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Impotence and Pre-Viagra Age

The word 'Impotence' was derived from the Latin term impotentia coeundi describing simple inability to insert the penis into the vagina. Because of the awkward nature and the feeling of humiliation associated with the term 'impotence' the subject remained a taboo for a long time. This subject was chosen for many urban legends; herbal remedies and magic potions were extensively advocated.

In ancient times, rulers and kings kept many physicians in their personal service to rejuvenate their body system and sexual appetite as they had many wives and mistresses and they had to cope with their desires and also fulfill those desires. If those personal physicians failed to evolve effective medicines for the treatment of impotency, they were sentenced even to death in worst cases.

These ancient physicians were the fathers of Herbal, Chinese, Unani and Ayurvedic treatments of impotence or erectile dysfunction which mainly directed their treatment towards the overall well-being of the man in order to treat impotence. These ancient treatments are still available and flourishing. The difference is that people in ancient times did not accept that they were suffering from erectile dysfunction out of shame and fear of losing their respect in the society.

We can find the oldest reference to impotence in the Samhita of Sushruta, around the 18th century BC in India. We find a reference that Hindus believed that impotence could have mental origin. In Ancient Egypt, impotence was considered to be of two types: a natural cause and evil charms and spells causing impotence. This can also be found in the Egyptian Papyrus Ebers, a medical Egyptian document dated 1600 BC, lists 811 prescriptions for various ailments, including impotence. We can also find the mention of impotence in Old Testament where king Abimelech of Gerar is believed to have become impotent as punishment for taking Abraham's wife, Sarah.

In the 9th century, Hincmar, the Archbishop of Rheims, pioneered in making a connection between witchcraft and impotence. Beginning from the 13th to the end of the 17th century, predominantly among the upper classes, impotence was considered the only grounds for divorce. In reality, in ecclesiastical law, it was a serious sin for an impotent man to marry. But there was no legal bar for an impotent to marry.

Different theories on impotence continued through the centuries, till in 19th century, authorities advocated a new theory in which impotence was a male disorder caused by insufficient self-control and sexual transgression. At this time, the impotence among Victorian men was high and it was ascribed to the voluntary loss of semen through masturbation and involuntary loss, termed spermatorrhoea. T

However, there were some physicians like T.F. Lockwood, who did not agree on this as the cause considering that masturbation is a natural process. Instead he pointed out that it might be the abuse and overindulgence that resulted in impotence.

For the first time Dr. John R. Brinkley initiated a boom in male impotence treatments in the US of 1920's and 1930's. Dr. John R. Brinkley used to recommend expensive goat gland implants and "mercurochrome" injections as the path that restored male virility through radio programs during 1920's. But in 1930's the Kansas State Medical Board revoked his medical license and the Federal Radio Commission refused to renew his radio license. Dr. Brinkley, then, not losing his enthusiasm, shifted his operations to the Texas border to Mexico. He opened a medical clinic and resumed broadcasting his impotence treatments through advertisements from a Border Blaster radio station into the US. Border Blaster is a licensed commercial radio station that transmits at very high power to the United States of America from various Mexican cities near the border.

Oswald Lowsley carried out experiments on dogs in the New York Hospital animal laboratory in 1935. In that experiment he ablated the ischiocavernosus and bulbocavernosus muscles, and found that the dogs were unable to acquire an erection. After that he plicated these muscles with several interrupted ribbon-gut mattress sutures. He found that erections occurred more easily and frequently in the dogs. However, if the plication was too tight, priapism occurred. Priapism is a painful penile erection without sexual stimulation for continuously several hours. The report of this operation on 51 patients was published in 1936, which had outstanding results in 31 patients.

General practitioners, by 1970's, had started providing patients with inflatable penile implants. A significant advancement in modern drug therapy for ED was seen in 1983. It was a historical moment when British physiologist Giles Brindley, Ph.D. dropped his trousers in front of the American Urological Association audience to demonstrate his phentolamine-induced erection.

Brindley injected a drug into his penis which was a non-specific vasodilator, an alpha-blocking agent. Its mechanism of action was plainly corporal smooth muscle relaxation which later was used in PDE5 inhibitors like Sildenafil citrate. This discovery by Brindley was the stepping-stone for the development of more unambiguous, safe and oral drug therapies for impotence or erectile dysfunction; Viagra.

But the problem of impotence never was ignored by the physicians as men always wanted a treatment if they were impotent and the demand for a treatment of erectile dysfunction was always there. But only thing was that no one talked openly about their sexual problems and just accepted the sufferings before the introduction of Viagra.

Ref: Erectile dysfunction through the ages: J. Shah (2002)

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