The good news about Peyronie’s is that usually it gets better by itself, over time. Sometimes medical treatment seems to improve matters. For some men, however, Peyronie’s gets worse. The bend in the penis can become so severe that intercourse is difficult. For a few unfortunate men, the scarring in the penis causes them to lose their ability to get an erection.

In such advanced cases, surgical treatment may help. For men still able to become erect, the doctor can cut out the scar and patch the area with tissue taken from another part of the body. If the scarring is extensive, however, the penis may be damaged and erectile ability lost after the procedure.

Another option is for the surgeon to take a tuck on the opposite side from the bend, and literally try to straighten out the penis surgically. For men who can’t get an erection at all, the most reliable surgery is to straighten the penis and put in an implant. For many men with Peyronie’s disease who are impotent, the implant is the only alternative.

Although the different treatments discussed in this chapter provide successful solutions to many patients, they are by no means the only options. Ifs always important to explore whatever treatments are available and applicable to your case. Even after surgery restores potency, some couples find they need help adjusting. Sex therapy can be a real help to such patients.

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Acupuncture has long been used in Asian countries as a way to treat men with ED. In this country, Alfred Peng, M.D., the president of the American College of Acupuncture, has had some success helping men with mild or moderate ED. Dr. Peng, an associate clinical professor of surgical science/pain control at New York University Medical School, believes that, in theory, the technique increases blood flow to the penis. He states, “Acupuncture is excellent for increasing microcirculation in the body. I’d recommend six to seven sessions. If you notice improvement with your sexual function, continue with the acupuncture treatment.”

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Researchers know that every bodily function, from hormone levels and blood pressure to sexual performance, varies regularly—and predictably—during the twenty-four-hour period. They also are aware that the antisexual side effects of many drugs are often diminished or nonexistent just before it’s time for the next dose.

They have seen that drugs act differently, depending on when they are taken and what is happening to the body at that time. For instance, hypertension levels are highest upon awakening. Awareness of this fact has led to the development of a new controlled-release medication called Covera-HS. This combination hypertension and angina pectoris drug contains verapamil hydrochloride, a commonly prescribed medication that has been reformulated to be released at a specific time. The pill is taken at night, but the medicine is not released until four to five hours later. Since the drug provides the greatest help when it is needed most—in the early morning hours—and lesser amounts during the day, the user has a much larger window of opportunity for sexual activity.

I saw this happen with Tyrone, a forty-three-year-old with high blood pressure whose medication was causing ED. When I suggested that he try Covera, I explained that everyone’s sexual timetable and function have their own particular rhythm, but that for men, the best time to take advantage of the cycle is early in the morning. At that time, body temperature is rising while Cortisol, the hormone that speeds up the release of energy-producing glucose in the blood, is also gradually increasing, peaking upon awakening. Testosterone levels usually surge between four and five o’clock in the morning. Add to this the fact that any other medication is at its lowest ebb before the morning’s dose, and that a man is likely to be at the least-stressed point of his day, and you have a formula for peak sexual power.

Tyrone’s response was extremely positive. The Covera worked for him and, as he told me, “I was always a morning man; I just never knew why. Now I’m back on my regular cycle.”

But if none of these options work for you, there is a new fallback position. The new erection pills can be taken half an hour before you want them to work. With their incredible ability to override sexually inhibiting side effects of so many medications, you have the wherewithal to reintroduce spontaneity into your love life.

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Now, with the advent of the erection pill, peak performers have a reliable intervention that can work for them when they need and want it. And they can use it far into their senior years. With this enormous concern lifted, these men are more confident, relaxed, and less anxious, at least sexually, about growing older. So many of these patients have expressed to me the opinion that fast lifestyles, pressured careers, and lack of down time have contributed to their ED. The pill, of course, is no cure for too intense a life—we are, after all, human and can take only so much wear and tear. But a man who feels better about himself is bound to have a positive effect on his partner, his family, his work, and the world he lives in.

But, then, having found this incredible drug, will those men want more? With expanded research, new medications are being developed, and different pathways to deliver them are being explored.

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Gradually, over a period of months, the 62-year-old man recovered. He slowly picked up the pieces of his life and began to make new plans. Now single, this attractive and vigorous man began receiving lots of invitations. George began dating, and after a while, he limited his attractions to just one woman, Claire, a 55-year-old real estate agent. It was with her that George first experienced an erection problem. “I was just unable to get a total erection,” he says, still uncomfortable at the memory. “Claire obviously felt it was my problem, not hers.”

At first, George attributed his erection difficulty to the loss of his wife, an interpretation his doctor agreed with. But as it persisted, he noticed a change in himself. Beset with anxiety about his ability to perform—would it work this time or not?—he watched himself as though he were someone else. He monitored his body’s reactions instead of enjoying them. This spectatoring caused more potency problems, more anxiety for George. A vicious cycle of potency problems, depression and stress was launched.

In George’s case, he had been diabetic for years, but it had never caused him erection problems (see chapter 4 for more on diabetes). The death of his wife was an enormous shock and caused him great stress and depression. By themselves, depression and other mental conditions can cause erection difficulties. In combination with other factors, they can be even more formidable. It seems likely that George’s first as-a-widower experience with erection problems was due to a combination of diabetes, some depression and perhaps anxiety over being with a new partner. Some empathetic professional counseling and information about diabetes and impotence, perhaps along with physical treatment, might have prevented the cycle from continuing.

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There is a theory that a woman’s instinct for sexual pleasure is so deeply ingrained in her nature that she has an overwhelming need to maintain body contact with her partner after orgasm, and thereby extend the period of enchantment for as long as possible.

But if her partner gets up, has a cigarette or simply rolls over and goes to sleep, a women usually feels neglected and bereft, and this kind of turning off without explanation after sexual union usually leaves her feeling lonely. A sudden withdrawal of this kind seems uncaring, if not brutal, to her.

Prolonging a man’s interest A man’s usual physiological response to orgasm is one of drowsiness and lethargy, and this is enhanced if lovemaking is left to times when he is already feeling tired and ready for sleep. Therefore, a change to morning lovemaking may bring about a more affectionate afterplay.

To encourage your man to stay awake, keep conversation light and romantic; tell him how much you love him and how wonderful he is. It is a good idea to avoid discussing household problems, as this is certain to send him off to sleep. Make sure, too, that after having sex it is not you who rushes off immediately to the bathroom to get washed. If you must have a wash, suggest you have a bath together.

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We should all let our partners know which caresses are pleasurable and which are not. We should always say if something is particularly arousing or painful. Lovers should be bold enough to suggest a different way of making love, and should ask each other questions and make requests. Exchanging of these confidences will help to build up a better physical relationship, while not doing so may make matters irrevocably worse. This can be achieved by saying that something is pleasant or it is not, making encouraging noises, or by moving a hand to a spot where the sensation is more pleasurable.

What is appropriate and enjoyable varies from occasion to occasion, so simply because you have expressed a preference once does not mean to say that you do not have to express it again, or that you might express a different preference on a different occasion. Good lovers should never take each other for granted. Ideally when conflicting desires are expressed, or when differing degrees of arousal are experienced, a couple should engage in a process of negotiation. If not, you will find yourselves falling into habitual, routine sexual activities. The best of partners may eventually become bored after years of exactly the same activity in the same sequence, in the same position, in the same bed. Boring sex is rarely rewarding to either, partner, and there is a vast range of sexual activities that people find appealing and stimulating. Communication does not mean that everything said has to be negative; say what pleases you, and at the same time listen to what your partner is telling you.

And if you want to get more enjoyment out of your sexual relationship, you need a partner’s full involvement and participation. For two people to enjoy their sexual relationship fully, both must be able to accept the pleasure a partner gives, and both must be able to enjoy the process of giving a partner pleasure. The most satisfying sexual relationships have the joint commitment and sharing of the two people involved. The more pleasure you give your partner, the more they will want to give you pleasure in return. A good sexual relationship is always a giving relationship, not a taking one.

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As a pleasurable sensation, though not a sexual one, infants fondle themselves around the ages of three and four, and may explore each other around the ages of five and six, but it is not until adolescence, when sex hormones are being produced, that masturbation for sexual pleasure starts. Age 10 or 11 is the earliest, but it can start much later; for some, masturbation is not experienced until the late teens or early 20s.

It is only through personal experimentation that people come to understand their preferences and develop techniques that they find most pleasing. But it is essential that these preferences are expressed to a partner, and that the techniques are candidly shared.

In the majority of people, auto-erotic experience is highly private and masturbation is one of the most difficult of all topics for couples to discuss. Perhaps religious orientation forbids it, or it still may be an area they feel unable to discuss because it is so highly private. Many people find masturbation a difficult subject to approach because they think they have to share what they actually do. This isn’t at all necessary, but you should try to share with your partner how you feel.

Auto-eroticism, of course, is not limited to self-stimulation of the genital organs; there are many other experiences in life that are auto-erotic, such as taking a long, luxurious, sensuous bath, or simply feeling the wind in your hair and the sun on your skin. Don’t limit your view of auto-eroticism entirely to sex; allow yourself to be stimulated by the many naturally occurring, everyday experiences such as a crisp, sunny winter morning, a walk along the beach on a fine day, or swimming in the sea.

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Attractiveness or sex appeal is hard to define but sexuality has more to do with your attitude towards yourself, your partner and your lifestyle than with anything else, and certainly more than with obvious physical attributes. We have all met rather plain, unassuming people who have great charm and attraction, which is difficult to pin down but often has to do with having a positive attitude towards life, a ready smile, a subtle sense of humour and enthusiasm. Other people are attractive because of their eccentricity and uniqueness – how they speak or express themselves, mannerisms, surprising candour, or individualistic presentation.

Such qualities are probably more important than your actual appearance, and while it is worth spending some time on how you look, you should maintain a sense of balance by not becoming obsessive about your physical appearance. Too many men and women feel dissatisfied because they compare themselves to an exaggerated image of what is good looking. Responding to your partner and being willing to share pleasure are the qualities that ultimately make a person attractive.

Although over-attention to appearance is not necessary, some relationships can founder if either partner neglects his or her appearance and hygiene. The best possible reason for taking trouble over your appearance is for your own self-esteem, but you should also do so for the sake of your partner, otherwise he or she could interpret neglect as a sign of not caring. This does not imply that one has to spend hours on preparation but an unclean and/or smelly body, dowdy, ill-kempt clothes, an unshaven face, curlers in the hair and an ill-tempered face all imprint themselves on the memory and become difficult to erase at times of intimacy. A sloppy appearance invites comparison with the time when you first met, and the inevitable thought arises that love is on the wane.

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Man’s experience-He maintains his sexual tension during the plateau phase and when his partner is ready, he penetrates her and begins thrusting. His thrusting will increase his desire until he achieves orgasm.

Sexual tension reaches its peak, culminating in orgasm and ejaculation, after which his excitement drops.

The man becomes aroused quickly during foreplay. His penis becomes fully erect and excitement continues with sexual stimulation.

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