Poor, poor impotent me
I am writing to post my experience in the treatment of male impotency, now leading to a penile prosthesis, at a time when I am full of self-loathing, disappointment, denial, and regret.
You see, I believe I brought on many of my own problems because I refused to seek proper medical help, and instead turned to advertised, so-called “male sex enhancement clinics”. These so-called clinics, in their underlying ethos of greed, pander to requests from men like me for strong, and long-lasting erections. While always warning their clients about the risk of priapism, they concoct unproven regimens and fail to warn clients that injecting these concoctions will take a chronic toll on the underlying venous and corporeal tissue, ultimately leading to permanent damage to the penile tissue, it’s veins, and its nerves.
I am a 58 year-old health care professional, and I should have known better. My impotency seemed to begin during the end times of a horrible marriage, and grew worse after I had a heart attack during my divorce proceedings. On beta-blockers, depressed, and facing the reality of no longer being the “young stud” I foolishly continued to see as my self-image, I began with Viagra, which didn’t work consistently; then intra-urethral prostaglandin, which didn’t work at all; then Levita, which worked for some time, and then finally that stopped working, too.
Girlfriends complained that I must not have loved them if I couldn’t achieve an erection; and when I did, they complained that condoms falling off were dangerous and these episodes always destroyed the moment, and were utterly embarrassing. And then when I turned to scrotal constricting rings, which helped, they thought I was some type of weirdo or sexual deviant. All I could think of saying was “Doctor’s orders!” and that helped, but not by much.
Then, a couple of years ago, out of desperation, and out of ignorance, I turned to the advertised sexual enhancement “clinics”. Why I didn’t go to a competent urologist, I’ll never know. Yes, I do know. It was out of utter embarrassment, arrogance, and hubris. How could a successful healthcare professional like me admit he was impotent? What would that mean to his inflated self-image?
I began with intracavernous injections of three-drug mixtures, which worked at first, and yet I was given poor directions and told to inject on the top of the penis, away from the midline, which is exactly where the dorsal nerves are located. As I now recall, injecting laterally into the corpora usually resulted in a poor effect, which I believe means the proper medication wasn’t being given. I kept asking for a mixture that would last some period of time, and result in a consistently firm erection. This was achieved at times early in my experience, and yet as the months went by, sometimes the formulations didn’t work at all.
As I began to suffer the embarrassment of a failed erection even with injections, the clinic kept increasing the dose, and now began, without telling me, to give me a four drug regimen. Some time after that I began to notice systemic symptoms of light-headedness, and an erection that was not self-sustained. I was told it was routine to have this happen, and that I should stand up during intercourse, and wear a constricting ring. And, as is typical, I was blamed for all of this, by being told at various times “it was my age”, “you have a sex problem”, “it’s your fault for injecting frequently”, and that “older people often get venous leakage”.
By this time girlfriends were concerned that they could not longer have sex with me in the “cowgirl” position, since that would result in deflation of my erection, even with a constricting ring on. They wanted to know why I had to stand up all the time, and why I wore those funny rings. And, why it took so long for me to ejaculate, and after all, “didn’t I love them?”. None of these things existed the year before, and they wondered how this had happened. It could only mean falling out of love, and you see, what could I say? I never told them that my trips to get water downstairs were actually the times I injected myself, because I was embarrassed to admit I was impotent without injections. Little did I know that this change in function was the end result of fibrosis setting in within the penile veins and surrounding the dorsal nerves (right where I was told to inject), and that my ability to use injections would soon come to an end.
Suddenly I realized that I had made a horrible mistake, after I began to do searches on the internet. During one such search I read about the many complaints against these clinics, usually because of cost, and sometimes because of lack of results. And, one post (I don’t remember where) saved me, because it said that the person posting went to Dr. Goldstein, and had all these problems sorted out. I thought Dr. Goldstein was in Boston, and then when I found out he had relocated to San Diego, it was as if, and I’m not exaggerating, the very hand of god had come down and guided by fingers to the proper posting on the Web. Coming from an agnostic like me reminds me there are “no atheists in foxholes”, and that is exactly how I felt. After extensive reading it became clear to me that, just as injecting certain drugs into peripheral veins in the hospital results in fibrosis and scarring, so too will injection of medications into the penis cause fibrosis and scarring, if these drugs are not compatible with the lining of penile veins, or not properly pH balanced. My heart sank as I realized what I had done by going to a sex enhancement clinic”, and not to a real doctor. Now, too late, it seemed obvious as to the cause of what happened to my penile tissue and veins.
Fortunately, I was able to see Dr. Goldstein, who explained the situation clearly to me. When he used the analogy that the penis was a “modified vein”, my heart sank even farther down, since then I knew that whatever I had been injecting from the clinic, which really hurt, must have caused sclerosis and fibrosis of penile venous tissue, and that has resulted in fibrosis and venous leak.
Dr. Goldstein and his staff did a tremendous job of diagnosing my problem from the hemodynamic standpoint, and I understood clearly the physiologic problems resulting from the damage from injections. The psychologic counseling was really important, because believe me, being told I had permanent damage to the penis, and that I needed a prosthesis if I wanted to have firm erections again, made me feel exactly what it must feel like to be told you have incurable cancer. Only, in this situation, I felt I had brought it upon myself, and that it was totally preventable, if I had only gone to a real doctor. And just imagine those feeling of shock, denial, and depression being put on top of the “head rush” from the office intracavernous injection, whose medications leaked systemically, as they always do. That was some surrealistic feeling, believe me.
In the past 72 hours I have really taken stock of my life, my goals, my sexuality, and what all of this means, in the grand scheme of things. I began to realize, even in this short time, how I had been using injections and artificial erections as a way of covering up many feelings of inadequacy, related to divorce; to not seeing my children to aging; to having a heart attack; and to the erroneous belief that women will not desire a man who isn’t a superman in bed. And then I realized just how much I had always disliked injections, because they were painful, and had to be timed just right; and how the erection might vanish suddenly, and couldn’t be there again in the morning; and how I had to scheme, and plan, and lie to use them without letting anyone know. And, I began to see that the women who really liked me were the ones I admitted my vulnerability to, and opened up to; and that my girlfriends always complained about the prolonged erections any way, since it didn’t seem like intimate, natural sex to them. And, how it was now time to grow-up, even at age 58, and realize that self-esteem is a matter of the human spirit, and is not of the flesh, and is certainly not contained in the penis.
I am now slowing coming to grips with my decision to have a penile prosthesis, which takes me down an irreversible road. I am determined to think of that road as “one of the two paths that diverged in a woods”, as the poet has said. I will be taking the “one less travelled”, and I know, just as the poet has written, that “it will make all the difference”.
Thankful that Dr. Goldstein is here in San Diego.