Chastity and orgasm denial discussion

**No. Not like what you’ve read. Here’s some research I found but it relates only to men whose nerve has been damaged by prostate surgery. Only after 6 months some lost 8% length and 9% girth. See the content below. — Penile fibrosis Historically, patients recovering from prostate cancer surgery have been advised that the return of erectile function (EF) can take from 6 to 18 months, or even longer. This cavernosal nerve disruption, even if brief, can lead to permanent smooth muscle damage and decreased long-term erectile function (EF).10, 11 Provoking an artificial erection during this time is thought to minimize cavernous tissue fibrosis, leading to potentially improved erection quality or decreased need for supplemental agents. The underlying hypothesis is that the artificial induction of erections shortly after surgery facilitates tissue oxygenation, reducing cavernosal fibrosis in the absence of nocturnal erections, potentially increasing the likelihood of preserving EF. Vacuum erection devices (VED), because of their ability to draw blood into the penis regardless of nerve disturbance, have become the centerpiece of penile rehabilitation protocols. This cavernosal nerve disruption, even if brief, can lead to permanent smooth muscle damage and decreased long-term erectile function (EF).10, 11 Provoking an artificial erection during this time is thought to minimize cavernous tissue fibrosis, leading to potentially improved erection quality or decreased need for supplemental agents. Much like other muscle groups, when its innervation is removed, cavernosal smooth muscle fibers degenerate sometime in the first 3–6 months.19 Muscle fibrosis was negligible at 3 months, but encompassed one third of the fiber population by 7 months. “In view of the irreversible nature of fibrosis, this study suggested that clinical intervention to rescue denervated posterior cricoarytenoid muscle fibers should be delayed no longer than 7 months to improve the chances for full recovery.” Furthermore, patients after RP lose the 3–5 nocturnal erections per night, a source of high arterial oxygen tension for 1 to 3.5 h per night.25 Apoptosis is also likely to play a role, as this has been shown in rat penile tissue after cavernous nerve denervation.20 Decreased smooth muscle tissue is accompanied by increased collagen type I and III deposition in rats after bilateral neurectomy and in men after RP.21, 22 It is possible that corporal smooth muscle apoptosis and increased collagen deposition seen in the rat nerve-crush model may also be present in human patients recovering from RP. The partial pressure of oxygen (pO2) within the corpus cavernosum is significantly higher in the erect vs the flaccid state.24 Furthermore, patients after RP lose the normal 3–5 nocturnal erections per night, a source of high arterial oxygen tension for 1 to 3.5 h per night.25 Lack of erections therefore leads to poorly oxygenated cavernosal tissue. Sustained hypoxia causes overexpression of transforming growth factor-β 1.26 This leads to increased synthesis of endothelin-1, which is a constrictor of penile smooth muscle and a profibrotic agent.27 This fibrosis leads to decreased EF.28, 29, 30 Low oxygen tension also decreases the level of prostaglandin-E1, which normally inhibits collagen formation by inhibiting transforming growth factor-β 1. Hence, hypoxia also causes fibrosis by loss of this ‘back-up mechanism’.31Oxygen tension therefore is likely the critical regulator of the delicate balance of smooth muscle and connective tissue by these molecular mechanisms. Under hypoxic conditions, cavernosal smooth muscle is replaced by collagen and the veno-occlusive mechanism required for EF may be significantly injured. Fraiman et al. were among the first to show changes in penile length and girth after nerve-sparing radical prostatectomy (NSRP). Using a cohort of 100 men undergoing NSRP and matched controls, it was shown that flaccid and erect measurements of length and circumference decreased 8 and 9%, respectively. In addition, a 19 and 22% change by volume in the flaccid and erect states, respectively, were documented between 4 and 8 months postoperatively.10 However, the measurement, which most accurately represents erect length, is stretched flaccid penile length as it is not influenced by state of mind, subjectivity or room temperature.32 This factor was studied 3 months after RP, and it showed that 48% had shortening greater than 1.0 cm.33 It is likely that the injuries, which lead to ED postoperatively, are also responsible for this decrease in size. No single protocol is currently considered the ‘standard of care’. Mulhall et al., studied long-term follow-up (18 months) with intracavernous injection (ICI) as part of his rehabilitation protocol. The overall goal of therapy was to induce erection in men 4 weeks after RP three times weekly. After 18 months, the treatment group had 52% medication-unassisted erections as compared with 19% in the on-demand group. Treated men also had a much higher response to sildenafil after 18 months, as well as higher IIEF–EF domain scores.38 It is noted that the use of needles dissuades men from strict ICI rehabilitation protocols, as the attrition rate is quite high several months into treatment.39 Witherington46 stated 92% of 1517 patients mailed a retrospective survey were satisfied, with 77% reportedly using it at least every 2 weeks. With MUSE, Corporal oximetry was then measured. It was found that even at these low doses, blood was arterialized in the penis both immediately after treatment, as well as the day after. As discussed earlier, this increased oxygen tension is the key to avoiding penile fibrosis,40 and MUSE is thus an under-utilized post-RP modality. Vacuum erection devices The first medically relevant VED was invented for personal use in the 1960's by Geddings D Osbon, Sr Manufacturers generally recommend that the ring not stay in place for more than 30 min to avoid hypoxic injury to the penis. The usual time required to achieve an adequate penile erection ranges from 30 s to 7 min.46, 49 They also showed that the patients with the highest success with VED were classified as having ‘moderate’ ED or were able to achieve spontaneous firmness for insertion, but unable to maintain it until completion of intercourse. Preliminary data has shown the VED's ability to stretch smooth muscle fibers leads to improvement of overall EF and potentially the maintenance of penile length.57, 16, 17 Raina et al., conducted a prospective study with 109 patients undergoing RP, randomized to either undergo daily VED use for 9 months starting 1 month after surgery or to receive no treatment. Of greater significance was that the treatment group was less likely to feel that their penis was shorter (85 vs 23%). Interestingly, these findings were independent of whether the surgery was nerve sparing or not.59 “In Group 1, 80% (60/74) successfully used their VCD with a constriction ring for vaginal intercourse at a frequency of twice/week with an overall spousal satisfaction rate of 55% (33/60).” Dalkin and Christopher administered a prospective study with 42 men to assess the effect of VED on stretched penile length. The day after their catheter was removed, VED use was initiated daily for 90 consecutive days. Patients compliant with the protocol had a significantly decreased risk of having a loss of length greater than 1.0 cm (3%) compared with data from earlier studies in which 48% of men had a significant length reduction.60 This is likely due to the tumescence effect of VED Kohler et al. tested stretched flaccid penile length in a prospective randomized trial. They assigned 28 men after RRP to either undergo daily VED usage without a constriction band starting 1 month after surgery for 5 months or to begin 6 months after surgery. The early intervention group had significantly higher IIEF scores in addition to preserved penile length. In contrast, patients not using the VED had approximately 2.0 cm decreased penile length at both 3 and 6 months (in five out of eleven patients). **