pe-sufferers can often be helped with medication, in the form of a tablet or a desensitizing cream or spray. Since the 1940s attempts have been made to make the glans and the penis less sensitive. Nowadays we use emla cream, usually applied to children’s skins to anaesthetize them before a blood sample is taken. emla contains lidocaine and prilocaine, two anaesthetics. The cream must be applied at least ten minutes before intercourse, and must be wiped off in good time to prevent the partner from also becoming genitally anaesthetized. A condom can of course also be used. One annoying side-effect of the cream is that when urina -
ting after intercourse the man may be troubled by a burning sensation at the end of the urethra. In addition the cream may cause skin rashes on the penis and the glans. Sex shops also sell anaesthetic sprays; years ago women carried similar-sized spray cans of ‘intimate deodorant’, which women’s magazines had convinced them they needed.
It was not until the early 1970s that a medication appeared on the market that could delay ejaculation and had few side-effects. Its trade name was Anafranil and its chemical name clomipramine. Although it 79
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was easily available on prescription, little use was made of it in sex o logy.
Only in the 1990s did treatment with pills attract widespread interest.
Up to then many sexologists felt that this was simply a ‘symptom -
suppressant’ medication, and that underlying mental problems had to be dealt with. The only snag was that in most cases there was no underlying psychological problem.
At the end of the 1980s selective serotonin re-uptake inhibitors (ssris) came on the market for the treatment of depression, the best-known examples being Prozac and Seroxat. In some men and women treated with certain ssris it was found that ejaculation or orgasm was delayed, and a number sometimes did not climax at all. In any case effect and side-effect are only words, interpretations of the result of medication. What is desirable for one person may be called a major effect. What is not desirable is quickly dismissed as a side-effect. This is what happened with ssris, although they are not officially indicated for pe. These types of medication should therefore be used under the supervision of a doctor.
Testicles as an aphrodisiac
Almost two thousand years ago the Latin writer Pliny recommended the eating of testicles in cases of poor sexual performance. Testes are on the menu in many countries. In Spain this delicacy is called cojones (with the same connotations of courage and manliness as English
‘balls’). Fighting bulls from the arenas are of course the best suppliers.
In the famous Florian restaurant in Barcelona they serve testicles, giving the name of the bull, its weight, a brief description, the pedigree, place and time of death and the name of the bullfighter responsible. Cojones taste of sweetbreads, but that’s all that can be said: it’s an illusion to think that they can be used to raise the testosterone level, since virtually all the remains of the testes will go down the drain, and the tiny amount of testosterone that is absorbed by the intestines will be immediately broken down in the liver.
Scientists
Not until the Renaissance did our knowledge of hormones and sexuality start to progress, and Paracelsus (1493–1541) became the most important scientist of the age. Theophrastus Bombastus von Hohenheim (his real name) hailed from Switzerland, and his greatest achievement was to demonstrate that many diseases could be treated and that sufferers did not always need to endure passively. He introduced mercury treatment for syphilis, the aids of the sixteenth century.
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t e s to s t e ro n e a n d s p e r m In the eighteenth century the English surgeon John Hunter (1728–
1793) did very important and original work, being the first to observe that the testes of animals slaughtered in the autumn were smaller than those slaughtered in spring. (The reason for this has only recently been discovered. The pineal gland at the base of the brain produces more melatonin when there is more sunlight, again boosting the production of hormones in the hypophysis, which in turn prompts the testicle to produce more testosterone and sperm.) Hunter also conducted experi -
ments with animals. After transplanting a section of a cock’s testicle into a hen, he saw the hen assuming male characteristics, for example, acquiring a coxcomb. Unfortunately Hunter omitted to publish most of his findings, so that there are only sparse references to him in medical history books.
The German physiologist Berthold demonstrated in the mid -
nineteenth century (1849) that when he reinserted the testicles of a castrated cockerel the creature once again developed a large comb and began behaving in a cockerel-like manner. Berthold, a professor at the University of Göttingen, wrote prolifically on every conceivable medi -
cal topic. What was his precise method? In an operation he removed the testicles of four cockerels, turning them into capons. Then he opened up the abdomen of two of the birds and implanted one testicle in each, so that that they were no longer attached to their previous nervous system. If they were to function, it would to be through the bloodstream. Berthold was incredibly lucky: antibiotics were still unknown and the capons could easily have succumbed to an inflammation of the abdominal membrane. But they survived, and the grafting of the tes ticles was successful. While those castrated birds in which no tes ticles had been replaced remained fat pacifists, the others turned back to cockerels in all respects. In his book on the male hormone Paul de Kruif puts it beautifully: ‘They crowed like the proud cocks they were, they fought till the feathers flew and they chased the females enthusiastically. Their beautiful bright-red combs and dewlaps went on growing.’
This was conclusive proof that the testicles fed a masculinizing substance into the blood.
Rejuvenation
Around 1900 average life expectancy increased. This was mainly due to better nutrition and hygiene. More and more people lived into middle age and beyond. Rather in the same way as in our own time, many people at the turn of the twentieth century felt the need to combat the decline that accompanies old age. It had been known since the eunuchs of Roman times that human potency is linked to the testicles, 81
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but around 1900 it was thought that vitality was also linked to them.
A Viennese physiologist, Eugen Steinach, assumed that ‘youth’ was a product of the puberty glands, the testicles, and wrote various books on the subject.
The testicular function in older people could lead to a second youth. It wasn’t really an original idea, since the celebrated physio -
logist Edouard Brown-Séquard (1817–1894) had already aired the same notion. He was certainly not a quack. Far from it: in his heyday the Frenchman was famed for his pioneering work in endocrinology and neurophysiology. However, the scientist could not bear the thought that he was ageing, and at the age of 70, in a desperate attempt to regain his youth, he injected himself with an extract he had made from minced rams’ testicles. He immediately felt his skin tightening and firming and his mind becoming more youthful and of course recommended everyone of his age to have a jab, but was laughed out of court by his fellow scientists for having treated himself and what’s more for presenting it as science.
In 1912 Steinach began his experiments with old rats. The creatures looked in poor shape, were thin and had lost their appetite for sex. Their seminal ducts were supposedly limp and empty, which made Steinbach decide to tie off their ducts and the accompanying draining blood vessels. He expected that this would result in the blood flow through the testicles increasing with a proportionate rise in testosterone production. Judging by the photos in his book, his male rats proved him right. They grew more hair, became more alert and aggressive, and their sexual interest also returned. If the treatment failed to produce the desired result, he implanted the testicles of other, young rats in the abdominal cavity or wall of the old animals and observed some degree of improvement. The rats lived twelve months longer than their usually allotted span of three y
ears.
On 1 November the great moment came. An exhausted, emaciated Viennese workman (Anton W.) became the first human being to undergo the ligature of both seminal ducts. In the first two months after his operation there was little change, but shortly after that he improved A rat before and
after a rejuvenat-
ing operation.
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Anton W. before
and a few months
after the tying of
his seminal ducts.
greatly. His appetite improved, he acquired more muscle bulk and was able to resume his work. This star witness of the rejuvenating operation walked the streets of Vienna as if reborn! Elderly gentlemen with sufficient funds soon found surgeons ready to perform the same pro cedure on them. In fact, some decades previously the Italian Francesco Parona had already reported on the injecting of veins. With a 30-year-old man who had been impotent all his life he injected a caustic substance into a kind of varicose vein on the penis. By the fifth day after the operation the patient had had sex five times!
Steinach was regarded as a charlatan by many of his colleagues, but in the meantime he had acquired Sigmund Freud as a patient. He himself was well aware of the limitations of his experiments, since the research field of ageing, impotence and possible hormonal effects was far too complex for one humble researcher. Others would continue his work.
In the same period Serge Voronoff began causing a stir with tes -
ticle extracts. After various travels in Africa, this eccentric, flamboyant Russian became head of the then renowned experimental laboratory at the Collège de France. While working as a surgeon in Algiers he had become interested in the welfare of castrated boys, whom he found both mentally and physically retarded. Young patients with tuberculosis of their sex organs were mostly castrated at the time, and as a result, so Voronoff believed, after some years suffered loss of memory and poor concentration. In addition, he had never known a eunuch to live beyond 60. For this reason he formulated the hypothesis that the loss of the testicles accelerated the occurrence of signs of ageing. He was firmly convinced that old testicles needed support, but unfortunately 83
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the Steinach operation had ultimately produced too few satisfied patients. What’s more, Voronoff had shown irrefutably by experiment that transplanting young testicles under the skin of the abdomen did not help either. Without an adequate blood supply the testicles soon failed. Vascular surgery was still in its infancy: nowadays blood vessels can if necessary be sewn together with the aid of a microscrope.
Voronoff therefore decided on a different approach from his Viennese colleague. He took testicular tissue, cut it into thin slices and placed it in the fleshy casing of the existing testicle, after first scratch-ing that casing with his scalpel, in the hope that this stimulus would cause new blood vessels to form, thus providing nutrition for the transplant. However, the most spectacular thing about his method was the donor. Whereas Steinach’s followers used the undescended testicles of young men, Voronoff favoured ape testicles.
In June 1920 he performed his first transplant, followed within a few years by three hundred others all over the world. By 1927 the figure had risen to over a thousand! Whether the transplant had taken could only be confirmed by microscopic examination. But who would sacrifice his feeling of being ‘reborn’ for the sake of science? In 1923 the Russian had personally performed over forty operations, half of them on patients under the age of 60. Of course, these were not just any patients: they included professors, architects, writers and industrialists.
For years they wrote letters about their young appearance and sexual potency! Predictably, Voronoff also transplanted testicles into homosexuals with the aim of ‘curing’ them. Like Steinach, Voronoff was scarcely taken seriously by official medicine, but this miracle-worker nevertheless became a worldwide celebrity among randy old men.
A contemporary Russian writer incorporated the theme of rejuvenation and testicle transplantation into his work, but turning the process on its head, he imagined a transplant from man to animal.
Mikhail Bulgakov (1890–1940) studied medicine and worked for a short time as a village doctor. His only literary work published in full in the former Soviet Union during his lifetime is a collection of satiri-cal stories, Heart of a Dog. In one of them a professor, who has more or less managed to escape the dictatorship of the proletariat, is working on rejuvenation experiments. He implants the testicles and pineal gland of a recently deceased, disreputable musician into a dog. The dog gradually turns into a loud, foul-mouthed human being. What’s more, he becomes close friends with the fanatical chairman of the residents’
committee, who is determined to destroy the professor and his prosperity. Under the influence of the fanatical chairman the dog becomes increasingly disobedient to its creator. The professor realizes his error and returns the dog to its original state. In this way he intends to rescue 84
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Chair for testicle
diathermia
procedure.
mankind from monsters like the doggish proletarian with his Marxist-Leninist pronouncements. The story is full of both science fiction and satire, and the indirect critique of Bolshevism is quite obvious.
The French doctor Denis Courtade believed, like many contemporaries, that application of all kinds of electricity – faradic or galvanic –
to different parts of the body – head, sacrum, lumbar vertebrae – could cure impotence. In cases of impotence through inflammation of the prostate an internal rectal electrode was inserted. The next step was application of diathermia to the testicles. By raising the temperature of the testes slightly it was hoped to boost the secretion of testosterone, and a special chair had been designed for the purpose. A hole at the front of a glass allowed the scrotum to be suspended in a saline solution, after which electrical stimulation could begin. The treatment was given three or four times a week for a month. That was enough: even then it was known that a long-term rise in temperature could lead to a reduction in sperm production.
Developments in America were almost identical to those in Europe.
There too the tying off of the arteries of the scrotum was the first surgical treatment for impotence. The surgeon James Duncan published on the subject in March 1895. A 66-year-old impotent widower, who had found Spanish fly ineffective, was the first victim. The operation took place under local anaesthetic (cocaine). Duncan’s fellow surgeon 85
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Wooten performed a similar operation in 1902 and wrote a verbose article about it. In 1908 the urologist Professor Lydston stated that the positive results were due to the relative impedence of drainage and the resulting enlarged testicles: ‘The larger the testicles are after the operation, the more impressed the patient is. He believes that the operation has been successful and his self-confidence returns. The positive results turn out to be mostly lasting, even after complications have developed in the long term’, wrote the professor from Illinois. Despite his optimistic pronouncements, however, the operation was soon forgotten.
The fact was that the long-term outcomes were dire. Nevertheless Lowsley continued the treatment until 1953, operating on thousands of men.
A certain Professor Lespinasse, though, managed to transplant testicular tissue from recently deceased men into the abdominal muscles of living impotent men. Whenever anyone had committed suicide or been executed, Lespinasse was on the scene in a flash to remove the testicles. Meanwhile the impotent recipient of the donor tissue was prepared for operation by his assistants. Unfortunately the transplant was invariably rejected. Up to now there have been very few successful attempts to transplant a testicle stalk and all. In every case the transplantation involved monozygotic twins, one of whom had no testicles and the other two.
A young prison doctor in San Quentin named Leo Stanley had an easier time in 1918. He implanted the testes of executed inma
tes into prisoners in various age groups to see if in this way he could effectively treat acne and asthma. His test subjects, though, received no remission of sentence.
The quest
American doctors performed many other odd experiments. The book The Male Hormone tells the story of Professor Fred Koch and his student Lemuel McGee, both employed at the University of Chicago.
They cheerfully mashed, extracted, fractionized and distilled thousands of kilograms of bulls’ testicles, in search of the pure male sex hormone.
From 40 kg of testicles they obtained 20 mg of impure but active substance. The effort was disproportionate: 40 kg for a few paltry milo-grams, and a narrowly failed attempt to win the Nobel Prize.
In 1929 it was the turn of human beings: a 26-year-old man with scarcely any pubic hair, no moustache or beard and with a high-pitched voice was treated with the substance for 53 days. And lo and behold, he was transformed into a real man! He also developed a normal sexual appetite with orgasm and ejaculation. The ultimate proof of the 86
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importance of the male sex hormone! However, disillusion followed, since it would never be possible to obtain enough bulls’ testicles for commercial use. Apart from which the processing of the testicles cost a fortune.
The dynamic German chemist Adolf Butenlandt took a different tack: he worked for the Schering chemical group and collected thousands of litres of urine, produced by policemen – over 25,000 litres in all. He knew that this must contain the active substance. Eventually he obtained a few crystals consisting mainly of androsterone, a decomposition product of testosterone.
On 27 May 1935 the chemist Ernst Laqueur succeeded in determining the exact structural formula of the sex hormone. He led an excellent research team at the Organon company, and was also a professor of pharmacology at Amsterdam University. He called the hormone testosterone, and the title of his famous article was ‘On crysta lline male hormone from testicles’. Laqueur too had unfortunately Testifortan,
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