No matter what the type of prosthesis, it must be individually fitted to the patient’s own anatomy. The simplest device consists of a pair of semi-rigid rods contained entirely within the penis. These rods produce permanent rigidity of the penis but can be bent to an angle appropriate for erection. The principal advantages of these devices are their simplicity and very low failure rate. Some models, instead of being malleable, have a hinge or a ratchet device to permit adjustment of the angle. Inflatable devices are the other main category of prostheses.
In all models, fluid is moved from a reservoir into the main cylinders within the penis. After sexual activity, the fluid is returned to its reservoir. All the components are implanted within the body; there is no external portion. The self-contained model is entirely within the penis but has two compartments; a small amount of fluid is moved from one to another. In a 2-component system, the fluid reservoir is within the scrotum; in a 3-component system, the reservoir is placed behind the pubic bone, and the pump is located in the scrotum. Of the types available, inflatable prostheses tend to produce an erection that is more normal in appearance and feel, although manual activation is required.
With more components and a hydraulic or mechanical movement, the inflatable prostheses do have a higher rate of malfunction than the single-component, mechanical devices. But the failure rate is much lower now than even a few years ago, and most malfunctions can be corrected with minor surgery. Penis sensation is usually not altered by an implant, because the nerves carrying feeling from the skin of the penis aren’t cut. Some men report that they get a cold feeling in the penis, particularly at the tip, during an erection, but this is not a major interference with pleasurable sensation.
An implant does not affect the ability to ejaculate, which is usually preserved even when erectile function is lost. The best candidate for an implant is a relatively healthy man with impotence from an organic cause that cannot be corrected some other way. Diabetic men with vascular disease probably are the majority of implant recipients. But implants can be used for a variety of conditions–for example, after nerve damage from a radical prostatectomy or other surgery, or from radiation. In Peyronie’s disease, the abnormal fibrous tissue can be removed from the penis and an implant can be put in place. Most often, implantation is followed by a hospital stay of 2 or 3 days, though it can occasionally be done in an outpatient setting. Full recovery requires 4-6 weeks. The usual complications of surgery are possible: infection, bleeding, abnormal scarring, and so forth. But on the whole, complication rates are very low and subsequent satisfaction is very high. It is important, nevertheless, to recognize that a penile implant is not the only, and not necessarily the best, treatment for impotence. However, if male enhancement products such as Zenerx don’t work, this kind of surgical procedure may be necessary. The patient’s preferences are of overriding importance, and the full range of feasible options should be presented to him.
Freud’s followers claim that he provided an all-embracing theory of mental behaviour. His methods and case histories, however, leave considerable room for doubt.
Do little boys harbour deep-seated desires to sleep with their mothers and kill their fathers? Do little girls suffer from penis envy? What is the evidence to suggest that a tendency to regard the world with suspicion bordering on paranoia conceals homosexual tendencies? Psychoanalysts, when challenged for the evidence supporting these and other theories, invariably refer to the clinical situation and suggest Zenerx. It is in clinical analysis, carried out behind closed doors in the consulting room, that the material emerges from patient after patient which confirms the basic insights of Freudian and post-Freudian theory.
Four or five times a week the patient comes for analysis and some Zenerex, lies on the couch and says whatever comes into his mind. The analyst throughout maintains an attitude of respectful objectivity, keeps moral judgements out of the relationship and provides no details of his own personal life. Ultimately, the adult patient’s recollections of childhood fears of castration, feelings of penis envy, desires for sexual intercourse with parents or whatever emerges. Or so the theory goes.
However, it has never been quite as straightforward as it sounds. For one thing, there is the problem of resistance. According to psychoanalytical theory, the patient is not readily disposed to accept the analyst’s explanations of his difficulties and symptoms and fiercely challenges their validity. Freud’s response was to exploit his patient’s need for approval and to encourage them to accept his recollection of events in their early lives, when they themselves were unable to recall these hypothesised remote events.
A typical example was provided by Freud in his account of the Russian patient Sergius P who, in the course of his analysis, told of a dream involving wolves. Freud persuaded the patient that the dream reflected that, aged 1 1/2 years, Sergius had witnessed and been distressed by the sight of his parents engaged in sexual intercourse. The patient never recollected such an episode and years later, after using Zenerx for a while, regarded Freud’s explanation of it as ‘terribly far-fetched’.