Dudley Seth Danoff's Blog, page 8

Sex Education

PENIS EDUCATION AT HOME

I am often asked by fathers, and occasionally by single mothers, "How do I educate my son about his penis?" "When do we have that 'birds and bees' dialogue?" "How do I promote a positive penis image for my son?" As a father, you are your son's primary penis role model. The smallest message from you—a nod, a grunt, a shrug, a casual remark—gets carved into his memory deeper and more permanently than anything he picks up in a sex education class or schoolyard. Set a good example, a responsible example, with a superpotent attitude.

A father who keeps his genitals under cover all the time and never mentions the word "penis" or who avoids his son's questions about sexuality will raise a self-conscious, and probably self-doubting, son. If you are open and honest and demonstrate penis pride, your son will absorb the right education by example.

You can reinforce your example by being candid and up-front about penis matters without making too big a deal about them. Treat the penis as a fact of life, not as something dirty to be hidden behind a zipper or something of great mystery that cannot be spoken about in public.

Make sure you are your son's main source of information, which means your top priority is to be as educated as possible about penis issues. Boys are extremely curious about their penises. If they suppress their curiosity because their parents evade the topic, they will come of age in ignorance or get their penis education the wrong way—from their peers.

Do not pull punches, hide behind cute euphemisms, or limit the discussion of these issues to brief moments of off-hand comments. It is important to be frank with your son, just as it is important to be casual and lighthearted.

A Case Study

Let me give you an example. When my son turned seven, he asked me, "When will my penis be as big as yours, Dad?" I said, "Put your hand in mine. When your fingers are as long as mine, which they definitely will be, then your penis will be as big as my penis."

I knew perfectly well that the penis is a special body part. (My son would not have bothered asking me when his hands and feet would be as big as mine.) I treated it as a simple fact of life, no different from fingers or toes.

Naturally, the mere fact that a son can ask that question suggests that he grew up in an atmosphere of openness and had occasion to be naked with his father. As your son grows, make sure he understands penis matters on a level commensurate with his age. Let him know you are there for him and that you have answers should he have penis questions.

Puberty & Adolescence

When boys go through puberty and adolescence, all of them wonder if their organ is normal. Let your son know that his penis is perfectly fine and help build and reinforce his self-confidence by describing the unique and special qualities of the penis—that it is a pleasure-giving appendage that should be appreciated, respected, and used wisely.

If you do that, your son will grow into a fully formed, superpotent man whose penis is as big as he thinks it is, as reliable as he thinks it is, and above all the only one he will ever have and his best friend—there to bring lifelong pleasure to him and his partner.

Let me give you another simple example from my own life. When I was a teenager, I was very self-conscious about being shorter than many girls at school. I once came home from a party feeling awful. I told my father, "I am really popular. I am a good dancer, but half the girls are taller than me, and I am embarrassed to dance with them." My father responded with a big smile that let me know I was okay. Then he said, "You know, Son, all girls are the same size lying down."

It was a simple man-to-man moment, but it had a big impact on me. In a subtle way, it instilled in me the confidence to approach any girl. (Later on, by the way, I learned that my father was somewhat right anatomically: there is relatively little size difference among most people if you measure from the pubic bone to the neck; it is mainly the length of the legs that creates height differences. When you are horizontal for sexual purposes, height becomes irrelevant except in extreme cases.)

Too Much Information

One caveat is worth mentioning regarding educating your son: sexual candor does not entail prying into your child's life. Teenagers need privacy. If you are too meddlesome and too up-front, you can intimidate your child. Unnecessary pressure has no place in your relationship with your son. Some fathers think they are instilling positive sexual attitudes by sharing sexy books or movies or alluding to their own exploits. Do not defeat your purpose by creating standards that make your child apprehensive and uncertain.

Your son should get the message that he and his penis are okay just the way they are. Given that message in every possible way, superpotency is a matter of penis attitude, and penis attitude is a direct reflection of self-image. Do everything in your power to raise your child to have a healthy self-esteem. Let him know that he is loved unconditionally and appreciated for who he is without regard to his performance in school or on the playing field. Teach your child to judge himself by his own standards, not by yours or anyone else's.

The Female Perspective

If you are a single mother, your challenge is a bit more difficult. The most important steps you can take as a single parent are to provide your son with unconditional love and let him know at every possible opportunity that he is worthy of his own self-respect. If you raise a healthy, self-assured son, the chances are that he will feel secure in his penis image.

As to the details of a young man's penis education, you can provide him with facts as easily as a man can, but you cannot speak from experience and you cannot be a role model. If you have a male relative or close male friend whom you and your son trust, someone who can take your son under his wing and teach him about his body and sexuality, then you can compensate to some degree for the absence of a father. If the surrogate is a man of true superpotency, his presence might serve your son's penis education better than a real father who neither cares nor is around.

The Male Orgasm

Nature designed the mechanism of erection for procreation. The reflex of ejaculation follows erection.

However, ejaculation is not to be confused with male orgasm, even though the two usually, but not always, go together.

What's the difference?

Orgasm refers to the intense feeling of pleasure and release felt at the climax of sexual excitement, and is mainly neurological in nature. It is an electrochemical event centered in areas of the brain that govern pleasure.

In our laboratories, we can trigger an orgasm in animals by stimulating the brain in the right way—no other bodily contact required.

Most of the time, men have orgasms when they ejaculate. This is referred to colloquially as "coming."  However, most men at some point have had the disconcerting experience of ejaculating without the pleasurable sensation of orgasm. This may have happened when, as adolescents, they were so overwhelmed by excitement and anxiety that they "came" in their pants.

Conversely, some men have experienced the reverse: orgasm without ejaculation. Some esoteric Oriental sex practices can accomplish this. Many of my elderly patients have also experienced it, to their considerable chagrin. Orgasm without ejaculation is not uncommon in the elderly age group.

Ejaculation And Sperm:  An Anatomy Lesson

Ejaculation is discharge of semen through the penis. This discharge occurs through a reflex action involving a number of body parts.

Let's begin with an explanation of the production of the semen, or ejaculate.  The sticky, milky-white ejaculate fluid is not produced exclusively in the testicles. It is the contribution of three different organs: the testicles, the seminal vesicles, and the prostate.

The testicles provide the smallest, but most important fluid—sperm. In a normal man, anywhere from 80 to 600 million sperm cells accompany each ejaculation in search of a fertile egg to impregnate. However, those millions of sperm cells constitute only a miniscule percentage of the total volume of ejaculate.

On its journey to ejaculation, sperm travels from each testicle through a pair of tubes called the vas deferens. The sperm is then stored in the seminal vesicles. These vesicles are two pouches that stick out like pennant flags in a stiff wind, behind the prostate. They are located near the point where the urethra emerges from the bladder.

In the seminal vesicles, the sperm is mixed with the rest of the seminal fluid, which is a medium to transport the sperm. Some of the fluid is manufactured in the seminal vesicles themselves. The remaining portion is produced in the prostate gland. This gland is an oval-shaped organ about the size of a plum, located at the neck of the bladder and surrounding the urethra.

Only men have prostates. The prostate not only contributes to the content of the semen, but also facilitates the process of ejaculation itself. It helps shut off the flow of urine from the bladder, so that semen alone enters the penis.

The complex products of the testicles, prostate, and seminal vesicles form the final composition of the fluid that is ejaculated at the climax of the sex act.

There is, however, another secretion that is actually the first to emerge. That honor belongs to a clear, sticky fluid manufactured in the bulbourethral glands. These glands are called Cowper's glands (named after the seventeenth century English surgeon, William Cowper). The Cowper's glands are about the size of peas and are located just under the prostate.

Small drops of the Cowper's fluid typically appear at the tip of the penis during the arousal stage.

Some men confuse this with ejaculate, causing them to panic. They believe that they are ejaculating too quickly. Other men know better, but do not make the mistake of assuming that the fluid contains no sperm cells. This fluid might contain some sperm cells, and only one sperm cell is needed to fertilize an egg. The purpose of the fluid from the Cowper's gland is to help lubricate the vagina. As you can see, this masterfully designed system does not miss a trick.

The Point of No Return: Ejaculation and Orgasm

With sufficient stimulation to an erect penis, the reflex action of ejaculation is eventually triggered. The amount of time it takes for this to occur depends on the individual and on the circumstances.

The sensation of pleasure involved also may vary with different encounters. A man might experience fireworks and ejaculate very quickly, or he might require an extended period of stimulation in order to achieve climax.

The differences in the intensity and pleasure of orgasm are mediated in the brain. These differences entail psychological and emotional factors such as love, romance, fantasy, physical chemistry, and the level of physical and emotional passion that precedes the orgasm.

What takes place physically during ejaculation is always the same. This is true with minor variations—whether a man is masturbating in a closet or making love under a tropical waterfall with the partner of his dreams. When a certain level of excitement is reached, a complex chain of nerve impulses signals the muscles in the pelvic floor to contract. These muscles are located in the perineum, the area between the back of the scrotum and the bottom of the rectum (often referred to as the "'tain't," as in "'tain't in the front and 'tain't in the back"). These contractions close the neck of the bladder and open the ejaculatory ducts. Sperm and seminal fluid can then enter the urethra, where the components are combined.

These pelvic contractions are accompanied by muscle contractions in other parts of the body (such as the lower back and abdomen). They are accompanied by an increase in the heart and respiratory rates, making ejaculation a whole body phenomenon.

It is at this point, when the contractions of the perineal muscles forcefully start to move the semen on its route through the penis, that men feel the sensations that tell them they are about to ejaculate. From this point on, ejaculation is inevitable. It is a pure reflex that cannot be stopped. Any effort to delay ejaculation has to be made prior to this point of no return.

The ejaculate is powerfully propelled from the back of the urethra through the penis and out the tip. It squirts out in several jelly-like clumps, which quickly liquefy into an opaque fluid allowing the sperm to swim to the ovary.

Exactly how much is ejaculated varies with factors such as age. There is less semen produced the older you get. Ejaculation is also influenced by the length of time since the previous ejaculation; the longer it has been since the last ejaculation, the greater the amount of semen.

Statistically, the amount of seminal fluid per ejaculate ranges from one-and-a-half to five cubic centimeters and averages about three ccs, which is about a teaspoon. The volume ejaculated decreases with age because the body simply produces less. The forcefulness of ejaculation also decreases with age due to a natural decline in muscular strength and changes in the vascular system. A young man might project five ccs of ejaculate halfway across the room, while an older man might just dribble a few drops. The mechanism is exactly the same.

It's Not About Volume

It is important to understand that there is no real correlation between the volume of ejaculate and the amount of pleasure that is experienced. Some men actually allow themselves to feel disappointed if they do not produce barrels of the stuff. They mistakenly link their masculinity to the volume of semen they produce.

Some men complain to me that their sex lives are lousy because they do not ejaculate as much as they used to. When I tell them that everyone produces less semen as they age and that it has nothing to do with their level of sexual pleasure, one of two things happen: they either start enjoying sex again because they are relieved of this self-imposed psychological burden, or they are forced to focus on the real problem, which can be anything from a conflict with their partner to a correctable medical condition.

I must emphasize this important point: any difference in the satisfaction of one ejaculation as compared to another is centered overwhelmingly between your ears, not between your legs or in your perineum.

A particular orgasm might feel especially satisfying because of the intensity of the emotions involved, or the partner's sexual skills, or the circumstances surrounding the experience. It is not because of the volume of seminal fluid.

If an orgasm that is accompanied by a large amount of semen does feel unusually intense, it is for a good reason. The most likely reason is that the man has gone a long time between ejaculations. The more extended this time gap is, the more fluid builds up in the seminal vesicles. The overdistension of these storage pouches creates the heightened sexual "tension" that is released in an "explosive" orgasm. When you finally ejaculate, you relieve that built-up volume.

That is why it feels so good.

The Refractory Period (A.K.A., "I Want to Be Alone Now.")

As soon as ejaculation is completed, the process is reversed. Heartbeat, blood pressure, and respiratory rate gradually slow down to resting levels. You feel sated and relaxed, and perhaps sleepy.

The scrotum, which reflexively contracts during sexual arousal, and the testes, which rise up within the scrotal sac, relax into their usual positions. The penis, as the blood drains out, reverts to its flaccid state. It is as if the penis, having worked so hard, wants to retreat into solitude and not be seen.

The head of the penis becomes extremely sensitive. It does not want to be touched. It does not want to be sucked. It might even burn or hurt if it makes contact with anything. It is as if, after ejaculation, the penis dons a neon sign that reads "Leave me alone!"

This is a time of rest, when the male body restores its energy before it can once again become aroused. This is called the refractory period. No amount of stimulation will produce an erection or ejaculation.

Exactly how long it takes for your sexual function to be restored varies considerably from one man to another. Any man will notice distinct variations in his refractory period depending on his partner, the circumstances of the sexual encounter, and other physical factors such as fatigue and general health.

The two main variables that determine the length of the refractory period are age and the length of time since the previous ejaculation. Generally speaking, men need more time to rest the older they are. This means a longer refractory period.

The same man who, at nineteen, was ready to go five minutes after ejaculating might need an hour at age forty or a full day at age sixty.

Conversely, a man who has gone without sex for a long period of time will be restored much more quickly than if he has just ejaculated for the tenth time in two days.

The refractory period is nature's way of making sure men do not waste their energy when they have no semen to contribute. It is during this rest phase that the seminal vesicles are refilled.

These vesicles act like a reservoir with a feedback system. When they are empty, or the volume of seminal fluid is low, the body starts producing more. During that period of time, a man will feel little, if any, desire and will not respond to any efforts to arouse him.

As the supply of semen is replenished, the seminal vesicles become distended. When they are filled up with fluid again, seminal production is curtailed. The refractory period is over.

The distended seminal vesicles trigger a neurological signal that produces a sense of pressure in the perineum. That is what produces the common feeling of being "frisky." Now that the refractory period is over and the gates are open, the penis perks up, raises his head, and starts calling attention to himself once again.

The Truth About Penis Enlargement

Every day on the Internet, I get six or more offers on how to make my penis, longer, wider, thicker, or more appealing. These ads promise to "satisfy my dreams." They offer me some magic potion or some ridiculous surgery that uses a grafting material that "promises" to enlarge my penis.

In the oft-quoted words of my friend, Professor Thomas Lue of the University of San Francisco in California (UCSF), a world-class authority on erectile dysfunction, "The surgical 'enlargement' of the penis is no more effective than taking your penis and whacking it with a large wooden mallet, which essentially results in a flattened, squashed, and mangled 'Polish sausage' effect."

There simply is no effective way of enhancing your penis size. The three oral erectile dysfunction drugs currently on the market (Viagra, Cialis, Levitra) only give one a firmer, but not a bigger, penis.

But What About Surgery?

One "penis enlargement" surgery that has been foisted on the consumer consists of nothing more than cutting the suspensory ligaments of the penis.

When cut, these ligaments, which attach to the undersurface of the pubic bone, give the appearance of length by allowing the penis to hang a bit lower. This optical illusion is produced at the expense of losing the erect "angle of the dangle"—meaning there is absolutely no length gained in the erect penis.

The other surgical penis extension technique that claims to increase penis length and girth involves applying grafted material (usually skin, fat, or a synthetic material) within the shaft of the penis. Unfortunately, this usually leads to an unsightly deformity. Furthermore, this procedure can cause serious and damaging complications.

Sorry, gentlemen, but there is no legitimate way to increase the length or width of the human penis. From the sincerest depths of my urologic heart, I pity the patient who tries.

Penis Size Is Determined At Birth

I cannot emphasize enough that the unique and individual size of every man's penis is determined at birth by the size of the corpora cavernosum—the two chambers within the shaft of the penis that fill with blood during an erection.

If one thinks of the two corpora cavernosum as "sausage casings," the size of these casings is predetermined by heredity. When filled with blood at the height of stimulation, both the length and the girth of each man's corpora are fixed.

Even when surgeons implant a penile prosthesis in a patient with erectile dysfunction, we must custom measure and fit the implant to the exact dimensions of the existing corpora. We cannot insert a larger implant than the genetically predetermined size of the casing (corpora) can accommodate.

When the surgical quacks and adventurists of the world try to stuff the corpora with autologous fat or other grafting material, the result is not only hideous, but invariably results in permanent physical impairment.

Don't Believe the Hype

As a urologic surgeon, my advice to the misinformed men out there is do not believe the "enlargement/ enhancement/bigger is better" ads appearing on the back pages of men's magazines. They are totally illegitimate!

Rather, look down at that friendly organ hanging between your thighs, and be happy with it. If it functions well, then you have nothing to worry about.

Do yourself the favor of treating your penis as a friend. Protect it from the mutilation that will occur if you trust anyone who promises an unobtainable result. The most pathetic and saddest men I see are those who have been subjected to phalloplasty (the surgical enhancement of the penis) for the purpose of increasing length or girth.

The main problem with any kind of penile grafting or enhancement surgery is that the penis, unlike the breast, is not a static organ. It is quite easy to put an implant in a breast. The breast is one size, remains one size, and does not grow with excitement. The same can be said for nasal surgery, where something can be added, moved, twisted, or upturned because the nose is a static organ.

The penis is quite small and unassuming in its flaccid state. When aroused, it can grow to ten times its resting size.  We have not yet discovered a way of implanting a material that will expand and contract the way nature intended, and at the same time be physiological and aesthetically pleasing.

Penis Size Doesn't Matter To Most Partners

The truth is that the issue of penis size is inconsequential in most relationships. The majority of women whom I have interviewed unanimously agree they have no preference in penis size, as long as it is firm and attached to a loving and kind person.

The notion that an enormous penis is somehow a sign of manhood or that having a horse-sized "member" will magically improve your love life is a myth that is propagated without shame throughout the mass media.

If men spent less time worrying about the size of their penises and more time learning how to use what they have more effectively, hucksters selling the illusion of happiness through penile enlargement would soon—and justifiably—find themselves out of business.

There is, however, one safe and foolproof method for instant penile enlargement:

Step 1: Go to your local stationary store.

Step 2: Buy a large magnifying glass.

Step 3: Unwrap it.

Step 4: Hold it over your organ and look down through the glass.

Voila! The Instant Penis Enlarger (IPE)!

How Recreational Drugs and Alcohol Affect Your Sex Life

Did you know that prescription medications, drug-abuse and addiction can cause everything from temporary penis failure to long-term impotence?  Some drugs create the illusion of enhanced sexuality because they seem to take the edge off, calm you down, lower inhibitions, and produce a heightened sensitivity—but that's all it is, an illusion.

To paraphrase one of Shakespeare's wisest observations: Drugs might add to desire, but they just as equally take away from performance.

Alcohol, Sex and Erections

"Candy is dandy, but liquor is quicker." We all know the routine. You have a few drinks, and everything from your tongue to your toes loosens up.  Wallflowers start to dance, the tongue-tied become candid and verbose, and the sexually repressed become Lotharios.

If the object of your attention has also been drinking, suddenly anything and everything becomes possible. For those reasons, alcohol has become as much a part of lovemaking for some people as soft lights. There is nothing dangerous about moderate, judicious drinking. If the moderate consumption of alcohol reduces anxiety, slows you down, and delays ejaculation a bit, then alcohol can be a boon to Penis Power.

Unfortunately, alcohol can also be the greatest enemy of your penis. If you overdo it, your penis will poop out when it ought to pop out.

More significant to our discussion are the effects of alcohol abuse. Overdoing it with alcohol or illicit substances makes it more difficult to become aroused. Overindulgence delays ejaculation, reduces the pleasure and intensity of orgasms, and greatly diminishes penis rigidity (firmness of erection).

In my practice, nearly 50 percent of the chronic alcoholics I have counseled experience either total or partial impotence. The short-term effects appear to be based on alcohol's sedative action on the central nervous system. The long-term or chronic effects include severe nerve damage of the kind that can diminish penis sensitivity and permanently impair the ability to get an erection.

Marijuana: Can it Enhance Male Potency?

Many patients have told me that marijuana enhances their Penis Power™. Some studies have indicated that marijuana can, in fact, slow the ejaculatory process. In other words, an erection can be maintained for a longer period of time before orgasm.  For a younger man who might be quick on the trigger, this can be perceived as "enhanced" potency because marijuana might lower inhibitory mechanisms, reduce anxiety, and heighten erotic sensations.

I must recommend extreme caution about jumping to the conclusion that marijuana is an aphrodisiac or an aid to Penis Power™. Since marijuana is a mind-altering substance, its effect on sexuality is most likely illusory.

Research shows that the negative effects of marijuana are similar to those of alcohol. Therefore I suspect that, like alcohol, it would be hostile to Penis Power in the long run. There is good evidence that long-term marijuana smoking weakens overall fitness and reduces energy and motivation. Such effects would not bode well for a superpotent man.

Cocaine Can Lead to Long-Term Erection Failure

In addition to alcohol and marijuana, cocaine can be detrimental to Penis Power™. When Cole Porter wrote "I get no kick from cocaine," he might not have been thinking about sex.  But the message applies: where the penis is concerned, cocaine is certainly no kick. In the short term, cocaine has an excitatory effect on the nervous system. It can stimulate arousal and make every sensory experience seem more intense. In the long run, though, cocaine will turn a superpotent man into a super-wimp.

Pharmacologically, cocaine decreases the reuptake of the neurotransmitter catecholamine. This chemical is essential for the adequate completion of the erection process. Failure to get and maintain erections is a common complaint from cocaine abusers. No man who aspires to Penis Power should go anywhere near this drug.

Amphetamines, Pain Killers, Cigarettes and Other Drugs

As for other illicit drugs such as amphetamines or ecstasy, no superpotent man should ever use them.

Regarding amphetamines, let me remind you of the 1960's poster: "Speed kills!"  It certainly kills libido, ejaculatory function, and erections. Its long-term sexual impact is devastating.

This is also true for drugs in the narcotic family such as heroin, codeine, Demerol, and pain killers (i.e., Vicodin, Valium, Oxycotin, etc.). Users of these drugs experience a drastic reduction in libido, as well as chronic difficulty with erections. Unquestionably, these recreational drugs produce the antithesis of Penis Power—penis failure.

One more drug must be mentioned, especially since it has long been associated with mating rituals—nicotine. As if there were not enough reasons to stop smoking, or never start, consider this: smoking has been linked to penis weakness.

Several studies have demonstrated that cigarette smoking is more prevalent among impotent men. In another study, animals exposed to tobacco smoke or intravenous nicotine were unable to produce or maintain erections.

There is a simple scientific reason for this. Nicotine constricts blood vessels. When you smoke, the supply of arterial blood to the penis is reduced, making it more difficult to get a firm erection. Simply put, smoking is as bad for your penis as it is for your lungs. If you want to be a man of Penis Power, just say no to drugs and nicotine.

Written by Dr. Dudley S. Danoff, M.D., F.A.C.S.

Author of Penis Power: The Ultimate Guide To Male Sexual Health

All Rights Reserved (c) 2011 Dudley S. Danoff

Sex and Illness

Any illness can have a dampening effect on a man's Penis Power™.  The general weakness and fatigue that accompanies sickness will naturally affect your sex drive and your ability to respond to stimulation.

Also, depending on the nature of the affliction and its severity, a patient's range of movement might be limited to the point where he is not able to engage in sex.

In many cases, illness brings with it a certain amount of depression or despair, a feeling of inadequacy, and an image of one's body as impaired. All of this can diminish Penis Power, even if the illness itself does not.

Sick Doesn't Mean You Can't Be Sexual

Unfortunately, many sick men give up on themselves as sexual beings because they're convinced they are no longer capable of virile, sexual activities. They might also become unreasonably fearful and refrain from all exertion, including sex-related exercise that could potentially benefit their condition.

Arthritis victims, for example, sometimes abstain from sex because the pain in their joints prevents them from moving around as vigorously as they would like. This is unfortunate. They are not only depriving themselves of some much-needed and well-deserved joy, but are also overlooking the significant ways in which sex can improve range of motion and relieve pain. My rheumatology colleagues tell me there is evidence that arthritis sufferers can experience relief from pain for up to four to six hours after an orgasm.

Unfortunately, some physicians play into much of the negative mind-set of their injured or sick patients. When illness strikes, they advise these patients to limit their sexual activity, or even give it up entirely. A doctor who goes by the book might even tell a patient that he will never have "normal sex relations" again.

What terrible advice to give!  Patients not only get depressed when they hear this, but they also take it to mean that they have to retire their penises and give up all sexual and sensual pleasures entirely.

Furthermore, the doctor's negative prognosis is often flawed. Not long ago, physicians told heart patients and people with back pain to avoid exercise. Today, we prescribe exercise programs for their rehabilitation and advise against being sedentary. In many cases, the same is true of sex. I advise and encourage my patients to use their penises to bring cheer to the sickbed, rather than allowing the penis to shrivel up before its time.

If your doctor tells you to abstain from exercising your Penis Power, get a second opinion! He or she may be misinformed or may simply be old-fashioned.

Illness might limit your sexuality, but it does not have to eliminate it.

For most individuals, the solution involves simply learning new habits.

Your condition might mean it takes longer to achieve an erection, in which case you can learn to be more patient, and your partner can learn new ways to stimulate you.

Your illness might make it impossible to make love in the positions to which you are accustomed. If so, practice the ones that do work.

You might have to have sex less often or less vigorously, but instead of lamenting that situation, you can learn to fully savor the slow and gentle sensuality that you used to hurry through.

If you have intercourse less often, you might be able to enjoy oral sex or mutual masturbation more often.

Such changes make sex different, not inferior. They should be viewed as opportunities for new experiences, rather than reasons to feel sorry for yourself or to give up one of life's greatest pleasures.

Written by Dr. Dudley S. Danoff, M.D., F.A.C.S.

Author of Penis Power: The Ultimate Guide To Male Sexual Health

All Rights Reserved (c) 2011 Dudley S. Danoff

My Friend Has This Problem: An Erection Problem

Few things are more difficult for a man than admitting he is having an erection problem. Even confessing it to a physician is so embarrassing that men put it off for as long as they can, sometimes until it is too late to correct the situation easily.

Most women have great difficulty in understanding the depths of humiliation a man feels when, in the midst of passionate foreplay, his penis does not get erect. They also have great difficulty understanding the even more humiliating situation when an erect penis suddenly and without warning goes limp.

Erection Problems Happen to Everyone

When a woman's genitalia do not lubricate, she can reach for the K-Y Jelly or her partner can use saliva. Even if she is not terribly aroused, a woman can proceed with intercourse. If she wants to, she can always pretend to be passionate.

A man without an erection has no such fallback position. With his penis drooping like a flag on a windless day, he is stripped bare of all pretenses. No artifice can compensate. This is a nightmare worse than dropping a touchdown pass in the end zone or striking out with the bases loaded.

Even if it happens just once, the event can be devastating. Very few men are able to shrug it off. When it happens more than once, the shake-up to self-esteem is high on a man's Richter scale. Most men fail to realize that they should shrug it off. This happens from time to time to every man.

How a Doctor Can Help

When a male patient comes into my office and reluctantly admits that he is having problems, the first thing I do is try to make him feel comfortable and safe. He can then speak openly and honestly about his situation.

Usually, the conversation starts with some equivalent of: "Doc, my friend has this problem."

I quickly try to earn his trust and confidence by letting him know that I understand it is his predicament, and that no matter what the details of the problem may be, we will straighten everything out.

Once I establish rapport, I take a medical history. The first thing I want to know is whether his problem with erections is of recent origin or if it has been going on for a long time.  I then ask if the onset of the problem was sudden or if it was gradual.  I ask a series of questions about his personal life, general lifestyle, and emotional state of mind. I follow an algorithm (a preset course of medical questions) in which the patient's answers guide each subsequent question. This leads to an accurate diagnosis.

You would be surprised how many men come to me in a complete penis panic, only to find out that their problem is not medical, but circumstantial. These circumstances include a marriage in jeopardy, aggravation over a business predicament, or just plain mental and physical fatigue.

If my analysis of the problem to this point has not revealed any obvious situational cause, my line of inquiry turns to medical factors. When the penis fails to perform properly, and when psychological factors are ruled out, the diagnosis falls into the clinical category of organic impotence.

Even though only a small number of the men who come to me fall into this category, my first responsibility is to search for a possible medical cause of the problem. Before embarking on a sophisticated medical evaluation, I have to be convinced that the patient is, in fact, physically incapable of having an erection. This is often accomplished with one question.

Take the case of a fifty-year-old executive who came to me with a minor irritation on his scrotal skin (the skin covering the testicles). I prescribed a topical ointment. I then listened as this aggressive, no-nonsense mover and shaker gazed at the floor and sheepishly told me the real reason for his visit to my office: "Doc, I just cannot get it up lately."

He said he felt fine otherwise and was not under any exceptional degree of stress. At that moment, my secretary buzzed to tell me that the lab assistant had stopped by to pick up a blood sample. Knowing that this assistant was a beautiful young woman (a frequent occurrence in Los Angeles, where unemployed actresses almost outnumber unemployed urologists), I seized the opportunity to use a visual aid to solve this diagnostic problem.

When the assistant entered the exam area, we exchanged pleasantries. I handed her the sample and she left. I watched as my patient eyed her shapely figure as it swayed out the door.

"If she came on to you," I asked, "do you think you would have any problem rising to the occasion?"

"Are you kidding, Doc?" said the patient. "When do we start?"

The patient's "medical" problem was solved because it never really existed! His problem was not the result of an anatomic malfunction of his organ.  His penis weakness was the result of problems within his marital bedroom.

A remark like the one he made does not constitute scientific proof, but in this patient's case, there was other evidence that the problem was not physical. He confessed to having had a recent dalliance with a woman he met on a business trip. During the affair, he performed adequately. From that fact alone, I was certain that the patient was not physically impaired. Therefore, I counseled the patient along psychological lines. I suggested that he and his wife see a marriage counselor.

For most patients, the question of whether a penis problem is physical or mental cannot be settled in an interview. I have to use reliable, objective criteria.  I have a method that is foolproof, but that's another topic for another blog post.

Written by Dr. Dudley S. Danoff, M.D., F.A.C.S.

Author of Penis Power: The Ultimate Guide To Male Sexual Health

All Rights Reserved (c) 2011 Dudley S. Danoff

You're As Big As You Think: Confidence Matters

The power of the mind has the most significant influence over sexuality. The only advantage a man with a large penis might have is if he thinks he has an advantage.  The myth of the importance of penis size is so strong that, if a man thinks he is exceptionally big, he might start acting big. He might develop such a strong sense of confidence and penis pride early in life that this alone, not the actual size of his penis, might endow him with exceptional Penis Power.

Far more men think they are too small. The exact opposite self-fulfilling prophecy takes place. Men who think they are small start acting small.  This usually starts at puberty, when boys start to be self-conscious about everything associated with masculinity:

Am I tall enough?

Am I strong enough?

Do I have pubic and underarm hair?

Is my penis big enough?

Most boys are so insecure that they magnify any sign of inadequacy they perceive. They compare themselves to older boys or men, or to peers who happen to mature faster. They end up convinced they do not measure up. They look down and see a puny, shriveled gherkin, then look across the locker room at someone else's dangling zucchini. They feel inferior.

These comparisons don't end with adolescence, either. Sometimes they even gets worse. If men hang around with guys who brag—or more likely, lie—about the size of their erections, or tell jokes that leave the impression that a small penis is tantamount to being effeminate, the crisis of confidence may worsen.

Watching pornographic movies makes things even worse. Whoever produces those films must have an open casting call for men with exceptionally large members. Then they use all sorts of lighting and camera tricks to make them look even bigger.

Many men feel worse about penis size as they age because they think their penises are shrinking. Men start to gain weight, and the added layers of abdominal fat obscure the base of the penis, which used to be visible. This is why chubby men may appear to have small penises—especially in their own eyes—because they are looking down over a potbelly.

Conversely, it explains why slim men appear to have big ones. There is no significant difference in size, especially when the penis is erect. In obese men, the shaft of the penis has to traverse two, three, or four inches of prepubic fat from under the pubic bone, where the base of the penis starts, until it is visible.

A man who does not learn the truth about penis size can be adversely affected by thinking his is too small. This sense of inadequacy can persist throughout his adult life. It manifests itself as self-doubt, which can have detrimental effects on his penis behavior. He thinks he is inadequate anatomically, so he must also be inadequate in performance. Of course, that very inadequacy will then be reflected in his behavior, creating a self-fulfilling prophecy.

Think small and you will be small .

Fortunately, this corollary is equally true:

Think big and you will be big .

What really matters are the size of your self-esteem and the size of your heart, not the size of your penis. Even if penis size did matter, there is nothing you can do about it. Size is strictly determined genetically.  If you can't change it, why worry about it?

The best answer to the question, "How big is your penis?" is, "Plenty big enough!"

You're Big As You Think: Confidence Matters

The power of the mind has the most significant influence over sexuality. The only advantage a man with a large penis might have is if he thinks he has an advantage.  The myth of the importance of penis size is so strong that, if a man thinks he is exceptionally big, he might start acting big. He might develop such a strong sense of confidence and penis pride early in life that this alone, not the actual size of his penis, might endow him with exceptional Penis Power.

Far more men think they are too small. The exact opposite self-fulfilling prophecy takes place. Men who think they are small start acting small.  This usually starts at puberty, when boys start to be self-conscious about everything associated with masculinity:

Am I tall enough?

Am I strong enough?

Do I have pubic and underarm hair?

Is my penis big enough?

Most boys are so insecure that they magnify any sign of inadequacy they perceive. They compare themselves to older boys or men, or to peers who happen to mature faster. They end up convinced they do not measure up. They look down and see a puny, shriveled gherkin, then look across the locker room at someone else's dangling zucchini. They feel inferior.

These comparisons don't end with adolescence, either. Sometimes they even gets worse. If men hang around with guys who brag—or more likely, lie—about the size of their erections, or tell jokes that leave the impression that a small penis is tantamount to being effeminate, the crisis of confidence may worsen.

Watching pornographic movies makes things even worse. Whoever produces those films must have an open casting call for men with exceptionally large members. Then they use all sorts of lighting and camera tricks to make them look even bigger.

Many men feel worse about penis size as they age because they think their penises are shrinking. Men start to gain weight, and the added layers of abdominal fat obscure the base of the penis, which used to be visible. This is why chubby men may appear to have small penises—especially in their own eyes—because they are looking down over a potbelly.

Conversely, it explains why slim men appear to have big ones. There is no significant difference in size, especially when the penis is erect. In obese men, the shaft of the penis has to traverse two, three, or four inches of prepubic fat from under the pubic bone, where the base of the penis starts, until it is visible.

A man who does not learn the truth about penis size can be adversely affected by thinking his is too small. This sense of inadequacy can persist throughout his adult life. It manifests itself as self-doubt, which can have detrimental effects on his penis behavior. He thinks he is inadequate anatomically, so he must also be inadequate in performance. Of course, that very inadequacy will then be reflected in his behavior, creating a self-fulfilling prophecy.

Think small and you will be small .

Fortunately, this corollary is equally true:

Think big and you will be big .

What really matters are the size of your self-esteem and the size of your heart, not the size of your penis. Even if penis size did matter, there is nothing you can do about it. Size is strictly determined genetically.  If you can't change it, why worry about it?

The best answer to the question, "How big is your penis?" is, "Plenty big enough!"

Penis Size is Not Related to Penis Power, Part II

Part I of this post examined size myths. But you're probably wondering:



Why the Fascination with Large Penises?

Some of the fascination with large penises can be attributed to the general cultural viewpoint that "bigger is better." The phallus is a symbol of potency, physical strength, and masculinity. It makes sense that, psychologically, some people conclude that bigger penises are better.

The fascination with large penises is not unlike a man's attraction to large breasts or a shapely behind. Finding someone with those features might enhance the sexual experience because it fulfills a fantasy, not because women with large breasts are better in bed or have more hospitable vaginas.

Physiologically and anatomically, what occurs during intercourse has nothing to do with the size of any body part. The orgasm is exactly the same regardless of the physical features of the partner. What may seem like something different is actually a result of the power of the mind and the emotions.

A woman with an exceptionally large vagina and a man with a very small penis might be sexually incompatible. I know of such a couple. The woman was nearly a foot taller than the man. They were hopelessly in love but dissatisfied sexually. They believed his penis was the wrong size for her vagina. Through experimentation they learned to adjust their positions and angles during intercourse. They varied their sexual practices so that eventually both of them were more than content.



Why Doesn't Size Matter?

There are sound physiological reasons why size does not contribute much to satisfaction. Nature, in its wisdom, has placed the principal nerve endings that produce sexual pleasure and orgasm right up front. By this grand design, they can be stimulated regardless of size.

The man's areas are on the head of the penis, and the woman's are on the clitoris. This means that any penis is capable of satisfying any woman. By experimenting with different positions, and by using hands, lips, or even by using the penis to stimulate the clitoris directly, any man can secure satisfaction for his partner.

Different women are aroused in different ways. I have talked to women who complained that even though their man was endowed with a large penis, they were still unable to be satisfied during sex. It is important for any sexually intimate couple to discuss their preferences and to experiment with different positions. Combining penile stimulation with the simultaneous aid of hands and lips is also a great way to help bring a partner to orgasm.

Some of you at this point are probably shaking your heads. I have to ask you: is the issue with penis size truly of a physical nature, or is it the product of a cultural and psychological point of view?

I know what kind of penises are out there. I feel safe in saying that most of the issue with penis size is between our ears, in our minds, and not between our legs.

Sex is a unique and intimate experience. Partners who are willing to communicate with each other and work together can learn to do the right things to make both parties happy.

Penis Size is Not Related to Penis Power, Part I

Penis size is a source of stress and worry for many men.  Popular culture's obsession with penis size, and the widespread availability of pornography, creates unrealistic expectations and a skewed perspective on what it means to be normal.  Penis size myths lead many men to believe that they are too small to satisfy.

Once I assure my patients that their penises are within the normal range, I stress this crucial point: Superpotency has nothing to do with the size of your penis.

When a superpotent man makes love, he is totally immersed in the erotic physical sensations, as well as the emotional feelings of intimacy and tenderness. The last thing on his mind, or on the mind of his lover, is the size of his penis.



Large Penises Are No Guarantee of Good Sex

I have seen men with larger-than-average penises who are plagued by sexual dysfunction. I have seen men with relatively small penises who represent the quintessence of superpotency.

I have been dealing with patients and their wives and lovers for many years. I have never had a woman complain to me that her man's penis was too small. It is conceivable that some women make such complaints to their gynecologists or to female physicians. In my experience, a prodigious penis is simply not a priority for the vast majority of women. My female colleagues agree with me.

A much more common complaint is that a lover's penis is too big. Intercourse can be painful for a woman whose vagina cannot accommodate a large penis. This is why I have never had a woman request that I make her man's penis longer or wider. However, some women have asked me if I can make it harder, or perhaps attach it to a more loving and sensitive guy.

Generally, when women do make a comment about their man's penis, they usually ask me about the feasibility of surgically reducing the size.



Can Surgery Change the Size of Your Penis?

Sorry, no.  There is no such procedure to decrease penis size, just as there is no legitimate and safe procedure to make penises bigger. Penile prostheses, which I often implant surgically to treat organic impotence, do not enlarge the penis. They merely fill the vascular compartments (corpora) in the penis with a firm, inert material that makes the penis firm enough for penetration.

What the majority of men and women do not understand is that size is determined by heredity.



What Women Want

From my experience, what most women care about above all else is finding a man with whom they have a special and intimate connection. They seek someone who can achieve an erection that can last long enough for mutual satisfaction. The rest of the details are insignificant.

The old homily, "It's not how big it is, but how you use it," is one of those penis clichés that holds up to close scrutiny. Many of my women patients complain that their man does not get aroused often enough. They complain that he is not imaginative enough. They complain that his penis does not get hard enough. A female patient of mine, a true sage said: "I don't care how long it is, I don't care how fat it is, I don't care how good-looking it is. I just care how hard it is!"

What women really care about is the size of your heart and the kindness in your soul. They want a good, caring, responsive lover who is sensitive to their needs and desires. If a woman sees all of these things in her partner, then the physical details, including penis size, become unimportant.

Some women discuss penis size with their friends. Others may fantasize about men with enormous members. It would be wrong for me to claim that some women do not have preferences for certain types of penises. There are women who have certain physical requirements that are necessary for their sexual satisfaction, and there are also some women who are obsessed with penis size. This is a truth that cannot be denied.

The reality of most relationships is that two people who care enough about being with each other will find ways to make their sex lives work so that both parties are satisfied in all aspects of that relationship.

Part Two of this post will be published next Wednesday.