American Medical Association Family Medical Guide - American Medical Association [259]
Vacuum devices
Vacuum devices produce erections by pulling blood into the penis and trapping it. You insert your penis into a hollow plastic tube that is closed at one end and press the tube against your body to form a seal. A vacuum is created in the tube with a small hand-or battery-driven pump, drawing blood into the penis and causing the penis to engorge, enlarge, and become rigid. After 1 to 3 minutes in the vacuum, an adequate erection develops and you place a soft rubber O-ring around the base of the penis to trap blood and maintain the erection until you remove the O-ring after sex. The O-ring should be left in place for no more than 30 minutes, or the blood supply to the penis could be blocked.
Penile implants
An implantable penile prosthesis (artificial device) is another treatment option for erection problems. All penile implants place prosthetic tubes inside the penis to produce engorgement similar to that of a atural erection. Most implants are inflatable and are flaccid when not in use. These devices are very effective for treating all types of erection problems but, because they are mechanical, they can occasionally malfunction.
Penile implant
The inflatable penile implant is a device that is surgically implanted in the penis, scrotum, and lower abdomen. The implant contains cylinders that fill with fluid in the penis to mimic the natural engorgement process that occurs during an erection. The cylinders are attached to a pump that is activated by squeezing the scrotum.
Vascular reconstructive surgery
Vascular reconstructive surgery is used only to treat erection problems caused by specific blood vessel abnormalities that block the flow of blood to the penis. Only a very small percentage of men are candidates for this surgery. Experimental techniques include revascularization (rerouting blood vessels to renew and increase blood flow to the penis) and venous ligation (sealing off the veins in the penis that leak blood and prevent erections).
Premature Ejaculation
Premature ejaculation is ejaculation with minimal sexual stimulation or too rapidly to allow full enjoyment of sexual relations. Most men have premature ejaculation from time to time, but it becomes a problem when it persists or recurs. The problem occurs most often in young, inexperienced men during their first sexual experiences, but it can affect men of any age. Many men with the condition are able to postpone orgasm and ejaculation while masturbating but cannot do so during intercourse.
Some affected men can delay ejaculation in a long-term relationship but find that it recurs when they are with a new partner. In these cases, the problem is likely to be caused by the lack of intercourse for a long period or by performance anxiety. Other men may have had early sexual experiences, such as masturbating hastily to avoid being caught by their parents, that programmed them to ejaculate quickly. But for most men with persistent premature ejaculation, the problem occurs because they have not learned how to regulate the amount of sexual stimulation and control the increase in sexual arousal before it reaches the point at which ejaculation is inevitable. Premature ejaculation can also be caused by withdrawal from alcohol or some illicit drugs such as heroin.
Diagnosis and Treatment
Premature ejaculation is often a temporary problem affecting sexually inexperienced men that resolves on its own over time, especially with an understanding partner. Your doctor will be able to diagnose premature ejaculation after listening to a description of your problem. He or she may prescribe a selective serotonin reuptake inhibitor, a medication usually used to treat depression, which is often effective for the treatment of premature ejaculation.
The doctor also may refer you to a sex therapist or suggest techniques that can help you delay ejaculation. Most of these techniques teach you how to identify and control the sensations that precede orgasm. For example,