In the last decade urological interest in ed has increased spectacularly. This is a positive development for various reasons: for instance, more attention has been paid to the sexual consequences of operations. It has also become apparent that physical abnormalities are more frequently involved than had been traditionally assumed by sexology. In addition, both the diagnostic and therapeutic options in dealing with impotence have greatly increased.

On 25 June 1980 the French cardiovascular surgeon Ronald Virag discovered by accident that direct administration of papaverine into the penis could cause an erection, but he only published on the subject in The Lancet in 1982. Since the 1960s papaverine had been used in surgical procedures to keep the two blood vessels to be stitched to­gether as wide open as possible: in other words, it is an established drug. Like opium, it is made from the poppyhead, but is completely non-addictive. During a cardiovascular surgical procedure Virag accidentally injected papaverine into the wrong vessel, inflicting an extremely long-lasting post-operative erection on the patient.

In fact, as long ago as the Second World War, the penis was used by military surgeons to transfuse large quantities of blood into soldiers
in deep shock (because the relevant veins could no longer be seen or felt, it was sometimes impossible to insert a drip into the arm of patients in shock). However, if the blood flow was too fast, it resulted in an erec­tion. Therefore injection therapy (in which the man injects himself in the penis with a vasodilatory drug) originates from the link established between a wartime procedure and a ‘slip’ during an operation.

In 1983 the world of urology was alarmed by a talk on this subject by the eccentric British professor Giles Brindley at the American Conference of Urologists in Las Vegas. He was conducting research into the effects of intrapenile administration of phentolamine, like papaverine a vasodilatory medication, but one that acted in a different way. Usually speakers at such a gathering are neatly dressed, that is, in suit and tie, but Professor Brindley appeared in shorts and sneakers. He talked about the results of his research, but after a quarter of an hour he interrupted the talk by announcing that he was getting a hard – on. The audience were shocked, not least because he went on to drop his shorts giving those at the front a close-up view and inviting them to feel it. . . He told us that he had injected himself before giving his presentation. An unforgettable, penetrating performance!

A prostaglandin or a combination of papaverine and phentolamine can be used for self-injection. This combination was officially regis­tered for intercavernosal use in 1992 under the brand name Androskat. The dosage for treatment depends on the cause of the impotence. The effect is virtually immediate, or takes at most between fifteen minutes and half an hour. Depending on the firmness and duration of the erec­tion, the dose should be adjusted step by step. A slow increase is prefer­able, and this is usually done in consultation with the urologist in charge of the case. In general the aim is to achieve an erection lasting between one and two hours. Injecting more than twice a week is not advisable, since this can cause sclerosis.

Penile injections can occasionally cause a long-lasting, usually painful erection (priapism). The blood is as it were trapped in the erec­tile tissue compartments, and is no longer replaced by new blood. As a result oxygen deficiency occurs and if action is not taken in time this is followed by morbidity in the erectile tissue. A faulty technique can result in a subcutaneous injection, and there will often be visible haem­orrhaging; the same can occur in a patient taking blood-thinning medi­cation. Caution must be used with patients suffering from cataracts or ailments in which an acute drop in blood pressure can be dangerous, for example shortly after a heart attack. Worldwide not only papaver­ine, phentolamine and prostaglandin ei, but also moxysylyte (especially in France), vasoactive intestinal polypeptide (vip), ketanserin, calci­tonin gene-related peptide and chlorpromazine are used.

Подпись: Intracavernosal injection.
High-tech: Old wine in new bottles

Papaverine was naturally also tested on women. . . Gynaecologists were keen to try injections into the labia minora (specifically, the bulbus vestibulum) with anorgasmic women, in the hope of producing at least some ‘moistening effect’. Attempts failed, and no orgasms resulted.