When the male equipment fails

Modern medicine may have the solution if the penis is bent, limp or otherwise falls short of the mark

BY MARK NICHOLS

Maclean's / February 22, 1999

For years, Dave (not his real name) was plagued by a crushing lack of self-confidence. Family problems in his childhood had left scars. He was chronically overweight. And there was the problem with his penis -- Dave was obsessed by the belief that it was too small. "It affected my whole life," he says. "I wouldn't go to a school that had a pool. I was afraid of meeting people, and I didn't have sex with anyone till I was 24 because I was so worried about my penis." Then in the summer of 1996, Dave's life was transformed when Toronto plastic surgeon Robert Stubbs performed a delicate and risky procedure that added just over an inch to the length of his penis. Enhancement came at a considerable cost: besides paying more than $5,000 out of his own pocket (no provincial health plans cover penis lengthening), Dave had to tape 14 ounces of weights to his organ for nine months and, as a result, suffered from urinary incontinence. But having a longer penis made it all worthwhile, says Dave, 47, a salesman in southwestern Ontario. "My confidence is way up," he says. "I feel like a man."

For obvious reasons, penis extension is not for every man who has doubts about his endowment. But feeling like a man -- feeling right about what's down there -- is something that matters deeply to most males. All kinds of things can go wrong with the male reproductive equipment. Close to one in 100 Canadian men may seek treatment -- with drugs or surgery -- for Peyronie's disease, an unexplained scarring of the penis interior that can bend the organ in awkward and sometimes painful ways. Some men feel so badly about having lost their foreskins to circumcision that they are taking extraordinary efforts to re-create one. Others suffer from the frustration of premature ejaculation or impotence. And there are concerns that environmental pollutants may be degrading sperm quality. "Our feeling," says Dr. Keith Jarvi, a Toronto urologist, "is that there are more infertile men out there." And infertility, he adds, can be a source of enormous distress for men -- "some feel just torn apart when they can't father children."

Among the troubling issues in the world of men's reproductive zones:

· Erectile dysfunction: An estimated three million Canadians suffer from the failure to have adequate erections or, in severe cases, any erections at all. Rarely discussed in public a generation ago, ED is a hot topic today, thanks to Viagra -- the highly effective potency pill that went on sale in the United States last March and has since been approved in 50 countries. But not in Canada. In a review process that has so far taken more than 14 months, Viagra is still being studied by Ottawa's Health Protection Branch. Now, officials say it could be available in Canada this spring -- if all goes well. "I think we are getting close to a final decision, if no other new developments occur," says Dr. André-Marie Leroux, a Health Canada medical officer.

Currently under scrutiny are reports of more than 170 Viagra-related deaths around the world. Many physicians note that some fatalities involved men with heart conditions who ignored warnings against using nitrate-based drugs along with Viagra. "Considering that the vast majority of men who use Viagra are over 65," says Dr. Rosemary Basson, a Vancouver physician specializing in sexual issues, "the number of deaths is a lot lower than I would have expected." Dr. Michael Stephensen, a Winnipeg family physician, deplores Ottawa's delay. "This is a quality-of-life issue for a lot of men," he says. "And I don't think Ottawa has a valid reason for holding back."

· Premature ejaculation: Affecting perhaps one in 10 men at some point in their lives, this condition can be another source of acute sexual distress. The problem is often considered to be psychological in origin, and experts say the widely accepted idea that partners' orgasms ought to coincide can exacerbate male "performance anxiety." Treatments include creams to desensitize penis tissue and, in recent years, the use of Prozac-like drugs, which can also delay orgasm -- and, unfortunately, reduce sexual drive. Talk therapy can also help, says Dr. Jeremy Heaton, a Kingston, Ont., urologist, "because people often have no points of reference about sexual problems -- they watch porn movies and see men who can make love for hours." Explaining that the average length of intercourse is "minutes rather than hours," says Heaton, "can help to dispel the emotional overlay and confusion."

· Fertility: Since alarms first sounded in the early 1990s over an apparent worldwide decline in sperm counts, a different consensus has developed among scientists. Counts appear to be falling in parts of France and Scotland, recent studies show, but American researchers have found slight increases in some regions of the United States. In Canada, an analysis of data from 11 fertility clinics published in July concluded that there had been a 4.3-per-cent decline in sperm counts between 1984 and 1996, to about 90 million per millilitre of semen from 94 million/mL. Canadian experts regard anywhere from 20 million/mL to 200 million/mL as normal.

But that does not necessarily mean Canadian sperm counts generally are slumping, noted the study's authors at Health Canada and McMaster University in Hamilton, because people who go to fertility clinics are not typical of the population. There are no reliable statistics on male infertility in Canada. "We're just seeing a ton of men with problems," says Toronto's Jarvi. But at least some of that, he notes, is attributable to many Canadian couples having children later in life, when sperm counts naturally declined. There may be other causes, however. Bernard Robaire, a pharmacology professor at Montreal's McGill University and an authority on fertility issues, thinks further research may show that industrial contaminants are affecting male fertility on a local basis. "As for there being a global problem," he adds, "I just don't believe it."

· Circumcision: For some men, lacking a foreskin is a major emotional and physical issue. When Wayne Hampton was four days old, a Chatham, Ont., doctor performed a minor surgical procedure that was common at the time -- and sliced away Wayne's foreskin. Now, like a small but growing number of circumcised men, Hampton, 49, has a "restored" foreskin, achieved by using elasticized tape for several years to stretch the remaining skin over the end of his penis. Like other members of the foreskin restoration movement, Hampton, a computer programmer in California's Silicon Valley, says he was driven by the feelings of "violation and anger" over his infant circumcision.

Such emotions have been intensified by the findings in recent years of researchers who carried out pioneering studies into the foreskin's anatomy. "Circumcision," says Dr. John Taylor, a retired Winnipeg pathologist and a foreskin expert, "removes some of the most specialized and sensitive tissue in the human body. Men have been told for years that the foreskin is just a useless flap of skin. But it is far more than that."

Once a widespread practice in some industrialized countries, infant circumcision is declining outside of Jewish and Muslim communities. In Canada, fewer than a quarter of male infants are currently being circumcised -- compared with an estimated 60 per cent a generation ago. Meanwhile, officials at the San Francisco-based lobby group the National Organization of Restoring Men claims that more than 10,000 Americans are re-creating their foreskins. The numbers in Canada are much smaller -- restoration groups exist in several Canadian cities, with about a dozen men attending meetings of NORM's Toronto chapter. And although a "restored" foreskin lacks the sensitivity of the original, Hampton says he is delighted with his. Now he is capable of a smoother, "gliding motion" during intercourse, says Hampton, "and my wife likes it, too."

· Penis extension: Working at an office in Toronto's upscale Yorkville district, Stubbs has made the penises of about 450 men an average of 1 1/4 inches longer since 1993. The operation exposes part of the organ that is normally hidden by tissue at the base of the penis. "I'm increasing the length of the visible penis," he notes, "and of the usable penis." Stubbs says that because there is a small risk of impaired sensation and even loss of the penis, he usually tries to talk patients out of lengthening, particularly men whose organs are already normal in size.

When he began, Stubbs was the only certified plastic surgeon in North America who lengthened penises. Now, he says, hundreds of American physicians and two more in Canada are performing similar procedures. Stubbs trained Vancouver plastic surgeon Don Fitzpatrick, who estimates he has lengthened about 60 organs since 1994. Fitzpatrick says he sometimes turns men down for the operation, "because they want more than I can deliver." Why does he perform penis extensions? Because, he says, it makes men feel better about themselves -- and about a part of the body that is enormously important to the male ego.

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