Proof In The Pants: A Pivotal Moment In Pre-Viagra History

I can't remember the last time a piece of important medical history made me gasp, drop my jaw and then explode into disbelieving laughter. But such was the effect of the passage below from Dr. Abraham Morgentaler's new book, "Why Men Fake It: The Totally Unexpected Truth About Men And Sex," which will be officially published April 16.

Now, I don't blame you if you find it a tad hard to believe that a prominent scientist at a major medical conference would in fact drop his pants and ask audience members to check his "degree of tumescence." (Oops. Spoiler alert.)

But I found confirmation from a second source in a medical journal, this similarly hilarious account in the journal BJUI, formerly known as the British Journal of Urology: How (not) To Communicate New Scientific Information: A Memoir of the Famous Brindley Lecture.

Just to set the scene: We're back in the 1980s, the not-so-distant dark ages for erectile dysfunction, when little was understood about its biological underpinnings, and psychological explanations ruled. Dr. Morgentaler writes that therapists offered "an endless set of psychological causes" to explain erectile dysfunction, from early bedwetting to an unexpected childhood glimpse of people having sex.

Meanwhile, researchers were beginning to understand more about how erections worked, particularly the key role of the "corpora cavernosa," anatomic structures whose spongy innards hold "'cavernous' spaces that are lined with smooth muscle."

But enough background. Let us jump to 1983 Las Vegas, and a memorable moment in pre-Viagra history...

Keep Your Pants On [Excerpted with permission; all rights reserved.]

Advances in medicine and science do not necessarily move forward in a series of considered steps, with each study adding to our knowledge incrementally. More often than not, science, like evolution, is propelled by major disruptions. In the world of male sexuality, that disruption was caused by an eccentric British neurophysiologist named Giles Brindley, who in 1983 gave a lecture that would change the field forever. Over the years I’ve asked several of my colleagues who attended what it was like, and they all smile and shake their heads in wonder.

Finally, he says, ‘Oh hell,’ or whatever the British equivalent is, and says, ‘I guess I need to demonstrate this for you.’

Recently, at a meeting of the Sexual Medicine Society of North America (yes, such a society really does exist!), I sat down with Irwin Goldstein, MD, accompanied by his wife, Sue, to talk about the shift from the Masters and Johnson psychological model of erections and ED to the physical model that followed. Irwin has been, in my opinion, the single most important figure in the world of sexual medicine over the last thirty years. During that period, wherever and whenever there was something important happening in the field, Irwin was there, often as the leading figure. A high-energy, enthusiastic, irrepressibly cheerful man, Irwin trained dozens of individuals who went on to achieve their own academic prominence. Several years ago he moved to San Diego, where he established the first department of sexual medicine in the country at Alvarado Hospital Medical Center.

“Before Giles Brindley,” explained Irwin, “we knew erection must be controlled somehow by smooth muscle. But we didn’t know whether smooth muscle in the penis caused erections by contracting or relaxing. Actually, the scientific community at the time was divided into two camps: ‘the vascular relaxation camp’ and ‘the vascular contraction camp.’ After Brindley, there was no more discussion. It was settled.”

“Were you there?” I asked.

“Of course,” he replied. “I was one of the speakers on the same program.”

“What happened?”

“It was incredible.

It was 1983, in Las Vegas, at the annual meeting of the AUA [American Urological Association]. There was a specialty program for the Urodynamics Society. It was organized by Jacques Susset from Rhode Island . . . a neurourologist who was becoming interested in the neurology of erection. It was a big meeting with approximately three hundred to four hundred people in the audience.”

“Some of the men were in tuxedoes,” added Sue. “There were a lot of wives there too, some in gowns, because folks were planning on going out for dinner after the program.”

“So,” continued Irwin, “I’m arranging my slides before my talk at the table where the audiovisual guys sit, I’m dressed in a suit and tie, and this guy I’d never seen before, who turns out to be
Giles Brindley, is arranging his slides too. Except that he’s dressed in this athletic gear, you know, a jogging suit, one of those matching top and bottom get-ups with a zipper down the front. I thought it was very strange. Right before the program was about to begin I went into the bathroom, and there he was too.

“Brindley gets up for his lecture, still wearing the track suit, and starts showing photos of human penises at various stages of erection. It’s all very scientific, with a grid behind the penis so that
one can see the angle of the erection. He’s talking about the effects of different medications on human erection. It was fascinating. It was the first talk on pharmacologic treatment of erections that I can recall. We had yohimbine, but that didn’t really work. Brindley was injecting medicine, phenoxybenzamine, into the corpora cavernosa and achieving full erections.

I think he wanted to prove it wasn’t a penile prosthesis. I’m not sure that anyone actually felt it.

“Then he informs the audience that the photographs are of his own penis! The audience starts laughing and giggling. Finally, he says, ‘Oh hell,’ or whatever the British equivalent is, and says, ‘I guess I need to demonstrate this for you.’ He goes on to say something like, ‘Twenty minutes ago I injected my right corpus cavernosum with such-and-such milligrams of phenoxybenzamine, a medication that causes smooth muscle relaxation, and this is the result.’ He drops his jogging pants, and he’s got a full erection. At which point I realized that when I’d seen him in the toilet, he’d gone in there to inject himself!

“People were going crazy. There was a lot of laughter, and I think he was concerned they were laughing at him, because he seemed to get a bit angry. So he stepped into the audience, down the aisle with his pants still down at his knees, asking people to feel his erection. I think he wanted to prove it wasn’t a penile prosthesis. I’m not sure that anyone actually felt it.

“There were two speakers on the program after him, including the moderator, Emil Tanagho, who was a huge figure in urology. No one listened to them. Everyone was still talking about Brindley’s presentation. It was the most important lecture in the history of the AUA, and it immediately changed our medical practice. Within a week of getting home I put patients on injections. And it solved once and for all the questions about how erection occurred.”

Excerpted from WHY MEN FAKE IT: The Totally Unexpected Truth About Men and Sex by Abraham Morgentaler, MD, to be published April 16th by Henry Holt and Company, LLC. Copyright © 2013 by Abraham Morgentaler. All rights reserved.

Postscript: I found myself a bit concerned about Giles Brindley. His conference appearance is exactly the stuff of some of my worst anxiety dreams, in which I suddenly find myself in public places lacking various important items of clothing. So I checked around a bit more, and found this prodigiously reported piece on Dr. Brindley's life and work: Professor Giles Brindley — Extreme Show And Tell. And I'm happy to report that he sounds like a truly brilliant polymath full of creativity in both science and music — described by a friend as a fan of self-experimentation and, perhaps most germane to this excerpt, "completely unembarrassable."