Ron, a forty-one-year-old electrician, was one of the first men who enroled in the Phase III Vasomax trials that I supervised. Using two thousand patients from around the country, Zonagen, the manufacturer of Vasomax, began additional research. The participating doctors and subjects knew the drug that was being tested. In this case, it happened to be the 40 mg dose of Vasomax. The goal was to get long-term safety experience with the medication prior to applying to the Food and Drug Administration for formal approval.

“I felt that the sex I was having was just okay,” Ron told me on his first visit. “I also knew that it should have been a lot better. I’m not looking for the stamina of a teenager,” he admitted, “but now sex doesn’t feel the way I know it can be. Getting an erection isn’t the problem—it’s that I’m not as firm and full as I used to be. Amy, my wife says it doesn’t bother her. But I’m very aware of it—and it upsets me. A lot.”

Ron was so dismayed by his problem that he mentioned it to his family physician after a routine checkup. His results were fine, with the exception of an elevated cholesterol count. At 260 milliliters per deciliter(ml/dl) it was high, and his doctor told him that he should work on lowering it to a healthier level of under 200 ml/dl.

When Ron voiced his sexual concerns, he was stunned by the doctor’s reaction. “You’re in your forties. What do you expect?” he was told. ” Yon have to expect a little letdown in your sexual performance as your age. It’s just the way it is.”

Not for Ron it wasn’t. Dissatisfied with both his doctor’s interpretation of, and insensitivity to, his problem, he made an appointment with a urologist for more detailed testing. Maybe, he thought, his doctor had missed a clue that would solve his ED.

After providing a complete medical history and answering questions about masturbation, morning erections, and his libido, Ron underwent a more complex physical exam which included the health of his genitals and prostate gland. Then he had to undergo what he referred to as “the single most embarrassing event of my adult life.”

The doctor explained to him that in order to fully determine the extent of Ron’s ED, he would begin tests to measure and scrutinize erectile function. Standing naked in front of the doctor, Ron saw what was going to happen next. The urologist was approaching him with an ultra-thin needle and his aim was low. Extremely needle-phobic, Ron tried to calm himself while he was injected in the base of his penis with tri-mix, the combination of papaverine, phentolamine, and prostaglandin E-l.

Within five minutes, the drugs began to take effect, resulting in an erection. But Ron’s experience wasn’t about to end there. Left alone in the examining room, he was instructed to remain standing and masturbate. Erotic materials were provided in the event that he needed them. Then, in order to test the effectiveness of the tri-mix, the doctor had to know whether or not he had successfully masturbated and how long his erection lasted. To ascertain this information, he checked on Ron every ten minutes to note penis rigidity and fullness. For almost twenty minutes after the injection, his erection was still hard, then began to subside. Needless to say, nothing about this episode even vaguely approached normal sexual response.

Nevertheless; comparing the test results with his medical history, the urologist was able to diagnose a mild blood flow disruption to the penis. He believed that Ron’s erection problem was triggered by early arteriosclerosis, or hardening on the arteries. This, the doctor informed him, was most likely linked to his elevated cholesterol. That, in turn, was connected to arterial blockage, which resulted in his mild blood flow problem.

Ron left the doctor’s office feeling, as he later put it, “about as lousy as I’ve ever felt. Telling me to inject myself every time I wanted to have sex with my wife was not what I wanted to hear. I had to find another way.”

*44\138\8*

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