Foreword
Masculinity is mainly expressed by the erection. Without an erection a man doesn’t feel complete. Not whole. It is the barometer of his health, his body and of his mind as well. It is the embodiment of his vital impetus. It is also and above all the mark of his uniqueness. He is a man to be because he is, equipped with a penis that does erect from an early stage. In the mother’s womb. The erection is automatic, independent and unpredictable, almost completely slipping away from the control of his Will. Just like the heart beats and beating would.
Having and keeping a firm and lasting erection throughout his existence, will become a constant concern for each man. The organ and its function are so tightly bound that he will keep a close, scrupulous and often worried eye on his penis: its shape, dimensions and its reactions to the external elements. Incredulous and ignorant of its functioning, he generally buries his questions and failures inside of him, behind the still very much alive sexual taboo. Yet, today, we know nearly everything about erection and the functioning of the penis. Erasing the excesses that in the past favored one or the other, Mind and body find their place in a common sense consensus. Especially for the numerous men who suffer from sexual difficulties (more than 30%, of all age), from what we don’t wish to call “impotence1” any longer, medicine provides positive and effective answers.
This book is nourished with my experience as a specialist, who has been studying masculine sexuality for more than 30 years. I attended hundreds of meetings and conventions on the topic, published dozens of articles and popularisation or scientific books2. Above all, I treated thousands of men, in the center dedicated to this area of expertise, known as CETI3 (see fig. 1). I gathered all of this in an easy manual, accessible to all. How does it work, why isn’t it working, how to treat or repair; questions that come to mind, the issues that arise. In a nutshell, a user’s guide displays the everyday life of the rational approach of the doctor and his scientific experience but never forgetting the emotional aspect. Technology at the service of the human nature.
1 But use the neologism “erectile dysfunction” (ED)
2 The references of the scientific papers approved by international journals can be find on “pubmed” : www.ncbi.nlm.nih.gov/pubmed, then type Virag R.
3 CETI acronym for ”Centre d’Exploration et Traitement de l’Impuissance”. (Center for Evaluation and Treatment of Impotence)
Fig. 1 : The logo of my center for evaluation and treatment of sexual dysfunctions and its symbol the poppy flower, from which was originally extracted the papaverine, the first drug
injected in the penis to induce an erection.
A user’s guide implies that a precise methodology has been developed to assess the erectile function and to provide a treatment when necessary.
This method is based on the absence of prejudice and on pragmatism. First the attention to the patient, then the required examinations and finally the conclusions and advices.
This is the method that is being presented here, based on the practice of the intracavernous mini injection. I discovered its beneficial effects more than 30 years ago. Almost pain free, instillation of medicines directly into the penis provokes an erection and allows its study, just as exercise testing allows the study of the cardiac effect. It will be used whenever necessary, for diagnosis and treatment, so as to produce, strengthen or extend an erection. The intracavernous mini injection is the heart of the Virag method to cure erection failures. While it is not a univocal procedure, it is central to the mechanism. The injection will be an absolute necessity for some, only a temporary solution for others and when it is still not sufficient, owing to the assessment it allows, the intracavernous mini injection will result in other effective treatments.
Rid a man of its fear of sexual failure means restoring his confidence for every moment of his life. Not only intimate, but his life in general. His relationship to others, not exclusively in the emotional sphere , but in the work life, in creativity changes as well. The common consideration of the men I successfully treated my whole career through was: “Do you know Doctor, you changed my life” or sometimes more solemnly: “Doctor, you saved me…”.
Erection, the user’s guide has no purpose but to provide the readers with the benefits of a unique experience materialised into a reliable method to treat masculine sexual difficulties. A message of hope for every one of us.
Part 1 How does the erection work?
What is it made of this unique accordion in the human body, named so differently?Why especially is it so insubordinate, as if independent from our will and sometimes even regardless of our desires? The conclusion is the one made a famous French stand-up comedian and illustrator say: “My penis doesn’t like the same women as I do”! The unpredictable feature of the erectile phenomenon is thus being humorously asserted. We breathe, our heart beats, our digestive system works, we urinate too without substantial change of the related organs. While the erection does lead to a transformation that turns the penis into a shaft. A transformation immediately detected by our brain and which is noticeable as well, hence accessible to the entourage. We don’t always know why we get a hard on, but it shows… What are the constituent elements of an organ so specific to the human that it does not exist in any placental mammal4? How can it reach such a stiffness when as opposed to all other animals, there is no bone inside of it? In a nutshell, how does an erection happen? What mechanisms allow its duration?
Chapter 1 - The human penis, a unique organ !
Evolution turned the man into the only genuine biped. And the only mammal whose reproductive organ has no skeleton. In the evolutionary history, the standing position most likely caused the loss of the penile bone that ensures rigidity for all other vertebrates. The position of his genital area became anterior and very exposed during the prehistoric fights, so that he needed to invent the complex organ that we are now about to describe. Easy to protect when at rest, flaccid5; enormously stiff when erected resulting from increasing action of the blood pressure on a tough fibrous layer called the tunica albuginea. It turned out to be what it is today: supple and discreet at ease, strong and well noticeable when needs to express its desire.
General aspect
The penis is a composite organ for it is made of two distinct adjoining parts, the corpora cavernosa on the one hand and the corpus spongiosum which surrounds the urethra and is crowned by the glans penis, on the other hand (fig. 2 A and C). 2/3rd of the penis is externally visible, the remaining third is buried underside and strongly attached to the pubic arch so as to enable the mobile part to erect: this is the erection. Indeed, under the pubic arch the corpora cavernosa part to attach onto the two bony branches named ischiopubic rami (fig. 2-C). The movable portion will lean on the bony surface, to which the penis is tied by ligaments and muscles, to straighten up. In the mid space created by the separation of the corpora cavernosa, the corpus spongiosum flares into a bulb wrapped by a muscle that will tighten during the orgasm. The top of this bulb is perforated by the urethra which goes through the prostate located under the bladder, before heading to the end of the glans. The penis thus ensures a double activity: urinating when flaccid, ejaculating when the shaft is stiff. This organ is covered with a rather thick and quite elastic skin for a better stretching capacity while erecting. At its tip, a thick fold of skin, the foreskin covers and protects the glans penis which remains permanently moisturised as if placed into a sheath. It will easily slide during the erection to 4 Evolution, through the disappearance of the erectile bone, made the human penis very complex. 5 The cup worn by those who do combat sports is the much later successor of the protective penis sheaths used by some primitive ethnic groups (New Guinea).
uncover the glans penis. Several men had their foreskin removed after birth or in their childhood, for religious, cultural motives or for hygiene purposes. In the circumcised men, the glans is always uncovered. It is drier and less sensitive.
Fig. 2 : A, schematic side view ; B, cross section ; C, lower view showing the separation of the corpus spongiosum surrounding the urethra, topped by the glans penis and the two corpus
cavernosa which base is attached to the pubis
The question of a difference between these two anatomical states regarding the sexual feeling is still being discussed. Indeed, it has never been proved that circumcision deprives those who had it done of any sexual possibility. At least, not when it comes to the quality of the erection.
Uncovered, the glans looks like an asymmetrical hat, slit on the back. It is tied up to the penis by a thin fold of thicker tissue called frenulum. Sometimes too short, it may tear during the first sexual intercourses. It is impressive but non-serious. During the erection the glans penis tensed by the extremely stiff corpora cavernosa swells but keeps some flexibility. The hypersensitivity of glans with foreskin, sometimes a little painful, vanishes with the erection and the sexual desire tension. “Glans penis becomes then the epicentre of the stimuli that leads to the orgasm6.” Where the penis attaches to the rest of the body the skin flares downward into a pouch –the scrotum- containing the 6 R.Virag Le Sexe de l’Homme (The Male Organ - New edition) Albin Michel p 49.
two testes. The skin of the penis is hairless while its base is hairy, as is the scrotum. If the organ is being gently pulled and flattened on the abdomen a cutaneous fold shows, binding the scrotal sac and the penis more or less tightly. A darker vertical line marks the reunion of the embryological drafts different at the moment of the formation of the organ. The entirety of the skin covering the male sexual organs is of great elasticity, insuring the frequent dimension changes at ease or erected.
Fig. 3 : The penis musculature and its role in the erection: A: pelvis median section; cross section of the muscles involved in erection; B : Transverse view showing the muscles playing a
role in erection; C: Rising of the erecting penis resulting from the intentional tightening of the perineal muscles
