Medical presentation proves erectile dysfunction is physical condition

In my previous column I wrote about Dr. Brindley’s exposure of a very private part of his body during a lecture he gave in Vegas. I said it was daring, perhaps outrageous. I did not reveal the details of the event, but I did divulge that Dr. Brindley was introducing a new treatment for erectile dysfunction.

Today, I will tell you about the treatments available for erectile dysfunction, a condition affecting one in five men. And, I will, at last, reveal what had happened during that scientific meeting in Vegas.

Treatment for erectile dysfunction may be as simple as taking a pill. Viagra (sildenafil), the first oral medication for erectile dysfunction, was made available in 1998. Its immense commercial success cannot be explained only by the initial curiosity with which it was met — it is the ease of use and effectiveness that made it a blockbuster. It works by inhibiting an enzyme that degrades cyclic GMP, which is a substance that participates in relaxation of smooth muscle in the arteries carrying blood to the penis.

Viagra is a relatively safe medication with only few contraindications and several side effects, including headache, flushing, nasal congestion and blue tint vision.

Most side effects of Viagra are minor and reversible. Priapism, or prolonged erection, however, is a serious side effect that requires immediate medical attention. but it is rare in men taking Viagra.

Other medications working in a way similar to Viagra include Levitra (vardenafil) and Cialis (tadalafil), which has a longer duration of action and can be taken daily, allowing 24-hour coverage.

Inflatable penile prosthesis is at the other end of the spectrum of treatments for erectile dysfunction. This device is made of silicone and filled with fluid. It consists of two cylinders (implanted into the penis, replacing the erectile tissue), a reservoir of fluid (implanted in the lower abdomen), and a pump (implanted in the scrotum).

These parts are connected with small tubes that allows movement of fluid between the different components. In the flaccid state, fluid stays within the reservoir and the cylinders are collapsed. When a man with penile implant wants to have an erection, he manipulates the pump, causing the fluid to flow from the reservoir to the cylinders in the penis. Once the silicone cylinders fill with fluid, they distend and harden, and an artificial erection ensues.

Penile prosthesis is an effective treatment with high satisfaction rates and acceptable complication rates, but as with any other surgical procedure, it carries risks. Therefore, it is typically reserved for men who do not respond to oral medications, such as Viagra, and fail or decline another form of treatment for erectile dysfunction — penile injections, or Dr. Brindley’s solution.

In Vegas at a medical conference, during a presentation given to medical professionals (some of them accompanied by their well-dressed wives on their way to an evening reception), Dr. Brindley presented several slides of his own penis before and after injection of “vasoactive materials” He suggested when these agents (papaverine and phentolamine) are injected directly into the penile erectile tissue, they cause dilation of blood vessels, and pulling of blood, resulting in erection.

Standing in front of his audience, an activity that cannot be considered erotic by any stretch of imagination, Dr. Brindley exposed his penis, which was erect. He revealed that moments prior to the event, in his hotel room, he injected himself with papaverine.

A urologist who was present at the lecture described the reaction in the audience: “There was not a sound in the room. Everyone stopped breathing. He waddled down the stairs, approaching… the first row (to provide the audience with a closer look)… his erection waggling before him. Women in the front rows threw their arms up in the air, seemingly in unison, and screamed loudly.”

Dr. Brindley proved, beyond any doubt, that injections delivered into the penis can induce erections. Intracavernous injections are still used today in the treatment of men with erectile dysfunction.

By proving that erections can happen without erotic stimulation, Dr. Brindley demonstrated that erectile function is first and foremost a physiological, rather than psychological condition. Men with erectile dysfunction should therefore overcome shame regarding their condition and openly ask their doctor for help coping with a very treatable condition.

Dr. Shahar Madjar is a urologist working at Aspirus Keweenaw Hospital. He sees patients in Laurium, Houghton and L’Anse. Contact him at smadjar@yahoo.com.

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