Answer:
by Hussein Ghanem: (05/24/2004)
I understand you have multiple concerns related to the rigidity of your erections, your control on the ejaculations and a penile curvature. Viewing the multiplicity of your complaints I strongly advice you to visit a physician with expertise in sexual medicine to address all physical and psychological aspects.
For general information purposes, I am enclosing this general classification of therapy for erectile dysfunction. Therapy is generally classified into first line, second line, and third line treatments options. Naturally, second line and third surgical options are mainly prescribed for patients with significant physical factors
Treatment decision-making
. 1st line therapy (Oral erectogenic agents): e.g. Viagra and other new medications in Vardenafil & Cialis; Vacuum devices;
Couples/sexual therapy
. 2nd line therapy (Local treatments): Intraurethral alprostadil; Intracavernosal self injections.
. 3rd line therapy (Surgery):
Please check my recent article on this subject - Modern Trends In The Management of Erectile Dysfunction - on sexualhealth.com (recent articles).
The following are some strategies that the sex therapists commonly prescribe for cases with psychogenic Erectile dysfunction and premature ejaculation.
Strategies for sex therapy
1- Sensate focus (relaxed sensual massage, Developed by Masters & Johnson)): Taking turns at giving & receiving stimulation while forbidding genital touching, vaginal penetration & orgasm. The period prescribed for sensual massage could be days or weeks depending on the severity of the performance related anxiety.
2- Non-demand genital touching: The next step is to allow mutual genital & breast touching but still intercourse & orgasm are not allowed.
3- Vaginal containment (quite vagina): Vaginal penetration is allowed but both partners remain still (no pelvic thrusting).
4- Fantasy: Imagining sexually stimulating situations.
5- Squeeze technique & start stop technique (Semans maneuver) to treat premature ejaculation: In the squeeze technique, the female partner stimulates the penis then squeezes the glans firmly when the male patner signals he is about to ejaculate. In the start stop technique, stimulation is stopped before ejaculation is inevitable & then resumed once more. The cycle is repeated over & over again.
Management of the curvature depends upon the degree and type of curve. We have previously published our experience in this area (Horizontal plication after vertical tunical incisions for the correction of congenital penile curvature. H Ghanem et al. International Journal of Impotence Research (2000) 12, 117-119. Macmillan Publishers Ltd).
Best wishes, Hussein Ghanem, MD
Reviewed by Sexual Health Editorial Team
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