Why Men Fake It by Dr. Abraham Morgentaler MD M.D. FACS

Author:Dr. Abraham Morgentaler, MD, M.D., FACS
Language: eng
Format: epub
Publisher: Henry Holt and Co.

Surgical Erections

After Brindley put sexual medicine on a biological foundation, there was great excitement for biological treatments for men with ED. Injections by themselves were a remarkable advance, and the ability to perform vascular studies on men was enormously helpful in making the diagnosis and explaining to men why they were having trouble with their erections. Epidemiologic studies were being done to define the extent of the problem, and it quickly became apparent that ED was remarkably common, increased in prevalence as men aged, and was associated with the same risk factors that were known to be bad for blood vessels in general.

Since the penis could now be considered a specialized blood vessel, a number of investigators around the world began exploring vascular solutions to ED. Penile venous ligation, the procedure I performed on Jose, became very popular during this time. It was a straightforward, clean operation, there were few problems with it, and many men had immediate positive results. Eventually, though, it became clear that in nearly all cases the venous leak returned, as it did with Jose. The real problem was that the tissues within the corpora cavernosa were impaired. Tying off some of the veins could help for a while, but eventually the blood would find a way out. Within a couple of years of Jose’s procedure I had given up performing penile venous ligations altogether, as did almost all of my colleagues.

Another operation that had more promise was a bypass procedure for blocked arteries to the penis, called a penile revascularization. It worked best in young men whose arteries feeding the penis had been injured from trauma. In those cases an artery feeding the underside of the abdominal muscles was used to provide new blood to the penis, bypassing the blocked artery much like the cardiac surgeons do in a coronary bypass operation. I had quite a few long-term successes with that procedure. However, there were few good candidates, and once Viagra became available the operation seemed like a long slide for a short gain. Today, only a handful of surgeons continue to offer penile revascularization, but it can be a good option for a highly selected group of young men.

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