Two very new designs of implants, the Flexi-Flate and the Hydroflex, represent something of a cross between the inflatable and the semirigid types. Like the semirigid implant, these consist of two cylinders placed in the corpora cavernosa. But like the inflatable type, these cylinders actually inflate and the penis can be flaccid or rigid. To inflate the implant, a man pushes on the part of the prosthesis near the head of the penis. This transfers all the fluid from one chamber into another, causing an erection. The beauty of this design is that the reservoir is actually contained inside the cylinders themselves.

For a man who runs a greater-than-average risk from general anesthesia but who prefers the inflatable implant, these newer models present a viable compromise, because often a local anesthetic is all that’s required.

The drawbacks to this crossbreed are that the penis never reaches a completely relaxed state, and it doesn’t increase in girth as much as the more traditional type of inflatable implant. That’s s because the reservoir has to be smaller since it is located inside the corpora cavernosa. And it may be two to three months after surgery before you can operate the implant fully.

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After taking your history, the doctor will probably give you a complete physical examination. This is an essential part of the medical detective work involved in diagnosing and treating erection problems. Your doctor is looking for signs of unsuspected diseases which could cause or contribute to your difficulty.

The physician should pay special attention to your pulses and arteries to check for signs of arterial disease which could make blood flow to the penis difficult or impossible. He’ll feel the arteries in your groin, behind your knee and in your feet. This may seem strange, but a sign of blockage in these arteries can be a tip-off that you have similar problems in the arteries to the penis. While your doctor may also try to feel arteries in the penis, they are very small and often escape detection. So, the state of your other arteries may be the best clue to the state of your blood-flow system.

Testing the “knee jerk” reflex in your legs and ankles is one indicator of the health of your nervous system. And the doctor may pinch your penis near the tip. He’s looking to see if your anal sphincter contracts, and checking the same response in the bulbocavernosus muscle, the one that encircles the urethra and propels semen. When these reflexes are present, it indicates that the nerves from the penis to the spinal cord and back to the penis are healthy. The absence of this reflex does not necessarily indicate a problem, but it may steer the doctor to further tests.

The doctor may test for a similar reflex by pricking (lightly!) the anal sphincter with a pin. The sphincter should contract. If it doesn’t, you may have nerve damage. The same type of pinpricks can be used to test sensations around the penis and the rectum. Brushing with a soft cotton ball also works—and feels better. The doctor may also test your ability to feel vibrations by putting a tuning fork or a special instrument on your penis. The whole point is to see if nerves in these crucial areas are functioning properly.

And, of course, a close inspection of the penis is in order. The doctor should feel your penis carefully. He’s checking for hard, lumpy scars that can be a symptom of Peyronie’s disease, which can cause impotence.

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Sometimes, the desire for a “quick fix” to an erection problem backfires because the woman’s needs, and the whole structure of the relationship, are ignored. It’s important that both partners agree on the therapy.

Martin’s experience illustrates just how crucial the involvement of the partner can be. This quiet man had been married for some 30 years and was nearing the age of retirement. He’d suffered from erection problems for the last 10 years, but didn’t think anything could change that. While in the hospital for a minor surgical procedure, however, Martin began talking with the nurses and doctors, and found out about penile implants. Martin decided this was the solution he was looking for.

A few weeks later, Martin showed up at the clinic. He was very direct about the problem and the solution. Tests showed that blood-flow problems were the culprit in his inability to get an erection, and a penile implant was suggested as a solution. First, however, the doctor wanted to explain the procedure to Martin’s wife. “My wife thinks the implant is the greatest thing since sliced bread,” Martin declared, and explained that she had been called out of town on pressing business. He assured the doctor, however, that he had explained the entire procedure to her, that she had no questions and that she was totally in favor of the operation.

The urologist, taking Martin at his word, performed the surgery without talking to or meeting Martin’s wife. Everything went without a hitch, and, after several days in the hospital, a happy Martin was sent home to recover, with instructions not to use the implant until the doctor said it was all right (usually, several weeks after surgery).

Martin had done extremely well in the hospital, with few complaints of pain. But after he returned home, he was very uncomfortable. Several office visits failed to establish any cause for the unusual amount of pain, and in fact Martin was healing very well. No one could find anything wrong with him, but he was clearly unhappy.

Finally, just three weeks after the surgery, Martin returned once again to the clinic, this time demanding that the implant be removed. “Take it out or I’ll cut it out myself,” he yelled.

He was adamant that the “thing” be removed, and would not answer any questions about his wife’s feelings about his operation.

Faced with this situation, the clinic doctors decided they had no choice but to schedule surgery to remove the implant. But the staff was troubled by Martin’s dramatic change in attitude. Finally, a staff member, attempting to reach Martin at home, found himself talking with Martin’s heretofore elusive, always out-of-town-on-business wife. She was extremely angry. “How dare you put this thing in my husband? It was those young nurses in the hospital who convinced him to have this done! I won’t let him back in the house until you remove it,” she said.

Martin’s wife said further that she had told him from the very beginning that she did not want him to have the surgery. She was through with sex, and she wanted things to remain as they had been.

As it turned out, Martin had never consulted his wife about having his potency problem treated. Like many couples, Martin and his wife had lived with the erection problem for ten years, and in many respects had adjusted to that situation. To change it suddenly without the clear and informed involvement of both partners was a disaster.

The surgeon, resolving to never again put an implant in a married man without first interviewing the wife, removed the prosthesis from Martin. He recovered without difficulty, and returned home.

Cases like this just reinforce the fact that the woman should be involved in treatment to boost potency.

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Severe kidney disease can destroy a man’s potency as it destroys his health. There are lots of reasons for this, Kidney disease can lower testosterone production and raise the level of another hormone, prolactin, which can cause erection problems. And patients with kidney disease may suffer damage to nerves that are essential for erection. And even dialysis, the mechanical blood-cleaning process that can save patients with kidney disease, can cause impotence. Some doctors have found that dialysis may remove zinc from the body, and too little zinc can cause erection problems. Giving patients extra zinc to make up for this loss may help with potency. But the results are not clear; different researchers have come up with different results, some finding that zinc supplementation doesn’t help.

Extra zinc is not a cure for impotence.)

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