How to Have Great Sex Forever
Viagra may put new life into your old equipment, but it’s up to you to keep the romance alive.
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Paris did something to each of us, something permanent. For the ï¬rst time, we fully understood the distinction between love and sex, and romance became a continuing affair. Phyllis resisted no impulse to surprise me with exotic gifts. No longer did I wait for Valentine’s Day or birthdays to bring her flowers or scribble love notes or pathetic attempts at poetry. We shared secrets and revealed naughty episodes from our pasts. Acts of altruism were invariably rewarded—sometimes with wild monkey love, followed by candlelight dinners with wine and music, and sometimes with simpler, more subtle expressions of love: a look or a touch or an act of kindness that worked some subliminal pleasure point deeper than the libido. Lovemaking became much more than the act itself. It became a long, periodically interrupted, almost subconscious tease that went on for hours or even days. The much-celebrated climax became, in many ways, anticlimactic, the swan song of an interlude. And life was ï¬nally revealed as nothing more than a series of unbearably sweet interludes.
A FEW MONTHS AFTER WE RETURNED from Paris, I ï¬nally admitted to myself that ED was a problem that would only get worse. With some trepidation I called my urologist for an appointment. I had been reading and ï¬ling away articles on the subject, the most dramatic of which was an account of a medical conference in Las Vegas. A 57-year-old British physician had presented a paper on a new injectable drug to treat ED and then demonstrated its effectiveness by dropping his pants and displaying his fully erect organ. The full monty in Vegas was more than a landmark event, it was a cultural epiphany. The drug that caused that famous erection was papaverine, which had previously been used to lower blood pressure. Other researchers had observed that some drugs designed to treat high blood pressure and other vascular diseases could, when administered in large enough doses, cause male patients to get an erection. One such drug was alprostadil (a naturally occurring form of the hormone prostaglandin E-1), which was used to treat a rare heart defect. Another was Viagra, which was originally designed to treat angina.
The connection between the heart and the penis should not have been such a surprise. The physiology of an erection depends on a series of interacting electrical and chemical impulses, starting with up-close personal contact or some observed or remembered sexual image. Once this registers in the brain, a message is sent to the penis, causing an increase in the production of the chemical cyclic GMP, which is normally broken down and kept in check by the enzyme phosphodiesterase type 5 (PDE5). The additional cyclic GMP causes muscles in the erectile tissue to relax and the arteries to expand. As blood rushes into the newly opened spaces, the penis stiffens and expands. Simultaneously, veins that normally drain blood away from the penis are squeezed shut, facilitating full erection. After orgasm, or when arousal subsides, the equilibrium between cylic GMP and PDE5 is restored. Impotency strikes when cyclic GMP is in short supply—and when the penis has been soft for so long or the erectile tissue is so defective it can’t expand enough to close off the veins. Men who suffer from mild cases of ED can often achieve a semi-erection through arousal, but the blood drains away as quickly as it arrives: It’s like trying to ï¬ll a bathtub with the drain open.
In July 1995 the FDA approved the nation’s ï¬rst drug for impotency, Caverject, the trade name for a product that consisted of a disposable needle and syringe of alprostadil. Injected into the base of the penis with a ï¬ne-gauge needle, the drug relaxes the smooth muscles surrounding the penile arteries, causing them to dilate and permit an increased flow of blood.
As expected, my initial visit to my urologist was awkward. First, a female therapist asked a lot of questions about my sex life with Phyllis. How often did we do it? How satisfactory was it? This was followed by a physical exam and ï¬nally a small-dose injection of alprostadil to determine if I would have any bad reaction to the drug. Apparently I passed the tests, because I left with a prescription for ten Caverject, at $18 a pop.
The ï¬rst time I used the needle, in the privacy of my walk-in closet, I recalled my Army lessons in marksmanship: Take a deep breath, let a little out, hold it, and squeeze (don’t jerk) the trigger. It worked: I felt a tiny pinprick and after a few minutes a nearly forgotten surge of blood in my groin.
“How’s it going?” Phyllis called from the bedroom.
“Does the term Louisville Slugger ring a bell?” I replied, stepping from the closet for my debut. We both erupted into uncontrollable laughter. This spontaneous levity shattered what might otherwise have been a tense moment. It also set a precedent. After that, the Slugger became our little joke, our way of agreeing that while penile injections were not the desired beginning of foreplay, they appeared to make a most valuable contribution.
TREATING IMPOTENCY REQUIRES MORE than a pill or a needle, it requires a sense of humor. If I didn’t already know this, I certainly discovered it while researching my book HeartWiseGuy, which deals with bypass surgery, hypertension, impotency, and other ordeals of aging. Between 1995 and 1997, I tried all the ED gadgets on the market except one: the penile implant. Back in the eighties the implant was considered the gold standard, even though it required expensive and potentially dangerous surgery and did not always work as advertised. The most popular model today consists of two inflatable cylinders that are planted surgically in the spongy tissue of the penis, a fluid reservoir placed in the pelvis, and a pump afï¬xed inside the scrotum. Squeezing the pump forces fluid into the cylinder, thereby making the penis rigid; a release valve reverses the process. But a friend who had had this model installed—on the advice of a golï¬ng buddy who assured him that his own implant made airline stewardesses faint with pleasure—found that it indeed rarely worked as advertised. In fact, it hurt all the time. Then one morning at his ofï¬ce he discovered he was sitting in a pool of blood. The operation had led to an infection that ruptured his scrotum and caused him to hemorrhage. The condition was complicated by his diabetes—his doctor had not warned him that diabetics are particularly at risk with this procedure. His only recourse was to have the implant surgically removed, again at considerable expense. Later, when he decided to try Caverject, he discovered, to his horror, that the implant had destroyed the erectile tissue in his penis. It was gone and could not be replaced.
“My God!” my friend screamed at his doctor. “Are you telling me I’ll never have another erection?”
“You’re nearly seventy,” the doctor reminded him. “You’ve screwed enough.”
In November 1996 a new therapy called the Medicated Urethral System for Erection (MUSE) hit the market, with pre-dictions that a new gold standard had been established. MUSE is a disposable cath-eter that inserts a BB-size pellet of alpros-tadil into the urethra. Essentially the same vasodilator therapy as Caverject, it spares the user the dreaded needle. But I learned, as did most others who tried it, that MUSE is less reliable than Caverject. Harin Padma-Nathan, a clinical professor of urology at the University of Southern California, reported in an article in the New En-gland Journal of Medicine that only about 30 to 40 percent of his patients got a rigid erection using MUSE.
The simplest and most efï¬cient therapy is the ErecAid, a hand-held pump that creates a vacuum and draws blood into the erectile tissue; the blood is dammed there with rubber tension rings attached to the base of the penis. The pump and attachments come in a carrying case about the size of a shaving kit and cost about $375. Unlike the alprostadil therapies, ErecAid does not require refrigeration and can therefore be taken on the road. Be warned, this is a clumsy piece of equipment, about as romantic as a tire jack. But here’s where the sense of humor comes in. If you incorporate the ErecAid into your foreplay, make it part of the ritual of lovemaking—think of yourself as a magician and his assistant, for example. The results are impressive. Even with Viagra in the house, the ErecAid remains a mainstay in our arsenal.
WITHOUT QUESTION, VIAGRA IS THE CURRENT gold standard. And its potential may have been barely tapped: Some scientists believe it may also improve the sexual response of postmenopausal women. Little research has been done on women’s sexual problems, even though older women have even more sexual dysfunction than men. Therapists suspect that the chief complaint, a lack of desire, really reflects women’s problems dealing with their aging bodies—vaginal dryness, the increased time needed for arousal, and difï¬culty reaching orgasms. Since the clitoris, like the penis, becomes engorged with blood during sexual arousal, Viagra may soon wind up on both sides of the medicine cabinet.
Viagra is a capacity drug, not a desire drug. Men still need to be aroused before anything can happen. It works by prolonging the effects of cyclic GMP—making a little go a long way—until it is sufï¬cient to overpower the killjoy PDE5. Since healthy erectile tissue accepts only a ï¬nite amount of cyclic GMP, men with normal erectile ability won’t notice any effect from Viagra, no matter how many pills they take.
None of the ED therapies can rejuvenate an affair that has lost its spark, which calls up an extremely important issue. Men need to pay more attention to the quality rather than the quantity of sexual experiences. “Starting in puberty,” says Harry Croft, “men somehow get the idea that all a woman needs to be happy is a good, stiff member. That’s a male conceit. What women are interested in is romance, touching, caressing—sex is something that comes later. When men begin to experience problems with erection, a lot of couples withdraw from kissing and hugging and all forms of intimacy, fearing that they are making promises they can’t keep.”
Couples who have not had sex for a long time are bound to have feelings of anger and frustration that can’t be addressed by the little blue pill. Reawakening sexual desire requires a reacquaintance with romance. I read recently about a middle-aged couple who lay quietly in bed waiting for Viagra to work and eventually fell asleep. Apparently they had forgotten about foreplay. Similarly, a guy who pops a Viagra, calls his wife at the ofï¬ce, and demands that she hurry home for a big surprise is in for a surprise of his own: You can’t kindle the ï¬re of love with a pill.
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