Penile (penis) anatomy

AL: Hi there Bob, please introduce yourself.

BS: OK. My name is Bob Smith and I'm 35 years old and have been impotent for the last 6 years.

AL: 29 looks young?

BS: Yes, but it’s because of my job. I work in the Navy- very high up. My job is very interesting and lots of fun- yet is very stressful. It takes an effort. At the time I was married- I'm divorced now. I blame it on my work . Well – that dysfunction could have been a good thing… but it's still a shame for a man.

AL: How did your problem make you feel?

BS: ED made me feel very unprotected and weak. I had no confidence - this feeling quickly spread to other parts of my life and soon became a conviction- my work and my marriage began to suffer. People around began to notice the change in myself.

AL: You might have been scared?

BS: More like terrified! I had no understanding why. Why me? I felt very upset, angry and worried at the same time. How confusing I thought…it felt like a part of me had died….

AL: Worried…confused…

BS: Yes, worried about my wife……wondering what would happen if she notices…..waiting for her to say something about it…wondering whether she'd go elsewhere

AL: And what was the most terrible thing for you in this situation?

BS: I am highly energetic person – passionate about being involved in everything and anything is a challenge-I never give up till success. Can you imagine what it meant to me to find out I was impotent? Getting to know that a part of me didn't work was so terrible-and it happened when I was very young-that made the situation worst-it influenced everything- my job, my family-I felt highly depressed. I became increasingly frustrated; both sexually and mentally, even sick, disappointed. I knew I needed to do something -but it was so hard…..I got used to my condition in some time.

AL: You managed to cope with the problem? What was the first thing you did?

BS: The first and the hardest step I took realizing the problem to myself- after I had admitted this I could do something to spare it.

AL: What did your wife think?

BS: After I had admitted the problem to myself, I admitted it to Sally, my dear wife. This wasn't at all hard- by this time the condition had got so bad she already knew that something pretty serious was going on.

AL: What was her reaction?

BS: Well, Sally was fantastic. We remain close friends even now. We had to divorce about 18 months ago. Sally supported me as she could; she comforted me. This was exactly what I needed at that moment-She told that it wasn’t a great deal -I had done the hardest thing- admitting it her and myself and the rest would follow and fall into place.

AL: Then what happened?

BS: Well, Sally and me started looking for solutions.

AL: And it helped?

BS: It did. It enabled me to put the whole thing in the right place. I found out that I wasn't the only one who was suffering there were many others -not as lucky as I was. It also led me to the right direction. The councilor gave us many pointers as to what step to take next.

AL: What did you do according to the councilor’s advice?

BS: Sally and I searched the Internet for any useful information. Of course, I'd heard of Viagra-but didn't know anything about it. Sally proposed that we went to the Doctors-just to ask about it- to get specific information on the drug.

AL: I was hard to take this step?

BS: No it wasn’t …. I'd already contacted the councilor. He helped me considerably. He explained all about Viagra and the pros and cons. He then screened the tests to find out if it was ok for me to take the drug-and I actually was!

AL: Go on….tell me, what happened then?

BS: Well I started taking Viagra and the medicine soon took hold of me. It was fantastic- it was like a totally new feeling of life. The power and the confidence returned. It felt like a second Honeymoon. That first night I was so nervous- it was so special it was like living the marriage all over again. I was also worried about Viagra’s effect, would it work? I felt much more confident about myself-the change in my life has been obvious.

AL: How did your life change?

BS: Sally and I got divorced about 18 months ago. We're friends and I will always be so obliged to her. I have girlfriend now, we live together. She's 8 months pregnant- it’s unbelievable. One pill has given me the life a man might dream of.

AL: Bob, what could you advise other men?

BS: Do not keep it just to yourself, speak out, admit the problem and solve it.

What Can I Do?
There are not very many things you can do all by yourself to live active sexual life. Sex does not necessarily have to include the act itself. Make your partner feel needed, the highest priority. Pay attention to his or her expectations. Take time to comprehend the changes you both are having. Change positions once in a while, make love to each other in the morning, when you are filled with power. You shouldn’t —you otherwise your lover will need to spend more time touching to become fully excited . Masturbation is a great way for those unmarried, widowed or divorced to enjoy the pleasures of sexual life.

Some people, especially older women, face the problem finding a partner with whom they can share different sorts of passion. Women live longer than men, so there is more women than men on the planet. Doing things that other older people enjoy or going places which older people find interesting are ways to meet new people. Mall shopping, senior centers, adult education classes, or day trips sponsored by your city or county recreation department.

If have a real problem that influences your sexual life, better consult your doctor. You will then have a treatment depending on the cause and seriousness of the problem. For instance, the most common sexual problem older women experience is dyspareunia, caused by the lack of vaginal lubrication. The solution may be water-based vaginal lubricants to use. Alternatively, your doctor can offer estrogen supplements.

When the erectile dysfunction is the problem, it can often be treated and perhaps even reversed. There is a medication that really helps. It is called sildenafil, or Viagra. This pill has possible side effects, especially when taken together with nitrate containing drugs. Some vacuum devices, self-injection of a drug or penile implants can also help greatly.

There is usually so much you can do to live an active sex life. Live a healthy life—exercise, eat good food, drink plenty of fluids like water or juices, don’t smoke, never drink alcoholic beverages. Avoid stress. Go to see your doctor regularly. Have a positive attitude always.

Physical Exam
The most important part in the erectile dysfunction treatment is to evaluate the seriousness of the problem and find the way to solve it, according to the history of the sexual dysfunction. A sexual history is pretty hard to discover for the inexperienced physician, but, is extremely important to search for the cause of the problem. Many areas should be subjected to thorough search while taking the history of a patient with sexual dysfunction. Special issues can include genitourinary disease, surgery, damage to testicles , prior testicular torsion, penile surgery, or scrotal surgery such as for hydrocele or spermatocele

The patient should be asked about any symptoms of vascular disease such as spasmodic claudication or blood vessel disease to the legs, and especially, about any diseases such as syndrome of Lerich. This is the cause of buttocks claudication in young men who lose their erections, which becomes a reason of erectile dysfunction in men with arterial insufficiency.

Endocrine problems are often the cause of the dysfunction, they should be carefully examined. The diabetes mellitus is the most common cause of erectile dysfunction but other causes, endocrine-based, including hyperprolactinemia, which is an elevated prolactin in the serum. This serious condition may be caused by adenoma and creates a differrent type of erectile dysfunction when a man loses interest for sex, but retains good erectile function.

Cancer should be especially noted, together with treatments such as chemotherapy or radiation. Multiple sclerosis, strokes, cord damage or other neurotic problems should also be discussed. Vascular surgeries, neurological spine or inguinal surgery should also be explored for evidence of damaged blood vessels, damaged innervations, or loss of the sympathetic nerve control.

The disorders of sleep, like sleep apnea syndromes, along with the names of any drugs used to treat them. The frequency of intercourse and ejaculations is very important too. Any change of mentality can be a reason as well. Other questions on the night pollutions , morning erections should be also mentioned. All medical preparations should be carefully observed and reviewed. Smoking, especially the length of time that the patient has smoked and the amount of cigarettes, are important to note. Any alcohol or drug use, especially marijuana, should also be documented. The doctor must find out whether the patient’s partner helped to solve the erectile problem. Divorce, problems at work or at home should be also considered.

We rate an erection on a scale of one to ten, with ten being rock hard and five being adequate for penetration sexual intercourse. We get information on how long the sexual act lasts, and frequency and the force of ejaculation, the smell of the ejaculate, presence of blood in the ejaculate, etc. The frequency of intercourses per week, the level of interest in sexual relations or how often does this happen interests us. We also discuss alternative sexual measures.

The complete examination of the patients that are obese must be provided and special attention should be paid to secondary sexual characteristics as breast swelling and enlargement or gynecomastia, that indicates a hormonal or drug cause of dysfunction or impotence. Physical examination of the genital organs includes determining the presence or absence of plaque-like formations in the corporal bodies indicative of Peyronie's disease as well as the anatomy of the urethra and meatus. The penis and testicles must be carefully examined. The pulse also indicates the vascular dysfunction.