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Edited by Bernard Levinson, M.B., B.Ch., D.P.M.
An owner’s manual for men Everyone is different There are no secrets about size How an erection happens And the result is... Problem...what problem? If you are having a problem What should I say to my doctor? Facts and fiction Guarantee 2 4 7 8 11 14 23 25 27 31
An owner's manual for men
Think about all the tools, equipment and appliances you’ve bought in your life. Almost all of these came complete with an owner’s manual containing instructions that explained how
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So why is it that you don’t get an owner’s manual for your body — especially your sex organs? Surveys show that in most healthy relationships, the penis is something that is used a lot. Unfortunately, it’s not always user friendly. You assume your penis will always work perfectly and mostly it does. But sometimes it fails and that’s scary. The situation can be bewildering, frustrating and at times terrifying for both you and your partner. 2
you should always talk with your doctor for personal advice. 3 . if you think you have a problem. Although this manual may answer some questions about problems with sex. To answer some of your questions and lessen some of your fears. This owner’s manual includes information on: q how your sex organs work q reasons why you might suddenly find it difficult to have sex q what your doctor can do to help when there’s a problem q how to help your partner understand the problem and share in solving it q ways to get back to a good sex life. in plain language. some of the things you need to know.A N OW N E R ' S M A N UA L F O R M E N It seems there is a real need for an owner’s manual for the penis — to help you when something goes wrong and tell you how to fix it. and mostly to let you know that you’re not alone: every man with a penis is in much the same boat. That is the purpose of this manual — to tell you.
Everyone is different Much as your nose or ears are unique. Your penis is actually quite hollow — it is made of three tubes which run from the base to the tip. each has its own personality. some are lean and sensitive. another may be round. some are thick and bulky. so is your penis. Structure of the penis Blood vessel Tubes of erectile tissue — these fill with blood during an erection Cross-section of the penis Urethra (tube allowing urine to pass from the bladder) Blood vessel Tube connecting to the bladder — allowing urine to be passed Direction of cross-section Spongy tissue (most of the penis is made of this tissue) Testis 4 . blunt or cone shaped. The head of one may resemble a fireman’s helmet. No two penises are exactly alike.
5 . You can see that your penis has to be able to change function as needed. q The other two tubes are used to make your penis hard enough to have sex (an erection). back into the rest of the body. q There is about seven to eight times more blood in your penis when it is hard than when it is soft. When at rest it is used to empty the bladder of urine. All this is controlled by the brain. the blood normally can’t flow back out. This happens when you become aroused or feel like having sex. q Between half and one teaspoonful of semen comes out of your penis each time you ejaculate (discharge semen). This is because the pressure of the blood in the tissues closes the blood vessels that would carry it out to the rest of the body. Once sex is over. q The semen contains millions of sperm — yet only one is needed to make a baby. the muscle tissue contracts and allows the blood to flow away. In a hard penis.EV E RYO N E I S D I F F E R E N T q One tube connects to your bladder and allows you to pass urine. They are filled with a special sponge-like tissue that swells and becomes firm when blood flows into it. when aroused and erect (hard) it provides the way to have sex and is a channel for semen.
then the amount of semen should be about the same each time. q Regular sexual activity can keep the body’s sexual systems in good shape.EV E RYO N E I S D I F F E R E N T q A smaller amount of semen will be released if you have a few ejaculations during one sex session. q Draw the foreskin (hood) back fully. 6 . it is difficult to urinate when the penis is erect. Lack of use can create its own problems with sex after a time. All men are born with uncircumcised penises. If you have many hours or days between the times you have sex. If your penis remains unchanged. This simple procedure loosens the foreskin and doesn’t require circumcision. it takes a little more time to keep the nooks and crannies clean. q As you may have noticed. q Remember to replace the hood in a comfortable position. or if it is painful and seems to stick in places a small repair job may be necessary. It is also difficult to ejaculate semen when the penis is limp. q If it gets stuck on the rim of the penis.
your inside feelings and the circumstances of the moment. Yet. their size when erect and hard is more or less the same. Your penis shrinks with fear and cold and appears larger in a warm. maleness and general strength are thought to be set by the size of the penis. heavily built man’s penis may look smaller. In many cultures.There are no secrets about size Nearly every man is concerned about the size of his penis. q A penis that seems small can swell a great deal to become erect. This is a fantasy because the penis will constantly change its size depending on the outside temperature. A large. Both types end up more or less the same size when fully erect. It is almost impossible to judge what the erect size of your penis is when it is at rest and limp. A small. the average length of the penis is twelve centimeters (about five inches). A seemingly large penis may swell less. In spite of the fact that all penises are physically different. There may be no worse place to try to compare yourself with others than in a urinal line or a group shower room. comfortable atmosphere. slightly built man may have what appears to be a large penis. 7 . potency. q When erect. q Size can be an illusion in men of differing build. it is frequently when at rest that men try to compare themselves.
it takes longer for your penis to harden. Usually. As you get much older.How an erection happens An erection — a hard penis — is simply a sign of comfort and arousal (sexual excitement). you are still in part of the dream cycle. When a woman dreams. It doesn’t take a lot of arousal to cause an erection. How it works There are both physical and mental ingredients involved in having an erection. men do have erections while they sleep. pictures or fantasy — or just thinking about sex. More time. They accompany dreams which happen three or four times each night — whether you remember them or not. similar to what happens to the penis during an erection. her sexual organ (the clitoris) swells. stimulation or manual help may be needed. 8 . Young men can get an erection very quickly — through erotic stories. This happens to women too. there will be no erection. It is also not always a sign of arousal. especially for younger men. Your erection has nothing to do with having a full bladder. q When you wake up with an erection. q If your dreams are in any way anxiety provoking or scary. These are parts of your relationship that can also affect your sexual health.
without too much stress. For example. q A relaxed and happy outlook.H OW A N E R E C T I O N H A P PE N S What a man needs for an erection Good nerve supply to the penis from the main nerves of the hip and backbone areas Healthy blood vessels to carry special body chemicals and to control the blood flow for an erection to be possible This is what a man needs to have an erection: q Healthy blood vessels throughout his body. 9 . q The right amount of special body chemicals (the ones that travel in the blood and affect the sex organs. so the blood flows in the right ways. stomach or the actual sex organs. those that help the blood stay in the penis during intercourse). q No nerve damage in the area of the hips.
the spongy tissue squeezes against veins in the walls of your penis stopping the blood from flowing back out. The process is like this: You have a sexual or erotic feeling A special body chemical is released causing the muscles in the walls of your penis to relax Blood flows into the spongy tissue of your penis causing it to harden and become erect. just waiting to be called into action. It is a step-by-step process that is set in motion by substances that are always present in the body.H OW A N E R E C T I O N H A P PE N S Being sexually aroused is the most important trigger to an erection. 10 . As the inside of your penis fills with blood. All this blood held in your penis keeps it hard.
. They finish before their partners can enter the general flow and rhythm of the sexual experience to enable them to also achieve an orgasm. the strength of your feelings and the amount of semen may lessen for a while. Sometimes the intensity of the sexual feeling may be so great that the muscle twitch may spread to the back passage (anus) causing a short.. the amount of semen should return to normal. This is a sudden spurt of semen lasting a few seconds. It can feel differently depending on how intense the arousal was. The semen may be passing into the bladder and not out of the tip of the penis..the ejaculation. Lasting longer is a learned experience and can contribute to a mutually satisfying relationship with the partner. q If you have frequent sex ending each time with an ejaculation. The number of times a man has sex over his lifetime does not affect the amount of semen the body produces.And the result is. 11 . Once your body has had a rest for a few hours or days. it may need a visit to a doctor for repairs. Some men have difficulty with ejaculation. sharp pain there — this is normal. If this happens. Many men ejaculate too quickly.. Usually a certain amount of semen is produced by the body each day.. The making of sperm inside the body continues at the same rate as long as a man is in good health.
is normal for all men. There is a normal build up of the semen that the body releases on its own while you sleep.A N D T H E R E S U LT I S . or ejaculating during an erotic dream while you are asleep. Blood now flows back out of your penis and into the rest of your body Your penis returns to its limp state 12 . . . After an ejaculation the system goes into reverse A different special body chemical is released This causes the muscles of your penis to contract or pull inwards. ‘Wet dreams’.
. having a good relationship with your partner and a healthy attitude towards sex will all help you as you age. In younger men. it may become more difficult to reach an erection — and you may lose it before you are ready to. taking care of your penis. If the stimulation is still there your penis might become hard again. . But this doesn’t always happen. A sudden distraction may cause you to lose your erection.A N D T H E R E S U LT I S . There are many senior citizens who function very well sexually. In older men this is more gradual. Fear or worry may cause an erection to fail. All erections are angled sharply upwards. Paying attention to your general health. As you age. Your erection will last as long as the sexual stimulation lasts. As you grow older your penis gradually sags to become more at right angles with your body. both getting and losing an erection can happen quickly. 13 .
Over 100 million men (1 in every 10) in the world worry about not being able to have an erection at some point in their lives.. .what problem? Did you know that more than half of all men over 40 have had a problem with getting and keeping an erection? In America alone. Only 2 million have ever had treatment (that’s only one man in every 15).Problem. It is a very common experience and is now understood to be a real medical condition that can be treated.. There are many problems — both physical and emotional 14 — that can affect the smooth functioning of your penis. it is thought that over 30 million men may suffer from this problem.
W H AT P RO B L E M ? Physical problems Among the physical problems that may cause you to have trouble with an erection are: q Aging q Illness q Accidents q Smoking q Operations q Alcohol. and q Drugs (both prescriptions from the doctor and illegal drugs) Aging Sometimes. . but changes can occur in the time it takes to get and keep an erection and in the hardness of your penis. If an older man finds it difficult to have sex.P RO B L E M . 15 . This doesn’t happen to everyone. It’s all perfectly natural. the aging process causes a change in the sexual habits and abilities of men. This could be enough to help get your sex life back to normal. and the solution may be an easy one. extra foreplay and attention may solve the problem. .
. to een T 40 Younger men can usually have an erection at almost any time.P RO B L E M . . just by thinking about sex. 16 . – 40 70 A man's response to sexual thoughts becomes slower. 70 ver O An older man's erections may be less firm. Manual help might be needed to make the penis firm enough to be able to have sex. They also usually have a higher sex drive than older men and may recover after ejaculation and be ready to have sex again in just a few minutes. and more foreplay tends to be needed. For men in their 70s. this can be as long as 12 to 24 hours. and he might find it difficult to have sex again for quite a few hours after a first ejaculation. W H AT P RO B L E M ? The chart below shows some of the differences among men as they age.
particularly if those special organs begin to fail. there is a 17 . when many illnesses start. there are lots of common diseases that can all cause problems in getting and keeping your penis hard enough to have sex. high blood pressure. Illnesses such as hardening of the arteries. If a man has cancer and is treated with chemotherapy. For example. stroke. This can mean taking energy away from sex to help make a man well again. A man can also have problems with the balance of the special body chemicals that help sex happen or control how a man feels in general. . Other illnesses such as kidney and liver diseases can affect your sex life. For long-term illness. this can be a slow process and the loss of ability in having an erection might not even be noticed for quite a while. Often. . heart attacks. a man can find it difficult to have or keep an erection because the body makes changes to try to get well again. this can also cause problems with sex. W H AT P RO B L E M ? Illness As men age. heart disease.P RO B L E M . diabetes (where the body is unable to control the blood sugar level) and injury to your sex organs can all cause problems. radiotherapy or surgery.
the amount of testosterone in the body nearly always begins to drop quite naturally. and this can make a man feel restless or very tired all the time. . 18 . W H AT P RO B L E M ? thyroid gland in the body that can be overactive or underactive. This is one reason why sex drive and ability can decline with age. A thyroid gland problem can cause a man to lose interest in sex because he is not relaxed enough or doesn’t have the energy. Accidents and operations Some men have problems with sex after they have had an accident or operation. The body chemical that controls sex in men is called testosterone and this is also what makes a man grow more hair than a woman. . Anything that causes the blood flow into your penis to be reduced can stop your penis becoming hard enough for sex. have a deeper voice and develop male sex organs (the penis and testicles). There can be problems with the levels of body chemicals that can control how a man feels about sex. This is usually because there has been some damage to nerves or blood vessels.P RO B L E M . As a man ages.
Operations on organs in the lower body. worry or high blood pressure. such as your hips or lower back (the pelvic area). Drugs Over 200 drugs used for other illnesses can affect your sex life. can also have an effect on your sexual function. . W H AT P RO B L E M ? Accidents or operations affecting your lower body might cause nerve damage that could affect your penis and whether you can have an erection. such as the prostate. the illnesses themselves can cause sexual problems. In either case. it’s important that the prescribed drugs are taken. because the illnesses they treat can be very serious. They include drugs to help depression. Breaking bones. or accidents to the spine can also affect the nerves or blood flow and cause erection problems. This kind of side effect may be only short term. Also. the bladder or large bowel. 19 . . or sometimes other drugs can be found that won’t cause this kind of problem.P RO B L E M .
and they are often poorly understood. . . Your doctor can give you good advice about what you might expect. Emotional problems Emotional problems can play a major role in being able to get and keep an erection. W H AT P RO B L E M ? Smoking and alcohol Drinking too much alcohol or smoking a lot of cigarettes can damage the blood vessels and nerves that affect your ability to have an erection. It may take a while for your body to recover from the use of alcohol. Giving up any of these can have a positive effect on your sex life — if the habit is stopped in time.P RO B L E M . drugs or cigarettes. 20 .
have become part of our lifestyle. both at home and at work. 21 .P RO B L E M . . W H AT P RO B L E M ? One of the reasons most often mentioned as causing sexual problems is stress. and there might be a drop in the ability to perform when he does try. Some of the other emotional issues that may cause sexual problems are: q thinking too much about other issues and forgetting about your sex life q shyness q concern about performance or about the size of your penis q being in a new relationship q worry about a long-term relationship. . Because stress lowers the levels of important male body chemicals. The stresses in our world. Few people today are totally free of stress or worry. a man might not want to have sex as often.
your desire to have sex and your ability to get and keep an erection is affected by: q your overall health q what happens in your social life q how happy or positive you are about life in general q what sort of attitude you have to problems not related to sex q your lifestyle — how busy you are. Also. . This is when a doctor might suggest going to a counselor (a person who works with emotional problems). These experts can give advice on why you have a problem and then help to solve it. what else is on your mind at the time. especially when you are so determined to succeed. remember that for most men who cannot get or keep an erection the problems can be treated. Sometimes these feelings are so deep that you are not even aware of them and the effect they are having.P RO B L E M . 22 . Remember! At all ages. W H AT P RO B L E M ? Another big issue is fear of failure – it’s hard to believe that fear of failure causes failure. Other emotions such as depression. A visit to the doctor can usually sort out a treatment that works. . worry or anger can also affect your sex life.
Not being able to have sex can greatly affect both your life and your partner’s. or it goes away too quickly or might not last long enough to satisfy your sexual partner. You might still feel like you want to have sex but you can’t because your erection is not hard enough. Men don’t often know why their sex lives have started to be a problem and they can feel sad. 23 . sexual problems like this can lead to problems like arguments. In a relationship. this doesn’t solve the problem or make it go away. Sometimes it creates more problems. blame. Unfortunately. The first step is to see your doctor. frustrated or maybe even angry. Some men hide their difficulties from their partners. loneliness or sadness. If you are experiencing a problem having sex — getting an erection or keeping one — there is help available and there are medical treatments. Your partner may feel unloved or unwanted — or might think you are having an affair or want to end the relationship.If you are having a problem Having a problem getting or keeping an erection is a big deal for a man.
.” “I feel less of a man” “I'm afraid to get married.” ..” “It can't be good for my partner....” “A huge sense of loss and an increasing feeling of uselessness” 24 “I began to feel like it was all my fault and that there was no solution.I F YO U A R E H AV I N G A P RO B L E M Here’s what some men with sexual problems have said to their doctors: “I kept my thoughts to myself and became “I'm afraid very bitter” of losing my partner....
What should I say to my doctor ? Among the many things that have kept men from talking about their sexual problems is the fear that What is normal for my age ? “the problem is in the mind”. 25 How much do treatments cost ? . so you can find out all you need to know about your problem and about treatment. Are there any side effects ? Why am I having difficulty getting an erection ? These are some examples of the questions doctors get asked most often on this page. it may be because of a physical reason be that can Why do I have an erection in the morning but not at other times ? treated. you now understand that if you are having a problem getting or keep- Why is my erection not like it used to be ? ing an erection. And talk to your doctor. You might like to use them. Hopefully. Talk to your partner.
so you can make notes of what your doctor says.W H AT S H O U L D I S AY TO M Y D O C TO R ? If you go to your Why am I not feeling as interested in sex as usual ? doctor. 26 . You may also want to write down some Do treatments really work ? questions of your own before you go. it might be a good idea to take a pen along.
Trying to wash out any germs after sex can be too late... This is Germs can completely enter the body normal. Many older men (in their 70s. “An erect penis must be absolutely straight” “Urinating after sex will WRONG wash out the possibility Some of an infection” penises WRONG have a slight curve. Wearing a condom is the best way to reduce risk to you or your partner. “Too much sex when you’re young will mean you can’t do it as much when you are older” WRONG Your sex life can carry on well into old age. through the skin of penis and this can happen in a few seconds.Facts and fiction There are lots of myths about sex and sexual ability. Younger men may be more healthy and energetic so they feel like having sex much more often — but this has no effect on what they will be able to do when they are much older. These are a few of the ones heard most often — and the real answers to the statements. 80s and more) have become fathers. 27 .
Also. Lasting longer is an internal sense. WRONG there is no real problem” WRONG An erection problem has a physical cause. some men might have only one erection during sex and then they continue the intimacy of sex in other ways. because the head of the penis is less sensitive” “It’s all in the mind. circumcised penises last longer during sexual intercourse. Sex is based on shared experience.FAC TS A N D F I C T I O N “Men who can have more than one erection during sex are more masculine than men who can only have one erection” WRONG All men need a rest after ejaculation while the body replaces semen. Usually it can be a sign of another illness or can occur because some medicines have side effects that cause this type of problem. not a “Men with single performance. 28 . The time for resting usually gets longer with age as your body’s overall function slows down. an awareness and a feeling of control and it can be learnt.
These feelings can become a downward spiral of failing to have an erection and then feeling inadequate. Millions of men are enjoying sex again after treatment. Because emotions can be so intense. By the age of 50 almost all men will have experienced some problems in having and keeping an erection. This is when outside help should be looked for and a visit to the doctor could really help.FAC TS A N D F I C T I O N “If a man can’t keep an erection it means that he doesn’t love his partner any more” WRONG You may be so involved with your partner that you try too hard to have an erection. the spiral of trying and failing may continue. you can feel under stress and the stress itself can stop an erection. WRONG It can almost always be treated. 29 . “Once you have a problem with erection you just have to learn to live with it” “Only old men are affected by this condition” WRONG Men of all ages are affected. No matter how hard you may try to relax or whatever other approach is used.
Often it is really other factors in the relationship that encourage sexual response. “Women prefer men with large penises so that they will have an orgasm” WRONG The nerves that trigger a woman’s orgasm are near the entrance to the vagina so penis size does not really matter. 30 .FAC TS A N D F I C T I O N “Not being able to have an erection is a sign of a loss of manhood or lack of sex drive” WRONG Erection problems usually involve other health problems which can include: q problems with blood flow in the body (such as high blood pressure) q diabetes (changes in blood sugar levels) or its treatment q “Only a few men suffer from problems like this” WRONG Over 100 million men (1 in every 10) in the world are not able to have an erection at some time in their lives — it is a very common condition. shock or wounds from accidents or operations.
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Erectile Dysfunction Advisory Council 1998 .32 © EDAC.
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