BETTER SEX THROUGH PROLONGED POTENCY

BETTER SEX THROUGH PROLONGED POTENCY

A Unique Guide for Men of All Ages

By David Schaeffer

Men. Dont go without checking out Vigoboost.  Its a long established herbal formulation that has been delighting our male customers for 26 years 

Chapter One

Many people believe that a man's sexual ability diminishes as he gets older. Although generally speaking this is usually the case, I can assure the reader that it does not have to be this way. Indeed, apart from a few exceptions, there I no reason why a man should not remain potent until he is well into his old age.

Several years ago I ghosted (wrote on behalf of somebody else) the autobiography of a prostitute who owned a massage parlour. During the course of her career this lady, who I will refer to as Ruby, had firsthand experience with literally dozens of elderly men in their seventies and eighties, many of whom had broken virtually every rule that would have been laid down by many doctors. One man for instance was a smoker, eighty-two years of age, had a good mop of hair and was very sprightly. He used to journey from London to Birmingham by train every week to visit Ruby's establishment to avail himself of her personal services.  This man was far from being sterile or impotent. Quite the contrary, his sexual performance outlasted and out-satisfied that of quite a number of men who were only half his age.

A considerable number of women, but prostitutes in particular, usually simulate enjoyment or satisfaction during intercourse, but Ruby confided to me that this was not the case with this gentleman, indeed she used to look forward to his weekly visits. Over a period of time she became very partial to elderly men and was curious, or even fascinated, as to why most of them could out-perform many of their younger contemporaries.

Apart from being discreet and understanding, she was also a very good listener. Consequently when she used to ask some of her clients, who ranged from retired postmen to accountants and barristers, how they managed to remain so sexually active, they were only too pleased and sometimes proud to tell her. In its turn this resulted in her gleaning numerous nuggets of knowledge and wedges of wisdom, not to mention certain common denominators which could have been presented as a kind of guide or information pack. Actually, this would have made a much more informative and interesting book than the theme on which she had commissioned me to write, which was about her childhood in Ireland, her life in a convent, how she became a prostitute and some of the bizarre sexual acts she had to perform etc. However, he who pays their piper calls the tune so this is what I did, but let me hastily add that certain information which she didn't want to go into her book is included in this, but first things first. We will come back to Ruby later in this work, in the meantime a subject which is not only VITAL to a man's sexuality but also to his LIFE, and which every man over forty should be aware of, must be dealt with and that is his ‘Prostate'.

In order to give the reader even a rudimentary understanding of the importance of a healthy prostate, several chapters will be necessary to give this subject adequate coverage.

Chapter Two

If you are male and over forty, it is almost inevitable that sooner or later you will suffer from some kind of prostate disorder. Indeed, the older you get the more likely your chances are of experiencing some kind of discomfort. This can range from having to get up several times during the night to visit the toilet, to impotence or even prostatic cancer.

For some reason, possibly because the prostate gland is identified with sexuality, a considerable number of men are reluctant to talk about this problem let alone admit that there could be something wrong and that they are getting old.

Incidentally, if you are looking for a rapid painless cure that can be administered by anyone, forget it. You might just as well try looking for an abortionist in the Vatican.

However, having said that, you may well find that things may not be quite as bad as you feared, and even if they are, at least you will know what to do about it and when.

Before going any further, the following analogy might help you to understand what I'm driving at. Any motor mechanic who is worth his salt can often identify certain malfunctions of a car simply by listening to the sounds of the engine.

Although his diagnosis might entail major and costly repairs, such as a new engine and so on, this may not always be necessary immediately. You could for instance get away with plugging a leak in a radiator for quite a long time before having to incur the cost of a replacement.

By the same token, although your particular prostate disorder might ultimately require some form of surgery, it could be years before it actually became necessary. In the meantime it may be possible for you to alleviate some discomfort by paying more attention to what you drink. If, for example, you can cut out caffeine beverages or drinking three to four pints of beer during the evening, this alone could reduce the number of times you would need to spend a penny.

Just before moving on to the symptoms and ramifications of this subject, I think this is a most opportune moment to establish exactly what the prostate is.

If you care to study the illustration below, you will notice that the prostate is situated under the bladder. The latter is a store for urine produced in the kidneys. From the bladder to the penis is a tube called the urethra which passes through the middle of the prostate, rather like the core through an apple.

Most men's prostates , for some unknown reason, begin to enlarge usually after they reach fifty but sometimes before. Although this enlargement in its initial stages might not cause any discomfort, as this growth gets bigger with increasing age it can gradually squeeze the urethra to such an extent that the force and size of the urine stream is reduced. This by the way is known in medical terminology as Benign Prostatic Hyperplasia, but sometimes called Hypertrophy, however it is usually referred to as B.P.H.

I don't wish to alarm you at this early stage but it should be pertinently pointed out that when B.P.H. remains untreated it can lead to a total closure of the urethra making it impossible to urinate. This can result in a very serious illness and even death, so if you discover that you have the symptoms of B.P.H., which will be outlined presently, don't waste time, get in touch with your doctor immediately. It could save your life.

By the way, a benign growth simply means that it is not cancerous and does not attack other tissues or cells or spreads to other parts of the body. A malignant growth, as in cancer of the prostate, would spread to other parts of the body attacking and destroying other cells or tissue in the process.

The size of the prostate in the average adult male is about that of a chestnut, and as it is both muscle and gland it is called musculoglandular. It is a very complex organ made up of fibrous tissues as well as muscles and glands, and the fluid which is emptied into the prostatic urethra is produced in many of these small glands. In addition to this, the tube responsible for bringing the spermatozoa from the testis also injects its product into the urethra.

The spasmodic contractions of the surrounding muscles of the urethra enable these two fluids, with the addition of a third one from the seminal resicles, to be ejaculated.

In short, the prostate plays an extremely important part in a man's ability to fulfil his role during sexual intercourse. Consequently, some men are, quite understandably, terrified that any prostatic malfunction might diminish their sexual ability. Once again I feel that this is an ideal moment to point out that this is only true in certain cases, and these will be covered in due course. In the meantime your next important step is to find out whether you have enough symptoms to warrant calling your doctor, or discover that you could be worrying over nothing, and this will be explained in the following chapter.

Chapter Three

These are the usual symptoms of B.P.H. and as you will see they are all connected with the waterworks.

• 1.) The desire to urinate frequently during the day.

• 2.) Waking several times during the night to urinate. (This is known as Nocturia).

• 3.) A hesitation to begin urinating.

• 4.) A slowing of the urine's stream force.

• 5.) Being unable to shut off urine, or a dribbling after trying to stop it.

• 6.) Tightness and being unable to urinate at all.

• 7.) The feeling that the bladder has not been completely emptied.

• 8.) If the kidneys have been damaged by the retention of urine this can be responsible for dizziness, nausea and feeling sleepy.

If you have three or more of the symptoms above, make an appointment with your family doctor.

He will then most probably perform what is known as a digital examination which is not in the least painful but just slightly uncomfortable. As the prostate is next to the rectum, it can be palpitated and your doctor will just want to check to see if it feels enlarged and at the same time find out if there are any lumps or hard spots on the two lobes he can touch.

As stated in the previous chapter, a healthy prostate is about the size of a chestnut or walnut, smooth and elastic. If you have B.P.H. it will still feel the same but obviously bigger.

Generally speaking, a patient is not a good candidate for surgery during the early stages of B.P.H.; he is more likely to be put on a kind of maintenance program which entails annual checks by an urologist for any developments of the condition. There are case histories of men in their fifties who have been on maintenance care for up to fifteen years before the prostate has become sufficiently enlarged to require surgery or one of the new alternative treatments or drugs which are still being developed.

Incidentally, the notion that B.P.H. is a leading cause of prostate cancer is a complete myth. The cause of the former is unknown but the cause of the latter is, and they are in no way connected. It is true that in some cases during surgery for the relief of B.P.H. the prostate has been discovered to be cancerous when it had not been diagnosed initially. Actually, one of the benefits of surgery is that cancer can often be detected in its early stages before it spreads.

Although certain operations will be covered in greater detail at a later stage, this is an ideal opportunity to explode another two myths associated with prostate surgery. Namely that after such an operation the patient becomes sterilized or that an orgasm doesn't feel the same.

When all or some of the prostate is removed by prostatic surgery, with about fifty per cent of the patients, a disruption in the normal course of semen and other fluids usually ejaculated occurs. An orgasm feels just the same; it is simply that instead of the fluid going down the urethra and out of the penis, it takes the course of least resistance by flowing upward into the bladder. On the face of it this might seem to end the patients prospects of becoming a father, but it must also be pointed out that the semen can be rescued from the next urination shortly after the orgasm and can be artificially inseminated. However, as in the majority of cases, this situation is most likely to occur when the patient is in his forties, fifties or sixties; this should not be of great importance.

There are some other fallacious notions associated with prostate disorders but these will be dealt with in due course, in the meantime I will move on to a few other tests which are available.

If, during the digital examination, the doctor has discovered hard lumps or nodes or on the prostate, of which he was suspicious, then a biopsy would be performed.

Also, as about one in ten cases of surgery for relief of B.P.H. result in the discovery of prostatic cancer in its early stages, the patient may have to undergo further tests in order to establish that the prostate is not cancerous as well.

P.S.A. are the initials of a blood test called the prostate specific antigen test. The elevation of antigen can reveal a possibility of the presence of cancer in the prostate, and an accompanying test for prostatic acid phosphate, (P.A.P.) may reveal whether the cancer has spread to other parts of the body.

Another test which might be made is the peak flow test which can be done with an instrument that will record the flow of urine. The timing of urination into a glass with a stopwatch can also obtain similar results. A weak flow, for example, that takes two or three times the normal length of time, can reveal a serious blockage in the urethra and would most certainly be followed up with further tests.

One method of testing which is becoming more popular with urologists is the use of ultrasound or sonography, as it is sometimes called.

Testing by this means is not only simple and quick, but also painless. In addition to this it is now available at most hospitals.

If you need to visit your doctor, having read this far, ask him about the possibility of having one or more of these tests or to tell you exactly what they entail. Actually, he will probably recommend a consultation with an urologist who has this equipment if he considers it necessary and if this facility is available.

Incidentally, unless your doctor is a clairvoyant, which is most unlikely, please remember that he can only give you a proper diagnosis and prognosis by asking you a number of questions.

Some of these might seem unconnected with your ailment, personal or even impertinent. For goodness sake, tell him or her the truth, whatever it is or how bad it might sound.

Just suppose for the sake of argument, you are fifty five and have been happily married for about thirty years. Your wife's ability as a cook and housekeeper is beyond reproach but over the years, especially since the change or menopause, she has let herself go and doesn't pay the same attention to her appearance as she used to. One day you suddenly notice that the bloom of youth has faded, as light from a darkening sky. She has perhaps become fat or slovenly, and instead of having the face of a Madonna like when you first fell in love with her, it now looks more like a bag of chisels. (Remember that women usually age much quicker than men). Worse still, the thought of making love to her is, and may have been for some time, just about as appealing as going nude hang gliding in the Himalayas. An attractive divorcee twenty years her junior comes on the scene and before you realise it, you find yourself having sex several times per week and sometimes during the day. This woman has given your sexual prowess, which you thought might have gone, a new lease of life.  You then begin to find it difficult or even painful to urinate and decide to visit your doctor.

At this point it is a very good time to make it emphatically clear that a man's sex life is NOT connected with the cause of B.P.H. or prostatic cancer, but a sudden upsurge of sexual activity OR CELIBACY can and often does, affect the prostate.

Consequently, if your doctor asks if you have had a recent bout of sexual activity, perhaps with another partner, it is not because he wants to pry into your personal life.

Fortunately, there are very few doctors in the blackmail business, so you should be quite safe in thinking that your doctor's vocation is not to judge you but to help and cure you. However, with the best will in the world, he or she can only do this with your FULL co-operation.

Chapter Four

A FEW RAMIFICATIONS OF B.P.H.

On some occasions a prostate that is only slightly enlarged will be found by your doctor or urologist, but it could also be slightly congested. Although there may be no sign of infection, in this case the bladder might contain a small amount of urine which can't be drained through urination.

Now the bigger the prostate becomes the harder the muscles of the bladder need to work in order to force the urine through the ever narrowing urethra. In its turn this may not only result in the bladder becoming fatigued, but stop working altogether and cause a build up of urine in the bladder. This can lead to real discomfort.

When the patient experiences a burning feeling whilst urinating this can be a sign of urinary infection, especially if traces of blood can be seen in the urine and has a bad odour.

The congested fluid can be expelled by the prostate being digitally massaged through the rectum, and this may be suggested by the doctor or urologist because, after this treatment the patient's life usually returns to normal and the feeling of heaviness he has experienced vanishes.

To relieve a congestion of this kind, regular prostate massages may be suggested, but sometimes it can be relieved through any kind of regular sexual activity that involves ejaculation.

Incidentally, a man's sexual habits or lack of them, as stated in the previous chapter, can cause prostatitis, the symptoms of which will be given shortly. This is because during sexual arousal, the prostate fluid produced by a man is about four times more than the normal amount, and this remains in the prostate when it is not released through ejaculation. Consequently, the prostate is likely to become congested if this happens regularly.

Although abstinence may cause a build up of prostatic fluid that may lead to congestion, a way that is almost certain to overwork the prostate and cause other problems is by having too much sex in a short period of time.

Just suppose that your new found girlfriend has been just as sex starved as yourself, and within a week of taking her out you have nine or ten ejaculations in a couple of days. You then discover that when you go to the toilet, which is more frequent than usual, a burning in the penis when urinating. You may also have noticed a slight pain after the last two or three ejaculations. If in addition to these discomforts, you have had pains in the lower part of your back and felt uncomfortable around the pelvic area, you have the symptoms of prostatitis. This by the way can affect men of all ages, and although it can be caused by an infectious agent which urologists know nothing about, it can and often is caused by excess sexual activity, or none at all.

According to many urologists, sexual activity that leads to ejaculation, as already stated, is the best way to empty and relieve the prostate of congestion. 

In short, both the cause and the solution for prostatitis may be paradoxically, sexual intercourse.

Perhaps one of the most insidious and dangerous problems concerning the prostate, apart from prostatic cancer, is silent prostatism. On some occasions the prostate will enlarge, gradually closing the urethra without any of the usual symptoms and the patient is either oblivious of anything being wrong, or doesn't realise that he could have a problem. He might even attribute it to simply getting old, when occasionally his plumbing department doesn't function properly.

If this condition escalates unchecked more and more urine, which cannot be expelled through urination, will be left in the bladder.

It should be noted at this stage that this condition is not quite the same as a congested prostate which was described earlier in this chapter, nor can the excess fluid be expelled by the same treatment. (A digital massage of the prostate through the rectum). This condition is much more serious and the patients will not only feel irritable, weak and excessively tired, but may suddenly collapse and go into a coma.

When this happens the patient should be rushed to the hospital as quickly as possible so that the bladder can be drained.

This is done by means of a tube designed to drain fluids, especially urine, from the body and is called a catheter.

The reason for this is because when large amounts of urine, which cannot be expelled through urination, are left in the bladder it can result in a serious backflow pressure of the urine on the kidneys. At its worst, a problem such as this can result in a quick death through kidney failure. 

Once the bladder has been drained the patient will feel much better, almost immediately. However, a thorough check for any permanent damage on the kidneys will then be made to establish if any further treatment may be necessary.

It ought to be mentioned at this stage that if you are not used to alcohol or being exposed to cold weather for long periods, these conditions can be responsible for a sudden attack of what is known as ‘Acute Urine Retention', which can happen to almost any man who already has some obstruction in his urethra. The sudden use of certain medicines for allergies such as hay fever or asthma and so on (these are known as antihistamines) can also be responsible for such an attack.

What happens in this case is similar to what has already been described.

Let us suppose you are in your late forties or early fifties and lead a very busy life as an executive or special consultant. It is well worth remembering that B.P.H. symptoms are more likely to sneak up unnoticed on a man who is busy.

Because your job entails a great deal of driving you don't normally drink, except perhaps the occasional half pint of beer or lager. One night, after spending an evening at a pub or party, and having consumed brandies instead of your usual glass of beer, then having walked or staggered home in sub-zero temperature, you try to urinate but suddenly discover that you can't. The pain becomes so excruciating that your wife calls an ambulance and you are whisked off to hospital to find out what is wrong. A catheter drains the urine from your bladder (this is known to have been as much as two pints with some patients of acute urine retention) and about an hour later you feel fine.

Quite a number of men who say that they would rather die then give up drinking when told they have B.P.H. usually change their minds after experiencing such an attack as the one just described.

In view of the aforementioned it should now go without saying that you pay a bit more attention to your waterworks, and any change or intensification of B.P.H. symptoms should be reported to your doctor without delay.

Chapter Five

HOW TO COPE WITH B.P.H.

Let us now move on a stage further and assume that you have recognised three of the symptoms given in chapter two, visited your doctor or urologist and he has diagnosed B.P.H. The P.S.A. or other tests which may have been performed have proved negative and this means you DON'T have cancer. Your physician might point out that in almost every case prostatic cancer is on the outside of the prostate lobes, whereas the enlarged prostate grows outward and inward. There is no connection whatever between the two. Also, it is important to bear in mind that cancer can strike at any time in life on any part of the body. In addition to this, nowadays cancer is not as fatal as it was a few years ago, especially when it is discovered during its early stages. Indeed, the number of people who are being cured of this once dreadful disease is increasing all the time.

At this stage you needn't get into a panic, after all you could have already had B.P.H. for years without realising it, and it could be ten years or more before you need to worry about the possible consequences of surgery.

The important thing is that you now know what has been causing these little problems or irritations and coping with them is largely a matter of common sense. Your body needs water and fluids to survive, but it would obviously be quite foolish to deliberately overload your urinary system by drinking several pins of beer.

Remember what goes in must come out. A wise policy is to discuss with your doctor or urologist how much fluid you require and what the minimum daily need is for intake of fluids for a man of your size. Obviously this will vary and depend on your occupation and how active you are, also it might be far less than you think.

B.P.H. patients do not need any more stimulation in their urinary tract than necessary, and neither any more volume. Hence the need to avoid caffeine fluids and not to drink any more than you need. Actually, the former should not pose any major problems because there are so many caffeine free products available such as de-caffeinated coffee and caffeine-free cola etc. so it's just a matter of checking the labels. Many people claim that after a week or two of using these products they don't notice the difference. Also remember that many pain killer pills for headaches and so on contain caffeine, so once again keep an eye on the labels. Regarding the intake of fluid, your body will tell you when you need a drink, so try to cut down on liquids gradually. Should having to get up several times during the night bother you, try to make a point of not drinking any fluids for four hours before you go to bed. By doing this, the fluids will be processed and passed before it is your sleeping time.

Nervous tension can also increase the need to urinate and many people in show business get this problem just before they go on the stage. If you decide to see a film or play that is full of suspense make sure you take an aisle seat, or one at the back of the theatre. Once again it should now go without saying that it would not be a good idea to sit guzzling pop during the performance or have a pint of beer at the bar during the interval, which brings me to the next item which you've probably been expecting.

 Alcohol can cause serious problems with the liver and some urologists have been saying for years that it irritates the prostate. In addition to this, some alcoholic flavours can affect the prostate to such an extent that a sort of chronic prostatitis can be caused. However, if you still insist on drinking beer use some common sense, but remember that too much or the sudden use of alcohol can bring on a surprise attack of acute urine retention, which was covered in chapter three, even if you only have early B.P.H.

No matter how many precautions you take regarding the aforementioned, sooner or later a situation is likely to occur when you've left it too long to urinate and this need not be your own fault. Just suppose you are driving home and get stuck in a traffic jam, perhaps on a motorway. By the time you get home or to a service station to use the toilet your whole crotch is burning. Instead of standing at the urinal, go into one of the toilets and sit down to urinate and if possible bend forward towards your knees. For some unknown reason, possibly because it relaxes a circular muscle called the urinary sphincter which contracts when the urine is shut off, sitting down this way makes urination much easier at times as difficult as this. The next time such a situation arises, try it.

Incidentally this is a good moment to put the record straight about another couple of myths or half-truths regarding the possible consequences of prostate surgery. One is the fear of incontinence (being unable to control the voiding of urine or faeces) and the other is impotence (being unable to get an erection or keep it long enough for vaginal penetration). Let me deal with the former first.

By the way, if it will make you feel any better, researchers say that only four per cent of B.P.H. surgeries will result in the patients having trouble retaining their urine and many urologists claim it is less frequent than that.

The urinary sphincter, which was mentioned a few moments ago, surrounds the urethra just beyond the prostate gland towards the penis. Now the problem occurs when, during the operation, the electric knife cuts too near the sphincter voluntary muscles which control the flow of urine, and if these muscles are damaged the patient may become incontinent.

It should be pointed out here that incontinence after surgery does not have to be permanent or irreversible because there are drugs that can be used to relieve the situation, and even the possible use of an artificial sphincter.

Impotence is a very touchy subject with most men, and some psychologists tell us that sex is 75 per cent mental. It is not uncommon, for example, for a YOUNG MAN not to achieve an erection at times, but this does not mean that he is impotent. There could be many reasons for this which could range from nervousness to being too intoxicated.

On the other hand, it is not uncommon for a man, or sometimes a woman for that matter, to have an orgasm by sometimes simply thinking about sex, providing the emotion is strong enough.

For this reason impotence is difficult to pinpoint, especially with men over sixty. A man's sexual habits change as he gets older. If, for instance, he is in his sixties or seventies when he has B.P.H. surgery he could have been impotent before his operation and only notice it afterwards. If the truth could be told, such an operation has been a good scapegoat for the sudden realisation of impotence.

It is true that if damage is done to one or both of the nerve bundles that are on each side of the prostate, this will result in the patient being impotent. However, these bundles are well outside of the true capsule of the prostate. In other words, they are well outside the area where a surgeon's electric knife should be operating to remove the prostate tissue clogging the urethra. In short, B.P.H. surgery properly carried out should not harm these nerve bundles, and this operation should NOT be the reason for any impotency.

On many occasions the reason is purely psychosomatic. If a man has a mental fixation prior to the operation that it will make him impotent, the chances are that it probably will. The constant taunting of a partner who is unsympathetic can also be instrumental in bringing about a negative psychological effect.

If this should happen to be your problem, see your doctor or urologist because there are some drugs which can defeat impotence by being injected directly into the side of the penis. A dilation of the arteries is caused thereby increasing the flow of blood to the penis and also causes less blood to leave the penis.

As it is blood which causes an erection, and with the increased flow, many impotent men are able to achieve a firm erection and subsequent intercourse.

It should be carefully noted here that the aforementioned only applies to surgery for B.P.H. and NOT cancer. Stage A and B cancer of the prostate for instance, usually involves a radical prostatectomy or the complete removal of the prostate. This nearly always harms the nerve bundles on both sides of the prostate and results in a man being impotent. In a case such as this the surgeon has to consider the patient's life rather than his sexual ability.

We will now move on a stage further and assume that a few years have slipped by, and during this time you have been having regular checks on your prostate by your physician.

It must be stressed once again that once the prostate begins to enlarge it will continue to do so. You can't take a pill like you can for a headache and expect it to go away. Sooner or later it will be necessary for you to undergo some kind of surgery.

It is true that one day a less intrusive cure for B.P.H. may be available but that could be years away, and this is no consolation to someone who needs treatment NOW.

You have probably been wondering, quite understandably, what is likely to happen once you get on that operating table. To give you some idea, a brief outline will be given in the next chapter.

Chapter Six

A CLOSED OPERATION

In every trade, industry and profession new ideas and techniques are constantly being injected. Indeed, some technical manuals become out of date almost before they come of the press. We don't notice these changes because they are so subtle. It is only when we look at a magazine about ten years old or watch an old movie that we notice the changes in fashion and styles of cars and so on. This situation also applies to the medical profession.

There are several types of surgery for B.P.H. and your urologist will probably explain which one is most suitable for your particular needs. However, as at the time of writing the majority of B.P.H. surgery uses the transurethral resection of the prostate, or T.U.R.P. as its known, an outline of this operation will now be given.

This is what is known as a closed operation, which means there is no incision made in the body to get at the problem.

After the use of anaesthesia, a surgical instrument is inserted into the penis through the urethra. This instrument is a non-flexible hollow tube which extends into the narrowed portion of the urethra inside the prostate. A fibre optic micro lens system called a resectoscope will then be inserted into the tube. This device includes a fibre optic light source, a lens and an electric wire element for surgery. The light inside the urethra enables the doctor to see and determine the severity of the problem.

The electrical wire loop emerges from the end of the tube and is used to cut away the prostatic tissue. The electric loop is powered by the use of a foot switch when the surgeon wants to cut.

Whilst doing this, the surgeon is watching the procedure through a lens that is located just outside the end of the penis.

When bleeding occurs inside the urethra, another foot pedal is pressed and the bleeding part is sealed off by cauterization so it won't bleed. During the surgery the entire area is washed by glycene (a common amino acid).

After the surgeon has decided that enough of the enlarged prostate has been removed, the glycene wash containing the chips and shavings of the prostate tissue are removed and sent to a pathologist. He will study them to see if there are any beginnings of cancer of the prostate.

The surgeon may decide to remove most or the entire prostate but he will NOT harm the prostate surgical capsule. The new hole which has been created through the overgrown prostate now becomes a urinary canal. This means that the prostate enlargement tissue was growing around the urethra, gradually narrowing it and closing it down. The inner walls of the urethra have been cut away carving a new canal through the prostatic tissue growth.

When the cutting is completed, a thin flexible rubber or plastic tube is then passed through the penis and urethra and into the bladder, so that urine can be drawn from the bladder.

This remains in place for a few days because of possible bleeding that may take place in the prostate. When this tube is removed the patient will be able to urinate normally again.

The catheter used after the T.U.R.P. surgery consists of three lumens or tubes. One is used to send in and remove a wash of saline solution (salt water) into the bladder to clean and irrigate it. This is generally used for twenty-four hours after surgery.

The second tube is used to draw off urine and the third usually has a small balloon attached and is inflated so the catheter will not fall out.

The catheter which draws urine from the body stays in place for two days after surgery.

Most patients feel well enough to get out of bed a day after surgery and feel much better after four days.

It is possible to walk, talk and sit down with the catheter in place and it usually comes out on the second day with no pain involved. The surgeon deflates the balloon and the catheter will simply slide out. Most patients are discharged and sent home the following day so their stay in hospital is normally two days.

A prescription for antibiotics as a precaution to ward off any infection is usually then given. This has to be taken by mouth for one to two weeks after surgery.

The urologist will probably advise the patient to take hot baths instead of showers for a while, drink lots of fluids, avoid spicy foods and be careful NOT to become constipated.

Most of the patient's activities can then be resumed including driving, taking walks and sitting at a desk, but there won't be any rock climbing or football games for a while.

If there is any trouble during the first couple of weeks it will be a slight burning when he urinates or perhaps small amounts of blood in his urine. Should this happen the patient, just to be on the safe side, should report the problem to his urologist.

The length of time a patient needs to remain off work will depend on his occupation and how quickly he recovers. The doctor will be the best judge to decide this.

One BIG caution. The patient MUST ABSTAIN from any sexual activity for at least SIX WEEKS after surgery, to allow the canal through the prostate to heal completely.

A non surgical treatment for B.P.H. that urologists have borrowed from heart surgeons is the use of a balloon. A small tube about the size of spaghetti is inserted into the urethra by the physician, and on the end of this tube is an un-flated balloon.

When the balloon is in the correct position in the urethra within the enlarged prostate, the balloon is inflated by the physician. The inflation is held for different periods of time and the pressure of the balloon within the urethra forces the urethra back to its original position.

Many urologists who have used the balloon technique speak very highly of it. They say it is effective, easy to do and has far less worry or stress on the patient. In addition to this there have been no side-effects so far and being non-surgical it is also popular with patients when contrasted with surgery.

However, not everyone agrees with the balloon method or the use of drugs to reduce B.P.H. symptoms. Some specialists say there is no accurate way of determining who has prostate cancer and who doesn't. Although a biopsy and ultrasound may help, they say that unless shavings of the gland are examined in a pathology laboratory, the cancer can spread to another part or parts of the body without anyone knowing until its too late.

This brings me to another touchy question which you might have thought but were too frightened to ask. What happens if I have cancer?    

Chapter Seven

THE BIG ‘C'

Many people still believe that a man with cancer has a death sentence and this is simply not true.

Medical experts tell us that there are hundreds of various types of cancer and some can and are being cured.

Cancer is described as being an uncontrolled growth of abnormal cells. These cells can spread quickly throughout the body and through the bloodstream and the lymph system. They can also create new tumours that begin replacing the normal tissue.

Some types don't move at all but some can be aggressive and attack different parts of the body.

One of the areas that cancer hits a man is in his prostate and this is usually what doctors call a primary cancer. This means that it originates in the prostate and has not been transported there from some other cancer in another part of the body.

The key to any cancer, especially of the prostate, is to catch the problem as early as possible. For this reason some urologists suggest that all men over forty should have a digital rectal examination once a year.

What makes prostate cancer so deadly is because it is so difficult to detect. Another big problem is that it's a silent killer and can show no symptoms at first. By the time it gets painful the cancer has spread to other parts of the body and it's often just a matter of time until it kills the patient.

By the way, if what you have read so far has been enlightening but also disturbing or even frightening , and prompts you to have an annual physical check-up, this work will not have been in vain, and you will have had more than your money's worth.

Urologists classify cancer of the prostate in four stages, two of which may be totally curable, providing they are detected in time and stopped.

STAGE A

Stage A cancer is silent and the patient doesn't know he has it. It can be felt by a digital rectal examination or even suspected for any reason.

The stage A of cancer is almost always found when a T.U.R.P. or other operation for B.P.H. is carried out.  The removed prostate tissue will show evidence of cancer when examined by a pathologist.

Stage B

This is usually detected as a lump or hard or firm area on the prostate's two outer lobes during a digital rectal examination. This could be after a man has reported B.P.H. symptoms or during his annual routine physical.

Stage C

In stage C the cancer is usually found by a digital rectal examination or after a B.P.H. caused examination. In this case much and sometimes all of the prostate that can be felt is hard and firm, indicating the cancer. At this stage the cancer has probably spread from the prostate itself into the immediate vicinity.

Stage D

Incidentally this is the very worst and at the time of writing it cannot be cured, only suppressed.

In stage D the cancer has spread from the prostate into any of the adjoining body areas such as the lymph nodes. By this time the cancer may have also spread into the lungs, bones or any part of the body.

The treatment for any of these cancers will obviously vary and depend on how soon or late they are detected. The urologist may suggest radiation treatment, or chemotherapy (the use of chemicals), laser surgery, hormone treatment or immunotherapy, (an attempt to build up a patient's natural defences against all diseases including cancer).

A fairly new treatment for cancer of the prostate is cryosurgery. This involves inserting a probe into the prostate which is positioned directly in the centre of a small tumour. Liquid hydrogen, with its extremely cold temperature, is then injected through the probe into the cancer, freezing it and destroying the tissue and cancer cells at the same time.

The services of the medical profession and all its peripheries is something that every human being on this planet needs at some time or other. Indeed, no eulogy or praise could adequately express what these dedicated people accomplish in their relentless battle to alleviate the physical and mental suffering of mankind.

However, as with all professional experts in their own particular field, one will sometimes find opinions that not only vary but in some cases actually conflict, which can be rather confusing for the layman. It must also be remembered that many EXPERT opinions change with every passing decade, when additional information comes to light. Hypnotherapy, for example, is now recognised and accepted far more widely now than it was forty years ago.

Pioneers and visionaries are often branded as crackpots and their claims dismissed as preposterous, sometimes without even being investigated, but on many occasions they turn out to be right, even though they may not always live long enough to be recognised.

In the next chapter we will examine a few alternative theories and medicines, some of which are not recognised or accepted by the medical profession.

Chapter Eight

LET THE BUYER BEWARE!

There are many advertisements which appear in newspapers and magazines that make all kinds of claims regarding some panacea that can cure just about anything from a bald head to a bunion. These products are usually available by mail order and the adverts often look most impressive, and the wording can be very convincing.

It was stated earlier in this app that nobody knows the reason for an enlarged prostate gland. Strictly speaking, this may not be entirely true, because there is a body of people who claim they do know or at least have a good idea. These people are certain dieticians and herbalists.

Research has shown that an enlarged prostate in this country was virtually unknown at the turn of the century as it is still practically unknown in Asia. However, the problem is by no means uncommon with Asians who have been living in the West for a number of years. In view of these facts it would be most imprudent to dismiss the notion that diet could be partially, if not principally, responsible or instrumental for B.P.H.

The common denominator of many dieticians regarding preventing prostate problems and treating those present, revolves round the mineral zinc. By the way, if the concept of a mineral being able to prevent and sometimes cure certain ailments seems ridiculous, a sobering thought must be brought to the attention of people harbouring this opinion.

It is now common knowledge that radiotherapy is used in the treatment of certain diseases, and RADIUM is a radioactive metallic element obtained from the MINERAL pitchblende.

It could turn out that one day ZINC may be a possible treatment or even a cure for B.P.H., but not yet.

For anyone who would like to get their vitamins that are claimed to be beneficial for a healthy prostate from foods, here is a shopping list you can rely on, but a little word of caution first.

If the Zinc and vitamin treatment interests you, then talk it over with your doctor or urologist first, before you make any final decisions.

• Orange juice and all citrus fruits; tomatoes; broccoli; Brussels sprouts; strawberries and green peppers.

• Tuna; sardines; egg yolks; margarine; fish liver oil and salmon.

• Peanuts; green leafy vegetable such as cabbage, spinach and asparagus; wheat germ; wholegrain bread; vegetable oils and rice.

Other foods high in Zinc include nuts, sunflower seeds, bran, milk, eggs, onions, brewer's yeast, almost all sea food, beef, liver, lentils, molasses, peas, beans and poultry.

Another alternative medicine which is gaining more recognition is the use of herbs. There is nothing new about this of course, herbs have been used since time immemorial for all kinds of ailments, and many people still swear by nature's own remedies. However, this is a wide and highly specialised field, and there are several companies who offer a large variety of products along these lines which are available by mail order or over the internet, namely PROSTAGUARD.

Unfortunately, although watchdog committees and trading standard departments are constantly on the alert for commercial malpractices, quite a number still manage to slip through the net. Nowadays, one has to be ultra careful before taking seriously the claims of many advertisements one sees in the media. Even money back guarantees may not be worth the paper they are printed on - remember that to take someone to a small claims court the amount has to be at least £500.

Consequently, if a thousand people send ten pounds for some obscure concoction that is guaranteed to grow hair on a billiard ball and it turns out to be useless, they really have no means of redress. Sometimes even complaining to the newspaper is a waste of time, as the following disturbing incident about to be related will show.

In order to illustrate just how serious this was, a brief word about advertising procedure is necessary.

If you are in business and agree to spend a certain amount of money, with most newspapers they will do what is known as an advertisement feature. This usually entails a journalist and photographer coming round to your place of business to get some background information and take a few photographs. The newspaper will then publish an article giving details of how you started in business and what your service offers, and so on, along with a photograph of yourself in your shop or office. This can sometimes occupy half a page or more, depending on how much you are prepared to spend, and will read like a news item. However, it will always have the heading ‘ADVERTISMENT FEATURE' in fairly small print at the top of the article, so readers will know it's an advertisement, and not a news item.

A few years ago I happened to be glancing through a national tabloid newspaper which someone had left on the train on which I was travelling.

On page three- which is the most important position for response from advertisements, bar the front page- there was a news story that sang the praises of a new slimming product that must have answered the prayers of anybody who was overweight. Towards the end of the article, which occupied most of the page, it referred to a coupon in another part of the newspaper where the reader could send away for this seemingly miraculous product.

The first thing I did after reading little more than a couple of hundred words was to look at the top to make sure it wasn't an advertisement feature. It was not. This meant that it must be news, because no reputable newspaper would print such glowing praises about anything they had not carefully checked first.

I personally do not have a weight problem, but I felt that a couple of friends of mine would be very interested.

Now some investigative journalists, like many detectives, have a special instinct which tells them when something is not quite right, and for my sin I fell into this category. Intuition may not be admissible as evidence but it often helps to solve many crimes.

As soon as I returned home I telephoned a fellow journalist and one of the most well informed Mail Order specialists in the country, asking them to make a few discreet enquiries regarding this new slimming product.

To cut a long story short, the person who was selling this new slimming panacea, which turned out to be useless, was the same person who owned the newspaper that was promoting it.

If you think this was bad, there is worse to follow.

During the following weeks, a modification of that same article with the coupon at the bottom appeared as an advert in several other newspapers.

Just how many people got cheated from this scam I daren't imagine.

By and large most traders are honest people and although the adage ‘Let the Buyer Beware' is very apt, when it applies to buying through the post I sometimes think it should be amended to ‘Let the buyer be psychic if he doesn't want to get ripped off'. The moral of the story is, always do your research, ask plenty of questions about the product in question, and read any user reviews to find out about their experiences with said product.

Chapter Nine

It was stated earlier that some psychologists claim that sex is 75 per cent mental, and that impotence was difficult to pinpoint with men over 60. However, some physical tests have demonstrated that physical causes are responsible for 50 per cent of impotency. These are certain diseases which impede blood circulation and there are quite a number of them, as you can see by the following list:

• Artheroslerosis

• Hypertension

• Diabetes Mellitus

• Alcohol abuse

• Smoking

• Drug abuse

• Liver or Kidney failure

• Parkinson's disease

• Fractures or surgery in the pelvic area (Prostate, Bladder, Rectum etc.)

• Spinal Cord Injuries

• Multiple Sclerosis

• Peyronie's disease (curvature of the penis)

• Priapism (persistent abnormal penis erection)

• Congenital problems of sexual organ development

• Congenital Hormonal problems

• Sickle - cell anaemia

• Hyper - and hypothyroidism

• Aortic aneurysm surgery

• Heavy metal poisoning - such as lead

• Cancer and radiation treatments

• Amyotropic lateral sclerosis (Lou Gehrig's disease)

• Prostate disease

• Direct injury to the penis

• Leriche's syndrome

Voltaire once wrote: ‘Doctors are men who prescribe medicines of which they know little about, to cure diseases of which they know less, in human beings of whom they know nothing'.

The previous statement might be somewhat unkind or even cynical, but I'm sure there are times when some people would agree with it.

Although the writer's respect for the medical profession has already been established and the aforementioned list may well cause impotency, but only with certain people, because every individual is different. I could cite several cases from my own personal experience that would make many doctors scratch their heads in bewilderment, but one should suffice.

A few years ago I used to work with a man who was not only a diabetic but smoked like a chimney and, during most evenings, drank several pints of ordinary beer. Now this man, who was then in his late forties, was far from being impotent. Quite the contrary, apart from his wife he had at least two mistresses, one of whom had a daughter by him.

I'm not suggesting of course that the best remedy for any diabetic who happens to be impotent is to start smoking and drinking if they want to resume a normal sex life. I'm simply stating that certain things which may have an adverse affect on some people need not always apply to everybody.

Incidentally, anyone who has just read the previous case with tongue in cheek or may perhaps think that the person in question couldn't survive for very long by living the way he did, couldn't be further from the truth. To the best of this writer's knowledge, this man who is now in his sixties, is the landlord of a pub and is still never short of girlfriends.

Shortly after I met him I remember one occasion when he passed out at his place of work and had to be taken to hospital. When he returned a few days later I was present when someone told him that unless he changed his way of living he would very soon have one foot in the grave and the other on a bar of soap.

He replied, somewhat flippantly, that it was all in the mind, and if people kept believing that certain things would happen to them, more often than not, they eventually would.

It is that reply which forms the basis of the next chapter, and where we return to Ruby.

Chapter Ten

Without exception every one of Ruby's elderly clients BELIEVED that they would be able to function sexually until their dying day. In order to prove this to themselves they were even prepared to pay for the privilege.

The reasons why men visit such questionable establishments are long and varied and some of these will be covered later. In the meantime we will examine the importance of a person's mental attitude, whether it appertains to sex or anything else.

To this end I would like to give two striking yet contrasting examples of the power of belief.

A woman I once knew had what was almost an obsession that she would contract cancer. She didn't smoke and was really quite healthy but almost every ailment she caught was nearly always interpreted by her as a possible symptom of this dreaded disease. Eventually, at the age of thirty five, she died a living skeleton of the disease she was always convinced she was going to get. I have good reason to be an authority on the power of belief because this woman was my first wife.

By contrast, consider the case of a man who had, among other things, a very bad cough, was very thin and was obviously suffering from something. For reasons best known to himself and much to his wife's annoyance, he would not consult a doctor. (This practice is NOT to be recommended.)

When he died his wife had an autopsy performed on him which revealed that he was riddled with tuberculosis. The doctors were absolutely amazed that a man could live in such a condition. When they told his wife this she said that her husband always BELIEVED that he would feel better the next day. THIS MAN LIVED TO BE SEVENTY-NINE YEARS OLD.

The expression: ‘As a man thinketh so he is', is very profound but I think it should be amended to: ‘A man eventually becomes what he believes himself to be'.

Keep telling yourself with firm conviction, especially just before you go to sleep and when you first wake up, that you will meet the person of your dreams, or find the answer to the mystery of life and the meaning of existence, or that you will maintain your potency, and eventually you will.

Some people call the above practice auto-suggestion, others call it psychology. I call it the miracle of belief.

Chapter Eleven

Apart from two gentlemen who were on the portly side, the rest of Ruby's clients (I'm speaking of men who were between 65 and 82) were of slim build, which prompted her to find out if they maintained some kind of diet or ate some special foods.

Although some were diet conscious others were not but they ALL preferred fresh fruit and vegetables wherever possible, as opposed to canned or frozen produce. The exception to this was baked beans and occasionally garden peas. They also preferred fresh meat, fish and poultry rather than frozen or tinned, the exception being salmon and corned beef. Actually, whether or not they were conscious of it is of little importance now, but having looked back through my notes on Ruby's autobiography they ALL ate most of the foods on the list given in a previous chapter which, according to many dieticians, are good for a healthy prostate. Considering this list was compiled eighteen years later and was made under totally different circumstances, even those who do not regard diet as an important link to a healthy sex life, must grudgingly admit that this is a remarkable coincidence.

I might add at this point that Ruby could only recall one client who was a vegetarian and didn't smoke or drink, and his sexual performance was no better or worse than most of the others. Indeed, the gentlemen of 82 I mentioned earlier who not only smoked, drank, ate meat and did just about everything that would make most physicians throw their hands up in horror, completely outperformed him.

Incidentally, this man's story is so unique and could offer so much hope to men who think, or may have thought for some time, that their days of sexual activity are gone forever, I feel it is worth relating. I will call this gentleman Ben.

Now Ben had been happily married and had a good sex life with his wife up to the time of her death (she was 65 and he was 72). For the first few months he let everything, including himself, go to pieces and found it difficult to cope without her.

About a year later he became very friendly with a former nurse in her fifties who helped him to get over his bereavement. One thing led to another and when the relationship developed into a physical one, he found that he couldn't get an erection, and thought that the loss of his wife had probably made him impotent. Fortunately for him this lady was very patient and understanding and one day, a few weeks later, she was fondling his genitals when he suddenly got an erection and was able to have intercourse once again. From that moment on there was no stopping him, and although his new companion died within a few years of their meeting, this time it made no difference to his libido whatsoever, as his regular visits to Ruby's establishment (and possibly others besides) proved. The moral of this little story is that a good remedy for natural impotence treatment is sometimes just a kind and patient woman and NOT some drug or aphrodisiac.

Just before saying a few words about the latter, NONE of which I might add any of Ruby's clients used, a brief mention of another relevant denominator is in order.

Obesity can also be responsible for impotence and the reader will no doubt recall that it was mostly men of slim build who made the most ardent lovers. Consequently, not only is diet very important but also exercise. It is true that a few of the men I'm writing about did special exercises but most of them used to simply take regular walks, sometimes cycled or went swimming. However the most important thing is that they did one or more of these virtually every day.

Plato once said that all diseases can be cured by proper exercise and diet. The only exception to this of course is when the digestive organs are so debilitated that they require rest before any other treatment. In very debilitated cases, passive exercises and massage may be best.

General exercise, within reason, stimulates all functions of the body; secretions and excretions will stay normal in most people who live active lives (remember that constipation also plays a primary role in impotence).

Chapter Twelve

Since time immemorial man has searched for aphrodisiacs to enhance sexual desire and performance. However, there is no evidence that substances such as ground rhinoceros horn, garlic, oysters, artichokes, truffles and so on affect anything except the imagination. Spanish fly is reputed to be a potent aphrodisiac but this simply irritates the digestive system and urinary tract causing a painful erection that is unrelated to sexual arousal. The side-effects include vomiting, diarrhoea, shock and even death. Beware of advertising claims selling ‘pills for potency'. These often cause urethral irritation and allergic reactions.

Tryptophan is an amino acid which has been used as an over-the-counter medication for its sedative effects, and as a prescription drug for schizophrenia. It has also been noted to cause increased sexual desire.

Patients suffering from Parkinson's disease who have been taking L-dopa have also reported increased sex drive.

The drugs parachlorophenylalanine (PCPA) and apomorphine have been used experimentally in the United States and have shown to increase sexual desire.

Luteinizing hormone-releasing hormone (LHRH) also intensifies sexual activity, especially when combined with oestrogen in women and testosterone in men. At the time of writing none of these medications are currently being used to treat impotence or loss of libido.

What the reader MUST keep in mind is that EVERY drug in the entire pharmacopoeia has side-effects, some known and some unknown. Consequently, drugs can be expensive, dangerous, addictive, unpredictable and less effective than other methods. With most normal men the mere sight of a naked or partially clothed beautiful woman- sometimes even on a photograph or video- is sufficient to arouse sexual interest or desire.

Chapter Thirteen

One of the biggest problems which can be most embarrassing for a man and frustrating for a woman is premature ejaculation.

The problem can be overcome much more easily than most men think, but like anything else worth achieving, it needs a little practice and patience. Just before enlarging on how this can be accomplished I would like to give a remarkable example of how important this was to one man's career, and if the truth could be known, probably with many other men who followed a similar profession.

During the 1970's I used to spend two weeks of my annual holiday in South Eastern Europe. The man who owned the apartment where I stayed in Vienna was the equivalent of a Detective Inspector in the Special Branch of the Austrian Police. Over a period of time, we became quite friendly and on one of my visits he told me an interesting story that would have made good copy for any man or woman's magazine.

About a week previous to this particular visit he had interrogated a man from Prague who wanted to defect to the West, (this was in the days when the ‘Iron Curtain' was still in force).

Now this man had a wealth of very important information to impart, all of which had been obtained from women, who ranged from the wives of two Embassy Officials to civil servants and filing clerks. To cut a long story short, this man was no young handsome Adonis, but had charisma and had also conquered premature ejaculation. He was able to hold back his orgasm for as long as he liked. Consequently his lady friends, who had probably been deliberately chosen for him by his superiors, were able to achieve several orgasms each time they had sex, and were not only satiated but were willing to do ANYTHING for him. This is how he got the information he wanted.

The two key factors for overcoming premature ejaculation are concentration and breath control.

The next time you have sex, as soon as you feel that sensation, which is at first fairly remote-that if you continue with the same deep thrusting movements you will soon have an orgasm- simply hold your breath and slow down the pace until it diminishes. Sometimes, it is helpful to curl your tongue and touch the roof of your mouth whilst doing this. Remember that steady breathing during intercourse facilitates the flow of semen. It is also a good idea to tell your partner not to move whilst you are doing this, since sometimes the movement- such as the opening or changing position of one of your partners legs- can rapidly take you to the point of no return. If this should happen, simply let nature take its course and ejaculate and wait for the next time to try again. UNDER NO CIRCUMSTANCES ALLOW THE SEMEN TO GO BACK INTO THE PROSTATE.

It is also possible to counteract a quick orgasm by concentrating on something totally different to what you are doing, whilst at the same time making the normal movements.

This however takes a bit more practice, but I can assure you that it is well worth the effort. (I mastered this many years ago and have never had a problem in getting or keeping girlfriends, but rather getting rid of them, even after I had re-married!)

Once this has been accomplished, you will be able to hold back as long as you want or feel it is necessary. In the meantime, your partner- unless she is indifferent or doing the same as you-will reach her climax. You can then continue until she has another orgasm, or simply transfer your concentration to what you are doing and ejaculate.

Most men and women are familiar with the basic positions of sexual intercourse and what position which might be suitable or pleasing for one couple might be distasteful to another, so a little experimentation may be necessary. It was stated earlier that every human being is different. Some women, for instance, close up after one orgasm and cannot go onto a second or third without a period of rest first. Indeed, some women consider sex once a week or even once per month sufficient for their needs. This could be one reason why their husbands or boyfriends either sometimes visit massage parlours and the like, or get themselves a spare girlfriend. The reverse of course, also happens.

However, other women can be virtually insatiable, and if the unfortunate man cannot meet the demand, he may become the subject of cruel taunts from his partner. This can cause tremendous psychological damage and make him feel worse, and even totally impotent.

Positions which the reader may find easier to hold back and practice breath control or concentration is when both partners are on their side facing each other. These positions have several advantages. They are very good for less vigorous and more intimate stages of intercourse. In addition to this, the clitoris can be stimulated manually-much easier to facilitate an orgasm with the female partner whilst the male-either through concentration or breath control, is able to hold back.

Once again it must be stressed that the aforementioned does require a bit of practice, but if the reader is able to try this, at least initially when both partners are on their side, he will be encouraged by the results much quicker than using the ‘missionary' position, for instance. (The woman lying on her back, with the man on top.)

Just a matter of incidental interest, the writer once lived with a woman who was extremely sexually demanding but was also paralysed down one side of her body. During intercourse, which was performed mostly in the ‘side by side' position, his partner was able to attain four or five orgasms, and on many occasions, this was more than once per day.

Apart from premature ejaculation, an equally frustrating and humiliating sexual malfunction is impotence brought about through chronic organic problems, especially the ones associated with rectal or prostate surgery, such as a prostatectomy. (The complete removal of the prostate as in stage A&B of cancer of the prostate.) This problem and how it may be overcome is the subject of the following chapter.

Chapter Fourteen

A penile implant is a device that is surgically inserted within each of two spongy chambers (corpus cavernosa) of the penis, allowing an individual to have and maintain an erection when desired.

Rod implants consist of semi-rigid and malleable types. Although all rod implants create a permanent erection, some semi-rigid devices are hinged for concealability in clothing. Malleable implants (those with an inner wire core) are also bendable for concealment. There are varying degrees of dependability, concealability and functionality, depending on implant use.

Inflatable implants for instance, offer a more natural cosmetic result than rod implants and consist of self-contained and multi component types. The surgical procedure is similar to that of rod surgery allowing the implant to be placed within the penis using a small incision. In the United States, inflatable implants are becoming the preferred choice of men desiring penile implantation.

According to some doctors a penile implant may only be advisable under the circumstances about to be outlined:

• 1.) When sexual desire is strong and intercourse is valued by both parties.

• 2.) When there is evidence of continuing sexual activity between partners, even in the absence of sexual intercourse.

• 3.) When the presence of impotence is having a destructive effect on the relationship.

• 4.) When the couple have a realistic understanding of what may be achieved, and both approve of surgery.

It should go without saying that a penile implant is something that ought not to be taken lightly, and the reader should discuss with the urologist the best implant for his particular needs.

Patients who are NOT considered good candidates for penile implants are those who have one or more of the following problems:

• 1.) Acute and severe depression which is untreated.

• 2.) A serious psychosis or brain disease.

• 3.) Severe personality disorders, including the chronically dissatisfied.

• 4.) Severe and complicated marital problems.

• 5.) Impotence which is clearly NOT organic.

Most penile implants are made of medical grade silicone rubber. It is possible that rejection may occur but as silicone has been widely used in the medical field for well over twenty years-including being used for testicular implants, as well- it is most unlikely that rejection should pose a problem.

However, it must be pointed out that a penile implant allows a man to have an erect penis, but it is not able to make the penis appear or function as it did prior to the onset of impotence. Consequently, it is a wise policy not to have unrealistic expectations.

After surgery a loss of girth, length or body may occur because the natural penis expands far better with normal blood flow than with a penile implant. The cosmetic results with inflatable implants normally improve with time due to improved tissue healing following surgery.

Penile implantation will not increase or decrease a man's sexual desire or harm his ability to have an orgasm. Sperm production and ability to ejaculate should remain unaffected if present prior to the onset of impotence. If the patient is uncircumcised it may be necessary for the surgeon to remove the foreskin during the surgical procedure. General, local or regional anaesthesia may be used, depending on the type of implant selected, surgical technique and the patients overall physical condition.

It is a good idea for the partner to be involved in the decision process whenever possible. Most physicians encourage partners to become involved at the early stage of evaluation and testing in order that she may express her feelings and concerns. Most women are relieved to know that some form of treatment can be used when impotence cannot be corrected by any other means.

Immediately after surgery, the patient will experience some pain and discomfort which will subside within a few weeks, and some kind of medication might be prescribed in order to help to ease any discomfort. Your urologist will advise when it is the best time to resume intercourse. Normally, this is four to six weeks after surgery.

When first resuming intercourse, some couples may experience uncomfortable penetration. This usually occurs when there has been a long absence of sexual activity. A change in sexual position or the use of a lubricant may help alleviate uncomfortable penetration.

The remedy just outlined is applicable to impotence brought about through a chronic organic problem, but once more it must be stressed that pain or illness are not the only things which can result in impotence. Fear, depression, jealously, guilt and resentment can all be far worse than anything else in ruining a man's ability to get and sustain an erection and destroy potency.

Chapter Fifteen

Something worthy of mentioning at this point is that virtually all of Ruby's elderly clients had a very optimistic outlook on life and a good sense of humour.

The reasons they visited her establishment were long and varied. On some occasions, it was because there was some sexual act or position which their parties found objectionable or uncomfortable. Others regarded it cheaper in the long run to pay for sex directly, rather than spend days or sometimes weeks wining and dining a younger woman who could still say ‘No'. It must also be remembered that any prostitute who is worth her salt will not make any emotional or financial demands, other than that of her fee. Consequently, there is little or no danger of any complications that often result from extra-marital affairs. The expression that love starts with a spiritual affinity, escalates to carnal desire and priority of ownership, and often culminates in dire consequences for both parties, might be a cynical statement, but you only have to look at the Sunday newspapers to find out how true it can sometimes be.

Apart from the fact that their wives were either past or incapable of having sex, many of Ruby's client's marriages were otherwise quite good.

Contrary to what some moralists might say, professional prostitutes provide a very useful service to the community, and if the truth was told they have probably saved more marriages than the establishment would care to admit. Sexuality is one of our most powerful emotions and with most normal adults-especially men- it is quite natural to expect them to indulge in some form of sexual activity. If a person cannot find an outlet for their needs in the conventional way, they will naturally seek an alternative.

When a man suffers any kind of sexual malfunction of which he is too embarrassed to discuss, it often makes him vulnerable to ‘Quackery Incorporated', or the claims of dubious adverts. Apart from being very expensive, many of these products can range from just being a placebo to being harmful, and actually worsen the condition.

Sometimes drugs are necessary but very often, especially if a man has a healthy prostate, a change of mental attitude, lifestyle, diet or sometimes even a sympathetic and understanding partner, are really all that may be required for a prolonged and healthy sex life.

When you hear a piece of music for the first time in its entirety, like Beethoven's Symphony Number Seven for example, the first time you hear it there are probably just a few passages or tunes which appeal to you and the rest goes unnoticed.

However, with each subsequent hearing, you will pick up something else which you missed on the previous one. This is because it is not humanly possible to absorb what could be the result of years of work which the composer has put into it, in the forty minutes or so that it takes to hear it.

The same principle also applies to certain literary works, including what you have almost completed. When you have finished this document, go through it again at least another twice and you'll see what I mean.