Doctor's Advice - Need help with my virility!

Q. Doc, I wonder if you could help me with a problem? I have heard that in America, it is possible for a man to have an operation that will give him an 'instant erection'. Well, I am a successful businessman, and everyone thinks that my life is great. But from I was 30 years old, I have had issues with losing my nature. This has already cost me one marriage. And my second marriage is not looking too good either.

I would do anything, and spend anything, in order to be able to have good erections again. I have tried Viagra, but it did not work for me.  However, the other day I read that in the United States, there are surgeons who can put a sort of 'splint' into a man's penis, so that he can have sex whenever he wants. I am sure I could afford that operation.  So would you advise it, Doc?

I am sorry to hear about your problem. The first thing I must say is that if Viagra has not worked for you, there are two other oral tablets which you should try. They are called Cialis and Levitra. Please ask your own doctor about them.

Alternatively, there is a tiny tablet which can be placed inside the penis, which induces an erection almost immediately. Your doctor could tell you about that too.

There are also self-administered jabs, which you can inject into your organ whenever you wish to have sex. All of these things are prescriptions-only. One of them should work for you.

But if you wish to have a surgery, you should know the facts. Yes, there are various operations in which a surgeon inserts a splint into the penis, so that the man can have sex. They are all pretty major procedures, but they have considerable risks and serious complications could arise. They are also very expensive.

The simplest operation involves the insertion of a firm plastic rod, which is around five inches long, into the penis. The rod does not inflate, but it provides some 'stiffness'. When the man wants to have sex with his partner, he simply points the rod upwards. And when he needs to pass urine, he points it downwards.

That is not a very satisfactory solution to the problem of erectile dysfunction, but it does enable couples to have some form of intercourse.  Much more sophisticated (and expensive) is the inflatable penile prosthesis. This contains fluid - and the idea is that the man can pump it up whenever he wants to. I understand that in the United States about 20,000 of these devices have been inserted.

At the moment, there are two main types of inflatable prosthesis. First, there is the American Medical Systems 700 device. It consists of two cylinders (around five inches long) plus a reservoir and a pump. The surgeon places the two cylinders inside the penis. He also fits a 'reservoir' in front of the bladder. This reservoir contains saline.

The reservoir and the cylinders are connected to a small pump, which is concealed inside the scrotum. So the idea is that whenever the man wishes to have an erection, he just squeezes this pump repeatedly. Saline will then flow into the two cylinders, and give him an erect penis.

The other popular type is called the Coloplast Titan. It too consists of a pair of cylinders, a reservoir and a pump. It has a special coating which is intended to reduce the risk of infection. I must add that the surgical insertion of any of these devices is very difficult. So you should only go to a surgeon who really has a lot of experience putting them in!

You should expect quite a lot of pain in the month following the operation. Also, there is a chance of bleeding, and infection. Finally, there are sometimes mechanical problems with the tubing-like leakage or blockage. So please think carefully before you go off to America and spend thousands of dollars! Before you make up your mind, I think you should consult a doctor here in Jamaica, and discuss the other types of treatment for erectile dysfunction that I have mentioned above.

Q. Doc, I am really terrified by my Pap smear result. It came back as 'carcinoma-in-situ'. Now I have looked up that word 'carcinoma', and apparently it means 'cancer'. Am I going to die?

No, you are not. In fact, you have nothing to worry about at all. Admittedly, you are right in saying that 'carcinoma' is a doctor's word for 'cancer'.

However, in the case of Pap smear results, the term carcinoma-in-situ just means that there are pre-cancerous cells, but at such an early stage everything is going to be ok. You may need some treatment - but you will certainly live. You see, the whole point of a Pap smear tests is to detect very early cancerous changes in a woman's cervix, long before she has any symptoms. That is what has happened in your case.

Q. Last night, my girlfriend gave me what is commonly known as a handjob. To both our surprise, the fluid came out bloodstained. Why?

This could just be due to a broken blood vessel - in other words, a leak in one of the tubes that carry blood. Or it could be an infection. But in any case, you must see a doctor right away, so he can examine you. The odds are that everything will be fine.

Q. I used to be a very sexy women. Then I got married and my husband and I moved in with his parents. Since then, I have been completely unable to have an orgasm. Why is this? I talked to a nurse who said it was 'all in the mind'.

It is very common for women who have moved in with their in-laws, or with their own parents, to find that they cannot climax.

This is because they cannot relax. Their minds tell them that when someone from an older generation is in the house, it would not be appropriate to have an orgasm.  So maybe you could train yourself to just lie back and have a good time, regardless of the fact that your mother-in-law is in the next bedroom. If not, then the best course may be for you and your husband to move out.

Q. Doc, sometimes when I have sex with my partner, I think that her vagina is wider than it used to be. Is this a sign that she is cheating on me?

A lot of men believe the old myth that if a woman cheats, that will somehow make her vagina larger. This is not the case. Sex does not increase the width or length of the vagina. The only thing that does increase the size of the vagina is childbirth. Has your partner had children?