AboutArthur Goldstein, M.D. Expertise Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations American Medical Association, American Urological Association, American College of Surgeons
Question Iam 30, Mr, black African with a wife and 2 kids. Living in
Markfield village Leicester UK.
Iam very grateful to your effort of transforming
female men to what they suppose to be.
With a shame to tell you, my penis is naturally very
tiny and curved/vended, my erection is also very bad. I can fall in love but I knew my wife
is not happy with my action at all.
This I wrote to you whether you can offer me any
cheapest medication.
Some doctors I contacted online recommended me to use 'Vimax'. But what I need is if possible to have a guaranteed and everlasting medication.
If you wish you might give me appointment or send me guidelines and conditions on the following address
But know that my wife is not living with me now
Till i heard from you.
Answer Saidu, your problem is complicated as your complains of a small penis, penile curvature and erection problems can all be unique. There is no simple fix or medication for these but I shall try and give you some insight into each.
The majority of men believe they were "short-changed" regarding penile size. The average erect penis is 4-6" (10-15 cm.) and indeed this is where the overwhelmingly number of men fall. I have read the web sites regarding claims of increasing penile size but have had no clinical experience with the techniques (ie massage, jelqing, andropenis, etc.). However, based on my years of practice and knowledge of anatomy and physiology, I find it difficult to believe they would work to any significant degree. I doubt they are harmful but again this is just a supposition. You probably have nothing to lose but money, hope and time. My best advise is to learn how to use what you were naturally endowed with to the maximum. There are many excellent books available on how to become a terrific lover almost regardless of penile size. You probably may just have some self-esteem issues. You might consider consulting a urologist if for no other reason than reassurance about your probable normality. If you are truly excessively small, there are operations available to increase the size of the penis. However, there are significant potential complications and because of these, this type of surgery is not recommended for routine use by the American Urological Association.
The normal anatomy of the penis consists of 3 cylindrical bodies each wrapped in an elastic membrane. The 3 structures are the urinary canal (urethra) and the paired corpora cavernosa. The latter 2 become engorged with blood during sexual arousal, stretching the membrane that surrounds them (tunica albuginea). Curvature of the penis to varying degrees occurs in about 50% of men. It is often congenital (born with the condition) but can be acquired due to injury or a disorder called Peyronie's disease. Curvature can be due to one of the corpora being shorter than the other or to the deposition of scar tissue in part of the tunica albuginea which acts like a bow string and prevents this area from expanding. I suggest that you see a urologist so that a proper examination and diagnosis be made. Generally, no treatment is necessary unless the curvature causes discomfort to you or your partner with sexual activity or if the curvature is so severe that you are unable to have conventional intercourse. I know of no successful conservative treatment if the problem is due to scarring from injury. The most common therapy is surgical correction which can either be done by slightly foreshortening the corpora on the side opposite the scarring (plication) or removing the scar tissue and placing a graft at that site. The latter is not as reliable as it heals with a varying degree of scar that is difficult to estimate and may not correct the problem. Generally, surgery is not done purely for cosmetic reasons. Therefore, if you otherwise function well sexually, an understanding partner is the best therapy.
There are many causes for erectile dysfunction (ED). The most common diseases associated with this disorder are vascular conditions (ie atherosclesosis – “hardening of the arteries” and abnormal varicose veins inside the penis) and diabetes. Some others include hormone imbalances, neurologic pathology, local penile diseases (ie Peyronie’s disease), smoking, obesity, alcoholism, prostatitis, prostate surgery, certain medications and chronic perineal pressure from overly aggressive bike or horse back riding. A variety of emotional disturbances (most commonly depression or performance anxiety) can also cause or be a significant factor in those suffering from ED. Very commonly, the etiology is multifactoral. As a result, consultation with a urologist skilled in the evaluation and treatment of ED is recommended.
In addition to a history and physical examination, specialized tests may be indicated to find a cause. Some of the commonly ordered studies include routine blood tests, hormone levels, and penile duplex color ultrasound.
If a correctible cause is found, specific treatment is instituted. If the condition is irreversible, most men today can still be restored to normal functionality with the numerous treatments available including oral medications in the class of PDE5 inhibitors (ie Viagra, Levitra, and Cialis), vacuum erection devices (VEDs), confidence rings (for those with a pure venous leakage), penile injections (ie Edex, Caverject), urethral suppositories (Muse) and penile prosthetic surgery. PDE5 inhibitors (in proper dosage which varies with the individual) have shown success in about 80% of patients. Side effects may include headaches, flushing, heart- burn, nasal congestion, visual disturbances, dizziness, etc. These drugs are contraindicated in patients with coronary artery disease who take nitrates (ie nitroglycerine) as some deaths have occurred in this group. There is also the potential for severe side effects if PDE5 inhibitors are used in patients who take alpha- blockers (ie Hytrin, Cardura, etc.) or are hypertensive. Several other types of medication may alter the blood level of PDE5 inhibitors possibly leading to significant side effects. Other contraindications include certain types of liver and visual disorders (ie retinitis pigmentosa). PDE5 inhibitors have been noted to cause abnormal liver function tests in some otherwise normal men. Because of this, although PDE5 inhibitors are well tolerated by most, they should only be taken with caution and under the supervision of a physician. All 3 of the PDE5 inhibitors available in the USA have about the same success rate. If one fails to respond to the initial dose, it should be increased until either tolerance or the desired effect is obtained. Cialis can be taken without regard to meals but takes 2-4 hours before it works, although the beneficial effect lasts about 18 hours. The dose is 10-20 mgm. Viagra and Levitra have an onset of action in 30-60 minutes and last about 4 hours. The absorption of these 2 medications can be adversely affected by diet, especially a diet high in fat. Therefore, it is best to take these an hour or 2 after meals. About 60% of patients who fail to respond to maximum doses of one of the PDE5 inhibitors. respond favorably to another and, in the absence of side effects, this is worth trying.
In summary, you need to consult with a urologist. Good luck.
