In emergency Surgeon may have to operate and perform circumcision.

However, in my practice almost all the people have been able to push the skin over the glans.
This is a how to do it procedure whereby you do not need to go to a doctor

HOW TO BRING THE FORESKIN BACK IN PLACE YOURSELF WITHOUT GOING TO DOCTOR

The three simple proven steps are:
1
Get Lignox 2% from chemists shop.

2
Take cold water bath or clean genitals with cold water and soap.
Reason:
Cold water helps penis to further shrink in size. Soap cleans any infection causing microbes.

3
Apply lignox 2% on affected part.
After 5 to 10 minutes penis skin will be painless.
Now manually bring foreskin back in position.

WHAT IF THIS DOES NOT HELP
Go to qualified General Surgeon or Urosurgeon. He will do circumcision.

IMPORTANT
Read about paraphimosis and circumcision and see illustrated pictures at http://doctortells.blogspot.com

WHAT IS SEX DEPRIVATION?
If a person has not had sex despite sexual desire for long period of time it is called Sex Deprivation.

Thus, the couple may have not had sex for 1 year or for even 10 years or more.

HOW WIFE REFUSES SEX?
Often wife refuses sex persistently with excuses.
Some of the excuses are:

• I am tired
• It pains
• Sex harms pregnancy
• No sex after delivery (bearing a child)/post partum
• We are old
• We have children and grand children
• Religion says control, no sex
• You are not well
• I am not well
• I do not feel like having sex, honey
• [ NO REASON . . .]

Wife says to her husband, “I am helpless. I know sex is your requirement, but I do not feel like having sex.”
This is not uncommon.
It is many a man’s silent unspoken misery.

SOME REASONS OF SEX DEPRIVATION
Why she (wife) does not participate in sex?
Of the many reasons some reasons are

• RESENTMENT
• she is in love with another guy
• Diseases/disability in husband
• Her own diseases (Depression is the commonest.)

Dislike of husband or some things about husband can culminate in Sex Deprivation.
Most often covertly, though not overtly, if wife resents husband, she does not feel like having sex with him, sex is repulsive to her.

Interestingly, insufficient privacy is not the cause of sex deprivation.

Love expresses ultimately as Sex in a couple
Resentment expresses ultimately as Sex Deprivation in a couple

Sex Deprivation almost always is unreported to sex therapist.

WHAT GOOD DOCTOR’S OUGHT TO DO?
Psychiatrist, Cardiologist, Gynecologist, Orthopedicians, Doctors managing recurrent illnesses and the Family Health Care Physicians are the doctors who must inquire about often the patient has sex.

A small questionnaire is designed by Dr. Ashok Koparday, that eliminates the taboo/shame barrier between the treating physician and the patient.

WHY IT IS IMPORTANT FOR THE TREATING PHYSICIAN TO KNOW ABOUT SEX DEPRIVATION?
HAZARDS OF SEX DEPRIVATION (As a corollary read benefits of Sex Chapters 1 to 11)
Why Doctors must ask and patients must tell doctors about Sex Deprivation?
Many couples just stop having sex. There are several reasons.
Sex Deprivation can cause psychosomatic illnesses of various types, depression and emotional breakdown, too.
Sex Deprivation aggravates existing illnesses like diabetes, hypertension, ischemic myocardial infarction, angina, stroke, renal diseases and decreases immune defense mechanism of human body, thus making the person susceptible to frequent illnesses.

On Fast Track
with
Dr. Ashok Koparday

Team lead my Mathew C. Raynor of the Department of Urology, Vanderbilt University Medical Center, Nashville, Tenessee, USA, used epigastric vessel for reanastomosis (joining of blood vessels) in penis. They used robot to get the epigastric artery. The entire procedure required 3 cm incision, which is better alternative to large midline incision. There work on five patients who had severe pelvic (hip bone) trauma following accident was published in the Journal of Sexual Medicine yesterday September 25, 2009. This article is quoted below verbatim.

From
Journal of Sexual Medicine
Early View (Articles online in advance of print)
Published Online: 25 Sep 2009

© 2009 International Society for Sexual Medicine

Robot-Assisted Vessel Harvesting for Penile Revascularization

Mathew C. Raynor, MD,* Rodney Davis, MD, † and Wayne J.G. Hellstrom, MD, FACS*
*Department of Urology, Tulane Health Sciences Center, New Orleans, Louisiana, USA; † Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Correspondence to Wayne J.G. Hellstrom, MS, FRCS, Chief, Section of Andrology, Tulane University Health Sciences Center, Department of Urology, 1430 Tulane Avenue, SL-42, New Orleans, LA 70112, USA. Tel: (504) 988-5372; Fax: 504-988-5059; E-mail: whellst@tulane.edu
Copyright © 2009 International Society for Sexual Medicine

KEYWORDS

Erectile Dysfunction • Trauma • Arteriography

ABSTRACT

Introduction. Ideal candidates for penile revascularization include young patients with documented vasculogenic erectile dysfunction usually resulting from pelvic trauma. Historically, large midline incisions were necessary to harvest the epigastric vessels for penile revascularization. We report our experience with robot-assisted epigastric vessel harvesting for use in penile revascularization procedures.

Aim.

To describe our technique and experience with robot-assisted vessel harvesting for use in penile revascularization.

Methods.

Five patients were selected for penile revascularization. Each patient suffered pelvic crush injuries resulting in post-traumatic erectile dysfunction. Each patient had no significant prior medical history and had normal erectile function prior to injury. Penile duplex Doppler ultrasound studies using vasoactive agents demonstrated decreased arterial inflow. Complementary pelvic angiography documented the corresponding arterial lesions. Each patient underwent attempted penile revascularization using a modified Virag-V technique.

The epigastric artery was harvested robotically and transposed through a 3 cm incision at the base of the penis. Microscopic revascularization was performed by anastamosing the epigastric artery to the deep dorsal vein. Distal dorsal vein ligation of the subcoronal plexus was performed to limit glans hyperemia.

Main Outcome Measures.

Description of a new method of vessel harvesting for penile revascularization.

Results.

Penile revascularization was successful in four out of five patients. One patient had complete thrombosis of the deep dorsal penile vein and underwent subsequent penile prosthesis implantation. Each patient undergoing successful revascularization was discharged home two days postoperatively and has reported resumption of sexual activity.

Conclusions.

The robot-assisted approach to epigastric vessel harvesting is an ideal minimally-invasive complement to penile revascularization. This procedure negates the need for a large midline incision and may shorten recovery time. Our described technique offers a novel option for the application of minimally-invasive technology, but longer-term follow-up is needed to further evaluate the success of penile revascularization. Raynor MC, Davis R, and Hellstrom WJG. Robot-assisted vessel harvesting for penile revascularization. J Sex Med **;**:**–**.

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1743-6109.2009.01462.x About DOI

ARE YOU A WORKAHOLIC?

You wrote:

Case File 1

Hi,
I had a healthy sex life till sometime back.Recently my sex drive has decreased majorly.I get a hard on but when i proceed to have sex it goes down in a few seconds.I went to a doctor that prescribed Viagra(penegra) to me.It helped a bit.But I dont wanna be depndent on a drug to have sex.My fiance is greatly dissapointed at me.Also I come really fast.Sum and substance I have never been able to satisfy her.Though a year back we were doin it up to 4 times a day.I am not bored of her.and very sexualy attracted to her but i fail to perform.Please help!!

Case File 2

Dear Sir

My name is xxx raju xxx,
Aged 32
Married have 1 baby.

I have a problem of premature Ejaculation. Ejaculation occures after 1 or 2 strokes or some time its even before insertion.

I have tried many treatments. I am not statisfied with the result.

Please help me getting goog treatment.

Regards…

Reply:
High Excitement
–>
Early ejaculation
—>
Nervousness, shame, disappointment of male.
incomplete, sex should be for longer time says female
—>
He tends to avoid/postpone sexual intercourse in order not to face shameful situation “I can’t do it.” “I can’t satisfy her.”
—>
Long gap between love making.
Meaning, frequency of sex is less.
It was 5 times a week, now it is 1 or 2 times a month.
—->
His excitement goes on rising. He also thinks that he has to fulfill her sexual need and cannot avoid sex.
—>
High excitement
—->

Early ejaculation
—>
vicious cycle
Thus, he is more disappointed, scared.
This causes UNTOLD suffering. Either he

• is further tricked by quack or

• bears the sorrow.

• He compensates by pampering female partner in all other areas.

• He has aches and pains. Example, he may complain of backache that causes difficulty in doing sex.
• This dampens his desire.
• Consequently his erection is not as it used to be.
• “The size of my penis is small.”
• He becomes workaholic.

Case File 3

am 28 yrs old young man, my weight is 95, i am married 2yrs back, duirng first year my weight was 75, even i had a happy sex no problem, but now a days i find some problems of early ejacuation during sex, after intercorse i get ejected with in 2 min, also i am finding my penis size is also geting smaller, please help me with this problem.

PREMATURE EJACULATION

People with ‘Early Discharge’, ‘Premature Ejaculation’ or ‘Early Orgasmic Response’, if given proper treatment get satisfactory results.

Two aspects weigh on the mind of the guy:

I.

What if I am not able to satisfy her?
(Fear that she may seek extramarital relation.)

II.

How can I prolong so that ejaculation is delayed?

IMPORTANT TIPS
Of FOREMOST importance is to know what is normal time.
Do you have realistic expectation?
If his expectation is to last for 30 minutes, he will get frustrated and would be visiting ‘n’ number of doctors.

To know the proper management of Premature Ejaculation please see this.

A. Non Medicinal Methods
B. Methods that use Medicine
C. FemaleSatisfaction

ADDITIONAL INFORMATION

ALSO SEE http://doctortells.blogspot.com . . . .sex matters.

On Fast Track
With
Dr. Ashok Koparday
Samadhan India
Center for Therapy, Education, Research in
Sex, Marriage, Relationships.

Download
Prescription Information on Caverject (c)

Self Injection to get Erection Satisfactory for Sexual Intercourse

• Who can use Caverject Injection?
• Who cannot use Caverject Injection?
• What is Caverject Injection?
• How to use Caverject Injection?
• How not to use Caverject Injection?
• What does Caverject Injection look like?
• What are the side effects of Caverject Injection?
• What precautions should be taken when using Caverject Injection?
• What Adverse Effect of Caverject Injection need URGENT medical treatment?
• How does Oral PGE5 Inhibitors like Viagra (c) [Sildenafil Citrate] compare with Caverject Injection? Which is the better and Why?
• References

What is Caverject Injection?

Manufactured and Marketed by Pfizer
CAVERJECT IMPULSE (c) is brand name of Injection in the Penis (Intracavernosal Use) of Alprostadil.
CAVERJECT Dual Chamber System contains alprostadil as the naturally occurring form of prostaglandin E1 (PGE1)

Caverject Alprostadil Injection for Erection Satisfactory for Sexual Intercourse

How to use Caverject Injection?

The site of injection is usually along the dorso-lateral aspect of the proximal
third of the penis. You must be taught by your doctor how to inject before using this drug.

What are the side effects of Caverject Injection?

The most common side effect of CAVERJECT IMPULSE is mild to moderate pain after injection. About one third of patients reported this pain but few stopped CAVERJECT IMPULSE for this reason.
Men may get a small amount of bleeding at the injection site.

What Adverse Effect of Caverject Injection need medical attention?

Call your doctor if you notice any redness, lumps, swelling, tenderness, or curving of the erect penis. Lumps or curving of the erect penis, including a condition called Peyronie”

How not to use Caverject Injection?

CAVERJECT IMPULSE should not be used more than 3 times per week. There must be at least 24 hours (1 day) between each dose. It should produce an erection in about 5 to 20 minutes that should last about 1 hour.

TO STOP PREMATURE EJACULATION

1. HAVE REALISTIC EXPECTATION
2. FEMALE SATISFACTION
3. MEDICAL METHODS TO DELAY EJACULATION
4. NON MEDICAL METHODS TO STOP PREMATURE EJACULATION
5. GO TO SEX THERAPIST

[1.]HAVE REALISTIC EXPECTATION

Know what is normal time for ejaculation. Be clear how long you wish to delay ejaculation? This is important because UNREALISTIC expectations (example 30 minutes) is common as people compare with what is shown in blue films.

[2.] HOW TO SATISFY FEMALE PARTNER To satisfy your partner is an important reason why you want to stop premature ejaculation.
1. Do not hurry to insert.
2. Do foreplay. You can even bring her to climax with foreplay alone.
3. Do after play. To satisfy female partner foreplay and after play are of paramount importance.
4. Do not just sexual intercourse, but sexual outer course too.
5. Learn and use non penile methods for female satisfaction. Female can have sexual satisfaction using non penile methods, such as her or partner’s finger, and knowing where and how much stimulation to give to get maximum sexual satisfaction. This takes away major burden off the mind of the man and treatment to stop Premature Ejaculation is easier.

FEMALE SATISFACTION AND DELAYING EJACULATION ARE TWO ESSENTIAL ASPECTS OF STOPPING PREMATURE EJACULATION. THEY ARE LIKE TWO SIDES OF SAME COIN

SATISFYING FEMALE AND DELAYING EJACULATION

[4.] WHAT ARE THE NON MEDICAL METHODS TO STOP PREMATURE EJACULATION

1. Masturbate before actual sexual intercourse.
2. Use condom.
3. Do not remove penis after ejaculation. Do rubbing action so that the vulva with clitoris is stimulated.
4. Do pubococcygeous muscle exercise couple of times a day. To do this imagine you have a strong urge to defecate, but there is no toilet around. In such a situation person contracts anal sphincter. Contract and release repeatedly. Do this for about 2 minutes every day.
5. Correct relationship discord. Understanding, indifferent or empathetic partner is beneficial in treatment of Premature Ejaculation.
6. Do not feel defeated and crest fallen if you ejaculate quickly. It is not a crime. Ejaculation quickly means your sexual arousal is high. Nothing bad in having high libido.
7. Increase frequency of sexual intercourse. This helps stop premature ejaculation. On the contrary, if you do sex infrequently (‘infrequently’ is a single word, not two words- ‘in frequently’) desire mounts resulting in premature ejaculation.
8. Use different sexual position or change sexual position during intercourse. However, there is no scientific proof to substantiate this.
9. Use which ever food, time, place, technique that works for you. For you that is the method to stop Premature Ejaculation.
10. If premature ejaculation does not trouble either of you do not trouble the trouble, or the trouble will double and trouble others too.

[5.] GO TO SEX THERAPIST if Premature Ejaculation is a major problem in your life.

Image Courtesy
http://www.flickr.com/people/blue-moose/

QUESTION

Dear Doctor,
is there any relation between erectile dysfunction and mastrubation?

REPLY

Masturbation never causes any side effects whatsoever even if a person believes he has begun early in childhood, for long time, too much.

After masturbation means friction on penis skin in a manner that increases excitement until there is orgasm and discharge of semen.

In all male, after discharge of semen there is a ‘time interval’ called the ‘refractory phase’ when even in presence of sexual excitement erection does not happen.

This is not called erectile dysfunction. Not getting erection immediately after sexual intercourse or masturbation is like taking pause to rest so that the tissues and sexual system can restart later.

Masturbation done early in life or any time is not a cause of Erectile Dysfunction.

I hope it answers your query.
Best Regards,
Dr. Ashok Koparday

QUESTION CONTINUES

Dear doctor,
thanks from your letter,I think that my problem is more psychological than physical.
For example when I am watching porno films (that I watch always when I have time, and it’s my hobby) I have a good erection.
Even I have upto 20 or 30 minutes full ererction.But when I face the real sex( which I had not more than 4 times in my life) I can’t get erection.
So please let mew know if my guess about this problem is right, or I have another problem?
And please show me the solution.

Best Regards
xxx XXX xxx

REPLY

PROBLEM SOLVED
Hi,

Your guess about the problem is accurate.

But when I face the real sex( which I had not more than 4 times in my life) I can’t get erection.

This is performance related where anticipation of possible failure can (not always) cause difficulty in erection. The severity depends upon the extent to which you are conscious about assumed possibility of not being able to do sex while you indulge in sex.

And please show me the solution.

Your solution is in your query itself.

I have a good erection. Even I have upto 20 or 30 minutes full ererction

The above sentence means your sexual apparatus is fine.

Example
You are like a student who has prepared very well for his exams, but some amount of tension remains while you actually go to give your exams. When you sit to write the answer paper everything goes smooth because you are well prepared. The surest and safest method that prepares you for sexual intercourse is masturbation. Be confident because you have direct evidence of good erection in your own hand.
Please let me know if you have any additional questions or issues.
Best regards,
Dr. Ashok Koparday MBBS FCSEPI

Why do intelligent people wish for increase in the size of penis?

I sympathize with your penchant for finding ‘something’ that ‘increases size of penis’.

Some

Important Reasons

for quest for increase in size of penis.

1.

Penis is the only structure that becomes long, broad, and stiff.
The ear, the nose do not change in size the same way as the penis does.

2.

The information that teenager/child gets about sex is the one that comes form powerful audio video media. One is not shown REAL educational videos, however the boy/man gets education from what he sees in blue films, pornography movies, XXX movies, the porn films. Just as you will not go to Surgeon to increase the size of your ‘little finger’ so too a person will not go in search of increasing size of penis provided he can routinely see penis (the way we get to see) of other people.

3.

Male psyche genetically for generations is wired to associate bigger size penis with ‘manliness’, ‘macho’, ‘capacity to satisfy a woman’. Hence, world over guys like you do get distressed. This distress is genuine. However, the cause of the distress lies in incorrect information. The moment you know what is normal most of them not all : ( quit foolish chasing. Focus is brought back to ‘one’s own and the partner’s sexual satisfaction from the obsession to increase the size of penis.

When should I visit the Sex Therapist regarding size of MY PENIS?
When it comes to individual / personal matter advice following examination becomes important.

I hope millions of people benefit from the rich knowledge of medical facts that beat myths.
2
^nd most common sex problem is: ‘SMALL SIZE OF PENIS”.
I am not surprised to notice that questions about how to increase size of penis keep on raining.

CLICK HERE TO KNOW ALL ABOUT HOW TO INCREASE SIZE OF PENIS

Note: People who believe their penis size is small are in millions. Huge population carries the burden of unspoken suffering due to presumed small size of their penis.

ALL YOU WANTED TO KNOW ABOUT
HOW TO INCREASE SIZE OF PENIS

QUESTION

sir please can you tell me you have that treatment for increasing the size of penis? you can enlarge the size of penis by your treatment without any side effect???

QUERY SOLVED

Reply

“Do you want penis to be as looong as that of bull elephant, stallion horse, bull, dudhi, bhopala, cucumber size – 30 cm in length?
Read below for you will not get this scientific information anywhere else.

Increase in size of penis:

Science and Technology uses some sure shot methods for this purpose. With skillful use of Technology one can get to see awesome penis size, the “Wow! Size”.
How long* do you want it?
(*pun intended)

1.

The Surgical Method that Medical Science makes possible today is use of penile implants (artificial prosthetic material) inside the penis. This is useful for those who have erectile dysfunction due to broken spine as in accident. All parts below the belly button up to the toes are paralyzed. He is a living man and wants satisfactory sex. This is called the “Imp Size”.
This guy can have good erection and father a child.
Wonderful, isn’t it?

2.

HOW DO PORN STARS HAVE INCREASED SIZE AND STIFFNESS AND DO SEX FOR LONG?

The “Wow! Size” is accomplished by using special effects like
3-D Computer Generated and Art Graphics and Special Effects of Cinematography to show on screen enviable sizes that one gets to see in porn films.

The “Imp Size” is accomplished by Surgeons who specialize in Penile Implant Surgery.

3.

Medicines – PGE5 inhibitors – with their chemical action give a stiffness more than NORMAL.
The emerging problem is people who take it for recreation get used to it. They come for treatment later on.
How can I get my normal erections? I do not get erection without taking the medicine.
This is the sad story of those who take the medicine for fun. Will you take Tuberculosis medicine or Diabetes medicine for fun? Imagine the consequences

In the methods described, see the risks involved, because
you wanted to know method that does not have SIDE EFFECTS.
So make a choice when you are reading the details.
CLICK HERE TO READ
Why do intelligent people want increased penis size?

4.

USING INTRAPENILE INJECTIONS
Injections containing vaso active medicines are given in the penile
tissue in the Doctor’s office.
The dose most effective is titrated
by the Doctor. You can take home
these medicated injections to use
before sex. Just as people with
diabetes can give themselves shot of insulin injection, so too a male can give himself these injections.
Indications
Contraindications
Precautions
Dose and Method

5.

USING VACUUM DEVICE

6.

USING MUSE
Medicated Urethral System for Erection.
A pellet containing vaso active drug is gently inserted in the urinary opening.
MUSE did not become popular and hence failed in the marker.

1. impotence resulting from a man’s inability to have or maintain an erection of his penis wordnet.princeton.edu/perl/webwn

2. Erectile dysfunction (ED or (male) impotence) is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis.
   There are various underlying
   causes, such as cardiovascular leakage and
   diabetes, many of which are medically treatable. …
   en.wikipedia.org/wiki/Erectile_dysfunction

3. The inability of a man to obtain or sustain an erection. Abbreviation: ED
   en.wiktionary.org/wiki/erectile_dysfunction

4. a consistent inability to sustain an erection sufficient for sexual intercourse. Also commonly known as impotence. …
   1stpropeciaprescription.com/Order/Order_Form/Medical_Definitions/medical_definitions.html

5. The loss of a man’s ability to have an erection. Some men may become impotent after having diabetes for a long time because the nerves or blood vessels have become damaged. Sometimes the problem has nothing to do with diabetes and may be treated with counselling.
   www.diabetesnsw.com.au/about_diabetes/diabetesdictionary.asp
6. Also known as “ED,” the loss of the ability to produce and/or sustain an erection (while desire for sex remains unchanged).
   www.dattolifoundation.org/glossary.htm
   Problems that a man may have in achieving an erect (firm) penis.
   www.spinalnet.co.uk/EEndCom/GBCON/homepage.nsf/(VIEWDOCSBYID)/1E68230AB2F65FF100256C59003EBE2C
   The inability to have or to maintain penile erection of sufficient firmness for coitus; also known as inhibited sexual excitement.
   www.crsupport.info/health_topics/sex-glossary-E.html

1
wordnet.princeton.edu/perl/webwn
2
en.wikipedia.org/wiki/Erectile_dysfunction
3
en.wiktionary.org/wiki/erectile_dysfunction
4
1stpropeciaprescription.com/Order/Order_Form/Medical_Definitions/medical_definitions.html
5
www.diabetesnsw.com.au/about_diabetes/diabetesdictionary.asp
6
www.dattolifoundation.org/glossary.htm
7
www.crsupport.info/health_topics/sex-glossary-E.html