Manhood

by Driel, Mels van.

  At last man appeared, joyous, healthy and vigorous, and begged God to appoint his time for him. ‘Thirty years shalt thou live,’ said the Lord. ‘Is that enough for thee?’ ‘What a short time,’ cried man, ‘when I have built my house and my fire burns on my own hearth; when I have planted trees which blossom and bear fruit, and am just intending to enjoy my life, I am to die! O Lord, lengthen my time.’ ‘I will add to it the ass’s eighteen years,’ said God. ‘That is not enough,’ replied the man. ‘Thou shalt also have the dog’s twelve years.’ ‘Still too little!’ ‘Well, then,’ said God, ‘I will give thee the monkey’s ten years also, but more thou shalt not have.’ The man went away, but was not satisfied.

  So man lives seventy years. The first thirty are his human years, which are soon gone; then is he healthy, merry, works with pleasure, and is glad of his life. Then follow the ass’s eighteen years, when one burden after another is laid on him, he has to carry the corn which feeds others, and blows and kicks are the reward of his faithful services. Then come the dog’s twelve years, when he lies in the corner, and growls and has no longer any teeth to bite with, and when this time is over the 195

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  monkey’s ten years form the end. Then man is weak-headed and foolish, does silly things, and becomes the jest of the children.

  This fairy tale by the Brothers Grimm, written over a hundred years ago, expresses very succinctly a view of older people that is current even today. Very many young people assume that the above-mentioned stupid old monkeys no longer indulge in sexual activities. Place ‘old’ in front of some of the slang words for penis, and the insult stings even more. Being called a ‘prick’ is bad enough, but an ‘old prick’, one that no longer works, is far worse. What man does not dread the moment when his penis leaves him in the lurch once and for all?

  Growing old has been compared to a game of chess, in which pieces are eventually lost, though certain strong pieces still control the board and can even engineer a powerful new position. But every chess player knows what the loss of the queen means in a game. The power of the queen is a very good analogy for the meaning of eroticism in a human life. In fact, it is not the loss of sexual performance, but the loss of the erotic dimension that generates most apprehension in confronting old age. Men can sometimes exorcize that fear, for example, through singing with their comrades. I was once given, by an anaesthetist friend of mine with greying temples, who had served as a doctor during his military service, the words of a song sung by British officers in the mess in the evenings. They are as follows:

  Your spooning days are over

  Your pilot light is out

  What used to be your sex appeal

  Is now your water spout

  You used to be embarrassed

  To make the thing behave

  For every bloody morning it

  Stood up to watch you shave

  But now that you are growing old

  It sure gives you the blues

  To see the thing hang down your leg

  And watch you shine your shoes

  One thing remains: with the passing of the years the frequency of sexual activity declines. The Rotterdam physiologist and sexologist Koos Slob presented the following figures based on various surveys: 84 per cent of men in their fifties, 67 per cent of those in their sixties, 43 per cent of septuagenarians and 16 per cent of octogenarians are sexually active.

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  a i l m e n t s o f t h e p e n i s For women the percentages are 76 per cent (51–60), 40 per cent (61–

  70) and 7 per cent (71–80) respectively. No survey information is available for women over 80. There are certainly great individual differences. The decline in later years is shown to be least in those most active at a young age.

  Until quite recently experts believed that ed later in life was almost always the result of arteriosclerosis. There are also indications that the stiffness of the penis declines as one gets older as a result of a change in composition of both the erectile tissue compartments and the stiff capsule of connective tissue surrounding them, which plays an important part in retaining blood. It is anyway generally true that muscles, tendons and articular capsules grow thinner with age and lose their elasticity, and the loss of elasticity in the erectile tissue compartments is actually the main reason why the penis becomes shorter as one gets older. Of course there are other factors that can affect potency in the elderly. Chronic medication dependency and diseases like diabetes mellitus are more prevalent. Joint calcification caused, for example, by rheumatism, may cause pain and restrict movement, impeding intercourse. And although heart attacks and strokes need not automatically lead to problems in lovemaking the patient and his partner are understandably often frightened of a recurrence.

  After a heart attack many men don’t dare ask their doctor for advice about their sex lives. For example, what exactly does ‘taking it easy’ mean in this context? It may well be that a reduction in sexual activity will have an adverse effect on the patient’s condition. It is understandable that men who have had a heart attack should be worried about putting too much strain on their heart, but heart patients can have a perfectly satisfying sex life without putting themselves at risk. Driving in heavy traffic, playing with a grandchild or having a heated discussion put more pressure on the heart than sexual intercourse. Research into the incidence of heart attacks during intercourse revealed that when these occurred they were almost always related to an extramarital affair, making such affairs particularly inadvisable for heart patients.

  Set in one’s ways

  ‘Getting stuck in a rut’ as one gets older is the theme of Guy de Maupassant’s story ‘Set in One’s Ways’ (‘La Rouille’), which describes how Monsieur and Madame de Courville finally fail to get the old Baron Hector Gontran de Coutelier to marry Berthe Vilers. To begin with the baron is very enthusiastic about the proposed bride-to-be, and she accompanies him on many hunting parties, but when after a while he 197

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  is asked straight out if he wants to marry her, he appears dumbstruck.

  Weeks later he announces to Monsieur de Courville that he does not wish to pursue the proposed marriage and months later confesses once and for all that he is impotent. The baron had decided first to go to Paris and had visited several ladies of loose morals, none of whom had been able to provoke an erection. Next he tried all kinds of piquant dishes, which did nothing but upset his stomach. He draws his conclusions and makes his confession. As he listens, Monsieur de Courville has great difficulty in not bursting out laughing, and on his return home he tells the story to his wife. She doesn’t laugh, but listens attentively and when the story is over says the following: ‘The baron is an idiot, my dear; he was afraid, that’s all. I’ll write to Berthe and tell her to come back straightaway . . . when a man loves his wife, you know, those things . . . always sort themselves out.’

  The psychoanalyst Wilhelm Stekel (1868–1940), a breakaway pupil of Sigmund Freud’s, takes the view that under certain circumstances the potency of older people can improve. According to Stekel, the peak of a man’s potency depends not on age, but on the sexual

  ‘object’ available to him. In one’s youth the sexual urge is generally stronger and more tempestuous. The man is less concerned about the soulmate who can satisfy him fully, than with ‘the bit of skirt’ that meets his taste and his daily needs. According to Stekel that is why many younger men may frequent prostitutes and as they grow older stop. In his view, in maturity, as desire becomes more refined, love becomes increasingly something ‘in the head’, which is why under certain circumstances potency can be even greater. Stekel believes that only in a sexually harmonious marriage, with mutual understanding between the partners, can the wife respond to the ‘refined taste’ and the ‘intellectual desire’. The man must show himself capable of bringing about a ‘spiritualization’ of the marriage . . .

  He illustrates this with the story of an elderly painter. His considerably younger
wife is described by Stekel as a strikingly intelligent,

  ‘Juno-esque’ lady of amazing beauty. The man has been impotent for twenty years. To begin with he still had erections, but these invariably disappeared the moment his wife approached. For the last ten years he has had no erections at all, not even in the mornings. In addition he suffers from nocturnal panic attacks, and is afraid of developing a heart complaint. The man’s behaviour is unpredictable and he often loses his self-control. These days his wife is only happy when he is away. He blames his wife:

  Do you know, doctor, even when I was young I often couldn’t perform normal intercourse. There always has to be an element 198

  a i l m e n t s o f t h e p e n i s of danger for me to perform well. You may laugh! I’ve never really been potent in bed, only with my wife when we were first married. But if I could throw some girl into a corner, on the floor or onto the sofa, then it was always terrific.

  His wife had fallen in love with him because she admired his paintings so much. She was his pupil, but gave up painting when they got married.

  When she took up painting again, he realized that he really didn’t care for her mediocre work. Subsequently his wife began criticizing his paintings, and took the side of an art critic who had attacked his work:

  ‘Was that before your impotence?’ asks Stekel.

  ‘Wait a moment, I remember the exact date of the exhibition. And the date of my first disgrace, it was my wife’s birth-day, and we were in Semmering . . . Of course. The disgrace befell me a few months later.’

  During the course of psychoanalysis his wife died. Two weeks later he raped his hunchbacked cook. A few months later he dismissed the cook and fell in love with a young pupil, who idolized him, and with whom he proves quite potent enough to be able to make love in the normal way in bed . . . .

  Stekel regards this case as an example of the dichotomy between animal and ‘spiritualized’ love The man undoubtedly harboured brutal and possessive sexual desires from an early age, but his sexual potency failed him when his wife denied him her ‘spiritual’ admiration, thus turning into a ‘bit of skirt’, whom he would most like to fling onto the sofa.

  Priapism

  Priapism is a totally different affliction of the penis. It is the medical term for a usually painful erection lasting longer than three hours, with a complete absence of any sexual arousal.

  In Graeco-Roman mythology Priapus is one of the lesser gods, of fertility, viticulture, gardening, beekeeping, etc. He is usually depicted with a gigantic phallus, and originated from Asia Minor. In the eyes of more educated Romans, Priapus was a figure of fun. He was imported from Greece in the first century by Roman practitioners of lighter verse.

  Almost always he is pictured as a scarecrow and a deterrent to thieves keeping watch over a patch of land growing some vegetables and fruit and his coloured image is carved from a rough piece of wood.

  He is considered to be a connoisseur of the erotic, whose rough appearance is echoed in his forthright language, and who is immensely proud 199

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  of his phallus. The Carmina Priapea, a collection of nearly a hundred obscene erotic poems from ad 100, are quite explicit about Priapus’

  life and works.

  The Priapus of the Priapea is a sexual glutton, a genuine Roman macho, who penetrates wherever he can. His sexuality is violent and unfeeling and some people have seen this as typical of the Roman male from the time of Nero:

  Take heed: a boy behind, a girl in front I’ll take.

  For bearded men who steal, remains a third ordeal.

  Briefly summarized, that is the standard penalty for theft from Priapus’

  garden or orchard. Depending on whether the offender is a woman, a man or a boy, they are threatened with vaginal, oral or anal rape.

  Priapus is also offered sacrifices in the poems, which are not only about crude sex. In one a dancer dedicates her tambourine and castanets to Priapus, expressing the hope that her audience will stay as enthusiastic as Priapus himself. Another promiscuous woman offers a generous number of wooden penises, one for every man she has ‘serviced’ the night before.

  Priapism may occur as a side-effect of self-injection in the penis, but can also be the result of leukaemia, malignant tumours in the lower abdomen, the use of certain drugs and also sickle-cell anaemia, a here -

  ditary disease affecting mainly non-white populations living in or originating historically from tropical or subtropical malarial regions. In this condition the red blood cells are more or less deformed, assuming a sickle shape, so that blood-clotting can quite easily occur, particularly when the flow speed is reduced. An instance of reduced flow is the state of erection, especially in sometimes 50-minute-long nocturnal erections.

  Young men with sickle-cell anaemia are prone to priapism. Treatment consists of the injection of a vascular constrictive medication directly into the penis. If that doesn’t help, an operation is necessary, in which a kind of bypass is constructed from the penis to an inguinal vein, allowing the accumulated blood to drain away uninterrupted. There are many variants: if an operation also fails to bring about flaccidity the erectile tissue compartments will fill up with connective tissue, giving them a wooden feel.

  This happened to one of our patients not so long ago: after taking medication for depression a man, not yet 40, developed priapism.

  Unfortunately it emerged that that not all doctors are equally up to date on the treatment of priapism: it is necessary to act as soon as possible after such an erection, which is often very painful, and preferably within six hours. He was dismissed by his doctor, who did not take the 200

  a i l m e n t s o f t h e p e n i s trouble to consult a specialist. Eventually the patient submitted a claim to his gp’s insurance company. However, damages had never been paid in the Netherlands in such a case, so that the patient’s lawyer sought advice from colleagues abroad. He found that in the United States about 200,000 euros would be paid out. The patient received less than a tenth of that . . .

  The crooked penis

  The name of Marquis François Gigot de la Peyronie, personal physican to King Louis xv, is linked to a most unusual abnormality of the penis.

  Peyronie’s disease indicates a crooked erect penis caused by excessive connective tissue formation in the wall of the erectile tissue compartment. At the point affected a hardening develops and elasticity is lost, hence causing crookedness in the erect position. The ailment is common, affecting an estimated 3.6 per cent of all adult males, and in most cases the onset is around the age of fifty. Approximately 20 per cent also suffer from connective tissue formation in and around tendon sheaths in the palm (Dupuytren’s disease), and the occasional one has problems on the sole of the foot. The cause of Peyronie’s disease is an abnormal inflammatory reaction in and under the capsule around the erectile tissue compartments, virtually always on the top, which means that the crooked position in the vast majority of cases is towards the abdomen.

  A crooked penis may also be the result of a congenital asymmetry of the erectile tissue compartments, in which case the bend is towards the ground or sideways. The estimated incidence of congenital crookedness is six per thousand male babies.

  Peyronie’s disease is not an easy ailment to go public with, or a suitable conversation topic at parties. Consequently the patient often thinks that he has a ‘unique’ malady, whereas it is something run-of-the-mill. Its manifestations are pain, insufficient hardness of erection or an awkward intromissio vaginalis, in which the penis can be inserted only with great difficulty. Above all a member shaped like a boomerang can make sex very painful for the woman, though many women appeared to be intrigued by a crooked penis.

  The cause of Peyronie’s disease is still unknown. Mainly on the basis of the existence of related ailments thinking tends to favour abnormal genes, for which scientists are at present searching. As regards treatment, the Marquis de la Peyronie sent his patients to Barega, a spa in the Pyrenees. Not such a b
ad cure, when one knows that 40 per cent of patients will show some improvement in due course. However, the restoration of a ramrod-stiff penis will be out of the question for the patient concerned. Over the years more than a hundred non-operative 201

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  Crooked position

  in Peyronie’s

  disease.

  treatments have been described in the literature. That in itself says enough: not a single one has been convincingly proved to produce a cure.

  If a year after the onset of the disease there is still serious crookedness, then provided the complaints of pain have ceased, there is good reason for an operation to correct the crookedness. Problems of rigid-ity are not solved by an operation, but problems with intercourse can be alleviated. The most frequently mentioned problem is that the penis regularly ‘flops out’ while the patient is thrusting. There are two different operations. In one the hard area is cut away and the defect created is covered with tissue taken from elsewhere or with synthetic material. In the other surgical technique the hard area is left untouched, and instead the operation takes place on the healthy side, where the penis is pulled back into line by the cutting out of small elliptical sections of wall or by a series of so-called reef knots. The main snag is that the penis may be shortened slightly, in addition to the shortening caused by the disease. The advantage is that there is no chance of dev elop ing ed. In contrast to the first operation, where the diseased tissue is removed, the malady is here treated with stitches on the healthy side.

  Hypospadia

  Hypospadia is a condition in which the opening of the urethra – which is normally at the top of the glans – is located on the underside, the shaft of the penis or even in the scrotum. In addition the foreskin on the underside of the glans is missing, and the erect penis is sometimes also bent. Approximately 1 in 300 males is born with this abnormality. The 202

  a i l m e n t s o f t h e p e n i s cause of hypospadia is very probably a relative testosterone deficiency between the sixth and thirteenth week of pregnancy.