The Dick Clinic

Prologue

I'm Writing here about a new human sexuality—at least that. A sexuality in which all men are just as potent as they care to be, in which there is neither failure nor the shadow of failure. I know. After five weeks of outpatient treatment, I went from Mr. Maybe to Mr. Magic Probe. All this despite tough luck and a whole mess of self-sabotage. Remember: For you, it'll probably take less than half that time. And most likely you won't experience any of the horrid events I endured.

Impotence is a vicious word. It denotes limpness, cowardice, inadequacy and critical impairment. The subject is so appalling it doesn't even have a place in the male rhetoric of insult. Men, no matter how irritated, almost never call one another impotent. We may accuse another guy of excessive fellatio or Oedipal sex, but we'll never use the word castrato or eunuch. I don't know about you, but I'm just a little, oh, superstitious. Which is probably why you've heard almost zero about prostaglandin treatment for impotence (what we will hereinafter call erectile dysfunction, or ED). Fifty-two percent of American men between the ages of 40 and 70 have at some time experienced chronic ED. Think about it: 20 million human beings afflicted with shame. It has the amplitude of a plague.

But the magic bullet has been concocted. By the year 2000 almost all men who so desire will be able to perform sexually on command. And that's why they call it the millennium.

Reflect for a while. Easy access to chemical machismo will mean, for instance:

(1) Our lovemaking no longer will be held hostage by a five- or six-inch length of self-important smooth muscle tissue.

(2) Men won't feel nervous, shamed and incomplete because some dumb artery didn't fill some dumb muscle tissue with blood on cue or for long enough.

(3) Women won't feel nervous, shamed and incomplete because they couldn't inspire some dumb artery to fill some (continued on page 96) (continued from page 84) dumb muscle tissue with blood on cue or for long enough.

(4) We can all be Zorba the Quinn, if we want to be. With prostaglandin, most men can haul up an erection no matter what their age.

(5) Married couples who can no longer create hardness between themselves (because of age or familiarity or other factors) will be able to jump-start their passion with prostaglandin. And then maybe he won't need that young thing to stiffen his resolve.

(6) Men with chronic diseases that affect their sexual performance will not forfeit their manhood. (I have Parkinson's—and, no, mine doesn't work like a vibrator, thank you.)

(7) Men who are confident in their sexual prowess tend to use condoms more willingly.

(8) Gender boundaries will blur. Men will be able to assume a more passive role if they so elect.

(9) Every day will feel like springtime in New York.

So pay attention. I underwent great physical discomfort—hell, I became a white rat—to bring you this report from a brave new world. Remember: Most men will not need any of the invasive tests I signed up for. Pay attention. And don't try this at home.

•

Monday, March 13, 1995

I think you'll like Dr. Harin Padma-Nathan. Born in Sri Lanka, age 39, trim and handsome, with a complexion the color of a polished grand piano. And lucky. A pioneer in pharmacological ED research, Dr. Padma-Nathan, assistant professor of clinical urology at the University of Southern California and director of the Male Clinic in Santa Monica, is in the right place at the right time with the right jism. Aided by his staff of attractive and quite unjudgmental young women, Padma-Nathan can get a rise from just about any man. This is Lourdes for the logless, where your plowshare will get beaten back into a sword. And Padma-Nathan's examination-room manner has the right combination of detachment and reverence.

He is both kind and simpatico. (Padma-Nathan didn't know until the previous Wednesday that I'd be doing this article.) And he has the passion of a faith healer. "We take people who haven't seen their penis erect in ten years. Erect? They may not have seen their penis flaccid because their tummy is a little bigger. We create an erection for them, so they see something they associate with pleasure and self-gratification. It validates their existence to see that again. And it isn't artificial—it's their old friend back."

My old friend hasn't left yet, but Parkinson's is a degenerative condition and the door may shut at any time. If it should, I want to have six dozen bottled hard-ons waiting in my refrigerator. I also want to be sure there is no other physiological dysfunction than PD affecting my gladius. (Well, yes, gladius. If the female sex organ is a vagina, which means sheath in Latin, then the male member should be a gladius, which means sword. Gladius—listen to it. Sounds better than that other clinical, hairless, pipsqueak word. Glad for short. A condom, of course, is a glad bag.)

Anyway, Padma-Nathan is now reciting the carte du jour of available diagnostic tests. I've already had blood taken for a testosterone count (normal). And Padma-Nathan has used the bio-thesiometer on me (this is a vibrating doohickus that can rate skin sensitivity—men lose receptors with age.) There remain the following tests:

(1) PSA (which monitors prostate-specific antigen levels—but don't ask me why).

(2) Rigiscan (a machine that can assess nocturnal penile tumescence and rigidity. In lay language, it measures your nighttime boners).

(3) Ultrasound (measures blood flow into the glad).

(4) Dynamic infusion cavernosometry and cavernosography, or DICC. "Rather memorable initials," says Padma-Nathan, who was part of a research team that developed the DICC. (Tests blood inflow, veno-occlusion and—eeee—your pain threshold.)

(5) Bladder scan—at my suggestion—will test your bladder control and general urodynamics, while making you confess—eeee—to anything.

In fairness, Padma-Nathan has tried to dissuade me from ordering the entire menu. "Are you sure, Mr. Mano? Some of these tests are invasive. I don't think you're a surgical candidate——"

But no, no, I've flown all the way from JFK, I'm booked to fly back in three days and—no, no—only the best for my glad.

Somehow I don't hear him say "invasive." Maybe because, at just that moment, Mildred comes swinging in through the door.

•

Mildred lies there—spread out and vulnerable—on my hotel bed. I'm feeling, oh, rather shy. I've never met a person (that is how I think of Mildred) who straps onto your thigh.

First you take this Velcro holster and wrap it groin-high around whichever leg you don't sleep on. (Figure that one out.) Then you slide Mildred, a four-pound machine, into the holster, from which she will fall out all night. Mildred, of course, is the Rigiscan ambulatory rigidity and tumescence monitor—a computer that will measure my erection size and duration while I (try to) sleep. Extending from Mildred on soft wire is a cloth and a pair of metal rings. These—one around my tip, one around my base—open and close every other minute or so, with a spiteful whir. It's like getting a hand job from R2-D2.

Turned over too fast at four A.M. and Mildred gave me one good whacko in the pod. Does this mean counseling?

•

Tuesday, March 14

I lie on an operating table in the gray bowels of USC University Hospital. Padma-Nathan has just administered local anesthesia. It didn't hurt—no more, anyhow, than it hurts when I pull my zipper up too fast. Nurse Tina, compassionate and deft, is prepping me for a test to detect blood leakage in my erectile chambers. I figure she has seen more flies than Beelzebub. While we wait, Padma-Nathan tells me about the anatomy of a good stiffer:

"To get an erection, you need three things. You need normally functioning nerves to stimulate the smooth muscle tissue of the penis to relax. When the muscle relaxes, the erection chambers fill with blood. If the chambers do not leak—that is, if they allow vein closure, you have a rigid erection. Let me offer an analogy: In order to fill a bathtub you need a faucet—the incoming artery. And you need a vein-closure mechanism—a drain plug—to trap the blood.

"In those people who present chronic erectile dysfunction, the vast majority will have a vascular abnormality brought on largely by lifestyle factors. In the more than 4000 patients we have studied, the number one risk factor is cigarette smoking. Next is a high cholesterol level, followed by diabetes and high blood pressure. Another risk factor may be the use of anabolic steroids." (I know of one famous (continued on page 128) (continued from page 96) action-film hero who has had a penile implant as a result of his overindulgence in steroids.)

The arteries involved are not much thicker than a piece of paper. Naturally they're vulnerable to atherosclerosis. Cocaine, for instance, can induce the condition and fry your manhood. "Regular use of cocaine can result in a 23-year-old with penile arteries that look like they're 70 years old," says Padma-Nathan. Trauma, too, can jam the feeder system. When your girlfriend is on top, ask her to settle down carefully. This isn't the time to play ringtoss. Also, believe it or not, avoid bikes, motorized or otherwise, especially if you have a thin perineum or crotch area. Now you know why the Hell's Angels dress so macho. They're compensating for a lot of bent perinea.

Let's assume there isn't any arterial bottleneck. Then your brain and blood can build a glad-on like so:

(1) Turn to centerfold. Brain admires young lady. But young lady too intimidating. Can't even fantasize. Turn back to this article.

(2) Remember Barbara from eleventh grade. More like it. Run head tape of Barbara. Get aroused. Brain sends prostaglandin and other neuro-transmitter requisition to groin. Prostaglandin shipped out (unless there is nerve damage). Smooth muscle has begun to relax. Blood rushes in. Chambers seal. Houston, we have liftoff. And you begin to rise like the stars and stripes on Mount Suribachi.

But nature built in an emergency recall system. All at once you remember the time Barbara's father caught the two of you playing pink weasel. Brain, even in retrospect, is startled. Brain orders groin to produce the Great Shriveler—noradrenaline. (Nature doesn't want you to encounter an enemy with your seeder up and vulnerable.) Both prostaglandin and noradrenaline are mobilized by the brain in four-second bursts—not in a steady stream. That is: Your brain must reincite horniness 15 times just to stay hard for one minute. So the brain telegraph is going like this: arousal, arousal, arousal, emergency (prostaglandin, prostaglandin, prostaglandin, noradrenaline), arousal, arousal, emergency, arousal, arousal, emergency, emergency, arousal, emergency, emergency, emergency, to hell with it—there is a noradrenaline override and no stopper in your tub. Psychogenic erectile dysfunction is caused by a brain that kicks off too much noradrenaline.

Synthetic prostaglandin has FDA approval. And why not? Nothing more than a synthetic version of the natural prostaglandin molecule, it metabolizes completely in your glad. Upjohn now markets it. Prostaglandin is effective in 75 percent of erectile dysfunction cases. For that stubborn 25 percent Padma-Nathan has brewed up a special compound put together at USC—prostaglandin and phentolamine. Phentolamine (which hasn't yet been approved by the FDA) is an adrenaline inhibitor that raises the success rate in men to 85 percent. As a last resort Padma-Nathan will add papaverine for seasoning. This formulation (called trimix) has a 92 percent uplift rate. We've come a long way from sheep testicles and ground-up rhinoceros horn.

Meanwhile—back on the table—my glad has gone numb. The homemade DICC contraption is built to detect blood leakage from my erectile chambers. But Padma-Nathan must first give me a good blue-veiner (with several doses of papaverine and phentolamine). I can't watch. Saline solution is then injected. The DICC starts to scribble like a seismograph. Padma-Nathan has begun to chat about "systolic pressure" and "arterial Doppler flow." I don't understand him. I don't want to understand him.

And by mistake I glance down.

My glad looks like a gaffed fish. Little mouth open, the urethra sucking air. A large needle has been jammed up and through my erection chambers. Wire is hanging from the needle. When he detumesces me, Padma-Nathan will spatter saline and blood all over the table. I don't look down again.

But that isn't all. I've forgotten the bladder test. Or, rather, I thought that this was the bladder test. PadmaNathan is reluctant. Perhaps I should take a pass on a second exam. But I know well enough—if I don't do it now, I'll never do it. Anyway, compared to getting a fishhook up your eel, how bad can it be?

Ugh.

Imagine your urine is kerosene. Imagine that someone touches a lit match to the stream just as you are taking a leak. Sssss-blam! That, more or less, is what a catheter feels like. The ultimate plumber's snake. Now, along with a tape of 1994 NFL highlights, I have a videotape of my bladder.

On the way from USC to the Hotel Sofitel my glad turns the color of moussaka. I begin to walk like Groucho Marx, but slower, much slower. My body is an infomercial for pain. If I can just reach good old room 811.

Unlock my door.

Turn on the light.

Oh God.

It's Mildred.

•

Wednesday, March 15

Padma-Nathan grew up in Canada and graduated with honors from Dalhousie University medical school in Halifax. He then chose (a "great decision") to do impotence research under Dr. Irwin Goldstein at Boston University. "In 1985 we had the first really large pharmacological erection program." Timing, as a spat manufacturer once said, is essential.

In 1985 penile implants were fashionable—the anatomical opposite of deboning. They are still used commonly (and with great success), where medical or psychological treatment has failed. But penile implants require surgery—and they are oh so prosthetic. Some, for instance, feature three-piece hookups, including a pump mechanism in the scrotum. Manual dexterity is required. Compare all that—in cost and realism—to one mosquito bite–like shot of prostaglandin. If I can do it, it is simple, believe me. My small motor skills are smaller than most.

But for those who are supersquea-mish—those who cover their eyes when a turkey is carved—there will soon be an even less intrusive approach. Padma-Nathan (along with Dr. Ridwan Shabsigh of Columbia-Presbyterian Medical Center in New York and Dr. Tom Lue at the University of California at San Francisco, among others) has been testing prostaglandin delivery by pellet, a method patented by Dr. Virgil Place. "It's phenomenal," says PadmaNathan. "You pee. You take a little inserter, drop a pellet into your urethra and it causes an erection." Now both he and she can be on the pill.

Even so, Dr. Goldstein thinks this is just a station on the train ride to Studville. "We are desperately seeking oral medication," he says. "Only 100,000 men are using prostaglandin—out of the 20 million who need it. Why?" Because, he suggests, Americans may be a pill-ridden folk. Injection and urethra-popping feel just (continued on page 182) (continued from page 128) the slightest bit coochy. Our Protestant work ethic insists that an erection should be organic and sincere, not drug-made. One couple dropped out of prostaglandin therapy because that little vial in their refrigerator made the children worry. It's a wonder we can breed at all.

The dropout rate has been between 30 percent and 40 percent. (Most often for reasons not particularly attributable to prostaglandin itself.) Says Goldstein: "Even after an injection, she—the wife—doesn't look like Marilyn Monroe. Passion flags. It isn't the romantic thing they thought it would be. Men don't like making the discreet trip to the bathroom beforehand. Most of our patients are between the ages of 40 to 60. Over that age, we find, men tend to lose interest. But the women aged 40 to 60 are also likely to have gone through menopause. So the wife may not be able to lubricate. Especially after a long layoff, she may experience enough pain to temper her enthusiasm. Also, it's relatively expensive. At the price Upjohn charges, an erection will cost around $20."

Side effects, according to PadmaNathan, occur infrequently and are associated with substantial use—though 30 percent report "mild to moderate aching" (I did not). In some cases (three percent, or 7.8 percent, according to which survey you favor) scar tissue may form, giving the gladius some degree of dogleg right or left. Padma-Nathan explains: "Like putting Scotch tape on a deflated balloon. When you blow it up, it pulls to one side. Many of these go away of their own accord." In some men surgical repair may be needed. Then there is priapism. Through several thousand cases, Padma-Nathan has seen only one instance of priapism occurring with a home injection.

Me.

But we'll get to that later.

I'd bet there is a potency clinic advertisement next to the racetrack analysis in the sports section of your local paper. Avoid these. Not that prostaglandin treatment is particularly problematic. Despite the bizarre personal experience related here, your prostaglandin regime should be as safe and as easy as treating a bee sting. But, if something were to go wrong, you would want a surgeon who specializes in urology. Unfortunately, as Goldstein says: "There aren't enough urologists to go around." Follow-up is critical, especially in the rare instances of scar tissue formation. Responsible behavior is also crucial—that means no more than one injection per day, no more than four or five times a week. "I hope prostaglandin therapy doesn't lead to a stupid caricature of supersexuality," Padma-Nathan reflects. You can see a new male clothing fashion. Not codpieces. Entire cods.

•

"Would you like to hear the blood in your penis, Mr. Mano?"

"Uh, well now...."

Sound system up. Ka-chunk, ka-chunk. The inside of my glad sounds like the inside of a submarine, with Richard Widmark as captain.

"Prepare to fire starboard tube."

"Yes, sir."

Woosht! Not only do I sound like a submarine, I look like one, too, lying flat, with periscope up. Like a scuttled submarine. I'm sore and, yes, somewhat cranky. But the ultrasound test I'm taking now is no problemo. For me, it requires only three needles in the glad. Just three.

One to make you go up. Two to make you go down. Is this Alice's secret potion?

Roberta Poppiti, ace vascular technician, has handled more gladii than a 108-year-old mohel. You know those airport cafeteria checkout counters? Roberta is the cashier. I'm a tray of food. She waves this wand thing over me—as if my glad had a universal bar code on it. Ring up the sale.

"Look at the TV monitor, Mr. Mano. This is a cross-section of your penis." What in God's name am I seeing here? Could it be the weather? Is that blue stuff a cold front over the Delaware Valley? I have no idea. Why am I a tray of food to this attractive woman? I lean forward. My glad disappears from the screen.

"Oops."

"Move just your upper body when you look."

"Uh. Showers over Fort Lee."

"You staying at the Ritz-Carlton?"

"No, why?"

"They have special discount rates for USC patients. And a bus drops you at the hospital."

"Ah." (Shall I reserve the penile suite, sir?) "You must get many celebrities here."

"Mmm. For one famous actor we had to move this 700-pound machine all the way across the plaza to Dr. PadmaNathan's office. I guess if that part of your anatomy doesn't work, it really changes your life, doesn't it?"

"Oh, I'm just doing an article."

Padma-Nathan and I are crossing the plaza. I have to get detumesced (a shot of Neo-Synephrine, nose drops, will do it).

"Uh, Mr. Mano," he says, "pull your attaché case up over your——"

"Not on your life."

He shrugs.

Proposed to Mildred this evening.

•

Thursday, March 16

Padma-Nathan and I are thumbing through my sexual SAT scores. Somehow it doesn't look as if I'll get accepted by a good school, so to speak. First of all, the test that felt worse than flaming kerosene shows I have bladder dysergia: lack of muscle coordination resulting from defective nerve conduction. (In plain English: For me the last drop is never the last drop.) Parkinson's has probably caused this and Hytrin can give relief—at least enough to keep all my zippers from rusting.

The DICC and ultrasound show a certain amount of vascular deterioration, most evident in my right cavernosal artery—which at age 53 I'm "entitled to," said Padma-Nathan. (A 364 cholesterol level doesn't help either.) But, generally speaking, the old bathtub faucet and stopper mechanism is functional. My flat tires are rather neurogenic and/or psychogenic in origin. That is: (a) the signal from my brain to produce prostaglandin isn't getting through often or forcefully enough, perhaps because I have nerve damage from Parkinson's, and (b) my spiteful mind is producing an overdose of the shriveler noradrenaline. To use athletic terminology, I choke in the clutch.

How does Padma-Nathan know all this? Mildred, that bitch, went and told him. So let me reveal something you weren't aware of. The average bloke—me, your priest, Newt Gingrich—will get four or five firm erections while asleep, with each erection lasting as long as a half hour or more. Imagine. You're probably hard for about two hours every night. Compute it out: That is more than five years over a normal lifetime. And not once did she bother to wake you up.

There is a physiological reason for all this night work. "Most of us after puberty," said PadmaNathan, "have more erections when we are asleep than when we're awake. And those erections really recharge the battery, keep that muscle intact, re-oxygenate it. When they stop, transforming growth factors increase, toxic substances increase and prostaglandins are no longer produced. The smooth muscle dies. You lose it."

Nightsticks, then, are positive signs. (Even with Mildred and a strange hotel bed I had one or two that stood out on the Rigiscan seismograph.) "If you get really huge, rigid erections at night that are long in duration—and you're having some problems and you're with a new partner and you've just had a death in the family and you're going through a financial crisis, then I can tell you that it's a situational dysfunction that will get better. It also tells me that your nerves are intact from here to here." From brain to groin, he means.

But there is much more at stake, I suspect, than just muscle and oxygen. The whole of male creativity may depend on our nighttime erections. This theory, understand, is based on no scientific data whatever—though Padma-Nathan found it not implausible.

Let me take you back a few decades. Around 1974 I wrote a piece on biofeed-back. People then were trying to self-induce "creative" brain-wave rhythms—most often alpha, the sort of high-frequency pattern that was scientifically associated with artistic and religious insight.

So I sat in a chair while a nice lady stuck electrodes on my cranium and told me to make alpha. Relax, concentrate, yawn. The biofeedback machine was silent—no beep to announce the proper set of electric cycles in my skull.

The nice lady, perhaps sensing my distress, leaned over. "Try sexual images," she said.

Beep!

That always intrigued me. Why would sexual musings trigger brain-wave action similar to the rhythms inspired by creative work? Does arousal initiate, sustain or just coincide with a heightened imagination? Erections occur during the most crucial period of subconscious enterprise—rapid-eye-movement sleep. Simplistically, a preorgasmic state of carnal excitement evidently parallels REM in its "primitive consciousness." Your erection acts both as antenna and as transmitter—jamming the diurnal brain-wave pattern, permitting free association. Creativity, it seems, is as related to sexuality as it is to intellect. I presuppose, of course, some analogous but less manifest brain-groin circuit in women.

•

I have tower clearance from PadmaNathan. Time to take off. The injection is quick and simple, nothing you'd need a lobster bib for. And close to painless. The glad base—where you prick yourself—has very few pain receptors. Just swab, suck a small amount of clear liquid from ampule to syringe (as they do on ER) and, plip, insert. The needle—hardly half an inch long—is disposable and not much thicker than an acupuncturist's. It's the same type of needle diabetics use for insulin injections. It was in before I knew it. Press plunger and out. Contact.

Padma-Nathan has allowed me to absorb 0.1 cc of his prostaglandin and phentolamine formulation. This is a minuscule amount, yet it is often more than sufficient. Padma-Nathan, you see, doesn't want me to look like a human diving board. If 100 percent is a 15-year-old's glad-on, Padma-Nathan would like his clientele at about 75 percent—where the flesh tusk will be full, nonbuckling and confident, but still human. It is more natural (and more sensuous) to generate that last 25 percent through love, romance and situational raunch—while knowing that one cannot fail.

"Well, things seem to be happening. Let me leave you alone for a while. See if you're comfortable. See how it feels."

It feels just fine. Somewhat like being the sexual equivalent of a ventriloquist's dummy, but fine, thank you. Just fine. I mean, why put my brain through all that trouble? Who needs concentration, fantasy-making?

Uh-oh.

Who needs me? Is that what you're saying, buster?

No, Brain. Gosh, no, never.

Went and bought yourself an erection, did you? In California, no less. Went over my head to some doctor.

Brain, it isn't what you think.

An erection without guilt? Without effort? There is no such thing for you.

No, please. Not the noradrenaline, no!

"Well, Mr. Mano, how's it going? Oh, that's excellent. Very good."

"Well, but it hasn't gotten any bigger, it's still 75 percent."

"Hey, don't worry. It's great. This is just where I wanted you to be. You're leaving in a few hours and there's no way I can monitor you. This is perfect for now. When you get home to a familiar, relaxed atmosphere...."

"I need another shot. Give me another shot."

"But suppose you have a priapism on the plane?"

"I won't, I won't, I won't."

"Hmm. Well, we have three hours—why is it so important to you?"

"Because there's a loud, deep voice in my head, and it's saying, 'No.' We need a show of force now, we need a preemptive strike."

"Oh. Gotcha."

To his credit, Padma-Nathan knew instantly what I was talking about and just how critical it could be: psychogenic self-sabotage, I mean. Since Monday he had been putting up with my batty, obsessive imagination. (I once wrote a 555-page novel, numbered 555 to zero, about this guy who lost his senses one after another, until he went mad or found God or both.) But, sympathetic as Padma-Nathan may be, he can't ignore prudent medical practice. ("In case you become priapic, please wait for the flight attendant to assist you.") Still, after ten minutes he gave me a stingy 0.15 cc booster shot. Nothing much happened. I feared I was in trouble.

"Have a good flight home, Mr. Mano." We shook hands. "Call me any time. Here's my home number. We have time. Your wife's out of town for another three weeks. By the time her show closes, I promise you'll be having dependable, persistent, firm erections. I'll talk you through it. I promise."

Padma-Nathan smiles. I smile. We both know he is trying to overwhelm my brain by the force of his medical authority. Now he is in trouble, too. I see my head do a 360-degree turn: And green puke hoses down Padma-Nathan.

The City of the Angels drops below me. Once again, to my amazement, I got through immigration, and am now heading for New York. A thermos is on my lap. In it sits one ampule containing 50 chilled erections. I am full of male-ness. After all, Dr. Harin Padma-Nathan—an expert in erectile dysfunction—has promised me.

And then this voice speaks out of the clouds:

A few diplomas? You're impressed by a few diplomas? Since when?

•

Prostaglandin Diary

March 18, Saturday: I'm not worried. With Dr. P-N listening from his home 3000 miles away, I shot myself up with 0.2 cc of prostaglandin and phentolamine. The injection part was a cinch.

Then I lay down and started reading The Wall Street Journal, as I had planned. I have to be scientific about this. Can't let subjective factors distort the data. My reaction is supposed to be chemical, period. It works or it doesn't. There is no placebo effect in this therapy.

It didn't work.

March 22, Wednesday: I'm not worried. P-N not worried. Shot up 0.3 cc this afternoon. Nothing.

March 25, Saturday: I'm not worried. I'm panicked. Shot up 0.4 cc. Then, in about ten minutes, when I just knew it wasn't going to work, I shot up another 0.2 cc, then another 0.2 cc. A total of 0.8 cc. Didn't even feel the needles.

Nothing happened.

Padma-Nathan is air-freighting me some trimix with papaverine. Papaverine is surefire stuff (though there is more scarring with it). Papaverine got me up for the DICC. It's pretty much irresistible. I tell myself that.

P-N just called. That's six times since Wednesday. He remains confident and encouraging. Has a great transcontinental bedside manner. Says it's lucky I had all those tests, because otherwise I'd have to get the ultrasound, etc., in New York now, just to be sure there were no physical problems.

This way he knows for certain I'm OK physically.

March 28, Tuesday: Give me a break, will you?

Took 0.2 cc of trimix and zilcho, balloon juice, nothing.

I know what's up. I know. Brain has decided to go one-on-one with PadmaNathan. Oh, yes. Brain is going to override the bad prostaglandin that might give us—God forbid—a little pleasure. Brain is going to prove itself more macho by failing. By being less macho. Oh, good idea, Mr. Brain. That'll be a satisfactory win.

And for this kind of thinking we evolved from Australopithecus?

March 29, Wednesday: It worked! And it's like Beethoven's Eroica. Magnificent. Sculptural. There.

Hit myself with 0.5 cc of trimix (as instructed) and lay down on my back to read. Eight minutes later I heard this tap-tapping on The Wall Street Journal. Polite like.

"May I come in?"

Well, hello there.

Lasted more than an hour. Told Padma-Nathan to have a drink on me. We are both relieved.

April 4, Tuesday: Another Ballantine blast! It's outta here! More than two hours hard at 0.5 cc trimix. We have broken Mr. Brain's will. The doctor says soon I can use a lower dosage—but later, later.

L arrives home on April 17. Think I'll try one more shakedown cruise.

Look what I got you, dear.

Oh, you shouldn't have.

April 11, Tuesday: Landed myself in the emergency room of Columbia-Presbyterian Hospital tonight.

Can you believe this?

Administered 0.5 cc trimix at seven P.M. At around ten P.M. I knew I had gone priapic. It ached. I couldn't get comfortable in any position. A tub of cold water didn't dent it. And I had to urinate at the ceiling.

Thank God P-N was home. "Mr. Mano, I swear, you are the first patient of mine ever to develop priapism. But don't worry. You'll be all right. There's no harm to the tissue until eight or ten hours. We'll wait until 11:30. Meanwhile, I'll alert Dr. Ridwan Shabsigh in New York. He's a good friend and a top specialist in erectile dysfunction. You'll be all right and maybe it'll go down of its own accord." It didn't.

I left the apartment like a cranky, bent old woman with osteoporosis. Try getting your priapism into a taxi seat—might as well squeeze in through the cash drawer.

Dr. Shabsigh was great: efficient, calm, and understanding. Still, it isn't painless—nor pleasant—to watch gobs of dark blood come out of your glad like cheap red bordeaux through a Sip-n-See straw. Still it didn't go down. Shabsigh had to drain nose drops in. And, of course, everybody stopped by to watch.

But Shabsigh concurs with P-N: Priapism is extremely rare.

Hooray for Mr. Brain—he suckered me into his trap. And I fell for it.

Attacked by the overconfident forces of trimix, Brain began retreating—like the Russian army before Napoléon—until I had overdosed myself. At 0.5 cc trimix the only thing keeping me from priapism was Brain's resistance, all that noradrenaline. When the resistance was withdrawn, I was overcommitted.

Winter fell on Moscow. There were bloody footprints in the snow.

April 18, Tuesday: At P-N's insistence (he has to be a little gun-shy) L and I use only 0.4 cc of the regular formula. Nothing. I have no faith.

L says: "Oh you. Compete, compete, compete. That poor doctor."

Good to have her home. Tomorrow we go with 0.1 cc of trimix. We're all nervous. Though I had no discomfort after today's dose, I don't want to go to Columbia-Presbyterian again.

What if P-N hadn't been home when I called that night?

April 19, Wednesday: Tonight I was Wagnerian. Tonight I was a character out of DC Comics—kapow! Take that! A 0.1 cc dose of trimix is perfect. For 85 exquisite minutes. L is quite amazed and pleased. The rest is none of your business.

April 23, Sunday: Damn tactical mistake. P-N told me to try lowering the dose (afraid of another priapism, I guess). So I hit up with 0.05 cc trimix.

Nothing. I should have reinforced myself at 0.1 cc first.

In my head I hear: Heh, heh, heh, heh, heh.

L beginning to roll her eyes.

April 26, Wednesday: Fail at 0.07 cc trimix. L puts her bare foot down: no chemical sex for at least two weeks. I start making love the normal way, not like a self-conscious lab animal. We have to reestablish the strong sexuality we had before I went to California. "This is like making love at a press conference," L says.

She's right. She's right.

May 10, Wednesday: trimix at 0.1 cc. Kapow!

Thank God.

•

And so Odysseus, having beaten the one-eyed monster, having slid (with some K-Y) between Scylla and Charybdis, settles down beside Penelope at 0.1 cc of trimix. There let him rest.

This has not been an easy article to write. The ironic stance I've taken is, as you may have guessed, defensive in large part. I still possess some male pride. And I certainly wish my experience with prostaglandin had been less like an SNL episode with "Mr. Bill." But that was not to be.

I believe in prostaglandin treatment for erectile dysfunction—as I believe in anything that might heal the chafing between male and female (or male and male). Prostaglandin may not be for you. Or, rather: Prostaglandin may not be for you now. But it is there whenever you want to try it. The injections are trivial. And you will almost surely not have to go through what—out of journalistic pig-headedness—I went through: high dosages, invasive tests, priapism and a long period of fine-tuning. Anyway, you have now heard the worst.

•

Padma-Nathan is writing one of those "all you wanted to know" books about prostaglandin therapy. It should sell: There is a large enough target audience. To offset my harrowing narrative, I asked Padma-Nathan if I could speak anonymously with some of his more representative clients. These excerpts convey, fairly I think, their gratefulness and enthusiasm:

A.Z., 56, marketing executive: "I had been impotent and uninterested for five years or so, when a friend mentioned Padma-Nathan. I shrugged and filed it away, but that same week I met the love of my life. I would never, never have dared to call her in my demoralized sexual frame of mind. But I went over to USC—the prostaglandin gave me confidence. We're engaged now and I've never been happier in my life."

R.H., 59, set designer: "I was diagnosed as bipolar three years ago. Prozac gave me a lot of relief. Unfortunately, it also left me pretty limp where it counts. With prostaglandin, thank God, I can be both sane and sexually active."

A.R., 48, airline consultant: "I had great results with the therapy, so I mentioned it to my buddies at our monthly poker night. Half of them went clammy and pale, like, 'How did he know? Did my wife tell his wife?' Believe me, at some age all men start worrying about it. Four of the guys called me. Three of them have had success with prostaglandin. We go out, and they pick up the tab."

T.R., 65, lawyer: "I was a womanizer all my life—especially young ladies. Then, around ten years ago, I lost faith in my staying power. I was miserable, even suicidal. There was no reason to live. Now women tell me I perform better than their 21-year-old boyfriends and I have the experience of 65 years."

B.L., 57, real-estate broker: "I wasn't impotent per se. Yet I needed novelty, which got me into a lot of trouble. But, with the therapy, I felt validated in my own bed. The wife did, too. It saved our marriage."

D.K.M., 53, Playboy contributing editor: "L and I use it when we feel the need. Most often just knowing there's an ampule in the refrigerator is enough. And I don't worry about the eventual effect of Parkinson's medication. You ask if I'd go through it again? My answer is yes—priapism and all."

That, let me tell you, is one hell of a recommendation.

Padma-Nathan can get a rise from just about any man. This is Lourdes for the logless.

When your girlfriend is on top, ask her to settle down carefully. This isn't the time to play ringtoss.