Psychosexual medicine specifically does not do this. By concentrating on the ‘here and now’ the doctor is made to listen to the patient and to what is happening between them in the room. The doctor may detect assumptions projected onto him or her and feel how he himself or she herself, reacts. It may be that the doctor is able to use some of these features of the relationship only because of his/her own deficiencies. However, to look at these separately as elements of transference or counter-transference brings risks of trying to tackle difficulties too deeply rooted in the unconscious of the patient, or conversely putting doctors under pressure to change their beliefs without the support that analysis provides. The doctor concentrating on the immediate dynamics of the relationship can make interpretations of immediate relevance and look for changes that such interpretations facilitate at a later consultation.

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Mrs F. marched into the clinic well ahead of her husband. She immediately launched into the story of how she was the most interesting case of polycystic ovaries that her GP had seen in years. Eventually the doctor managed to bring Mr F. into the discussion and made a comment about how important it was to hear both sides of the story. A short while later he felt able to reveal, for the first time ever to anyone, that he had undescended testes. He had read about it, and knew what the probable outcome would be, and now he wanted to be examined without his wife present. The anger that she felt was overwhelming, too much for the doctor to do other than acknowledge. Whether it was due to the sudden realization of ensuing childlessness with this man, fury at the secret he had kept or the fact that he was now the one with the interesting medical condition, the doctor was not sure. What was certain was that she had kept him out of the consultation, ignoring him in the room, and in the same way had kept him out of all investigations by the normally very efficient GP. After several more visits they decided not to return.

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Feeling truly feminine;

Feeling she has a role in life;

Looking forward to something to love and love her;

Following in mother’s footsteps;

A feeling of continuity and eternity;

An opportunity to give up an unfulfilling work role and take on a more comfortable domestic one;

Approval by family and society.

Some negative feelings in pregnancy include:

Loss of freedom;

Loss of income;

Loss of a job, career prospects and status;

Fear of losing sex appeal;

Making her sexuality public;

Feeling she can no longer be a child herself and have to take a responsible role;

Fear of being an inadequate mother;

Disapproval of family and society.

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*9/197/1*

Lipoproteins come in two forms: low density lipoproteins (LDLs) and high density lipoproteins (HDLs).

Both substances carry cholesterol in the blood, but with a crucial difference. LDLs appear to clog the arteries by depositing cholesterol that narrows these essential pathways. But nature has provided a counterpart to LDLs: HDLs help clean cholesterol out of the body, opening the arteries.

The higher your level of HDLs, and the lower your level of cholesterol and LDLs, the better off you are.

Arteries don’t become clogged with fats and cholesterol overnight. Instead, the clogging takes place gradually—and silently. And this process can begin early in life. In fact, researchers have found fatty deposits in the arteries of children as young as 6, and in young men.

More evidence that impotence-causing arterial blockage can begin early in life comes from Czechoslovakia, where doctors examined the penile arteries of deceased men whose ages at death ranged from 19 to 85. All men 38 years of age and older had some blockage in these arteries.

This research makes it clear that a man who wants to keep enjoying intercourse must keep his penile arteries clean. The type of diet which will help to protect your penile arteries is one which will be healthy for your entire blood-flow system, including your heart.

But suppose you’ve spent most of your life enjoying hearty meals loaded with fat and cholesterol: bacon and eggs for breakfast, a double cheeseburger for lunch and, as one man put it, “anything for dinner, as long as ifs fried.” Will switching your diet do anything for potency and the health of your penile arteries?

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Of all these options, penile implants have received the most publicity—good and bad, informed and fabricated. It’s hard for the consumer to sort through the myths and misinformation to find the truth. Well, here are the facts.

There are three basic types of penile implants, made either of plastic or silicone. Each will provide an erection. Each makes it possible for a man to have intercourse. Each must be surgically inserted.

In most cases, the implant will leave your ability to have an orgasm and ejaculate unchanged. If you can ejaculate before you have the surgery, you’ll be able to afterwards; if you can’t, you won’t.

Implant surgery is a final commitment, because once you have the operation, your chances of ever having a natural erection are almost certainly lost. That’s because the surgery usually damages the sinuses within the corpora cavernosa that normally fill with blood during an erection. A man who gets partial erections or occasionally gets a full erection must realize that if he gets an implant his natural capability will in all likelihood be gone and he will be dependent on the prosthesis. That’s one of the important reasons why all prospective implant patients should explore other solutions before deciding on surgery. And they should decide exactly why they want an implant. Some people want them for the wrong reasons.

Just as important as knowing what an implant can do is knowing what it cannot do.

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Not surprisingly, Jason left the office and never returned.

Fortunately, he later found help from a doctor who wanted to listen to his story, do a complete workup and then explain in detail the choices for treatment.

Jason’s experience also illustrates the importance of sensitivity. You’re going to be discussing some very intimate experiences, and if s essential that the doctor be at ease—and help you to feel the same way.

Ifs also important that the physician welcome—not just tolerate—the involvement of your wife or lover. Some doctors actively seek the participation of the partner; others just leave it up to the patient to decide whether she should be involved. Ideally, the physician should direct some of his attention to your partner and should try to make her feel comfortable and part of the process.

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A woman who sees an erection as a type of lie detector which reveals the man’s true feelings may be so concerned about her own self-worth that she may ignore her partner’s explanations and his pain. “I tried to explain my situation to one woman I cared for,” recalls Andy, a 34-year-old insurance agent whose potency problem is caused by his diabetes. “But she couldn’t accept what was happening.”

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An hour later Jack saw blood in his urine and, still in agony, called his doctor, who suggested a urological examination. At the doctor’s office, Jack had a complete work-up. The urologist’s diagnosis was somewhat reassuring. He stated that there was no need for immediate concern, but it was still important for Jack to monitor both his urinary flow and erectile function to determine any residual damage. His urine remained clear but, two weeks later, when his fiancee came back from a business trip, he discovered the full extent of his injury, both physical and psychological.

For the eighteen months they had been together, Jack and Christina had reveled in their sexual prowess. It was a big turn-on for them both, the bond that brought and kept them together. However, on Christina’s first night back something happened. Or, rather, didn’t happen. For the first time in his life Jack couldn’t perform. Stunned, he couldn’t believe it. Neither could Christina, who, missing him for two weeks and in the mood for a prolonged sexual encounter, was both disappointed and suspicious. Becoming angry, she accused him of seeing another woman in her absence. Jack told her, as calmly as he could, what had happened to him but she didn’t believe a fall could hurt him that badly.

“You’ve fallen off that bike before—and this never happened!” she pointed out angrily. Then, calming down somewhat, she suggested that they visit another urologist together. Unfortunately, the news they heard only contributed to the downward spiral of their relationship. The new urologist informed them that the type of bicycle accident Jack had sustained often causes mild to moderate erection difficulties, and it could take some time for full healing to take place—if it did at all. But the doctor had a recommendation: he proposed that Jack begin injecting himself with tri-mix. Then he went one step further, stating that if Jack’s condition deteriorated over time, he should consider getting a penile implant.

Five months before their wedding, this news shocked them. They decided to postpone the ceremony to give them time to adjust to what would be, in both their eyes, a lifetime of artificial sex. But the adjustment never took place. Six weeks later Christina returned his ring and Jack was left alone with his problem.

Determined to prove his virility, Jack decided to use the tri-mix injections. Not wanting any woman to be aware of what he was doing, his challenge was to master the needle. Then, not satisfied with the one-hour erection the drugs gave him, he began to experiment with the dosages on his own. Figuring out a way to give himself a two-hour erection was, to him, a triumph. While demonstrating his sexual stamina fueled his badly eroded self-esteem, soothed his battered ego, and even appealed to his competitive nature, the most intimate bond he had was with his frequent injection. Ultimately, his erection—not his feelings for a woman—was the most important aspect ol any sexual encounter be had.

After two years of boasting how his sexual skills were all-conquering, Jack began to feel ashamed of himself. Looking inward, he knew that he was offering women little of who he was; all that he was willing to give them was a super-hard erection. And on the flip side, what were women contributing if all their encounters were centered around how long intercourse lasted?

Realizing it was time for professional help, Jack sought out a psychotherapist who advised him to regroup, both physically and emotionally. Telling him that it would be in his best interest to cease all sexual activity for a while, the doctor said that Jack had to acknowledge the change in his erectile capabilities. In essence, he needed to take the time to mourn his loss, something he had not allowed himself to do.

Additionally, the therapist suggested that he date women with the clear understanding that sex was a boundary that was not to be crossed. This would give him time to understand that there were women who were interested in the whole person who was Jack. Over time, he began to heal and date again. He found that he was having spontaneous morning erections. When the therapist felt that he was ready, she referred Jack—and his girlfriend Gayle—to me to become part of the Vasomax trials. Interestingly, Jack wanted to first experience the effects of the medication by himself.

Observing himself respond naturally to erotic stimulation and feeling himself become hard as he masturbated was incredible to him. Then ejaculating and watching his penis retract—just as it had before the accident—made him realize two very important things. One, of course, was that for all practical purposes, he could resume a normal sex life once again. The other was that after all the emotional suffering he had endured, he now understood the value of having someone he cared about, someone with whom he could spend time and know intimately. This would make him happier than he ever thought he could be. And dually, he realized who had been missing from his sexual encounters of the past few years himself.

With these insights, Jack was able to move forward with his psychotherapy and in his relationship with Gayle. This time, with the medication, sex was a natural outgrowth of bonding. Needless to say, it was satisfying, physically and emotionally, for both of them.

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