growing bigger penises. Pumps may make the penis somewhat larger than it normally would be when erect, but the effect is temporary. (For more on penis pumps, see Health Update, July 2001.)

Likewise, there are myriad sites on the Internet that would like to sell you programs by which you can stretch your penis. From having you tug on it with your hands to applying contraptions, they all claim to somehow permanently elongate or increase in volume the tissues of the penis. None of them has been proved to work long-term.

For the most part, there’s probably not much harm–other than to your wallet–in such machinations. I do worry, though, about aggressive manipulation of the penis. On the whole, it’s a pretty durable organ, but it can be damaged. Fractures are possible when erect, and it’s possible that abuse could lead to the scar tissue that causes Peyronie’s disease, a painful condition marked by severe curvature of the penis.

BUILDING A NEW ONE

Surgical penile augmentation has a long, checkered history. The first recorded operation was in 1893. Over the intervening century, the techniques have become more sophisticated, but they can still be broken down into two basic approaches.

To make the penis “longer,” a surgeon severs or moves the suspensory ligament, which holds the penis to the pubic bone. I put “longer” in quotes because this doesn’t actually lengthen the penis; it just allows some of the portion inside the abdomen to be moved out and skin to be grafted in place. But I suppose seeing more penis is, in effect, having more.

I have read claims of 1 1/2 inches of lengthening from this procedure, although results dearly vary depending on both the individual and the surgeon. Some men see no lengthening at all. It’s also important to understand that the lengthening is almost entirely when flaccid; when erect, the difference will amount to less than half an inch. Also, when the suspensory ligament is severed and not reattached, the angle of erection will be considerably lower than before.

To add girth to the penis, the surgeon extracts fat from the groin area and adds it to the penis in one of two ways. The fat may simply be aspirated with a syringe and injected into the penis, or a layer of skin and the fat below it may be removed from the groin area and attached in place of the normal skin of the penis.

Injection is easy, but not very effective. Most of the fat cells don’t survive, and the layer drops to a fraction of its initial thickness over a few months. A lumpy appearance and scar tissue may also result.

Grafting may result in a more aesthetically pleasing effect when done by a skilled surgeon, but it’s difficult to maintain normal sensation. It’s also considerably more involved–which brings up the point that none of these surgeries is trivial. A urologist and a cosmetic surgeon may both be required in order to produce a result without ugly scars. Expect to pay $3,000 to $8,000–depending on how extensive the work is and what the market will bear–for their services and perhaps another $4,000 in other charges. And infection is always a risk.

There is little solid information on how satisfied men are with their augmentation procedures. Information from surgeons obviously tends to be positive. But one study of 51 men published in the Electronic Journal of Human Sexuality was not encouraging. Among those who had lengthening surgery, 69 percent were disappointed with the results. About half were satisfied with increases in girth. Most telling, perhaps, was that more than three-quarters were unhappy about how the finished result looked.

CHEAP AND EASY

Before you spend any money, may I suggest that you try another approach to penis enlargement? The typical man I see in my practice has at least a couple of inches of fat in his groin helping to hide his penis. If he loses the fat, he gets more organ. According to “Total Sex,” a guide published by MEN’S FITNESS, every 35 pounds of additional fat can hide up to an inch of your penis. Fat loss is a no-cost, do-it-yourself procedure without nasty side effects. You’ll feel better, look better and. probably have better sex. Can’t beat that!

Ken Goldberg

COPYRIGHT 2002 Weider Publications
COPYRIGHT 2001 Gale Group