Ronald Virag's Ebook "Erection, the user's guide" 1st chapter free


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Ronald Virag is a French surgeon, Research pioneer in the speciality of masculine sexuality and in particular of the erectile dysfunction. He revolutionized the research in erectile dysfunctions and their treatment by offering, as soon as 1982, an effective medical treatment which paved the way to each progress that occurred since, and among which the famous Viagra©. His immense experience at the same time clinical, experimental and bookish, is now made available to the public with this publication accessible to all.

Erection the user’s guide we have the pride to publish only on a digital support in English, French, Russian, Spanish, Portuguese and Italian, has the ambition to give to as many readers as possible a maximum of information about an organ that is not only essential to a harmonious sexuality but also to the construction of masculinity. Everyone, women and men, teenagers and elders will find an answer to all the questions they ask themselves and do not dare asking.

In this all digital age, it is also a book open to all comments and questions.
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Ronald Virag's Ebook "Erection, the user's guide" 1st chapter free

  1. 1. Dr Ronald ViragErection : The user’s guide
  2. 2. Table of contentForeword1stPart:How does erection work?Chapter 1 – The human penis, a unique organ!Chapter 2 – Grounds of workingChapter 3 – The major actorsChapter 4 – What are the standards?My suggestions2ndPart : Why is it not working ?Chapter 5 – How it feelsChapter 6 – The erection, barometer of masculine sexualityChapter 7 – The ways of knowing and quantifyingChapter 8 – Review and choice of treatment3rdPart: How is it treated?Chapter 9 – Restore the erection with medicinesChapter 10 - Mini intra-cavernous injection, the “almost” ultimate weaponChapter 11 –Erection on cue: the hydraulic prosthesisChapter 12 –Surgical repairChapter 13 –Restoring the balances for a better and longer lifeChapter14 – Re build the erection from oneselfAppendixIndex
  3. 3. ForewordMasculinity is mainly expressed by the erection. Without an erection a man doesn’t feelcomplete. Not whole. It is the barometer of his health, his body and of his mind as well. It is theembodiment of his vital impetus. It is also and above all the mark of his uniqueness. He is a man tobe because he is, equipped with a penis that does erect from an early stage. In the mother’s womb.The erection is automatic, independent and unpredictable, almost completely slipping away from thecontrol of Will. Just like the heart beats and breathing would.Having and keeping a firm and lasting erection throughout his existence, will become aconstant concern for each man. The organ and its function are so tightly bound that he will keep aclose, scrupulous and often worried eye on his penis: its shape, dimensions and its reactions to theexternal elements. Incredulous and ignorant of its functioning, he generally buries his questions andfailures inside of him, behind the still very much alive sexual taboo. Yet, today, we know nearlyeverything about erection and the working of the penis. Erasing the excesses that in the past favoredone or the other, Mental and Physical are finding their place in a common sense consensus.Especially for the numerous men who suffer from sexual difficulties (more than 30%, of all age), fromwhat we don’t wish to call “impotence1” any longer, medicine provides positive and effectiveanswers.This book is nourished with my experience as specialist, who studied masculine sexuality formore than 30 years. I attended hundreds of meetings and conventions on the topic, publisheddozens of articles and popularisation or scientific books2. Above all, I treated thousands of men, inthe center dedicated to this area of expertise, known as CETI3(see fig. 1). I gathered all of this in aneasy manual, accessible to all. How does it work, why isn’t it working, how to treat or repair;1But the neologism “erectile dysfunction”2The references of the scientific papers approved by international journals can be find on “pubmed”, ten ask Virag R.3CETI acronym for ”Centre d’Exploration et Traitement de l’Impuissance”. (Center for Exploration andImpotence Treatment)
  4. 4. questions that come to mind, the issues that arise. In a nutshell, a user’s guide displaying theeveryday life of the rational approach of the doctor and his scientific experience but never forgetsthe emotional aspect. Technology at the service of the human nature.Fig.1 : The logo of my center for exploration and treatment of sexual dysfunctions and its symbol thepoppy flower, from which was originally extracted the papaverine, first medicine to be injected in thepenis to induce an erection.A user’s guide implies that a precise methodology has been developed to assess the erectilefunctioning and consider a treatment when proved necessary.This method is based on the absence of prejudice and on pragmatism. First the attention of the onewho sees the patient, then required examinations and finally the conclusions and advice.This is the method that is being presented here, based on the practice of the intracavernous miniinjection. I discovered its beneficial effects more than 30 years ago. Almost pain free, instillation ofmedicines directly into the penis provokes an erection and allows its study, just as exercise testingallows the study of the cardiac effect. It will be used whenever necessary, for diagnosis andtreatment, so as to produce, strengthen or extend an erection. The intracavernous mini injection is
  5. 5. the heart of the Virag method to cure erection failures. While it is not a univocal procedure, it iscentral to the mechanism. The injection will be an absolute necessity for some, only a temporarysolution for others and when it is still not sufficient, owing to the assessment it allows, theintracavernous mini injection will result in other effective treatments.Rid a man of its fear of sexual failure means restoring his confidence for every moment of hislife. Not only intimate, but his life in general. His relationship to others, not exclusively in theemotional sphere , but in the work life, in creativity changes as well. The common consideration ofthe men I successfully treated my whole career through was: “Do you know Doctor, you changed mylife” or sometimes more solemnly: “Doctor, you saved me…”.Erection, the user’s guide has no purpose but to provide the readers with the benefits of aunique experience materialised into a reliable method to treat masculine sexual difficulties. Amessage of hope for every one of us.Part 1How does erection work?What is this unique accordion in the human body, to which give so many names, made of. How doesit work?Why especially is it so insubordinate, as if independent from our will and sometimes even regardlessof our desires? The conclusion that also made a famous French stand-up comedian and illustratorsay: “My penis doesn’t like the same women as I do”! The unpredictable feature of the erectilephenomenon is thus being humorously asserted. We breathe, our heart beats, our digestive system
  6. 6. works, we urinate too without substantial change of the related organs. While the erection does leadto a transformation that turns the penis into a shaft. A transformation immediately detected by ourbrain and which is noticeable as well, hence accessible to the entourage. We don’t always know whywe get a hard on, but it shows… What are the constituent elements of an organ so specific to thehuman that it does not exist in any placental mammal4? How can it reach such a stiffness when asopposed to all other animals, there is no bone inside of it? In a nutshell, how does an erectionhappen? What mechanisms allow its duration?Chapter 1The human penis: a unique organ!Evolution turned the man into the only genuine biped. And the only mammal whose reproductiveorgan has no skeleton. In the evolutionary history, the standing position most likely caused the lossof the bone that ensures rigidity for all other vertebrates. The position of his genital area becameanterior and very exposed during the prehistoric fights, so that he needed to invent the complexorgan we are now about to describe. Easy to protect when at rest, flaccid5; enormously stiff whenerected owing to an action of the blood pressure on a tough fibrous layer called the tunica albuginea.It turned out to be what it is today: supple and discreet at ease, strong and well noticeable whenneeds to express its desire.4Evolution,through the disappearance of the erectile bone, made the human penis very complex.5The cup worn by those who do combat sports is the much later successor of the protective penis sheaths usedby some primitive ethnic groups (New Guinea).
  7. 7. General aspectThe penis is a composite organ for it is made of two distinct adjoining parts, the corpora cavernosaon the one hand and the corpus spongiosum which surrounds the urethra and is crowned by theglans penis, on the other hand (fig. 2 A and C). 2/3rdof the penis is external visible, the remainingthird is buried underside and strongly attached to the pubic arch so as to enable the mobile part toerect: this is the erection. Indeed, under the pubic arch the corpora cavernosa part to attach ontothe two bony branches named ischiopubic rami (fig. 2-C). The movable portion will lean on the bonysurface, to which the penis is tied by ligaments and muscles, to straighten up. In the mid spacecreated by the separation of the corpora cavernosa, the corpus spongiosum flares into a bulbwrapped by a muscle that will tighten during the orgasm. The top of this bulb is perforated by theurethra which goes through the prostate located under the bladder, before heading to the end of theglans. The penis thus ensures a double activity: urinating when flaccid, ejaculating when the shaft isstiff. This organ is covered with a rather thick and quite elastic skin for a better stretching capacitywhile erecting. At its tip, a thick fold of skin, the foreskin (prepuce), covers and protects the glanspenis which remains permanently moisturised as if placed into a sheath. It will easily slide during theerection to uncover the glans penis. Several men had their foreskin removed after birth or in theirchildhood, for religious, cultural motives or for hygiene purposes. In the circumcised men, the glansis always uncovered. It is drier and less sensitive.
  8. 8. Fig. 2:General anatomy of the penis : A, schematic side view ; B, cross section ; C, lower view showing theseparation of the corpus spongiosum surrounding the urethra, topped by the glans penis and the twocorpus cavernosa which base is attached to the pubis.The question of a difference between these two anatomical states regarding the sexual feeling is stillbeing discussed. Indeed, it has never been proved that circumcision deprives those who had it doneof any sexual possibility. At least, not when it comes to the quality of the erection.Uncovered, the glans looks like an asymmetrical hat, slit on the back. It is tied up to the penis by athin fold of thicker tissue called frenulum. Sometimes too short, it may tear during the first sexualintercourses. It is impressive but non-serious. During the erection the glans penis tensed by the
  9. 9. extremely stiff corpora cavernosa swells but keeps some flexibility. The hypersensitivity of glans withforeskin, sometimes a little painful, vanishes with the erection and the sexual desire tension. “Glanspenis becomes then the epicentre of the stimuli that leads to the orgasm6.” Where the penisattaches to the rest of the body the skin flares downward into a pouch –the scrotum- containing thetwo testes. The skin of the penis is hairless while its base is hairy, as is the scrotum. If the organ isbeing gently pulled and flattened on the abdomen a cutaneous fold shows, binding the scrotal sacand the penis more or less tightly. A darker vertical line marks the reunion of the embryologicaldrafts different at the moment of the formation of the organ. The entirety of the skin covering themale sexual organs is of great elasticity, insuring the frequent dimension changes at ease or erected.6R.ViragLe Sexe de l’Homme (The Male Organ) (New edition) Albin Michel p 49
  10. 10. Fig. 3The penis musculature and its role in the erection: A- pelvis median section; cross section of themuscles involved in erection; C: Rising of the erecting penis resulting from the intentional tighteningof the perineal muscles
  11. 11. Fig. 4: Ligaments and muscular expansions at the base of thepenisShapes of the erect penisThe stiff organ is like the pole of a flag raised slightly over horizontal. It is securely tied to the bonyframe by the muscles and ligaments above-described (fig.2). The angle between the penis and theabdomen is variable. It is related to the tension of the suspensory ligament and the organ dimension.The man may vary this angulation when having an erection, by tightening the base of the penismuscles (fig. 2C). The resulting stiffening makes the angle with the abdomen more acute. A biggerligamentous laxity7, greater length or a shape that is wider towards the end will make the erect shaftmore horizontal. Variation doesn’t mean anomaly, the shapes the penis takes on can be breakdowninto three different categories the “straight on”, the penile trunk is tubular; the “Eiffel Tower” shaftswider at the base than at the tip; finally the “baseball bat” penises narrower at the joint on theabdomen than the tip (fig.5).7It can be structural or linked to a ligamentous and muscular strain (age or obesity less frequently traumatism)
  12. 12. Fig. 5: The 3 usual figures of the erect shaft; from left to right: cylindrical, “Eiffel Tower”; “baseballbat”Anyway, the penis cannot present a flawless straightness but it can be discreetly curved, eitherlaterally or from the top down without causing a functional discomfort. These little variations shouldnot be more worrying than any other small anatomical strangeness that build each and everyone’suniqueness. They are common and quite different from real distortions making the erectionabnormal and not suitable for use. Too many men, mostly young, see a doctor for those venialanatomical variations which more often than not only hide an exaggerated anxiety about their sexualactivity. These “penis narcissistics” need to be comforted and it is not always an easy task. I am usedto telling them that as long as the erection really is there, stiff and allowing a complete sexualactivity, there is no need to worry.Today, we do overly tend to instil an aesthetic concern to the anatomy of an organ that is and mustessentially remain, by its primary function, functional. The aesthetic concern must be downplayedhere. Quite different is the problem of the sizes of the organ, usual subject of both genders fantasies.
  13. 13. Dimensions / VolumeThe man concerns regarding the dimensions of his organ aren’t new. Ancient medical documents(Jewish, Roman, Arab) mention ointments, plants and various methods to improve not only thefunction of the shaft but its dimensions (size and volume). However, this day and age completelyundressed our genitals, not only in the secret of our alcoves but in front every man and woman too.Every man, that is to say our gym neighbour and almost every woman, newer fact, comparing theirsuccessive or potential partners. Fantasies and anthropological8leftovers blend with the spread ofthe Internet pornographic images display. We will analyse the consequences. For now, we will hereonly consider general notions coming from several studies throughout the world. The individualappraisal mustn’t prevail but the level at which we stand in the general distribution of population(see also Chapter 4 « What are the standards?»). the average length of the erect penis is of 15 cm, with gaps in the population from11.5 to 19 centimeters. the average girth in full erection is of 14 cm with differences from 9.5 to 17 cm. the volume of the stiff shaft means more than its length: the average requiredvolume to get an erection, measured with a special formula9is of 130 ml withvariations from 70 to 200 ml. We will see that this notion of an erectile volume,which few experts studied, is very important for an essential function: maintainingthe erection. If we dare a parallel with the automotive sector: small ones need lessfuel and reach their cruising stiffness faster.Another factor to consider is the ratio between length and girth.The researchers proved that aharmonious working of the erection would match a ratio that equals to 1.3 between these two8According to the American anthropologist H. Fisher, the choice made by the protohominid females of thesexually best equipped males led to the natural selection of the human penises, which are in proportion thebiggest among the placental mammals.9Using the cone trunk formula, takes into account for the length, the intra pelvic part of the penis.
  14. 14. factors.This figure, kind of a golden number of the erectile harmony, would guarantee the organstability and its erect angulation. Other data, like the way the fixed portion of the corpus cavernosumattach to the skeleton (angulation of the pubic10branches and insertion length on the bone) certainlytakes part in the static of the organ. All of these morphological aspects are to put into perspectivewith its internal architecture and so specific way of working.Internal architecture of the corpus cavernosum and spongiosumIfvirtually, thank to computer technology, the erect shaft is sliced11like a cucumber, we may noticethat the two erectile bodies are hollow organs, like bees nests. Their alveoli are filled with the honeyof life, blood. They represent as many little “caverns” lined with a specialised tissue, theendothelium, surrounded by smooth muscle cells like the ones that cover the bladder and theintestine.Before studying the physiological groundsof the erection functioning (see chapter 2) let us questionourselves to understand how can this type of sponge, devoid of bony skeleton, become so stiff.Simply enough, because just like a soccer or rugby ball, the inner tube - the contents is here liquid- islined with a thick tissue (between 1 and 1.5mm) made of a white tissue similar to that of thetendons. The tunica albuginea is stretchy enough to lengthen the penis of 4.5 cm and enlarge itsgirth of 3 cm (average figures). When it reaches the stretching limit the shaft has become stiff andstands up back straight because of its ties onto the skeleton. This membrane has another distinctivefeature: it produces via its internal face the wall dividing the two corpora cavernosa, which are saidto be lying together like the barrels of a gun. This screen wall is open in a way that allows asynchronous working of the two corpora cavernosa. Thinner cells cover the adjoining caverns, in the10F Paul and R Virag in J Sex Medbe published in January 2013.11The forerunners of the XVIth and XVIIth century used to do that on the corpses of the executed (Leonardo daVinci) or on live animals (Raynier de Graff).
  15. 15. manner of a shroud. The whole of it is then flexible and solid at the same time, “ready to hoist thejib12sail”.Curled up in the gutter delimited in the back by the two corpora cavernosa, the corpus spongiosum isof a similar internal structure. Nevertheless, it remains turgescent without becoming rigid during theerection like its neighbours, on account of a membrane much thinner than the one surrounding thecorpora cavernosa. Indeed, it must not be squeezed to avoid disturbing the ejaculation.Things to remember :o The shaft consists of two different parts : the corpora cavernosa which”make” the erection “ and the corpus spongiosum surrounding the urethraand topped by the glans peniso They fill with blood that triggers the erectiono A part of the penis attaches to the pubis which allows it to straighten upduring the erectiono The average length of the erect shaft is of 15 cm. The corpora caverosa arewrapped in a thick and expandable membrane : the tunica abluginea. Bymeans of which the penis becomes stiff when erecto Circumcised or not, during the rection the glans stays supple12One of the qualifying terms of « having an erection » according to FrédéricDardin Les Pensées de San Antonio(San Antonio Toughts) quoted by Alain Rey DictionnaireCulturel en langue française (Cultural Dictionnary inFrench, Ed. le Robert, Paris, p. 612.