Friday Weird Science: the malleable prosthesis

Sep 18 2009 Published by under Friday Weird Science

Sci is sick today. She's cuddled up with her tea, and desperately hoping she has a cold rather than the flu. But the weird science CALLS US, precious. No matter how sick. It calls.
Judging from the vast number of commercials out there hawking various pills and diets and whatnot, you'd think that erectile dysfunction (ED) was the scourge of mankind. Whether or not it leaves the species begging for help is certainly a matter of debate, but there is definitely a quality of life issue to be addressed. Of course there are lots of pills (Viagra, anyone?) marketed to help, and they do often help a great deal, especially for vascular issues. But some types of ED are far more difficult to treat (for example, those arising from badly-controlled diabetes mellitus), and for those which no pill seems to help, a penis prosthesis is one major option. There are several types available, the hydraulic type (which has a little pump you squeeze to fill it with saline), and the semirigid type, which is a flexible, semirigid material, that you just...bend into the correct position (I've heard some great stories of medical student reactions to finding these in the cadavers in their anatomy lab. One wonders if they are mostly myths, though).
Though implantation with these doesn't sound fun, they are relatively safe, and extremely reliable. But what about the feelings of the men who get them? And what about...their partners? Salama, N. "Satisfaction with the malleable penile prosthesis among couples from the Middle East: is it different from that reported elsewhere?" International Journal of Impotence Research, 2004.
And WHY are these studies ALWAYS conducted in the Middle East?!

For this study, they took 50 men who had received a malleable penile prosthesis, and checked up on them between 8 months and 10 YEARS later. This is probably because there aren't too many of these operations, so it was hard to get enough people. This "checkup" wasn't a physical one, rather, it was a questionnaire of how well they liked their prosthesis. More importantly, they asked more than just the men. They asked their WIVES.
They ended up with 53 total pairs, include a few guys with two wives, and one or two with three (remember, we're dealing with people in the Middle East, apparently some from Sudan, which included the polygamous pairs and women who also had suffered through female circumcision, the most severe type, and also included a wife who was 14. Luckily this post isn't about that, or Sci would have to be getting really angry right about now. But the sample was what the sample was).
Anyway, they had 50 men who had had these prostheses inserted. Most of them suffered ED as complications of diabetes, hypertension, or coronary artery disease. And for all of them, the prosthesis was the court of last resort. Many had already tried yohimbine (popular ED drug) and hormonal therapy, and ALL of them had tried traditional remedies, including metal rings, ritual handling, and various herbs and stuff.
So, they asked both patients and wives what they thought of the prosthesis, how it felt, and would they recommend it to their friends (which makes me wonder in WHICH social situations one goes about recommending penis prostheses to one's friends). Most of the men liked theirs, though a few suffered pain, many could achieve erection and orgasm with the aid of the prosthesis (a malleable penile prosthesis doesn't create an erection FOR you, rather it just supports the penis from flopping over, so if you're halfway there, it will help you out).
There was a very significant difference found between those who were satisfied with the prosthesis and those who weren't in the amount of sex they had. Men who were satisfied managed about 13 times a month (better than some I know without a prosthesis!), but those who were unsatisfied were around 3 times a month. Interestingly, while more men claimed being satisfied, more women did not (n=5 men dissatisfied, n=13 women). Those who were unsatisfied mostly complained about how weird it felt. Though one pair did complain of "insufficient penile girth". One wonders what they were expecting.
Of the pairs evaluated, 43% of the women were in polygamous relationships. Satisfaction with the prosthesis did not differ, but the vast majority of these women did not know any of the possible consequences of the implant, and 64% of them were completely unaware that it had taken place until after the surgery was over. Some of them were unaware of it until told by doctors! But then they recalled noticing things had felt off recently.
The paper notes that what is really necessary here is to counsel both the man AND his partner(s) prior to implantation. Most of the women who didn't like the prosthesis didn't even know about it until hubby came home one day with a "gift". Both patients and their partners need to know what to expect, ain't gonna turn you into a porn star. And the study brought out one other thing. The women were questioned as to the prosthesis in a separate room from the men. The husbands never knew what the women answered, which might account for a little more honesty on the part of the women. So men, before you get that prosthesis, maybe you should ask your wife.
Salama, N. (2004). Satisfaction with the malleable penile prosthesis among couples from the middle east--is it different from that reported elsewhere? International Journal of Impotence Research, 16 (2), 175-180 DOI: 10.1038/sj.ijir.3901150
Ok. Sci tried to be funny. It didn't work. She's sick. And this isn't funny.
It's not that the malleable penile prosthesis isn't funny, cause it IS!!! It's awesome!!!
No. What's not funny, and what I can't get over here, is the fact that some of these women, wives as young as 14, were having sex up to 13 times a month with the worst possible type of female genital mutilation, the Sudanese type, which includes removing the labia minora, and sewing shut the labia majora most of the way. It can often include full excision of the clitoris. This procedure is not only horrible in and of itself, allowing the woman to feel reduced pleasure from intercourse and sometimes to never experience orgasm, it also is often performed under minimal anesthesia and in unsanitary conditions. Women with genital mutilations often have severe trouble in childbirth as well as severe pain and discomfort in normal everyday life.
Practices like this are often intensively woven into the fabric of the local culture, and women are under intense pressure to conform. Many, even after childbirth, will insist that their vagina be re-closed, because this is so dominant in society. But just because it is woven into the fabric of society doesn't mean it's right, and doesn't mean it is necessary. There are no health benefits to female genital mutilation, and the severe pain and health consequences it can cause make it a violation of human rights. There should be no tolerance for this kind of oppression, not only oppression of the sexuality of women, but a deliberate negative impact on their health. Awareness needs to be raised, and this needs to be condemned along with other types of violence against women.

8 responses so far

  • Sigmund says:

    Given the locations of where the patients came from it is highly likely that the vast majority of the women had been subject to female genital mutilation. Something like 90-95% of Egyptian women have gone through this and its common in east Africa and across to Yemen (I'm not so sure about the proportions in Saudi Arabia, but its certainly not universal).
    While I guess only a few will have had the Sudanese type disfiguration you talked about, the others will most likely have a pretty severe 'operation' that involves complete or partial clitorectomy - which is bound to affect their future sexual function.

  • Scicurious says:

    Sigmund: The paper actually specified that only the women in polygamous marriages (of which I think there were 9) had been subjected to Sudanese type. It didn't talk about the others, but less severe types in other cases would not have surprised me.

  • Daneel says:

    Yes, female genital mutilation is sickening and what is even worse is that male genital mutilation is even more widespread in the world and nobody seams to care.
    Talking about double standards...

  • MonkeyPox says:

    No kidding. How much has your mutilation affected your sexuality? I know it's gotta suck (no pun intended) getting turned away so often because of your mutilated phallus.

  • C.A. says:

    Quite a lot of people seem to care, Daneel. See places like , for instance. Male circumcision, while generally not as physically traumatic as its female counterpart, has its own host of issues, it's true. In some places it is practiced with a similar lack of sterile procedure or anesthetic, and yes, this is horrifying.
    But the penis is rarely entirely removed.
    Look into what many varieties of female circumcision involve. Maybe you'll understand a little more why outraged concern tends to gravitate in this direction rather than assuming a mere cultural double standard.

  • I'm with you sci - it's hard to find the funny side to what is clearly an incredibly funny situation (a bendy penis! OMG - you could bend it into anything, even make artistic sculptures with it!) when something so messed up is happening in the background. Genital mutilation is seriously wrong, I can't believe the things people can do to other people.
    On another note, I saw Puppetry of the Penis once, and they arranged their junk into all sorts of shapes! Isn't physiology fun?

  • Donna B. says:

    Puhleeze... can we finally agree that men and women are different in physical ways?
    A circumcised man has no problem getting an erection or experiencing orgasm. A woman whose exterior genitalia has been surgically altered will experience pain and, depending on the "depth" of the surgery, may not ever be able to experience orgasm. Either way, sex is not pleasant. That doesn't even begin to cover the problems of childbirth.

  • C.A. says:

    Male and female genitalia is actually quite comparable in the human species; the significant differences are mostly in the surgeries themselves. Male circumcisions generally remove only the prepuce (though note that even this does tend to result in some loss of sensation when done on someone old enough to tell the difference, and has been shown to disturb normal copulatory behavior in non-human primates). Female circumcision generally is much more extensive, often removing part or all of the clitoris itself or partially/completely closing the entrance to the vagina. It's not hard to see why this causes a few more problems.
    Female circumcision which removes only the prepuce does exist, by the way, and does not necessarily interfere with sexual functioning to a greater degree than your run-of-the-mill male circumcision.

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