The first of the modern semirigid prostheses was the Small-Carrion, named for the two doctors who developed it. It’s been around since 1973 and is still being used by some physicians.

Now, other variations on the same theme have been introduced. The newer models—the Flexirod, invented by Dr. Roy Finney, the Jonas Silicone-Silver prosthesis, named for its developer Dr. Udo Jonas, and the AMS 600—were designed to make the implant more concealable and bendable when not in the erect position.

The Small-Carrion prosthesis is bendable and allows the penis to be moved up, down or to the side. It has no portion specifically designed to bend, however. It is uniformly stiff throughout.

Unlike the Small-Carrion implant, the Flexirod was specifically designed to bend at the base of the penis to be more easily concealed. And the Flexirod is slightly stiffer along the shaft.

Yet another variation of the semirigid implant has a kind of memory: When you bend it, it will stay where you put it, and not snap back. Both the Jonas and the AMS 600 prostheses have this characteristic, made possible by their twisted wire core covered by silicone rubber. The advantage of these models is that once the penis is bent down, it will stay that way, so the penis won’t always look erect. The one drawback to this type is that rarely, a wire may break, and although the wire is still covered by the silicone rubber, the penis then becomes more floppy at the base.

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Blood tests are a crucial part of a workup for erection problems. Here’s what your blood is being tested for, and why:

• Testosterone and prolactin. Testosterone is necessary for sexual desire, and, apparently, also for erection. Prolactin is a hormone from the pituitary gland which, in excess, can sneakily sabotage erections. If your body makes too much prolactin, low sexual desire, decreased testosterone and impotence may result.

• Fasting blood sugar and glucose tolerance. To see if diabetes may be contributing to your problem.

• Thyroid function. Too much or too little thyroid hormone may be connected with potency problems. (Ifs an easily treated condition.)

• Liver function. Because liver disease can affect potency.

• Kidney function. Kidney function can also affect potency.

Not all of these tests may be required in each case. In the absence of any suspicious evidence of disease, the last three tests may be omitted. Discuss this with your doctor.

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Gary manages a furniture store and he met Cynthia, his second wife, when she began working at a nearby business. Gary and Cynthia dated for almost a year before they married.

Cynthia was burdened by a painful history when she married Gary. She had previously been married to a man who constantly criticized her and belittled her appearance and her sexuality. For a long time, she believed that she was incapable of enjoying sex or of pleasing a man sexually. But being with Gary changed all that. «It opened up a whole world to me, it was wonderful,» says this petite, shy woman. Then, after a couple of years of marriage, Gary developed erection problems. «It came on gradually. There was absolutely no problem when we first married,» says Cynthia.

Gary and Cynthia didn’t talk about the change in their sex life and their painful silence continued for three long years. «I kept thinking it was an isolated problem. But it was driving me up the wall and the last year I finally had to accept the fact it just was not working, and I tried to talk to Gary about it,» says Cynthia. She prepared herself for this discussion by reading a book on sexual responsiveness. But just mentioning the topic upset Gary tremendously. Concerned that she had caused him such pain, Cynthia dropped the matter. «We went for two weeks without talking about it—at all. Then he said, ‘Okay we really should do something.’ So we tried to follow some of the recommendations in the book—sort of doing sex therapy at home. And it helped some. But I got impatient. I short-circuited the whole thing.»

Gary finally sought medical help several months later, but he didn’t tell his wife until after he went to the doctor. She was greatly relieved when she learned that he had finally taken the first step. «I didn’t want to bring up the subject again because felt guilty. I mean, on some level, when a failure occurs, when he can’t get an erection, I feel he must hate me. It feels like rejection.

Gary went through several tests, and much to the surprise o his physician, was found to have extremely low levels of testosterone. In addition to causing Gary’s erection problems, the abnormality could even have contributed to his lack of motivation to correct the situation, since low testosterone can reduce desire. Gary was placed on shots of the hormone, and severe weeks later reported that his erections were normal. And he and Cynthia were able to make love again.

«If s been reasonably successful,» says Cynthia of the treatment. «But Gary still doesn’t talk about the cause. We don’t tall about it.» Tears well up in her eyes. Although her husband has c demonstrable physical cause for his potency problem, she still feels rejected. And his silence hasn’t helped her.

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Sexual expectations are not always conscious, nor are they regularly communicated to another person. As a result, partners are often at cross-purposes when their pleasure-seeking goals are on the line. That was the situation of Gina and Paul, both in their mid-thirties, who had been married for four years. Their mutual attraction bad been based on their shared work—both were dedicated medical researchers—but now they seemed to be going in opposite directions.

«Ever since Paul began lo experience his ED. something has changed,» Gina began. «I don’t mean just the physical side; I mean the emotional one as well. He’s pulled away from me. Anytime I start to talk about how I feel about our situation he walks out of the room. He’s taken up a hobby—coin collecting—which he works on alone, in the middle of the night.»

His face reddening, Paul replied, «That’s because the last thing I want to do is discuss my erections with her. I feel strongly that it’s my problem. I realize she’s affected by it but I don’t see how having a sensitivity session about it is going to make it any better.»

«It’s not going to make it worse,» she pointed out.

«I disagree. The truth is—I never felt that we had such a great sex life to begin with. Now I have the opportunity to change it—»

«And you’d rather explore that brave new world with someone else,» she finished the sentence for him.

As he nodded his head in assent, Gina excused herself and walked out of my office.

«I’m sorry about this,» Paul told me. «It’s not that I don’t have feelings for Gina. It’s just that we were each other’s first real lover, and then we got married and spent so much time working that we—I— never had the time or inclination to explore what I really wanted from sex. I didn’t even want to, until my ED occurred. Now I have another opportunity—and I want to take it.»

Not surprisingly, Gina and Paul split up a short time later. The basis for their marriage—shared work—was not enough to keep them together. Sadly, their breakdown in communication prevented them from trying to find another bond to keep them together. Today, Paul’s ED is under control and he is excited at the prospect of exploring his own sexuality more fully.

The emotional issues in their situation included:

• dissatisfaction of one partner with their sex lives

• a change in feelings toward a partner

• unwillingness to discuss the problem

Think about your own feelings concerning:

• how satisfied you are with your sex life

• how content you are with your present partner or partners

• how pleased your partner is with your sexual relationship

• the frequency of your sexual encounters

• what the core of your relationship is, and whether it is based on sex, friendship, or family

• your comfort level in discussing your sexual attitudes

• the reaction of your partner

• the likes and dislikes in the sexual history with your partner

• things you would like your partner to do

• things you wish your partner wouldn’t do

• any changes you would like to make

Remember that a satisfying sex life is a major component of a healthy life. When the physical aspects of a relationship are on track, you and your partner are in sync. Anticipating each other’s needs and wants, you create an experience that is greater than the two of you. Boosting vitality, vigor, and optimism, a mutually gratifying sex life adds to overall mental and physical contentment.

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