Andrew Siegel MD 5/16/2020
The PENIS: Extraordinary. Magical. Multifunctional. Under-appreciated until things go awry. A urinary organ to direct urinary flow with (sometimes) laser-like precision that enables standing to urinate, a decided male advantage over the fairer gender, who struggle with a clumsy apparatus, the need to sit to urinate, and an imprecise and spraying stream that requires toilet tissue. A sexual organ that in milliseconds can increase its blood flow to transform it from listless and flaccid to proud soldier rigidity, enabling penetration of the dark and mysterious nooks and crannies of the vagina. A reproductive organ that funnels and conducts genetic material into the female, making possible perpetuation of the species. No other human organ demonstrates greater changes in proportion that occur between inactive and active states, as impressive as the change in the biceps of Popeye the sailor man before and after consuming spinach!
Penis artwork, photo taken at Iceland Phallogical Museum, Reykjavik
- At the time I did my urology training, erection problems were referred to as “impotence,” a pejorative, unkind and demeaning term. In 1992 that name was abandoned and replaced with “erectile dysfunction” or “ED,” clearly much friendlier and more specific verbiage.
- Back in the day, most causes of ED were attributed to psychological factors and patients referred to psychologists or psychiatrists. Our contemporary understanding is that in most circumstances ED is due to physical factors, although undoubtedly there is a great deal of psychology underlying sexual function.
- It is entirely possible to ejaculate and climax without an erection (as many men with ED eventually figure out), although an erection certainly enhances the process.
- Way back when, the only medical treatment for ED was a prescription called Yohimbine, derived from the bark of an African tree; this worked little better than placebo.
- The most common male sexual dysfunction is not ED, but premature ejaculation (PE). In a study of over 1500 men, The Journal of Sexual Medicine reported that the average time between penetration and ejaculation for a premature ejaculator was 1.8 minutes, compared to 7.3 minutes for non-premature ejaculators. Another study of 500 couples across five countries reported results ranging from 33 seconds to 44 minutes with the median being 5.4 minutes.
- Some men who believe they have ED in fact have PE. The natural loss of the erection following ejaculation with a delayed time period before being able to achieve another erection is mistakenly thought to be ED.
- Delayed ejaculation used to be referred to by the politically incorrect term “retarded” ejaculation. The “R” word is no longer PC. In this circumstance, ejaculation only occurs after a prolonged time, resulting in frustration and sometimes pain for both partners. As tempting as it is to think that in terms of pleasing your partner this may be an asset, in reality, a marathon performance has major shortcomings. A common cause of the issue is the SSRI type of anti-depressants, prescribe to millions of people, and urologists prescribe this class of medication to help manage premature ejaculation.
- Some men with ED complain of loss of sex drive (libido). This often happens as it is human nature to lose interest in activities in which performance is sub-optimal.
- Aging results in the need for more direct penile stimulation to obtain an erection, more rapid loss of the erection after climax, and an increased period of time before being able to get another erection.
- There is no bone in the human penis, whereas there is a bone in the penis of many other mammals, referred to as the os penis.
- A rock-hard erection is achieved via blood used as a pressurized hydraulic fluid, a fascinating adaptation by nature. The blood pressure in the erectile chambers of the penis at the time of a rigid erection is > 200 mm, the only place in the body that hypertension is necessary and desirable. If systemic blood pressure was this high it would be considered a hypertensive crisis and a medical emergency. An erection is literally a compartmentalized hypertensive crisis. Tell your partner that you are having a hypertensive crisis of your penis and see where that gets you!
- Preserving sexual function is all about cardiovascular health: not smoking, healthy weight and diet, regular exercise, moderate alcohol consumption, sufficient sleep, stress management, etc. The key to rock-hard rigidity are the male pelvic floor muscles, so do your man-Kegels.
- The sheath covering the erectile chambers (tunica albuginea = “white tunic”) is durable and hardy because of the high blood pressures it supports; in fact, this is the second toughest connective tissue in the body, the first being the tunic covering the brain and spinal cord (dura mater = “tough mother”). It’s somewhat amusing that the brain and penis are protected by the sturdiest and most rugged body tissues!
- Peyronie’s disease (penile scarring and angulation with erection)—common in men in their 50s– is theorized to be caused by having intercourse with a less-than-fully- rigid penis, leading to thrusting-related injuries of the sheath of the erectile chambers that heals with scarring.
- Paralleling chronic traumatic encephalopathy (CTE) in football players and boxers from head injuries, “chronic traumatic corporapathy” (the corpora are the erectile chambers of the penis) is the more functional term I have coined for Peyronie’s, due to chronic penile trauma from the physical demands of sexual intercourse.
- Penile fracture is an acute injury with rupture of the sheath covering the erectile chambers, causing an audible pop, immediate loss of erection and significant penile swelling and bruising, most often requiring surgical repair. It most commonly happens when “she zigs and he zags,” resulting in forceful blunt trauma. Female on top sexual positioning, particularly “reverse cowgirl,” is most likely to result in penile slippage, torque injuries and fracture.
- Penile shortening can occur with disuse atrophy, radical prostatectomy, Peyronie’s disease, testosterone deficiency, abdominal obesity, and any form of damage and scarring of the tissue within the erectile chambers of the penis.
- The Viagra story: A chance discovery. Seeking a new medication to treat high blood pressure and chest pain, Pfizer scientists trialed an experimental formulation that works by causing blood vessel expansion. It did not work well for the intended purposes, but dramatically improved erections. The participants were profoundly disturbed when the clinical trial ended. The rest is history!
- The penile injection story: In 1983, at the national urology meeting in Las Vegas, Giles Brindley, a British physiologist, appeared from behind the podium and dropped his trousers, revealing to the entire audience his sky-pointing erection that he induced by injecting a medication into his penis. Commented one authority: “Farther down the Strip, Seigfried and Roy (who sadly just died from Covid-19) were making a white Bengal tiger disappear, and two circus aerialists—one sitting on the other’s shoulders—were traversing a tightrope without a net. But even in Vegas they’d never seen a show like this.” Few medical breakthroughs have had the dramatic effect that this demonstration had, solidifying the principle that an erection is caused by smooth muscle relaxation of the tissues within the erectile chambers. Nowadays, penile self-injection therapy is a commonly used and bonafide treatment for ED.
- Penile implants: Analogous to a total joint replacement for crippling arthritis, a penile implant can restore sexual function, virility and vitality for the man with complete ED, converting a “sexual cripple” into a man who can achieve erectile rigidity on demand for as long as desirable, even persisting after ejaculation.
Penises of members of the Icelandic handball team, photo taken Icelandic Phallogical Museum, Reykjavik
Wishing you the best of health,
“Always bring homework…”
Much of the content of this entry is derived from Dr. Siegel’s book: MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”: www.HealthDoc13.WordPress.com
Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Prostate Cancer 20/20 on Apple iBooks
PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Tags: Andrew Siegel MD, erectile dysfunction, penile injection therapy, penile prosthesis, penis, penis perspectives, Peyronie's disease, premature ejaculation, Viagra
Our Greatest Wealth Is Health 
Leave a Reply