The Taiwanese Fix and the Penile Pricking Ring

Creative Approaches to Impotence

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man having penis surgery is the opposite of a man in a fig leaf He is concealed face-to-feet in surgical sheets, with only his penis on view. It appears in a small, square cutout in the fabric, spotlit by surgical lamps. To lie completely naked would preserve more modesty, for then the onlooker’s gaze is bound to stray. There are moles and chest hair to look at, knees, nipples, Adam’s apples. This way, all eyes stay on the organ.

But a man, even an impotent man, needn’t feel self­conscious under the gaze of Geng-Long Hsu. Dr. Hsu, who practices in his native country, Taiwan, has been a uro­logical surgeon for twenty-one years. Whatever one might come here for, it is safe to assume Dr. Hsu has seen worse. He has seen smaller, crookeder, pinker, limper. He has seen penises with implants poking through their tips like col­lar stays. One day this year, he repaired a penis that had ruptured during a performance of jui yang shen gong, an obscure martial art.[42] “He tried to lift one hundred kilo­grams with his penis!” Dr. Hsu exclaimed yesterday while we rode the elevator to the lobby.

Dr. Hsu runs the Microsurgical Potency Reconstruc­tion and Research Center in Taipei, where he has been researching and honing a surgical treatment for impotence. The operation, which involves tying off and removing some of the veins of the penis, has fallen out of favor elsewhere in the urological community, but Dr. Hsu believes that if it is done correctly and thoroughly, it can help up to 90 percent of men with erectile dysfunction (known among urologists as ED, to the minor chagrin of Eds the world over).

The dysfunctional penis in the spotlight this morning has been so for the last eight of its forty-seven years. The patient has tried Viagra, with limited success. The organ sits alone on its little skin stage, looking vulnerable. I find myself feeling nervous for it, as one might for a fifth-grader before a solo recital.

Once the anesthesia takes effect, Dr. Hsu will begin “degloving” the organ. The verb “skinning” would get the idea across more efficiently, but it is more pleasant, I sup­pose, to picture an aristocrat gently loosening the fingers of his opera gloves.

Dr. Hsu makes a cut in the flesh just above the penis.

He slips his blade into the wound, and slides it underneath the skin.

“Remember the night market?” he says. Last night, Dr. Hsu took me to Huahsi Street, a market known for the lurid shows put on by its snake-medicine vendors. Unlike snake shows in Morocco or India, Taiwanese snakes are not charmed. Pretty much the opposite of charmed. They are skinned alive, bled, and made into stews.

Dr. Hsu works his scalpel down the shaft of the penis, detaching the skin from the pulpy pinkness underneath. “Very like the night market!”

Dr. Hsu speaks English with great enthusiasm and fit­ful syntax. This is occasionally frustrating but mostly just endearing. Yesterday he took me and his business associ­ate Alice Wen on a tour of Taipei city sights. “Okay!” he exclaimed as we piled out of the car. “Let’s experience!” He is patient, polite, and unwaveringly generous. As we set off into the crippling midday heat, he doled out sun visors and baseball caps, taking the one no one picked for himself: a China Youth Camps cap with a pink bunny motif.

By his own description, Hsu is something of a “queer bird.” He once inserted a Foley catheter into his own ure­thra, “just to feel what patients feel.” He self-medicates with acupuncture, sometimes walking around his clinic with a needle protruding from the side of his head. I have heard him use a translation of one of Chiang Kai-Shek’s names (“central uprightness”) to make a point about penile curva­ture.[43] Today finds him wearing blue plastic wraparound
sunglasses as he operates. He explains that this is because he suffered a seizure some years back, which left him sensi­tive to glare. His face is still partly paralyzed. This is notice­able only when he smiles, which he does with just one side of his face, in the manner of a dramatics-club mask.

The next step in the operation Dr. Hsu has named the “inside-out maneuver.” Though it is not so much “inside — out” as just “out.” Using his gloved fingers, Dr. Hsu pulls the man’s penis up and out of its skin, through the three — inch slit, by its midshaft. The protruding skinless portion is doubled over inchworm-style. (The skin at the head of the penis has been left attached.) I ask Dr. Hsu what this maneuver would feel like without anesthesia. His answer: “Like the way to treat a spy.”

For the next three hours, Dr. Hsu isolates the veins he is after, ties off the blood supply with sutures half again as fine as a strand of his hair, and then snips the veins away. He begins with the deep dorsal vein, the fattest. Bit by bit, he frees it from its moorings. As he works, he pulls the vein taut and holds it out away from the penis, like a robin pull­ing on a worm.

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o understand why removing veins from a penis can help it stay erect, you need to understand how it gets that way in the first place. Erections are all about blood. Blood is the backbone of a stiff penis. Though it was a long time before anyone figured this out. In the Middle Ages, the erect male member was thought to be filled with pressur­ized air, a miniature skin blimp. It was Leonardo da Vinci who made the breakthrough. Cadavers available for anat­omy study back then were typically those of executed mur­derers. Because they’d been hanged, the dead criminals had erections, and because Leonardo was dissecting them, he noticed that their penises were, in his very own words, “full of a large quantity of blood.”

The blood resides in a pair of cylindrical chambers— the corpora cavernosa—which lie side by side like a diver’s tanks. The chambers are filled with smooth-muscle erectile tissue, full of thousands of tiny hollow spaces, like a sponge. When the smooth-muscle tissue relaxes—which it does at the behest of an enzyme activated when the brain perceives a sexual stimulus—it expands. (Smooth muscle, unlike the striated muscles of your arms and legs, is operated by the autonomic nervous system; this is why men can’t simply will themselves erect—or unerect.) The relaxation of the erectile tissue allows blood to rush in and fill out the spongy hollows. Drugs like Viagra enhance the erection process by knocking out a substance nicknamed PDE5, which inhib­its smooth-muscle relaxation. They inhibit the inhibitor. (Thus, they’re called PDE5 inhibitors.)

So now we have achieved, in the parlance of ED experts, an erection. It is a respectable achievement, but it is not enough. An erection, like a motorcycle or a lawn, must also be maintained. The blood that has filled the two erection chambers* must be trapped there, otherwise the erection wilts. This is tricky, as the chambers are equipped with drainage veins along their surface. What keeps the blood from leaking out via these veins? The miracle of passive venous occlusion. (Stay with me here.) These drain­age veins lie outside the erection chambers but inside the stiff outer membrane (called the tunica) that protects the ^Actually, there’s a third, that runs beneath these two, but it’s a lesser player and we’re going to ignore it. Likewise, we are going to ignore the erectile tissue in the lining of the nose—which does, very occasion­ally, expand when its owner is sexually aroused. It too is made erect by increased blood flow. Nasal congestion is an erection inside your nose.

erectile tissue. When the chambers expand with blood, they slam up against the tunica—which also expands, but not as much—and this pressure squeezes shut the veins caught in between. If all goes well, the blood stays trapped until a postorgasm chemical messenger tells the smooth-muscle tissue to stop relaxing.

When a man is impotent, very often it’s because the erectile tissue isn’t expanding as vigorously as it needs to squeeze shut the veins, and some of the blood seeps out. The result: “Like a tire! Flat!” Dr. Hsu relies on a lively repertoire of metaphors and analogies to explain the vari­ous functions and dysfunctions of the male genitalia. One particularly ambitious explanation, delivered earlier today, involved a Christmas tree and an elephant’s trunk. A diver was diving into a pool, and an aircraft was taking off. I felt like ducking under the table.

The most common explanation for ED is that the erec­tile tissue is simply getting old. “As we age, we lose elastic fibers, we lose smooth muscle, our tissues become more rigid,” explains Gerry Brock, a professor of urology at the University of Western Ontario who sits on the board of the Journal ofAndrology. In an offshoot of aging called fibro­sis, some of the muscle cells in the erectile chambers are gradually replaced by fibers of connective tissue that don’t have the elasticity that youthful smooth-muscle tissue has. When erectile tissue loses its stretch, it no longer expands fully and presses hard against the walls of the tunica. Thus, the veins aren’t squeezed shut, and blood leaks out. If you were to tie off and remove some of those veins, it would prevent—or at least slow—the leakage.

Because the largest of these drainage tubes, the dorsal vein, runs just under the skin along the top of the penis, it’s possible to effect a crude version of Hsu’s surgery by sim­ply constricting the thing with an elasticized band or clamp.

A surprising amount of this went on in the pre-Viagra era, long before the cock ring entered modern vernacular. There are so many patents on file for erector rings[44] that they earn their own chapter in Hoag Levins’s diverting book Ameri­can Sex Machines: The Hidden History of Sex at the U. S. Patent Office. Levins traces the ring’s evolution, from the hand­some steel clamps of the circa 1900 metal-machining era clear through to a 1989 model with a hand-held remote, stopping along the way for a double-page spread of “Penile Ring Clamp Patents of the Post-WWII Years.” Though very few of the early patent titles contain the words penile or erection. Many employ the unhelpful rubric “Appliance for Assisting Anatomical Organs.” A 1900 patent is coyly titled “A Boon to Men.” Descriptions are similarly vague. One 1897 clamp is for use on male organs that “fail to perform their office,” leaving it unclear, at first glance, whether the device is intended to aid the organ or court-martial it.

Dr. Hsu was not the first surgeon to realize that limit­ing venous drainage could be a ticket to newfound potency. A Dr. Joe Wooten tied off a man’s dorsal vein with catgut in 1902. The high risk of infection—penicillin hadn’t yet been discovered—probably kept most of Wooten’s col­leagues from taking up the scalpel, but it might also have been Wooten’s flummoxing conclusion in a Texas Medical Journal article from that year: “It has now been about four months since the operation, and the party reported to me. . . that he had had for the first time in nearly three years complete and satisfactory coitus and was now willing to stop trying.”

It was Hsu’s mentor and fellowship advisor Tom Lue,[45] a professor of urological surgery at the University of Cali­fornia, San Francisco, who refined and championed the procedure in the late eighties. Alas, a long-term cure proved elusive—the success rate dropping in one study from 62 percent after three months to 31 percent after forty-five months. Why would this happen? The logical reason, say Brock and others, is that the body tends to compensate when someone or something destroys or blocks a vein. It grows new veins, and/or the remaining ones get bigger. Lue ultimately distanced himself from the procedure, and oth­ers followed suit.

Most everyone but Dr. Hsu. In a 2005 paper published in the Journal of Andrology, twenty-one of Hsu’s patients who underwent an early version of penile venous strip­ping surgery in 1986 were contacted for a follow-up. They filled out the same questionnaire they had filled out before the surgery: the International Index of Erectile Function (IIEF). Their mean preoperative score had been 10 (out of a possible 25), and their follow-up score was 19. Hsu saw no evidence that the penises had grown new veins.

“See the difference?” says Dr. Hsu, who is by now clos­ing up the incision. “Already. Look how engorged.” The organ is visibly larger than it was when it walked in. Dr. Hsu says many of his patients report that their penis is mildly engorged all the time. He adds that many enjoy this, that it makes them feel more confident.

“So this guy. Now ready to make a home run. Like a baseball bat!”

Why would Dr. Hsu be able to cure so many men, when other competent urologists who undertake the pro­cedure have seen, for the most part, only short-term ben­efits for their patients? “I can’t for the life of me answer that question,” says Gerry Brock. “I’ve seen Geng’s surgery, and he does a good job. He’s an honest guy, a great guy. But I have a hard time understanding, from a physiologic basis, how his results can be so distinctly different from those of others.” One possibility is that Taiwanese patients are more polite—or more timid—than Western patients. Perhaps Dr. Hsu’s patients are hesitant to report that the surgery’s effects are fading.

Then again, the possibility exists that no one who does this technique is as good at it as Dr. Hsu. Few urologists seem as lovingly immersed in the anatomy of the penis as Geng-Long Hsu. He publishes papers on the tunica, the deep dorsal vein, the distal ligament. He has a standing order for “leftovers” at the dissection lab of the anatomy department of Taiwan Adventist Hospital: “Please give all the penises to me.” Some years back, a lab tech threw away a box containing seventy-three penises that Dr. Hsu had
collected from researchers and anatomy labs over the years and stored in a freezer. The memory pains him to this day

The next time a cadaver becomes available, Dr. Hsu plans to make a detailed examination of the penile veins to see which ones account for what percentage of the drain­age. He wants to know which are most critical to remove, and which make little difference, in terms of erectile func­tion. Which begs the question, Can a dead man get an erec­tion? He can. I have seen it myself, on a DVD of a previous research operation,* which Dr. Hsu sent me before I came to Taiwan. Standing in for blood was saline, being pumped in at more or less the same rate that the heart pumps in blood during a normal erection.

One day this week, Dr. Hsu and I walked to a temple high on a hill behind his apartment complex. He said he regularly walks the two-mile road to the top (stopping to pick up litter along the way), and when he gets there, he jogs up and down the flights of steps to the temple door fifteen times. He explained that because he feels an obliga­tion to help as many men as he can, he does not want poor health to cut short his life.

Geng-Long Hsu is a man on a mission. He feels he has a cure for ED and wants it to be used throughout the world, but is, well, impotent to make it happen. Until other sur­geons are able to replicate his success rates, the procedure will likely remain shelved everywhere but in his clinic.

^Because the man had been dead only a few hours and his face was covered by a surgical cloth, the video was no more gruesome than your average Dr. Hsu production. Also, someone had added a soothing soundtrack, the sort of innocuous instrumental one hears in shopping mall atriums.

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eng-Long Hsu is typical among modern urologists in his enthusiasm for the medical and surgical treatment of what had long been considered a psychological problem. In The Rise of Viagra, Meika Loe makes the case that urology pretty much stole impotence out from under psychology’s nose. (Loe, a sociology professor, earned my abiding respect by waitressing undercover at Hooters as part of a gradu­ate research project in gender studies.) From the heyday of Freud all the way through the behavior therapy era of the fifties and sixties, the causes of impotence were thought to dwell in the psyche. Penises went limp from unresolved neuroses, deep-seated anxieties, distraction, obsession. If you wanted help, you turned to a shrink.

All that began to change in 1980. Loe cites as the turn­ing point the publication of a contentious JAMA article entitled “Impotence Is Not All Psychogenic,” as well as the introduction of the vacuum pump and the penile implant, neither of which your therapist was likely to have on hand. The medicalization of impotence was underway.

Viagra sealed the deal. In 1998, Pfizer—with a cadre of media-sawy urologists in tow—launched a massive pub­licity campaign to announce an exciting new approach to impotence. Only it wasn’t called impotence anymore; it was “erectile dysfunction.” The stigma of the psychologi­cal had been removed. Impotence had morphed into a tidy biological problem treatable with a harmless pill. There wasn’t something wrong with the man, there was some­thing wrong with the plumbing. Pfizer craftily introduced three categories of ED: mild, moderate, severe. Heck, it now seemed, everyone has it sometimes, to some degree, even Bob Dole. No need to be embarrassed. Urologists— most of them consultants for Pfizer—began appearing on talk shows, chatting about “ED” as casually as the last guest had chatted about his wheat-free cookbook.

In truth, plenty of cases of psychologically based impo­tence exist, and it’s relatively simple to sort out which ones they are. If a man is medically impotent—because his smooth-muscle tissue is damaged, say, or there’s a prob­lem with his nerves—then he won’t get erections in his sleep. If the problem is purely psychological, he will. That is why diagnosis is sometimes done by checking for night­time erections with gizmos like the RigiScan-Plus Rigidity Assessment System (with Self-Calibrating Penile Loops). Once upon a time, it was done by having a nurse watch your penis as you slept. The next generation of “nocturnal penile tumescence monitoring,” as it is officially known, took the form of a strip of old-fashioned perforated postage stamps slipped around the organ at bedtime and either torn or not torn during the night. The advantage of the “postage stamp tumescence test”[46] was that it could be done in the privacy of one’s home and—thankfully or disappointingly— no longer involved anyone in a nurse’s uniform.

Even when a patient is young and the physical state of his erectile tissue is unlikely to be the problem, urologists are inclined to skip the RigiScan and try a Viagra-type drug. I asked Ira Sharlip, a spokesman for the American Uro­logical Association and a clinical professor of urology at the University of California, San Francisco, why these men would be prescribed pills if their condition is likely to be psychological. “These patients get into a vicious cycle,” he said, “where the anxiety over not being able to get an erec­tion compounds the problem.” A PDE5 inhibitor can help reverse the cycle. “We use it as a bridge. But at the same time, I have all of those patients, if they’re willing, work with a sex therapist or a psychologist.”

Meika Loe quotes the medical essayist Franz Alexander on the enduring appeal of medical—over psychological— approaches to conditions like impotence. “Alexander claimed that medicine’s aversion to psycho-social factors harkened back to ‘the remote days of medicine as sorcery, expelling demons from the body.’ . . . Twentieth-century medicine was ‘dedicated to forgetting its dark magical past.’”

That’s too bad, because it was, as we’re about to find out, pretty darn entertaining.

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n the Middle Ages, the common assumption was that impotent men had been cursed by a demon or by a witch, acting as a sort of local proxy for the Devil. According to Malleus Malejicarum—a 1491 handbook of judicial proceed­ings against witches and methods of “curing” curses and spells—witches could induce both impotence and steril­ity. Some displayed a surprisingly sophisticated grasp of male anatomy. While impotence was achieved by simply “suppressing the vigor of the member,” the sterility curse required the witch to “prevent the flow of the semen to the member… by as it were closing the seminal duct so that it does not descend to the genital vessels.”

Witches with no formal training in andrology could employ a simpler, more fanciful approach. They made the man’s penis disappear. Authorities quoted in Malleus Maleji­carum disagree as to whether the organ is truly gone or the bewitched individual is simply under the sway of a percep­tual illusion that causes him to believe it’s gone. The author quotes an unnamed venerable Dominican father who, dur­ing a confession, hears a parishioner confide that he has “lost his member” to witchcraft. The priest relates that he asked the lad to remove his clothes, so that he might, likely story, check for the missing part.

The author of Malleus brings up the strange matter of penises stockpiled in birds’ nests, which he presents as proof of a literal disappearance. “What, then, is to be thought of those witches who. . . sometimes collect male organs in great numbers, as many as twenty or thirty mem­bers together, and put them in a bird’s nest or shut them up in a box, where they move themselves like living members, and eat oats and corn, as has been seen by many and is a matter of common report?” It’s a question I cannot answer. I can only lament the long, dry journey that legal publish­ing has made in the centuries since 1491.

The recommended cures for impotence suggest that medieval authorities may have suspected that psychologi­cal, not supernatural, powers were more likely at play. The accursed man who seeks advice is invariably asked to give some thought to whom he believes might have bewitched him. He is then urged to “prudently approach” this person and to sit down and have a talk. “Soften her with gentle words.” Whereupon the penis generally reappears. As a Plan B, the learned tome recommends that the accursed “use some violence.”

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ome the late 1700s, blame for impotency shifted from supernatural beings to men themselves. The year 1760 saw the publication of a slim, pernicious work of hyperbolic quackery called Onanism; or, A Treatise upon the

Disorders Produced by Masturbation. A shrewd blend of the clinical and the moral, it spread like a virus through the medical circles of Europe and the United States. Impo­tence was prime among the disorders said to be produced. Sperm-carrying semen was believed to be a vital source of life energy.[47] As with fossil fuel or health insurance payouts, there was thought to be a finite amount of it available; woe befall the man who wantonly squandered it. Masturba­tion and casual sex—particularly with “ugly” women, who sapped one’s vitality faster than the handsome ones—led to all manner of bodily woes. (Spilling sperm into someone you love did not deplete one’s vital juices because, quot­ing Onanism author Samuel Tissot, “the joy which the soul feels. . . repairs what was lost.”)

Onanism and its imitators—Excessive Venery, Mastur­bation, and Continence, by American M. D. Joseph Howe, came out over a century later but is no less hysterical— had citizens worrying that masturbation could cause not only impotence, but blindness, heart trouble, insanity, stu­pidity, clammy hands, “suppurating pustules on the face,” acrid belches, “a flow of fetid matter from the fundament,” tongue coatings, stooped shoulders, flabby muscles, under­eye circles, and a “draggy” gait. It was the Victorian-era ver­sion of the anticrack campaigns that you see today, with their closeups of acne-blighted cheeks and discolored teeth: vanity as a force more powerful than medicine.

Tissot took it to the extreme in his description of the effects of “self-pollution” on a watchmaker referred to as L. D.: “A pale and watery blood often dripped from his nose, he drooled continually; subject to attacks of diarrhea, he defecated in his bed without noticing it, there was a con­stant flow of semen. …” Hello, yes, this watch you sold me is all sticky and stuff? Impotence was almost beside the point. Masturbate for a few months, and you’d soon be so revolt­ing no one was going to climb in bed with you anyhow.

The cure for erectile troubles, then, was simple: Quit masturbating. Stop wasting your vital sap. Dismayingly, this included sap spilled involuntarily during sleep. Nocturnal emissions had to be prevented too. Here simple willpower wouldn’t do the trick. You needed technology. You needed, in the words of the U. S. Patent Office, a Device for Pre­venting or Checking Involuntary Spermatic Discharges.[48]

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n the simple side, there was the Penile Pricking Ring.

Invented in the 1850s, this was an adjustable, expand­able metal ring slipped onto the penis at bedtime. If the sleeper’s penis begins to expand, it forces the ring open wider, exposing metal spikes that, should it expand still further, are pushed down into the flesh, awakening the sleeper. Later, higher-tech variations had the expandable ring hooked up to an alarm bell or—suppurating pustules!—a shock-producing current. One device monitored length rather than girth. A metal cap was slipped over the end of the organ, giving it somewhat the appearance of a muzzled dog snout. Attached to the cap by short chains on either side was a pair of clips. These were affixed to tufts of pubic hair. I will let James H. Bowen, the owner of U. S. Patent 397,106, describe the ensuing scenario. “When a discharge is likely to occur, the device is elevated with the organ, and the connec­tions are drawn sufficiently taut as to pull the hair.”

Many of these devices included an option for daytime use, along with a lock-and-key mechanism. For the true target customer was not the penitent masturbator, but the worried parent and, even more so, the insane asylum caretaker. The institutionalized lunatic who attempted to remove his antimasturbation device faced—in the words of Raphael Sonn, inventor of the Mechanical Penis Sheath— “great physical pain and possible mutilation.” Sonn’s pat­ent reads like the instruction manual for something in the Marquis de Sade’s basement, with “clamping members,” “gripping elements,” teeth, prongs, and hinges “of the tight-butt type.”

Happily, parents of K-through-8 masturbators were encouraged to try less drastic preventive measures. Little hands were tied to headboards, and trousers fashioned without pockets. Hobbyhorses were taken away, and climbing ropes removed from school gymnasiums. One of the biggest spoilsports in the antimasturbation crusade was American physician William Robinson. His 1916 Practical Treatise on the Causes, Symptoms, and Treatment of Sexual Impo­tence and Other Sexual Disorders in Men and Women includes a long chapter on preventing the premature awakening of the sexual instinct in children. “I strongly urge parents to keep their boys away from sensuous musical comedies and obscene vaudeville acts,” tutted Robinson, clearly some­thing of the tight-butt type himself “Many of my patients told me that their first masturbatory act took place while witnessing some musical show.”

Mental masturbation was also to be discouraged. “It is very rare,” wrote Robinson, “that people who devote all their time to severe intellectual work do not pay for it by sexual weakness or impotence.” He goes on to describe the case of a famous mathematician who, during each attempt at intercourse, “would be disturbed by an abstruse math­ematical problem and the attempt would fail.” Somewhat contradictory advice, mentioned in Masturbation: The His­tory of a Great Terror; comes to us courtesy of a Dr. Crom — melinck, who advocated memorizing difficult passages on philosophy or history when overcome by the desire to masturbate.

Truly it seemed that any activity undertaken—sleeping, thinking, eating spiced food, taking in a matinee of Marne— led the heedless male down the path to self-pollution. A man couldn’t even relieve himself without having to worry. Crommelinck urged gentlemen to avoid touching their genitals at all times, lest they inadvertently arouse them­selves—even at the urinal. “Urinate quickly, do not shake your penis, even if it means having several drops of urine drip into your pants.”

Those who could not manage to curb their impulses with philosophical tracts and antimasturbation gadgetry faced a withering assortment of brutal treatments. Robin­son casually states that in two or three cases he applied “a red hot wire” to a child’s genitals. Joseph Howe advocated a treatment that involved a six-inch syringe (“Dr. Bumstead’s syringes are the best”) up the urethra.

The bitter irony here is that regularly spilling one’s seed serves a valuable biological function. Sex physiologist Roy Levin explained to me that sperm which sit around the factory a week or more start to develop abnormalities: missing heads, extra heads, shriveled heads, tapered and bent heads. All of which render them less effective at head­banging their way into an egg. Levin speculates that that’s why men masturbate so much: It’s an evolutionary strategy. “If I keep tossing myself off, I get fresh sperm being made.” Thereby upping the likelihood of impregnating someone and passing on your genes.

Though if conception is the goal, you don’t want the sperm to be too fresh. Daily masturbation would deplete the number of sperm per ejaculate. Got to give the pinheads time to build up their ranks. To produce an ejaculate with optimum potential for fertilization, Levin recommends a holding time of five days.

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ranсe in the late-sixteenth and seventeenth centuries was really and truly a place where you did not want to be an impotent male. This was the era of the “impotence trial.” Compared to the magistrates of these Reformation-era tri­als, Dr. Bumstead is the Gumdrop Fairy. When theologians elevated marriage to the status of a sacrament, impotence was likewise elevated, from a source of frustration to an actual crime. And because impotence was thought to arise from the intemperate spilling of one’s seed, it was assumed that a man who could not get hard for his wife had been spending too much time doing so for others. Or, at the very least, that he was an immoderate masturbator.

Be that all as it was, the main reason a man’s erectile capacity found its way into the courts was that impotence was a legal ground for divorce. Women seeking to escape a
miserable marriage would accuse their husbands of it, with or without cause. If the wife won the case, the man would not only be fined and forbidden to remarry, but would have to return the dowry he had received from the woman’s fam­ily The legal battle that ensued was a spectacle a hundred times more surreal than Michael Jackson in his pajamas, though here too the defendant wore pajamas.

For the husband to win his case, he had to prove him­self capable of, as they say in modern-day erectile parlance, achieving and maintaining an erection. This meant a visit— often two or three or four visits—from a team of “experts” and examiners: as many as fifteen physicians, surgeons, and legal functionaries kitted out with their clipboards and pince-nez.

The defendant was examined in his home rather than in the courtroom, but it only moderately softened the humiliation. The team would arrive at the appointed hour and wait outside the bedroom until the defendant yelled through the door that he was ready for viewing. The exam­iners would file into the room and gather around the bed, whereupon the accused would pull back the bedclothes and show them what he had. These were tough critics. “We did find him in a state of erection upon our arrival,” reads one report excerpted in Pierre Darmon’s Trial by Impotence, “but he did not have sufficient attributes to consummate a marriage.” How did they know? They leaned in and groped (“Touching this swelling, we felt it to be flabby”).

Insult to injury, the examiners tended to wander afield from their appointed task, noting and commenting upon irrelevant anatomical quirks and afflictions. “We did per­ceive on the anus divers rather swollen haemorrhoids,” snipes the report on one Jacques Francois Michel. Another defendant whose report is excerpted in Darmon’s book,
the Baron D’Argenton, was observed to have “no visible cullions [testicles], but as if a purse without sovereigns,. . . which did withdraw inside his person when he turned over, in such fashion that he had nothing left him but his member, and even this being far smaller than is customary among men. …”

Defendants occasionally resorted to extreme measures. The Marquis de Gesvres hired a theater troupe to perform an obscene vaudeville in his boudoir just prior to the arrival of the examiners. Others simply cheated. M. Michel, he of the swollen hemorrhoids, “uncovered himself only with the left hand while the fingers of the right pressed the root of the penis.” (Too bad Robert C. Barrie hadn’t been born yet. In 1907, Barrie received a patent for a hidden penis splint, which stretched the flagging organ along a thin rod between two metal rings, one concealed by “the gathered prepuce,” the other by the man’s pubic hair, “thus present­ing a seemingly natural and unoffensive appearance to alley suspicion. . . [in] the opposite sex.”)

A parallel absurdity took root around 1550. A medical expert of some repute made the claim that erection alone could not be considered sufficient proof of potency. Accused men would hereafter need to prove, in front of a panel of examiners, that they could mount their wife and ejaculate, as the medico put it, “into the appropriate orifice.” Here it was the wife’s genitalia that received the more rigorous scrutiny. “The woman is examined close up, to discover if she be more dilated than on the last inspection. . . (and if there be an emission, and where, and of what nature).”

Given that the wife stood to lose her case if her hus­band succeeded at his task, you had a situation that was equal parts rape and burlesque: “The husband complaining that his partner will not permit him to perform and does hinder intromission, his wife the while denying the charge and claiming that he would put his finger therein and dilate and open her by such means alone.”

The year 1677, blessedly, saw the end of the era. A pub­lic prosecutor decreed the practice obscene and deplorable, and trial by congress was condemned to, as they say, the appropriate orifice.

t

his morning finds Dr. Hsu’s patient subjected to a pub­lic inspection that, while not on the order of a French impotence trial, must be awkward to say the very least. The man reclines on a vinyl examining table, his arm behind his head. I am behind Dr. Hsu, trying to look as though I belong here. If not for the scatter of gray hairs, you would not guess the patient to be much over thirty. He looks at once bookish and athletic, the sort of man a mother will approve of He is chatting with Dr. Hsu, who translates for me.

“He is feeling every morning tumescence. He hasn’t had sex yet, but . . . No pressure, no pain.” The patient is dressed in loose-fitting cotton shorts, which Dr. Hsu now instructs him to pull down. I pick up a journal on Dr. Hsu’s desk and pretend to read it. It is published by the Taiwanese Association of Andrology, whose logo, I note, is a diverting variant of the snakes-and-sword caduceus: a penis flanked by free-floating testicles.

The man pulls down his pants without a flicker of embarrassment. Maybe he thinks I’m a nurse. Maybe it’s different here in Taiwan. Maybe the population is more matter-of-fact about sex and nakedness than we are in the States. Taipei hotel rooms, I’ve noticed, have condoms the way American hotel rooms have shower caps and Bibles. Last night, channel surfing, I stumbled upon what appeared to be the local shopping channel. A man in a golf cap, looking
bored, displayed a Nokia cell phone. Ordering information appeared on the screen. But rather than a narration about the excellent features of this telephone, the soundtrack was a song being sung by an agitated, single-minded woman: “I don’t know your name, but it doesn’t really matter. Let’s have good hot long fast wild horny dirty sexl”

I find myself wondering about this patient. He seems too young to have problems with aging erectile tissue. What if his problem is psychological? Would therapy have been a better bet? Who knows. Perhaps he did not care to confront his emotional gremlins. Perhaps he preferred to blame his veins.

The desire to blame impotence on physiology rather than psyche is understandable. But caution is advised. You can’t always trust science to get it right. Indeed, the first widespread surgical treatment of impotence was a farce of grand proportions.