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Case XIII. A mechanic, twenty-three years of age....Examination with a No. 25 explorer [the bougie] disclosed intense hyperaesthesia of the entire urethra, and particularly of its prostatic portion....As soon as the instrument entered the passage it occasioned tremor and retraction of the testes, and when it reached the prostatic portion [the patient] shrank from the excessive suffering from which it awakened, and the muscles of the lids, nose, and mouth twitched convulsively. On its withdrawal, the bulb [at the tip of the bougie] brought forth a considerable prostatic discharge. [The patient] afterward rode to his home on street cars, and about two hours later, after urinating, was seized with a curious crawling sensation in his arms and legs, lost consciousness, and, when found by his friends, was lying on the floor, his face livid.Amazingly, this patient returned to Dr. Gross to have his condition treated, which meant several more intimate invasions. Blasts of hot and cold water were sent down his urethra, a hot rubber plug was jammed into his rectum, and the bougie was reinserted after being dipped in corrosive chemicals.In cases that still failed to respond, many urologists used a method inspired by Varolio's sixteenth-century anatomical speculations and Eckhard's more recent experiments on dogs: they applied electricity to the (mythical) erector muscles inside the penis. The first step in this procedure required the doctor to insert a twin-pronged metal instrument, shaped like a tiny pitchfork, handle-first into the meatus (pronounced me-ATE-us) of the penis, the place we nonurologists call "the hole." The prongs were connected to a small generator, which was then turned on and off. An illustration in a contemporaneous urology textbook shows the treatment to resemble our current practice of restarting a car battery with jumper cables. Many doctors touting electrotherapy sold the machines providing current to the disabled penis or wrote books extolling the virtues of the treatment. Very few of them lost money at it.
Aper, the boar: the stones and pizzle dried, and given in powder, help weakness and barrenness. Canis, the dog: the testicles and secretion provoke lust....Buteo, the buzzard: the testicles help weakness of generation.An understanding of the true androgenic role of testicles (that is, on secondary sex characteristics such as facial hair) was not achieved until 1848, when the German physiologist Arnold Berthold did the following experiment on six freshly castrated roosters. Two of these birds had one of their own testicles returned to their abdominal cavity; two others had testes from another bird in the experiment implanted in them; the remaining two were left castrated, as controls. Berthold saw that the comb and wattle of his castrated birds quickly deteriorated after surgery, but returned to normal in the birds that had been "re-testified." He attributed this, correctly, to "the productive function of the testes, i.e., by their action on the blood stream, and then by the corresponding reaction of the blood upon the entire organism."This experiment is now considered one of the founding acts of modern endocrinology. Unfortunately, it was ignored for the next fifty years. As a result, ignorance of the testes' true function, and misconceptions about their potency-restoring properties if eaten, continued. Thus, when Charles Brown-Sequard, one of the world's most respected physicians, said he had rejuvenated his own sexual powers in 1889 by ingesting a potion made of crushed dog testes, one circle dating back to the ancients was completed, and a new one, thankfully of much shorter duration, was about to begin. Weeks after his "rejuvenation," Brown-Sequard was mailing vials of his liquide testiculaire (obtained from dogs or guinea pigs) to any physician who wanted to experiment with it. When these doctors were unable to replicate his results, they concluded the problem was not with the concept, but with the materials: the extract was too weak. What was needed, they thought, were actual testes.As it happened, the first testicle transplant in the medical literature was not about sex. At least not directly. The patient seen by Drs. Levi Hammond and Howard Sutton in Philadelphia in November 1911 was a nineteen-year-old boy who had been kicked in the scrotum, after which one of his testes had swollen by more than ten inches. The doctors' original plan, motivated primarily by aesthetic concerns, was to replace that testicle with one from a sheep. But a day before that was to happen, a human testicle became available from a young man who bled to death. Somewhat impulsively, the surgeons decided to use it. They removed the testicle from the donor, flushed it with sterile saline, stored it overnight in a glass jar at forty degrees Fahrenheit, then transplanted it into their patient the following morning. (This appears to be the first transplant of any human organ in the medical literature.) A month later, however, the doctors were disappointed to see that their transplant had atrophied considerably. Hammond and Sutton never published a follow-up. Knowing what we know now, it is safe to say the transplant was rejected.But the fact of tissue rejection -- indeed, the very idea of the body's immune system -- was not yet well-understood, so testicle transplants continued. Chicago urologist Victor Lespinasse claimed to have performed a transplant several months before Hammond and Sutton, reporting his results in Journal of the American Medical Association and Chicago Medical Report a few years later. Unlike Hammond and Sutton, Lespinasse's goal most definitely was improving sexual function. But rather than transplanting an entire testicle, as the Philadelphians had done, he carved the donor's testicle into slices, then grafted them into muscle tissue in and around the recipient's scrotum. This is how Lespinasse described the procedure in 1914:A man, aged 38, consulted me in January, 1911, to find out if anything could be done for the loss of both testicles. One testicle was removed during a hernia operation; the other had been lost in [an] accident....He was unable to have intercourse, which was his chief reason for seeking medical advice....
A testicle from a normal man was easily obtained....The two patients were anesthetized at the same time, and the recipient prepared as follows: The scrotum was opened high up and a bed prepared in the same way as we prepare the bed for the reception of an undescended testicle....The fibers of the rectus muscle were exposed and separated...and then the testicle to be transplanted was removed. It was stripped of the epididymis...and then sliced transversely to its long axis [in slices] approximately 1 mm. thick. The central slice and the one next to it were taken out and placed among the fibers of the rectus muscle. Another slice was placed in the scrotum.Lespinasse wrote that he was "surprised at the number of testicles that are available for transplantation purposes." He made no mention, however, if (or how much) those living donors were paid for their services.Four days later Lespinasse's patient "had a strong erection accompanied by marked sexual desire. He insisted on leaving his hospital bed to satisfy this desire." This the patient did -- and continued to do so, Lespinasse reported, for the next two years, after which the surgeon lost contact with him. Even so, Lespinasse was reluctant to take all the credit. "The sexual function is about nine-tenths psychic," he wrote, "and how much is due to the strong mental stimulus engendered by the operation, and how much to the actual functioning of the [grafted testicular] cells, is impossible to determine."That uncertainty did not stop Lespinasse from doing more transplants. In 1922 one of his gland-grafting cases made the front page of the New York Times, no doubt because of the identity of his patient, the chairman of the International Harvester Corporation -- the IBM of that era -- Harry F. McCormick. The fact that McCormick, then fifty-one, was married to Edith Rockefeller, daughter of John D., made him one of the richest men in the world twice over. That he was carrying on a well-publicized love affair with a beautiful European opera star made him even more newsworthy. The headline and subheads in the Times piece read, "SECRET OPERATION FOR H. F. M'CORMICK / Family Refuses to Say Whether His Stay in Hospital is for Gland Transplanting / KEEPING YOUNG IS HIS HOBBY / Lespinasse, His Surgeon, A Leader in Rejuvenation, Also is Silent on Case." The donor was rumored to be an Illinois blacksmith. True or not, the following ditty, inspired by verse by Henry Wadsworth Longfellow, was soon heard in taverns all across America:
Lespinasse was certainly getting famous for his work, but a colleague in Chicago had gone him one better. In 1920 Dr. G. Frank Lydston informed the press that he had transplanted a testicle into himself. Lydston wrote in the Journal of the American Medical Association of nine other grafts, eight done by him on volunteers, the other done by Leo L. Stanley, chief surgeon at California's San Quentin prison. Dr. Stanley had no shortage of freshly deceased donors -- inmates were executed often at his place of work. Lydston's JAMA report on one of Stanley's cases, based on facts given him by the prison doctor, is a peerless blend of optimism and condescension:Under the spreading chestnut tree,
The village smithy stands;
The smith a gloomy man is he,
McCormick has his glands.
Case 9 -- A man, aged 25, evidently a moron, committed for burglary, had been kicked in the testicle five years previously....At the time of operation the testes were the size of olive pits. The patient was tall, thin, anemic, very dull and apathetic....The donor was a negro hanged for murder. The glands were removed...fifteen minutes after death...refrigerated...[and implanted several hours later....] Seven weeks after the operation the doctor reported that the testes were firm and..."resting nicely in the scrotal sac." The patient gained fifteen pounds and had become active and alert -- in fact, he was improved in every way -- and sexually had become very active....Dr. Stanley said: "He now has erections nightly and in the daytime, something he never had before."In the "comment" section of his JAMA piece, Lydston noted the cross-racial aspect of Stanley's case. Lydston's fascination with the donor's race and the recipient's improved sex life (in an all-male prison population!) reflected an enduring interest of his. In 1893 he cowrote "Sexual Crimes Among the Southern Negroes -- Scientifically Considered," an article calling for the full "Oriental" castration -- testes and penis -- of any Negro convicted of raping a white woman as the only effective punishment. Clearly, Dr. Lydston spent a lot of time thinking about black genitalia.Lydston went public about his surgery on himself because, as the 1920s moved along, the most celebrated testicle transplanter in the world became a publicity-seeking, Russian-born surgeon working in Paris named Serge Voronoff. Ever the jingoist, Lydston wanted to remind the world that gland grafting had started in the good old U.S.A., where dozens of surgeons were doing the procedure and promising great results to all comers. That fact was certainly true, but it failed to halt Dr. Voronoff's publicity juggernaut. This wasn't because Voronoff was doing more testicle transplants than anyone else. It was because he didn't bother to use humans as donors.
One shutter of the trapdoor is an open trellis permitting free access of air to the ape, while the second shutter is solid. The latter is lowered just before the cage is saturated with the anaesthetic.A small window in this "Anaesthetizing Box" enabled Voronoff to see when the ape was dazed. "No time must be lost" at this moment, he warned. The ape "must be got out of the cage and onto the operating table...before he is sufficiently recovered to get his teeth into the hands of those who control him."Once there, the ape was administered chloroform, after which his four limbs were spread out and tied down. Then an extensive pre-op session began. "Owing to [the ape's] uncleanly habits, meticulous care" was taken to shave the "scrotum, the lower part of the hypogastrium and the upper portions of both thighs; they must be well scrubbed with soap and hot water, washed with plenty of ether or spirit, and carefully painted with tincture of iodine," Voronoff wrote. On a table several feet away, the human recipient was similarly prepared. One assumes he escaped the indignity of the "Anaesthetizing Box" and -- it is hoped -- required less scrubbing and shaving.After this, a testicle was removed from the ape by Voronoff's cosurgeon, who cut that testis into two halves, then cut three slices from each half. As this was happening, Voronoff prepared the human recipient, opening his scrotum, and exposing the tunicae vaginalis inside. Voronoff scratched the first tunica, prompting the flow of blood serum. Then he took the three monkey grafts prepared by his cosurgeon and sewed them onto its grooved surface, ensuring that none of the grafts was in contact with another. He then repeated this procedure on the other tunica. All of these steps were demonstrated in Rejuvenation with lifelike illustrations.Most people, however, learned about Voronoff's operation in the popular press. Several monkey-gland recipients were practiced boulevardiers before the surgery; afterward, newspapers noted approvingly, their success rate as seducers soared even higher. The German humor magazine Simplicissimus ran a cartoon showing Voronoff's operating room crowded with a pregnant woman and dozens of her scrawny children, many with their hands in a supplicant's position, begging the surgeon not to operate on the ape sitting on his operating table, or their father, lying nearby. "Professor, please," the caption began, "wouldn't you rather use a method that prematurely makes our father older?"Voronoff's operations were soon mimicked in America. Max Thorek, the esteemed physician who later wrote The Human Testis, spent much of the 1920s supplying his patients with slices of monkey testes. He had a small zoo built on the roof of a Chicago hospital to house his donors. One Sunday morning the monkeys escaped, gathering minutes later, for no known reason, at a nearby Catholic church. In his memoirs Thorek declined to describe in print "the sacrilegious actions" of those beasts, witnessed by a packed house of shocked congregants. Strange things with animals were also occurring in rural Kansas. There "Dr." John R. Brinkley got rich grafting goat testes into human patients. Unlike Voronoff and Thorek, however, Brinkley's credentials were highly suspect. In fact, it appears he bought them.In England Voronoff's procedures inspired a novel called The Gland Stealers, issued by the same house that published P. G. Wodehouse. "Gran'pa is ninety-five, possessed of £100,000, a fertile imagination, and a good physique," the promotional copy on the book jacket began. "He sees in the papers accounts of Professor Voronoff's theory of rejuvenation by means of gland-grafting. Nothing will satisfy him but that the experiment should be made on himself....
He acquires a gorilla, a hefty murderous brute, and the operation is performed with success. That is only the beginning....Inspired to philanthropy by the thrill of regained youth, Gran'pa decides to take a hundred or so old men to Africa, capture a like number of gorillas, and borrow their glands....In this case fiction reflected fact: Voronoff's operation became so popular that the French government felt compelled to ban monkey hunting in its African colonies.The press marveled at Voronoff's extravagant lifestyle -- the huge hotel suite on the Champs-Elysées, where he lived with his wife and a staff of servants, his holiday home on the Riviera, the fancy cars and parties, etcetera. Voronoff could certainly afford it. He charged $5,000 per surgery, a prodigious sum eighty years ago. By the end of 1926, Voronoff said he had done one thousand of them.The enduring power of the placebo effect is certainly one reason why Voronoff was so successful. The surgeon's career was also given a boost by the then-burgeoning eugenics movement. Because World War I "destroyed a fit elite and left behind a degenerating, elderly rump," David Hamilton writes in The Monkey Gland Affair, "Voronoff's efforts at rejuvenating the aging wealthy classes was [seen as] a step in the right direction." At the same time, recent advances in plastic surgery and orthopedics led many to believe, as British scientist Julian Huxley did, that "biological knowledge enable[s] us to modify the processes of our bodies more in accord with our wishes." Just about everything was deemed malleable in the hands of the scientist. Why not add man's testes to that list?Because, in the end, it was proved that Voronoff's operation did not work. One would hope to learn this sorry episode was ended by one of Voronoff's medical peers, after putting Voronoff's claims to rigorous scientific scrutiny. But that was only partly the case. In truth, few medical doctors ever challenged Voronoff's claims. The scientist who finally did prove the futility of Voronoff's testicle grafts was a French veterinarian, working in Morocco, named Henri Velu. In the late 1920s, Velu re-created Voronoff's early experiments on rams. After performing his own testes grafts, Velu removed them months later and examined them himself under a microscope. He concluded, correctly, that the "graft" was really a scar plus some inflammatory cells, the latter a remnant of the "invading force" that had successfully rejected the graft. Testicle grafts, Velu wrote in 1929, are "une grande illusion."Skepticism regarding Voronoff's work finally began to grow, and Velu's findings were confirmed by subsequent medical advances. After testosterone was isolated in 1935, scientists demonstrated its inability to reverse the aging process or, by itself, to restore potency to a dysfunctional man who was otherwise healthy. In the next decade biologist Peter Medawar's work on the immune system proved that any and all of Voronoff's grafts would have been quickly destroyed by the host. (Professor Medawar was later awarded the Nobel Prize.)There are conflicting reports of Voronoff's state when he died in 1951, at eighty-five. In Medical Blunders, Robert Youngson and Ian Schott wrote that "Voronoff lived to be ridiculed, but bore it with dignity." But Patrick McGrady, in The Youth Doctors, quoted a Swiss physician who knew the monkey-gland doctor as saying Voronoff was severely depressed near the end. Not because of what happened to him, the Swiss said -- because of what may have happened to his patients because of him. Apparently, Voronoff feared that several of his grafts may have transferred syphilis from his apes to his human recipients. Voronoff was horrified by this thought, the Swiss said, and spent much of his final days in depressed isolation because of it. Only one thing is certain: depressed or not, the pioneer in the erection industry named Serge Voronoff died an extremely wealthy man.
Mr. X., thirty years of age, was as a young boy regularly taken to the Tyrolean mountains [for his] vacation. When he was fifteen...he lived with his parents near an Alpine dairy where he roamed around among the cows and became quite attached to a pretty, twenty-year-old dairy maid who, on her side, took an erotic fancy to the handsome boy.One day, while young Mr. X. was sunning himself near the grazing cows,
she joined him and taught him the ars amandi. This she repeated every day as long as the vacation lasted. [Later,] when Mr. X. married, he found that conjunction was possible only if his wife was attired in Tyrolean peasant costume and assumed the same posture as his pretty dairy maid years ago....In the beginning of their married life...the wife granted his requests. The erections were perfectly normal, and two children were born. Lately the wife has rebelled against the masquerade, and Mr. X. found himself completely impotent. In the lupenar where, for a remuneration, anything can be obtained, he has violent erections with a [prostitute] dressed as an Alpine dairy maid.Dr. Talmey's response was to accuse Mrs. X. of a "sanctimonious frigidity" he said he often found in upper-class wives. Such women think that "assuming the supine position and [a state of] femoral divergence are the only contributions" to intercourse required of them. To help her husband's impotence, Talmey said, Mrs. X. must improve her attitude and don that damn peasant blouse. If not, she was dooming him to more visits to the lupenar, where the outcome would be even more impotence. "Extreme excitement after long abstinence," Talmey wrote, causes serious erectile dysfunction.
The expectancy and joy over the final reaching of the goal causes a great nervous disturbance within the inhibitory center which becomes overexcited, and at the critical moment the erections fail, the penis becomes flaccid, and shrivels to half its normal size.In 1936 New York urologist Max Huhner had read enough. He challenged Karl Menninger, head of the famous psychoanalytic clinic in Kansas that bore his name, to a debate on impotence therapy in the Journal of Urology. Menninger, who went first, argued that even when interventions such as the cauterization of the prostatic urethra produced the resumption of erectile functioning, they only did so because of their psychological effects. "The patient thinks there is something wrong with his genitalia," Menninger wrote. Urologists "know this is not true, or at least, that the organ pathology is secondary to the psycho-pathology, but experience has taught them the curative value of treating the genitalia locally, and by its suggestive value reassuring the patient and relieving his anxiety and thereby his impotence." The reality of the situation, Menninger said, is that impotence is caused by anxiety, a condition best treated by psychoanalysis. The talking cure made conscious "the unconscious emotions that often (always?) determine the inhibition of sexual functioning." The specific nature of those negative emotions, Menninger wrote, include "fears, especially of punishment or injury; hostility toward the love object; and conflicting loves, particularly parental and homosexual fixations."Dr. Huhner responded by dismissing psychoanalysis's claim that impotence is psychological in 95 percent of the cases as less a scientific fact than a philosophical assertion. Huhner did not rule out the possibility of psychogenic impotence. He argued that urologists can discern such a patient from one with organic disease because they do a medical examination, something a psychoanalyst never does. What would one think, he asked,
if a patient with an undersized penis complained of his inability to perform the sexual act and consulted a physician who, without even looking at that organ, informed him that his condition was purely psychic and due to some unresolved complex from his childhood days? This certainly seems ridiculous...but it is exactly the procedure that is followed daily by psychoanalysts.Huhner also wrote that, while he was not "doubting the psychoanalyst's findings" regarding the prevalence of unresolved Oedipal issues in impotent men, he doubted their methodology in asserting it.
Just as in other branches of medical science, a control should be established to determine the possible presence of such an unresolved Oedipal complex in men who are not impotent....In any other branch of medical experimentation, such a system of control would be the obvious rule.On these two points, Huhner was on solid ground. Unfortunately, he weakened his case, from our viewpoint today, by insisting on the reality of the link between masturbation and impotence, and the efficacy of treating that condition with jolts of electric current to the penis. (It goes without saying, of course, that he was wrong on both counts.) Equally distressing to contemporary eyes is Huhner's qualified endorsement of the "clinical observations of Stanley," the San Quentin prison doctor, "and Voronoff," Mr. Monkey Gland -- each of whom, Huhner wrote, had scientifically established the "endocrine action" in erectile physiology.
Both of these operators have had [temporary] success in producing sexual desire and erection in impotent persons....And yet, in the face of all these modern observations on the influence of sex hormone, psychoanalysts still believe that everything sexual comes from the brain, and simply ignore the fact that we have been endowed with sexual organs as well as brains.The fact that a scientist as serious as Dr. Huhner wrote these words in 1936, several years after the Frenchman Henri Velu proved that testicle grafts were "une grande illusion," is troubling. It is also one more reason why urologists lost the early battle for therapeutic control of erectile functioning to psychotherapists and, for several years after the 1970 publication of Human Sexual Inadequacy, by Dr. William H. Masters and Virginia E. Johnson, to sex therapists. Urologists would not, however, lose the war.
The size of a penis is as much a function of psychological processes as it is anatomy. Often erection endows a situation with a sexuality the owner may not have recognized or be prepared to acknowledge. And how often does the penis resolutely refuse to support its owner in a sexual endeavor, as if to say, "you have no business doing this -- count me out of it?"Either way, the penis is the most honest organ on a man's body. It tells the truth, Bancroft was reminding his readers, whether its "owner" wants to hear it or not. (The identical conclusion was reached by Gay Talese in Thy Neighbor's Wife, the best-selling book in which Talese did some extremely personal reporting on the Sexual Revolution of the 1960s and '70s.) "Late in my career," Bancroft wrote, "and, it should be added, in my personal life, I have come to recognize the importance of this understanding between a man and his penis, ironically at a time when developments in medical care appear to be rejecting it."Eleven years after writing those words, Bancroft said he would not retract them, though he wasn't quite as worried as he used to be. "The easy availability of oral medications has pushed surgeons aside for the moment. We're still in the early stages of all this, however, and I certainly do not think urological surgery is about to become obsolete. Most urologists still say, 'Let's concentrate on the penis. No need to think about the man attached to it.' As if you could separate them."It just might be, however, that the erection industry and the urologists who created it understand the relationship between man and his penis far better than their critics realize. Sure, they are confident in the superiority of their approach. But this arrogance is neither new nor unjustified. It is part of a process that began more than five centuries ago with Leonardo da Vinci and Regnier de Graaf, men who used science and the spirit of experimentation to address difficult questions about sex and masculinity. What once seemed divine or demonic became neither. This process created a new relationship between man and his defining organ. Now the penis is seen as a complex but knowable organic machine. Man is capable of not only understanding Nature, but his own nature -- and altering it. And most men are happy about that.This is why the urologists who compared Cialis, the once-a-day erection pill now in clinical trials, to putting a man on the moon have not lost their sense of proportion, despite their mixed metaphor. Ending impotence by bringing a small pill to your lips -- my apologies, Commander Armstrong -- is a giant leap for mankind. With it the idea of the penis has made its most dramatic evolution yet, becoming a daily reinflatable tire, with every man just a prescription away from owning the proper pump. And even a urologist can grasp the psychological impact of that.One ED specialist, Dr. J. Francois Eid of New York, says his practice made him realize that losing potency is like losing a part of one's mind. "I don't mean the patient goes insane," Eid says. "But he definitely loses a part of his identity." It is precisely because a man can hold his manhood in his hand that he needs it to feel strong and capable -- and some would argue this need is now more urgent than ever. This is because technology has rendered nearly all the previous definitions of masculinity obsolete. A man is no longer measured by his physical strength -- his ability to build shelter for his family, fight in hand-to-hand combat, or draw water from a well. Machines do that for him. Muscles are more symbolic than useful. So the erect penis has become the most powerfully symbolic "muscle" of them all.One of Eid's patients told him his impotence robbed him of everything he valued most: his self-respect, the intimate part of his marriage, his patience with his children, even his sense of humor. "Every time he heard a joke about sex his head would sink into his shoulders," Eid says. "It was like he had cancer of the ego." This phallocentrism, Tiefer and like-minded critics would argue, is less a biological fact than something men learn -- and therefore something they can and should unlearn. It is a social construction, they say, part of a male-centered sexual script written by the culture at large and reinforced by the first sexual act that most males experience: masturbation. The importance of that act in writing an individual's "sexual script," say John H. Gagnon and William Simon, the coiners of that term, cannot be overestimated.Masturbation "proclaims the male's independence," they wrote in Sexual Conduct. It "focuses male sexual desire in the penis, giving the genitals centrality in the physical and symbolic domains....The capacity for erection is an important sign" -- most men would say the most important sign -- "of masculinity and control."This concept of sexual script suggests another cinematic metaphor with which to view the erection industry and the ways it has changed man's bond with his penis. The history of that relationship has all the elements of an epic Hollywood film: sex, conflict, mystery, religion, heroes, villains, piles of money, high-tech machinery -- even death. And now, thanks to the erection industry, that relationship has something every film epic needs. An ending.For that is what you get when you answer the control question. Prior efforts to deal with the "who's in charge?" issue have created the numerous lenses that man has used to examine the most enduring mystery in his life. The history of the penis is the history of its evolution as an idea. Over time the penis has been deified, demonized, secularized, racialized, psychoanalyzed, politicized, and, finally, medicalized by the modern erection industry. Each of these lenses has been an attempt to make intellectual and emotional sense of man's relationship with his defining organ; clearly, some lenses were sharper than others. There is no denying the weighty influence of Augustine and Freud, but it appears the medicalized lens may have the heaviest impact of them all.We have an ending to our story, but not the end. The bond between man and his penis, fundamentally altered as it is, continues. And while much of its central mystery has been solved, other mysteries remain. The medicalized penis is only two decades old, the era of the erection pill younger still. Both have answered huge questions but raise others. Science has helped men with erectile dysfunction, and a medicalized penis is certainly better than a demonized one, but the long-term effects of PDE-5 inhibitors on the penis have yet to be determined. Might not regular exposure to them cause the body to produce an abnormally high level of PDE-5? (Such a reaction would not be unprecedented, or even unexpected.) And what effect would that have on a man's internal chemistry? Or behavior? The answers will be known later -- maybe too late for some.On another front, admittedly more metaphysical than medical, some critics worry that the erection industry has replaced an idea of the penis with an anti-idea, a body part with a thing, a symbol of manhood with a punctureproof balloon. Whether today's erection entrepreneurs truly grasp the psychological aspects of man's relationship with his penis or not, their treatment breakthroughs have permanently altered that mental bond -- chemically dissolving its most puzzling part. That, of course, is the control issue, a question that has shaped that relationship, for better and worse, for all of history. Now man can hold his manhood in his hand, confident in knowing who is in charge. When a man uses the products of the erection industry, his penis works for him.This is more than a temporary jolt in the balance of power. It is a paradigm shift and a revolutionary restructuring of the masculine mystique. That mystique -- and the psychic vault of attitudes, aptitudes, and anxieties which give it so much confusing urgency -- compels man to impose his will on the world. Yet man has not always been able to impose his will on his penis, the flesh-and-blood symbol of that mystique. The penis used to have a mind of its own. Not anymore. The erection industry has reconfigured the organ, replacing the finicky original with a more reliable model. But the price tag for this new power tool is hidden. Eventually, we'll learn if we can afford it.Copyright 2001 by David M. Friedman