Erectile dysfunction (ED) is no stranger to a man, which is defined as inability of penis to achieve full erection. ED can occur in all male irregardless of age, it occurs commonly in man after 40-year-old. ED in this group of patients is usually due to vessels obstruction. Penis is filled up with vascular cushion; when a man encounters sexual stimulation, and this vascular cushion is dilated and flown in with blood, resulting in penile erection. When a patient has ED, there is obstruction at penile vessels preventing the inflow of blood into penile cushion. ED is an alarming sign for the body, indicating atherosclerosis process is progressing in the body. Evidences from studies show that ED patients have significant risk of cardiovascular disease.
Since atherosclerosis is the most common etiology of ED, we must therefore know the diseases or the habits that can cause atherosclerosis and try to prevent them. These diseases or habits are commonly found among Malaysians such as diabetes mellitus, hypertension, hypercholesterolemia, and smoking. How can we successfully prevent ED? Preventions circle around the same old advices from doctor. We need to eat healthy with balanced nutrition, reduce consumption of high cholesterol, high salt and high calorie food. We need to have regular exercises, quit smoking and the lists go on. When you are maintaining good man health, you are also at the same time, maintaining good general health. It is a myth that erection has to deteriorate with age. If a man can maintain a good general health, the penile erection still can be preserved even in older age.
ED resulted from metabolic diseases as mentioned above can be treated successfully with current treatment options, however it cannot be cured. Concomitant metabolic diseases should always be well controlled as the first step of any ED treatment. Treatment will be started with oral medications. Up to a point when the penis no longer responds to oral medications, second line of treatment will be utilized. Second line of treatment is intracarvenosal injection. Intacarvenosal injection is performed 30 min prior to sexual intercourse to achieve erection. Patients need to learn the proper injection method and dosing adjustment from medical practitioners. Similar to the oral medications, there will be a point where penis no longer responds to intacarvenosal injection. Hence, the final resort will be surgical implantation of penile prosthesis. Vacuum erection devices (VED) is also another option of treatment for ED. It provides passive engorgement of the corpora cavernosa, together with a constrictor ring placed at the base of the penis to retain blood within the corpora. Constricting ring should not apply more than 30 minutes to avoid devastating complications.
Many patients tend to believe that traditional medications can enhance or preserve erection. We strongly advice patients to not consume medicines with unknown ingredients as we are unsure if the unknown ingredients might be harmful to the penis or any other organs of the body. Some of these traditional medicines induce a very potent erectogenic effect that might cause prolong erection. The medical term for this situation is priapism. Priapism might cause long-term damage to the penile cushion. In worst scenario, patient will encounter permanent ED.
Another common scenario is patient who came seeking for consultation after they have undergone foreign material injections to their penis. To those who are unaware, these few questions might be running in your mind at this point of reading this article.
- Why would someone allow foreign material be injected into their penis?
- What is foreign material?
- What is so big deal about injecting something into the penis?
Patients is misled by unethical party that the foreign body injected into the penis can do wonder to ‘Enlarge’ their penis. However, as at this point, there is no any sort of technology or surgical technique in this world for penile enlargement.
Foreign material injections to penis are commonly practice by non-medical practitioners worldwide. Foreign materials that are commonly used for this purpose are paraffin oil, olive oil and silicone.
Injection of foreign material will cause irreversible harmful effect to the penis, and adverse outcome to patients. This is because foreign material injected at subcutaneous layer of penis will induce massive immunological responds from white blood cell towards the foreign material. This process will cause thickening and hardening of penile skin.
At the initial phase after injection, the penile skin will become thick and hard. Patients will achieve a very satisfying erection at this stage, which will usually last for 1 to 2 years. The immunological process will continue. Granuloma will grow and form hard masses after about 3 years of injection. The hard masses will stretch the overlying skin until the skin become thin and bleed. These masses will cause pain and vaginal injury to sexual partner during sexual intercourse. The granuloma will continue to grow and harden until patients are unable to achieve penile erection. Usually patients will seek medical treatment after 4 to 5 years of injection when the situation is severe.
What is the next important question? Can this situation be successfully treated? YES, this situation is best treated surgically. The medical term for this situation is Penile lipogranuloma. First of all, the hardened skin and masses needs to be completely removed. We use Split thickness Skin Graft (SSG) from thigh for wound closure in UKMMC. Our series showed excellent reconstructive outcomes using SSG. The SSG will be fully epithelized at penis after 6 months.
Penile enlargement using foreign body injection is a misleading concept that has been capitalized by unethical practices. I hereby hope to create public awareness on the detrimental effects of such injections. Patients who had received the injection should seek medical attention early.
Fam Xeng Inn
Consultant Urologist and Lecturer
UKM Medical Centre