The 20th century will be remembered for many things. The A-bomb, the Beatles, a couple of world wars, and of course, Weird Al Yankovic. But for the penis-centrics amongst us it will also be remembered as the time that science finally rolled up its sleeves to solve the problem of erectile dysfunction. As you might remember, at the end of the 19th century science was taking its first tentative, albeit wholly misplaced, steps to deal with the problem.
By the turn of that century this much was known about the erection: 1) It was vascular. Blood went in yet somehow didn't come out until the erection subsided; 2) It was neurological; 3) It was hormonal. The defining male essence, testosterone wasn't isolated until 1934 but they knew something in the testicles was responsible; and 4) It was mental. In other words, they knew all the elements involved in a pocket rocket but had no idea how lift off actually occurred. They had no shortage of theories though.
One of the earliest approaches was also in many respects the most obvious. If a stiffy was produced by blood coming in and not going out, then it stood to reason that the lack of a stiffy was a function of blood draining too quickly. The solution: block the drains. While a handful of doctors attempted various forms of venal ligation with middling success, it was a urologist by the name of G. Frank Lydston who is most closely associated with the procedure. Lydston was something of a latter day Renaissance Man. He wrote several works of fiction and went on to become one of the leading lights of the eugenics movement, advocating sterilization of criminals and the castration of Negroes accused of raping white women.
Lydston eventually abandoned venal ligation in favor of testicle transplantation (you may remember Frank as the dude who transplanted a testicle into himself). While venal ligations were performed throughout most of the century, it had a low success rate (less than 30 percent) and there were some serious complications including penile necrosis. "We have good news and bad news. The good news: The surgery was a success, your dick can get hard again! The bad news: It's gonna fall off... sorry."
The second approach was hormonal. As we've seen, testicle transplants were de rigueur during the 1920s, as were testicular extracts. When testosterone was isolated in 1934 there was a brief flurry of excitement (Hitler reportedly received injections) until it became clear that, while it had many effects, (increased strength and aggression, acne, hair loss and little bitty balls) it didn't do much to cure erectile dysfunction. While extremely low levels of serum testosterone have been associated with erectile difficulty, erectile dysfunction is rarely the result of low testosterone.
The third therapeutic approach was psychiatric and this eventually became the dominant means of dealing with erectile dysfunction for most of the century. In fact, as recently as the early 1980s, impotence was understood be almost entirely psychological in origin. Despite the success of Viagra and other erectile medications, many psychologists still cling to this belief. The "it's all in the mind" point of view was an outgrowth of the Freudian revolution. Freud believed that impotence arose from anxiety stemming from unresolved Oedipal issues. The idea that a man can't get it up because he unconsciously wants to sleep with mother and fears castration from his father may seem laughable from a 21st century perspective, but one cannot dismiss the power that Freudianism had over modern thought. People really bought into this.
There developed something of a turf war between those that believed impotence to have a psychological etiology and those (mostly urologists) who insisted it was physiologic in origin. The gauntlet was thrown down in 1927 with the publication "Impotence in the Male" by Wilhelm Stekel. Stekel, a disciple of Freud, insisted that, except in the rarest of cases where there was genital damage or disease, there was no such thing as organic impotence. In Stekel's estimate, impotence was 95 percent psychological in origin. He had no epidemiological evidence to support this assertion but people, both scientists and laymen, accepted the figure as fact.
This may seem bewildering given that it was so obviously off the mark. Did no one ask themselves why, after humping happily for most of their adult lives, men would suddenly be seized by Oedipal conflict? Urologists did, of course. There was even a debate held in 1936 between urologist Max Huhner and the famous psychoanalyst, Karl Menninger. But science, then as now, is driven largely by fad and the prevailing winds of the zeitgeist. Sometimes baseless assertions stick. Witness the orthodoxy of behaviorism in the 1950s or the current assumption that all rape is about power. In the battle for therapeutic supremacy, the psychologists won out - for a time anyway.
This was largely because the urologists of the time had so little to offer. Max Huhner himself was still clinging to the 19th century notion that impotence was a function of too much stroking-off. Add to this the questionable surgeries that were being performed with little success and it's no surprise that the prevailing winds drifted away from the physical etiology of impotence to the mental.
As it turned out though, the only real success achieved in combating erectile dysfunction for much of the 20th century fell to engineers. Engineers didn't know what organic or psychological issues caused the phallic balloon to go flat and they didn't care. They just wanted to pump it up again.
The first bright idea came by way of an Austrian inventor/engineer by the name of Otto Ledever. Ledever reasoned that if erection was achieved by blood being drawn into the penis and staying there, the effect could be achieved by applying a negative pressure on the penis and pulling the blood in. In 1917, Ledever patented an airtight cylinder topped by a bulb that acted as a vacuum extractor. It was the world's first penis pump and it worked... after a fashion. A limp dick could indeed by converted to an impressive erection. The trick was to maintain it when the vacuum was released. This was achieved by means of a constriction band around the base of the penis. It didn't last long and it tended to be floppy (the root of the penis inside the body remained flaccid), but for those willing to go to the effort it permitted insertion and something a little like sexual intercourse. And, as any mathematician can tell you, even a little is infinitely more than none.
The second major innovation was the prosthetic implant. The first of these was fashioned by Nicolai Borgoras out of rib cartilage. Borgoras was inspired by the baculum or os penis found in many mammals. His experiment was not a success, as the cartilage was reabsorbed after a few months. But it did allow for insertion and once this effect was acknowledged it was only a matter of finding a rigid material that wouldn't be rejected by the body. The answer lay in plastics.
In 1952, surgeons implanted acrylic splints between the corpora cavernosa in five patients. It worked but proved too uncomfortable and the approach was superseded in the 1960s by polyethylene prostheses that could be inserted into the corpora itself. The technique was improved further in the seventies with the introduction of sponge-filled silicone implants placed intracavernosally. The main problem was the penis was maintained in a state of constant erection. It could be folded up or down but it remained stiff. This problem was overcome with the development of the "Flexi-Rod" that could be bent as the owner required. It still left the patient with a permanently expanded penis but hey, that was a cross most recipients were willing to bear.
The real breakthrough came in 1973 when F. Brantley Scott developed the inflatable prosthesis. The Scott device consisted of two silicone reservoirs that were inflated by means of a subcutaneous pump, positioned in the scrotum. And for some years this was the gold standard in erectile therapy and it remains in use today. I remember reading about it wide-eyed when I was a teenager. The problem with the device is that it requires slicing open your dick and walking around with permanent hardware in your nether regions. It's an extreme measure for any man to take and many are understandably reticent about undergoing the procedure.
Then in 1983, the world of erectile dysfunction was turned upside down when an Englishman named Giles Brindley stood up in front of several thousand attendees at a urological convention and pulled down his pants. But that's a story I'll leave to another week.
