Evaluation of Methods to Induce Erectile Dysfunction

1. Destructive Ischemic Priapism
1.1. Procedure
1.2. Selection of Drugs
2. Surgery
2.1. Excision of Erectile Tissue
2.2. Creation of a Shunt
2.3. Permanent embolization
3. Botox Injections
3.1. Penile
3.2. Muscular
3.2.1. Ischiocavernosus Muscle
3.2.2. Bulbospongiosus muscle
4. Vasodilation-inducing Medications
5. Side Effects of Other Medications
6. Disuse Atrophy with Feminising Hormone Replacement Therapy
6.1. Selection of Drugs
7. Novel Medications
8. Quotes of Further Investigation
References

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There are many reasons to want to cause Erectile Dysfunction (ED). This document evaluates various methods for inducing ED, and should be used as a starting point of research. While this document cites scientific sources, no testing has been made by the author of the methods below. No method in this document should be used without complete understanding of erectile physiology and further research into the method. All of the methods below must be assumed to be permanent, even if their biology suggests otherwise. Based on the research made in this document, the author chose to begin using Disuse Atrophy.

1. Destructive Ischemic Priapism

By causing Ischemic Priapism and having the priapism last for longer than 48 hours, ED is considered guaranteed. (Podolej, 2017) However, this method is painful and may result in penile gangrene. This method is sub-optimal in that it likely requires presenting to the emergency room to complete. While with the correct selection of a drug to induce priapism it is likely to succeed, this method has a risk of losing penile sensation or even penile amputation because of gangrene.

1.1. Procedure

A drug known to cause priapism is selected, then administered in overdose. If the erection subsides, more of the drug should not be administered; Instead, you should wait until you have recovered, and attempt to gain an erection. Another attempt may be made with a higher dose if such a dose is not toxic should you still be able to get an erection. If the erection does not subside after 48 hours, you should go to the emergency room and undergo normal treatment for Ischemic Priapism.

While there are some treatments for priapism suitable for self-surgery, these treatments aren’t guaranteed success in detumescence, especially in advanced priapism. If these methods fail, you would have to present to the emergency room and explain the suspicious wounds created by these treatments. It may be difficult to avoid seeing a psychologist. If one is especially terrible at speaking, they may be involuntarily admitted to a mental hospital for a time.

1.2. Selection of Drugs

Many drugs injected directly into the penis to treat erectile dysfunction can cause priapism in overdose. These drugs include alprostadil, papaverine, and phentolamine. (Mayo Clinic, 2019) Viagra / Sildenafil, while the most well known drug for treating erectile dysfunction as well as being easily-obtained and oral, is likely to be completely ineffective in causing ED. (Morales, 1998)

Other drugs, while having side effects of priapism, are not recommended for use. These drugs could have unwanted side effects that manifest far sooner than priapism, as well as only manifesting priapism in some patients.

2. Surgery

Surgery is very likely to succeed, however it requires a sterile environment and proper anesthesia. Consideration should be given to all factors, and surgery should only be preformed with a complete understanding of the relevant anatomy and technique.

2.1. Excision of Erectile Tissue

Surgically cutting out the Corpus Cavernosum Penis will render the patient unable to gain a complete erection. However, the body of the penis is mostly made up of corpus cavernosum, and removing this tissue would likely result in an "empty" appearance. For this reason, some filler must be used. TODO: Evaluate different options for fillers. Silicone and fat come to mind.

It must be noted however that the corpus cavernosum contains nervous tissue, and that removing the corpus cavernosum may result in some loss of sensation in the penis. This is especially true for circumcised patients.

2.2. Creation of a Shunt

Using a needle or scalpel, a shunt can be created flowing from the Corpus Cavernosum to the Corpus Spongiosum. This shunt will drain blood out of the penis, impeding the start of an erection. Techniques for the creation of a shunt that are suitable for self-surgery include a Corporoglanular (Winter) Shunt and a Corporoglanular (Ebbehoj and T-) Shunt. (Smith, 2012)

It is likely that these shunts are short-lasting, and repeating the procedure may create scar tissue that impedes future procedure’s effectiveness in inducing ED. As with all methods listed in this document however, this surgery should also be assumed to be permanent. There is a possibility this procedure may cause nonischemic priapism.

2.3. Permanent embolization

Normally a treatment for nonischemic priapism. The reviewed literature showed resolution of high-flow priapism in 78% of cases treated with permanent embolization technologies and an associated erectile dysfunction rate of 39%. (American Urological Accociation, 2010) Maybe with more embolization, rates of ED will rise too? TODO: Research this more.

3. Botox Injections

3.1. Penile

TODO: Not likely to work anyways.

3.2. Muscular

Multiple muscles play a role in keeping the penis erect; A injection of botox or other similar drug into these muscles may retard the erection, making it more difficult to gain an erection. This retardation can either be combined with HRT-based Disuse Atrophy or used alone.

However, some of these muscles may also have roles unrelated to erection. As such, this method may have long-lasting or incurable side effects relating to gait, posture, and incontinence. Many of the muscles listed below are difficult to inject into while avoiding the blood supply, as they lay below the scrotum. This is likely to be true even in patients who have undergone an orchiectomy.

3.2.1. Ischiocavernosus Muscle

This muscle is responsible for stabilizing the erect penis, and also compresses the crux penis to retard the flow of blood out of the penis.

3.2.2. Bulbospongiosus muscle

This muscle contributes to erection and the contractions of orgasm and ejaculation. However, it also serves to expel the canal of the urethra after urination. Paralyzing this muscle is likely to be a bad idea, as it would likely result in urine slowly leaking out of the urethra minutes after urination.

4. Vasodilation-inducing Medications

Drugs that induce vasodilation may be used to eliminate erections, however long-term use may be harmful to cardiovascular health.

5. Side Effects of Other Medications

Many medications have the side effect of erectile dysfunction. By researching and trying different medications, one may be able to induce ED. While doses can be raised to increase the chances of inducing ED, one should always be careful to pay attention to when a dose becomes toxic.

6. Disuse Atrophy with Feminising Hormone Replacement Therapy

Feminising Hormone Replacement Therapy (hereby referred to as HRT) is well known to eliminate nocturnal erections. It is also well known in the transgender healthcare community that if an erection is not sustained for about an hour a week, erections will become painful and difficult to obtain. Furthermore, some transgender individuals report a complete loss in ability to gain an erection after months to years of disuse. Thus, the method is simple: Start HRT and completely avoid penile masturbation. After a period of time, the ability to gain an erection is lost.

However, this method has a large downside in that Feminising HRT causes feminisation, including breast growth, fat redistribution, skin lightening, loss of fertility, and mood changes. These changes are unwanted by many male individuals. However, there is no known way to get some effects of HRT while avoiding others.

6.1. Selection of Drugs

Bicalutamide as an anti-androgen should be avoided, as it is known to not completely stop nocturnal erections. Bicalutamide also allows the continuation of the male libido, which makes the cessation of masturbation required difficult. Other antiandrogens causes the libido to change to a more "female" form, making the this method easier. The observations made in this paragraph are made by the author in their own experiences with HRT.

As such, Cyproterone acetate or High-Dose Estrodiol Monotherapy are recommended for use in this method. Spironolactone should never be used, because of its harsh side-effects and difficulty in proper dosing.

7. Novel Medications

Studying the physiology of erections yields multiple chemical pathways that could be used to effectively prevent erections. If a drug could be created that inhibits one of these pathways exclusively in erectile tissue, it could be used to cause iED. However, the logistics and research in creating a new drug are incredibly difficult, such that it would be nearly impossible for a small group of individuals to create such a drug and get it approved. Even the process of discovering a possible drug to evaluate in a animal study is likely impossible. As such, while effective, this method remains in purely theory.

8. Quotes of Further Investigation

Systemic therapies proposed for the prevention of priapism have included hormonal agents, baclofen, digoxin, and terbutaline. Although terbutaline has been shown to be effective in the management of prolonged erections, there is little evidence to support its use in this clinical setting. Digoxin has no proven efficacy in the treatment of priapism. Recently, two cases of stuttering priapism have been successfully treated with oral baclofen (American Urological Accociation, 2010)

References

Podolej, 2017.

GS Podolej and C Babcock, “Emergency Department Management Of Priapism,” Emergency Medicine Practice(19), pp. 1-16 (Jan 2017). https://pubmed.ncbi.nlm.nih.gov/28027457.

Mayo Clinic, 2019.

Mayo Clinic, Priapism - Symptoms and Causes (June 2019). https://www.mayoclinic.org/diseases-conditions/priapism/symptoms-causes/syc-20352005.

Morales, 1998.

A Morales, C Gingell, M Collins, PA Wicker, and IH Osterloh, “Clinical safety of oral sildenafil citrate (VIAGRA TM) in the treatment of erectile dysfunction,” International Journal of Impotence Research(10), pp. 69-73 (1998). https://doi.org/10.1038/sj.ijir.3900354.

Smith, 2012.

Joseph A Smith, Stuart S Howards, Edward J McGuire, and Glenn M Preminger in Hinman’s Atlas of Urologic Surgery (2012). 978-1-4160-4210.

American Urological Accociation, 2010.

American Urological Accociation, Management of Priapism (2010). https://www.auanet.org/guidelines/priapism-guideline.


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