FrankTalk.org

There was a Franktalk post a while ago titled “Where have they gone” The author wondered why many men who once were active in Franktalk eventually drift away. The consensus was that ED and IPP surgery are a very significant life experience for men. Franktalk provides a much needed source of information and support. Speaking for myself, after the surgery and being extremely happy with the result: I find that my intense thoughts, feelings, fears and hopes surrounding ED are dissipating and I am happily moving on with life. I spend less and less time on Franktalk. I do feel very guilty about this. I gained so much using Franktalk I feel an obligation to contribute.

I have reviewed my experience and asked: If I were making this journey again what would I want to know. What would be most useful? What would inform, support and maybe bring a smile. My wish is that men wrestling with ED avoid some of the pain and heartache I experienced. It is very easy to try to deal with this by yourself and in the process isolate yourself from your loved ones and not seek or receive the help you need. Most ED has a physical cause. It could be viewed in the same as any other physical condition such as diabetes, heart disease. The Penile Implant could be viewed the same as a knee or hip replacement.

I found that I was terribly embarrassed by my ED. My sense of self-worth and manhood was diminished. My relationship and marriage suffered. I wish I could relive this with the knowledge and wisdom I have gained. I pulled this together and offer it to the community. My hope is to help others going through similar situations.

I am organizing my information into separate sections (posts) as these can be rather long. The topics that I think are important are:
1. Focus on what you have to gain not what you have lost
2. Male biological clock :What you may have to lose with inaction
3. The elephant in the room (Implant Surgery)
4. ED support: finding an ED coach
5. Financial consideration
6. Picking a surgeon and facility
7. My advice to women when their husbands have ED

Focus on what you have to gain

I found that with ED I seemed to focus on what I had lost. This in many ways is detrimental. I will never be 22 again. Then I never had to think about or worry about getting an erection. It just always worked. Those days are gone. My situation is different now, with different problems and opportunities.
I don't consider myself as a great LOVER. I am unremarkable in the bedroom. I have succeeded in one aspect: being a “considerate” lover. I realized early in our relationship that my wife's pleasure and satisfaction was in large part dependent on my performance. I needed to ensure I sustained an erection sufficient for her satisfaction. I made it a very high priority to ensure my wife had “Happy Ending” before I did. Eventually we gravitated to female dominate positions so my wife could be in better control of her outcome. I was basically along for the ride. Many times my wife would be in the throes of passion and I would be thinking BASEBALL, FOOTBALL anything that distracted me from the moment. If I felt myself slipping I had a secret weapon, the IRS. I would close my eyes upload a tax form in my mind. Nothing sucks the joy out of life like the IRS.

My endurance ability in the bedroom became a key item in my sense of self-worth. In my mind, my bedroom performance determined my value as a husband, a lover, a man. ED interfered with the joy and happiness we had enjoyed as a couple. With ED, each time we tried to make love I was always fearful: would this be another one of my failures. I didn't need the IRS anymore I was sucking the joy out myself.
My equipment failures before take-off were disappointing. My equipment failures mid flight were disastrous. I remember I would put my wife in an impossible position:If she seemed annoyed or disappointed I felt she was heartless. If she was kind and understanding I felt I don't need her pity. As my equipment failures became more frequent I felt she was just having “Mercy Sex” with me. I was in a deepening downward cycle. I was a basket case.

Now for the good news: My implant makes me 100 percent reliable: My equipment works anytime, every time, for as long as we want. I was totally unprepared for what I would gain with the implant.

Now I have stress free, worry free, anxiety free, spontaneous, playful, joyful, fun filled lovemaking and sex with the woman I have adored for 45 years.

Do we always have fireworks? No, we each may have difficulties. However I know that my performance will not be the problem. I am care free and spontaneous. My wife tells me that at this point in her life her desire comes and goes at odd times. I am always ready. I tell her: if she is up at night, can't sleep, staring at the ceiling, if the urge is there you know where the pump is. Pump me up. Enjoy yourself. All I ask is that you deflate me when you are done and tell me how great I was in the morning

The implant has restored the joy and happiness to our love life. This is a wonderful blessing and gift. I believe this is what you have to gain.

Male biological clock (What you may have to lose)

I was 68 years old and referred to the University of Utah Men’s Health Center. I made an appointment with Dr. Hotaling's physician’s Assistant Ariel. Ariel became my ED coach. She was a blessing in helping me through this process. Having a knowledgeable professional willing to work with you for information, guidance and emotional support provides immeasurable benefit. Ariel spent approximately 2 hours with me. She explained the complete ED process. I was a classic predictable example.

Ariel described the anatomy of the male penis and the biological necessity for erections. The penis has 2 main erection chambers (corpus cavernosum ) The erection chambers are filled with erectile tissue. This is a microscopic matrix of blood vessels. These structures act like microscopic balloons or sponges. Under the right conditions the erectile tissue fills with blood. Millions of tiny vessels swell with blood and expand. This expansion creates the erection. This a simplified description of a more complex biological processes ( arteries supply incoming blood flow and the veins must contract to hold the pressure)

Male adults, adolescents, boys and infants have spontaneous erections. I thought these erections were God's way of saying “Find a woman” I found a woman and still had nightly erections. Ariel explained that these erections were a biological necessity. By filling the erectile tissue with fresh blood the tissue is nourished and oxygenated. Without this nourishment, on a regular basis, the erectile tissue is starved of oxygen (hypoxia) the erectile tissue turns into scar tissue/ fibrosis. This can permanently decrease the size of the penis both length and girth. This fact was confirmed by reading posts here on franktalk. A common regret is “I wish I had the implant sooner” Lost size is a common complaint. Many times caused by lack of erections leading to fibrosis.

I realized that at this point in the ED process, the only erections I was getting was with Trimix injections. This was only once a week or so. After my conversation with Ariel, I used a vacuum erection device daily to establish a maintenance program while I worked through the emotions and details of the implant. The vacuum erection device creates an erection that nourishes and stretches the penis. Studies have shown this to be helpful.

In all the years I have had ED the medical profession hadn't explained the complete predictable process
I have multiple chronic and progressive conditions leading to my ED, Arteriosclerosis, type 2 Diabetes, high cholesterol and high blood pressure. I began to have erection problems in my early 50s. My primary care doctor prescribed PDE5 inhibitors, Viagra. The pills worked well, however 6 years later I was in the cardiac lab with 95 percent blockage of my right coronary artery. Two stents later I left the lab. After approximately 4 more years, the pills stopped working. ED is often an early warning of heart disease. I wish someone had connected these events for me.

I now was referred to an urologist and moved from pills to penile injections. My first experience with the injections resulted in priapism and an embarrassing visit to the emergency room. I eventually regulated the dosage for successful lovemaking. We realized how much we enjoyed vaginal penetrative sex. As a couple we had tackled my ED limitations with creative solutions to keep passion alive. I had forgotten how much I missed regular lovemaking. I missed the sense of fulfillment of my role as husband and lover. My sense of manhood somewhat restored with the help of some chemicals and a needle.

It wasn't very long, maybe less than a year, I noticed that it was taking more and more trimix and increased potency prescription to maintain the erections. I later learned from franktalk posts and my ED coach that injections and infrequent erections can lead to fibrosis.

I was told that I was a good candidate for an implant. I initially was horrified of the implant. I will elaborate on the implant later in my story.

All of this was very predictable. My experience was: ED, then heart problems, then pills then pills failing, then injections then finally the implant. All this was very predictable. No one in the medical profession took the time to explain the complete process to me. Modern medicine's business practices have evolved to an almost “Assembly Line” approach for efficiency. Time with the doctor/surgeon will be limited. My experience says that patients’ need to ask the system for what they need, beyond clinical diagnosis and treatments, I will write later on one way to mitigate this.

This ED process was my predictable biological clock. In all probability my natural body process was programmed for eventual permanent impotence without medical intervention. It is just a matter of time.

Males need nightly erections to oxygenate, stretch and keep the erectile tissue healthy. Without these series of erections there will be damage to the penis, loss of length loss of girth and possibly peyronies disease. Please watch the video https://www.youtube.com/watch?v=6lNgT6fjkU0.

This is not meant to frighten you into the implant. These are medical facts that should influence your decision, A good coach and men’s health professionals will provide testing, monitoring and a sustainment plan. Please don’t ignore this as the consequences can be permanent. If I could do it over again I would have found a good ED coach and a facility with all medical options and would specifically ask for coach, diagnostics, explanations and a monitoring and sustainment plan, also a treatment plan,

The elephant in the room: Penile Implant Surgery

I remember very clearly when my urologist suggested the penile implant. He seemed very excited and brought out the AMS 700 demonstration equipment. He had, in his left palm, the reservoir, with the two cylinders extending between his fingers like two small snakes. In his other hand he held the pump. All this connected with tubes. He slowly worked the pump and the fluid left the reservoir and the two cylinders filled and rose. He was very excited, I am sure he viewed this device as a marvel of bio-engineering and material science. What I saw was a “ZOMBIE PENIS” all I could think of was this zombie doctor wants to give me a zombie penis. (Too many Walking Dead episodes I guess). Well what is a zombie: something that is dead but still moves?

I really was horrified at the thought of the implant. I was still wrestling with putting a needle in my penis (Oh what we do for love)

When I got home my wife asked me how it went. I told her the doctor suggested a penile implant. She asked “What is that” I went on youtube and showed her a demonstration of the device just like what the doctor did in his office. I asked her “What does that look like to you” She responded: Wow, that looks just like a zombie penis! JUST KIDDING, JUST KIDDING. She was not impressed. I explained it needed to be surgically implanted. She and I ruled this out.

It just so happened that I was soon scheduled for my yearly physical exam. I have the best doctor ever. I trust his judgment very much. He asked how it went at the urologist. He asked how the
injections were working out. I mentioned the urologist suggested a penile implant. I told him I rejected the idea. He calmly told me that every one of his patients that had the implant just loved it. He encouraged me to not reject the idea but to do some research. I am an engineer, the one thing I can do is research.

This is when I learned of Frantalk. What a great resource. I read many posts on Franktalk describing how pleased men were with the implant. Franktalk has an extensive bibliography of research materials. If you have a question, do a search, chances are there will be wisdom waiting for you.

I googled IPP satisfaction and found several satisfaction studies. All of the studies showed 90-96 percent satisfaction. This is incredible. I have some experience with the general public. I could give away money free for nothing and the public would still complain: “I can't believe they gave me a check, I wanted cash”. “I can't believe they took out taxes”, “I had to wait 20 minutes” blah blah blah

The level of satisfaction with the implant is incredible and duplicated many times. All this evidence was hard to ignore. I kept reading postings in Franktalk of how pleased men were with their implant. There were some not so happy incidences. I will talk about that later when I talk about risk. Below is my analysis of my condition, my situation and the logic (absent the emotional issues).

My decision process to go ahead with the implant:

1) My situation: I have two chronic conditions Arteriosclerosis and Diabetes that are progressively limiting my ability to get and maintain an erection. My ED will get progressively worse with no real hope of reversal.
2) I do not have spontaneous nightly erections. This creates the real possibility of fibrosis of the penis and pyronies disease
3) The dosage and potency of the trimix injections necessary for satisfactory erections was increasing. This meant that my ED was getting worse and eventually even injections would stop working
4) The high satisfaction rate and the fact that the implant will stop fibrosis and loss of length and girth
5) I was 68 years old. The expected life of the implant is 10+years. My wife and I will most probably be in our 80s before I will need a replacement. If my wife and I are still knocking socks at that age I will gladly jump back on the operating table
6) The most significant risk with the IPP (inflatable penile implant) is that of infection. A good surgeon will have a 1 percent or less infection rate. If there is an infection, the Mulcahy salvage procedure is successful 80 percent of the time. So my calculation of the probably of an infection with serious long term consequences is (0.01 X .2 ) = .002 which translates into 2 out of a thousand men will have significant problems with infection. This seemed acceptable to me

My choices were: 1) do nothing, 2) continue with injections or 3) get the implant. The risk of permanent loss of function with options 1 and 2 was 100 percent (eventually). The implant offered high satisfaction and virtually unlimited function with preservation of my current size and effectiveness.

From a data driven factual perspective the implant was by far the best solution. Ariel and my surgeon Dr. James Hotaling agreed. I also contacted the AMS representative (Kelly Bland) . He was a wealth of information and I relied on his expertise and experience.

From an emotional perspective I was very conflicted. I was very fearful about the procedure. I was also very unhappy with my current condition. The University of Utah Men's Health Center was very welcoming of including my wife in all exams and discussions. My coach (Ariel) and wife became my support system. My wife said that if you go ahead with the IPP, do it for you not for me.

As we became serious about the implant my, wife and I had some very emotionally deep and intense discussions. One I remember well is my wife asking me why my sexual performance was so important to me. I had to dig very deep for the answer. One reason it was so important was my insecurity. I looked at myself as failing, as a disappointment. She asked why. Somehow I didn't feel worthy of her.
I have one job in the bedroom, I was good at it and now I can't even do that. Why would she stay with me? Why would she still see me as a man a lover? My insecurity laid bare. I questioned my manhood, my worth as a husband and lover. I was an emotional wreck. I drove my self crazy. I drove my wife crazy ( Way more than usual)

ED support: finding an ED coach(s)

Talking about ED was difficult for me. I remember almost whispering to my doctor the first time. The popularity of Viagra certainly has helped take away some of this hesitancy. Looking back, what I have learned over the years, is that it wasn't until I or my wife asked very direct questions did health care providers explore the issues associated with ED. In discussions of the implant with Ariel my PA/coach I found I was scared to death of the procedure. I did a lot of research. I had a two inch binder of research reports and surgical methods. I had spent many hours on Franktalk, I had over 50 direct questions. I believe that providers are hesitant to fully discuss the issues unless you express an interest. Otherwise they seem to be assuming you are embarrassed or don't want to know. Ask them to support you by 1) seeing the same person each time 2) ability to make appointments with the time to work through your questions, fears, emotions 3) Use all communication channels: computer portal, email etc. 4) Ask them to be your coach/advisor through this experience. Make sure to include your wife.

I spent most of my years with ED just working with my primary care physician. Pills worked for a long time. Somehow I thought this was a permanent fix. My heart condition took most of my attention until the ED became severe enough that pills stopped working altogether. I wish I had gone directly to a full service Men’s Health Facility when I first had ED, I would have had information and support for the full ED process. Maybe with their help I could have managed my sexual and medical conditions in a much more proactive way. I am grateful I eventually received the support I needed.

I recommend that you think about what support you would like to have while going through this process. I realized at my first appointment with Ariel that I needed a coach. I needed someone knowledgeable who would take the time to answer questions, discuss, explain my conditions my options and the consequences. Time with the doctor especially a surgeon will be very limited. If you are anything like my wife and I, we needed much more time and attention to feel comfortable.

A quick thought upon reflection: I preferred to have my PA/coach and my doctor be the team I see each time. It becomes much easier when you see the same person. Over a few visits you build a familiarity a relationship. My wife attended most of my visits and we became partners in the ED correction enterprise. My coach and my surgeon saw me as a person and I got to feel I had a support system.

I told my coach that I didn't want to approach my surgery with fear. I wanted to experience the surgery with confidence and expectation. This takes knowledge about the device, understanding the surgery and faith and belief in the medical team.

I believe it is very important that you and your partner are comfortable with 1) the decision to get the implant 2) your surgeon 3) the support (coaching) before, during and after the procedure

Advice for Partners of men with ED

Men don't talk about ED. It is strange because I work at an Air Force Base and sometimes my friends ask “Hi Gene, how they hanging” . Experience has shown me that they really don't want to know. Most men don't feel comfortable with the subject even with their wives/lovers. Franktalk serves a much needed function: Providing a safe, private mechanism for men to discuss and learn about this condition.

We don't talk/discuss much about how ED effects our wives/partners and the relationship. There is a very revealing photo on the AMS ED Cure website of a failed bedroom encounter. The man looks defeated, ashamed, embarrassed and confused. The woman looks shocked, bewildered sympathetic but not knowing what to do. This is a very difficult time for couples. Emotions are raw, communication (or miscommunication) is problematic. Significant damage to the relationship can be an unwelcome result.

This forum rightfully concentrates on the male perspective. I believe that the experience and wisdom on this platform can provide valuable advice and support for future partners of men with ED.

If I could speak to wives/partners here is what I would say:

1) Every wife/partner should be aware of the male biological clock. Every male if he lives long enough and stays sexually active will eventually have to deal with ED. It is an inescapable fact of biology and aging.
2) Every wife/partner should be aware of the male anatomy especially as related to erections.
3) Every wife/partner should know of the medical conditions the male has that can contribute to ED. High blood pressure, high cholesterol, weight, smoking, lifestyle etc. These are all indicators that sooner or later will effect his performance
4) Every wife/partner should know that there are medical treatments that are available.
5) Every wife/partner should be prepared in advance to handle this situation
6) It is extremely important that the partner not entertain doubts about themselves or let their own insecurities interfere with helping their partners

I caution that partners don't take this upon themselves. Am I getting old? Have I gained weight? Am I attractive? Is there something wrong with me. The answer is most definately NO! The reality as I see it is: Take a healthy male. Deprive him of release. The fluids build up. The pressure builds up. The desire increased. Put him in bed with a warm. Loving. naked female stimulating his man parts and if nature doesn't present itself something is broken AND IT IS DEFINATELY NOT YOU! There is most likely a physical cause that can be identified and treated.

I would recommend that when a man continually under-performs in the bedroom. That you calmly say Honey this is totally natural and expected. It could be temporary or it could be your body’s natural process. All men will have this problem if they live long enough. Arousal is only part of what is necessary for performance. There are physical and biological mechanisms that can interfere. We can work this out together. There is help to fix this for both of us.

Finding a surgeon and facility

Finding medical treatment for ED and finding a surgeon for implant surgery may be two separate searches. I finally went to University of Utah Mens Health. Here I found specialist to educate, diagnose and treat the full ED process all the way to the IPP. I wish I had gone there when I first suffered ED. I would have been educated on the complete ED process with each level of treatment explained before I needed it. Also there might have been lifestyle and or medical treatments to slow or remediate the health, psychological and relationship issues.

This section focuses solely on picking a surgeon. Reading Franktalk the most common advice seems to be “Pick the most well-known, highest volume surgeon possible”. Kramer, Eid, Perrito, Christine, Henry etc. The logic being: if you pick the best master practitioners in their field you won't be disappointed. There is truth to this. I cannot fault this logic. I took a slightly different approach.

I studied IPP surgical technique. Dr. Eid has a detailed description of his surgical technique, along with operating room videos. His “No Touch technique” was revolutionary in lowering infection rates. Dr, Kramer has an extensive video library of surgeries including the most difficult of patient conditions. These are master craftsman. After studying these techniques I made a list of must have and like to have.

Must Have:

1. High volume. 50 or more per year. Studies show that higher volume surgeons have better results
2. Must use the Dr. Eid “No Touch” techniques
3. Penile scrotal approach
4. Low infection rate less than 1%
5. Surgery in a highly rated hospital (not surgical center)
6. After care especially if there were an infection
7. low visibility pump position

Like to have:
1. Tissue sparing dilatation. No serial dilation. Preferably using only the furlow surgical insertion tool measuring tool
2. Spinal anesthesia
3. vertical incision in the scrotal raphe ( hidden scar)

I was fully expecting to fly to New York or Baltimore. As it turned out the University of Utah and Dr Hotaling fulfilled all my all my must haves but none of my like to have. Dr Hotaling is very experienced with IPP surgery performing 50-100 per year. I was sure he would perform the install perfectly. My only other fear was the possibility ,however slight, of infection. Dr Hotaling put his hand on my shoulder, looked me in the eye and said: If this happened he would be with me every step of the was. I was so lucky. I found my coach (Ariel) and my surgeon. I went into surgery very confidently.

That's my story. I spent a year agonizing about the surgery. I made myself miserable, I made my wife miserable. After the surgery my wife told the doctor “ I am so happy to get my husband back” I am so happy to be back. I wish you all the very best. I am so torn: I gained so much support from the Franktalk community when I truly needed it. Now I think less and less of my sexual problem and am finding myself putting attention into other things (like life), I do have some amount of guilt and this is my way of saying thank you and contributing back

Gene

Absolutely great post Gene this will help so many people. Fair play to ya!!!

I second Irishguy, you've put a lot of effort into this most valuable post.
'I am an engineer'....that didn't take me by surprise, you are clear, structured, logical, and you write very well.

Thank you, gene308!

Really inspiring post. Thank you for sharing <3