| Case Study
1 Psychological Assessment Using Survey Study of the International Male Enhancement Program By Dennis Rockwell, Ph.D Senior V.P. for EMARC, Inc. |
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02:41:12 06/03/03 1.0 Psychological
Assessment
Introduction Brief Summary of Program Topic Discussion Sexual dysfunction in the male is a prevalent problem, in all
societies, and seriously affects the male's self-confidence and ability to
sexually perform. This problem is currently treated with psychotherapy (by
sex therapists), herbal treatments, and medical applications. Not only can
this dysfunction create serious psychological ramifications, but it can
become expensive in the areas of doctor's visits, price of medications,
and costly mechanisms. Furthermore, the medications presently used can
have serious side affects, depending on the individual's physiology and
other current medications that he is taking. Even the herbal applications
can have counter side affects with other medications and supplements,
along with various problems due to the individual's physiology (Finger,
Lund, & Slagle, 1997).
Testosterone levels in males steadily decrease during aging and this
affects the male's abilities to perform and their sexual desire. People
feel that sexual abilities are somehow a reflection of something very
basic in them; and each individual feels revealed as well as naked before
the other in physical and psychological ways. Therefore, when the male's
testosterone levels start decreasing their sex drive also decreases,
usually after 40; however, the female's sex drive increases with age. This
can cause severe intimacy problems in a relationship as the male's desires
decrease and the female's increases (Lidz, 1983).
Sexual compatibility is also a variable in a relationship and tends to
be a critical measure of two persons' capacities to achieve true intimacy
(Masters and Johnson, 1966). After child birth a female's vagina
stretches, so as to assist in giving birth, and after giving birth it
maintains a more elastic capability. This increased elasticity can create
difficulties in sexual intimacy with partners who have not had problems
prior to child birth, due to the male's penis not increasing in size,
whereas the females vaginal canal now becomes bigger and more loose during
intercourse. This particular problem can create a sexual pleasure problem
for the female as well as the male, where there may not have been a
problem prior to child birth.
The human body responds; grows, develops, and adapts; to physical
stimulation and exercise. The tendons, ligaments, muscle fibers, and
cellular tissue stretch and heal to adapt to new stressors on them (Berne,
Levy, Koeppen, & Stanton, 1998). This is the innate physiology of the
human body, to grow and adapt to change, and all tissue in the body
responds to the various stressors exerted on it. Due to this innate
ability muscle fibers stretch and grow to accommodate exercise, along with
the tendons and ligaments. However, the penis is not made up of muscle
tissue, but it is affected by the ligaments attaching it to the pubic
bone. In addition, the erectile tissue, corpora cavernosa, is a spongy
tissue containing distensible blood spaces, which increases in size when
blood is pumped into it (Martini, 1998).
Can the corpora cavernosa increase its distensible blood space size?
The corpora cavernosa in the male penis is similar in construction to the
pore cells in marine life called sponges. Repeatedly stretching the pore
cells in a live sponge will cause it's absorption pores to expand and heal
in this expanded state to adapt to the minute tearing of the cellular
walls of the pores, thereby making the pore cells larger and more capable
of absorbing more water and nutrients. The corpora cavernosa is a live
tissue which responds similarly in the manner of a sponge (Martini, 1998);
therefore, continuous stretching and healing should cause the distensible
blood spaces to increase their ability to absorb more blood, as a sponge
does with water, and thereby increase actual size of the erectile tissue.
The ligament which connects the penis to the pubic bone and runs up the
back of the penis, Fundiform Ligament, is cut in penile enlargement
surgery, so as to allow the longer extension of the penis. However, this
can have adverse effects, such as the penis staying in a hanging state,
even when erect, and other possible problems. It has been proven in
bodybuilding that the tendons and ligaments will adapt to repeated
stretching exercises and thereby (using the same application to the penis
ligaments) become longer and allow the penis to increase in length and
girth along with the erectile tissues increase in blood capacity, when
stretched at the same time.
As the male ages and the testes decrease their output of testosterone
they become smaller and sex drive is decreased. However, continued
stimulation of the testes will stop and reverse this process; thereby,
increasing sex drive and sensitivity (Masters and Johnson, 1966). Masters
and Johnson's study in 1966 showed that the more a male has sexual
stimulation the more their sex drive is increased and that their later sex
life is also increased. In other words, the more the male has sexual
activity in his earlier years the more he will have sexual activity in his
senior years. This has been shown by numerous studies and that the
increase in sex drive is related to the amount of testosterone levels in
the body and sexual self-confidence (Lue, 1998).
It is common knowledge that a man's ability to stave off orgasm during
intercourse can have a direct effect on the woman's ability to reach
orgasm during intercourse. The amount of sexual pleasure each partner
experiences, while having sexual intimacy, and the male's self-confidence
in performing during sexual relations are also directly related.
Therefore, if a male can control his ability to refrain from having orgasm
then the sexual pleasure is increased for both parties and the male's
self-confidence is increased, thereby decreasing any performance anxiety
that would be related. The orgasm can be controlled by exercising the
muscles associated with squeezing the penis' bulb of spongiosum (base of
penis) and resulting internal urethra, which is at the base of the scrotum
and directly effects the blood supply to the penis, along with contracting
the urethra and thereby staving off ejaculation. By being able to control
the Urogenital diaphragm muscle and associated muscle groups (Levator ani,
or Puborectalis, which includes the Pubococcygeus, Iliococcygeus, and the
Ischiococcygeus muscles (Agur, 1991)) the male can stop orgasm and control
ejaculation thereby increasing the amount of sexual intimacy with his
partner.
In conclusion, empirical evidence has shown that as a man ages his
penis length shrinks, due to the ligaments and tendons in his body getting
shorter, along with the decreased testosterone output of the testes. Also,
that a man's penis size, ability to perform, and sex drive are in direct
correlation with his self-confidence and ability to become intimate.
Therefore, any program which can stave off the effects of aging on the
penis and testes would directly effect his sexual performance, self-image,
and decrease his performance anxiety. This would also thereby increase his
and his partner's sexual intimacy and sexual pleasure.
Background of Related Topics and Programs The drawbacks of these techniques are down played and sometimes totally
ignored. Some men have used these techniques with disastrous results.
Ahmed I. El-Sakka and Tom F. Lue recently published a paper, with compiled
research, on the possible problems resulting from the use of these
procedures (1997). They state, "Many devastating complications have been
reported, eg debilitating silicone granuloma of the penis and scrotum,
parafinoma of the penis and unsuccessful or even crippling effects of not
only autologous fat injection but a variety of surgical procedures as
well." These are only a few of the possible complications from the various
types of surgery. Disclaimers are attached to all of the various
procedures, surgical, medicinal, herbal, and mechanical. These disclaimers
describe everything from mild side affects to possibility of amputation
and death, depending on the procedure.
Psychological issues are also a prominent factor in determining whether
or not the patients should attempt any technique. El-Sakka and Lue
describe how "patient's motives, expectations and psychological health
should be thoroughly evaluated, preferably by a psychologist or
psychiatrist familiar with the surgery. A severely depressed, disturbed,
psychotic or unrealistic patient must not undergo surgery." This
emphasizes not only the importance of weeding out patients who are not
psychologically stable, but also assist the physician in avoiding possible
law suits if the patient isn't satisfied. This also limits who would be
allowed these procedures and thereby limits the individual's options,
putting them back into a "no win" situation. Of course, these
psychological aspects should always be considered when surgery is being
performed. However, are these procedures worth the possible anxiety,
aggravation, and/or possible severe complications?
The various surgical techniques include, but aren't limited to: skin
incision where the Fundiform suspensory ligament is cut allowing the penis
to drop, fat grafts and transfers where fat from other areas of the body
are inserted in the penis, and splitting the corpora cavernosa and
inserting silicone. All of these surgical techniques can have disastrous
results such as: wound dehiscence, scarring, hair on penis, shortening of
the penis due to scarring, penis staying pointed down even upon erection,
granuloma formation with fat transfer, reabsorption of fat and migration
of fat, curved penis, lumps in penis, distortion of penis, and possible
amputation if infection occurs or blood circulation restricts. In
addition, as with all surgeries possibility of complications from
anesthetic is also a factor. The results from surgery are mixed and many
patients don't gain any length at all. The girth is usually increased in
the fat grafts, but the length isn't affected and a large incision down
the penis is necessary. Splitting the corpora cavernosa, erectile tissue,
and inserting silicone can cause all of the above difficulties.
Other types of alternative treatments are offered to the individual if
they aren't able to have surgery, or aren't considering that option. These
include mechanical devices such as the penile pump and weights. The penile
pump is a device which is placed over the penis and creates a vacuum
around it so that blood is forced into the erectile tissue. By forcing the
expansion of the tissues of the penis, by using a vacuum, the penis is
forced to stretch and thereby fill by sucking blood into the blood spaces
and veins. However, any misuse of this device can create serious
malformations, breakage of capillaries and veins, and even breaking open
the distensible blood spaces of the corpora cavernosa. The gains are
varied and repeated use of this device and storage is necessary. The
device is used prior to sexual activity to gain an erection for sex;
however, it is stated that possibility of erection without the device may
occur after prolonged use. This means that just before having sex with
your partner you need to bring out the pump, apply it to your penis, and
then after gaining an erection with it remove it and perform your sexual
activity. This can be embarrassing and cumbersome for the individual and
their sex partner. Prices for the device can vary from approximately
$150.00 to as much as $500.00 and more, depending on the device and where
it is obtained.
An additional mechanical device used for penile enhancement is the
weights. This is a relatively inexpensive device, which is basically using
varied weights (depending on the individual's tolerance to the weight)
attached to a noose and strapping the noose just below the glans of the
penis. The device is left on the penis for a period of time, daily, to
allow the weight to stretch the Fundiform ligament and the erectile
tissue. However, this device can cause problems in glans of the penis, due
to it possibly cutting off the blood circulation to the penis. If the
device is left on for any lengthy period the glans receives a restricted
blood flow and this can cause the tissue to atrophy and desensitize the
glans. This device is usually used after various surgical techniques, in a
limited manner, to assist in stretching the surgically augmented tissue.
Overuse of this device can cause the glans to have nephropathy
(hemorrhaging and inflammation) and neuropathy (caused by restricted blood
supply to the neural tissues). These can possibly lead to tissue death,
ulceration, infection, and loss of the tissue (Martini, 1998), the glans.
Penile injection therapy uses a diabetic needle to insert a medication
into the corpora cavernosa, which acts on the smooth muscle tissue
allowing erection. This can be painful from the injection and costs
approximately $20 to $25 per injection. The injection is done just prior
to sex and can be part of the intimate experience. Medications such as
Viagra and Vasomax are oral medications which allow for the penis to
become erect, but don't increase size of penis nor sex drive and are
strictly used for ED (erectile dysfunction). Viagra states possible side
effects of headache, flushing, and visual problems. In addition, Viagra
can't be taken with any nitrate drug, due to the body using both in a
similar fashion and the synergistic effect can be physically harmful.
Vasomax expresses possible side effects of tachycardia, dizziness,
rhinitis, and hypotension. Natural herbal treatments include the use of
Yohimbehe, which is from the bark of a South American tree and this can
also cause similar side effects as Viagra.
Using testosterone replacement therapy can decrease impotence, if the
problem is caused by a deficiency in the hormone. However, testosterone
therapy can effect the heart, kidneys, liver, and prostate severely.
Growth hormone therapy is very expensive and needs to be injected into the
fat surrounding the stomach. Growth hormone therapy has not been shown to
improve ED and serious side effects can result with continued use. Neither
of these have been shown to increase penis length or girth and both can be
extremely expensive and prescription prohibitive. In addition, extensive
use of testosterone can cause shrinkage of the testes, due to the body
adapting to the extra hormone levels.
Comparison and Contrast of Program and It's Results The issue of penis length and girth is also alleviated with the
prescribed exercises and various increases, with an average of 1/4" in
length and 1/8" in girth every 6 weeks, were reported. The variance was
found to be mainly due to amount of time allotted daily and dedication to
the recommended regime. None of the participants of the survey were
disappointed and some were astounded by their results, in all areas of the
program. A few of the surveyed clients had tried some of the above stated
options, in the previous section, and found their results with IMEW's
program to have alleviated some malformations that they had experienced
from opting to try some of these programs. For example, one client had
used a pump and after 6 months found that his penis had a severe bend to
the side when erect. After doing the program for 3 months this condition
was alleviated.
Another person surveyed had reported having the surgery done, where the
Fundiform ligament had been cut, and found that his penis gained
approximately 1 1ܲ" in length, no attributable girth, and would hang in
the flaccid state even when erect. After doing the program for 6 months
this person had an increase of 3 1/2" in length and 1 1/4" in girth;
however, due to the Fundiform ligament being cut his erection would still
stay in a down turned state. This individual also expressed that there had
been no sex drive increase with his surgery and that his sex drive has now
increased to 1 to 2 times a day from once every two weeks, on average.
Another aspect presented by this person was that his sexual control had
not been increased by the surgery, but by doing the program exercises it
had increased at a considerable rate. This aspect has advanced to the
point where he can now stave off ejaculation during intercourse so that he
can not only perform for longer periods of time, he stated as long as he
wants, but that he has control to have partial orgasms and thereby have
more than one orgasm during copulation.
Sensitivity is also an issue in sexual performance and all of the
surveyed group reported an increase in sensitivity to the glans of their
penis. One of the surveyed individuals had expressed trying weights, pump,
testosterone treatments, and growth hormone treatments with no results in
girth, sensitivity, or sex drive and minimal results in length, 1/4" to
1/2" maximum. This individual is a doctor and owns an anti-aging clinic of
his own, where these options are available. He expressed that he is 65
years of age and upon doing the program for six months has found his
sensitivity and sex drive to have increased to when he was a teenager. He
additionally stated that growth hormone and testosterone, long term usage,
can have physical side affects to the various organs of the body.
The flaccid length, length of penis when not erect, has been reported
to be one of the first things to increase and alleviates the "shower"
anxiety that occurs when an individual has to shower with other males.
Another surveyed client said that his flaccid length has increased to
approximately 7" since doing the program, his length and girth have
increased from 6.8" to 8.5", and his sex drive and sexual control have
also increased considerably. He stated, "I can now have sex until my
girlfriend wants to stop and the program has taken me to the next level in
my sex life." Furthermore, he expressed that he was at Mardi Gras in New
Orleans recently and that women were throwing beads and coins at him to
pull his pants down. He expressed feeling a strong self-confidence and
also increase in testosterone.
This last testimonial exemplifies some added bonus' that other programs
don't and that is sexual prowess, increase in personal confidence, and
knowledge of their ability to please their partner in all areas. Age
appears not to be a factor in any of these areas, when a medical condition
is not present. Clients surveyed were from age 16 to 76 and all of the
sample expressed results of gratification with the program. However, this
program survey only surveyed those who are presently in the program and
use IMEW's chat line and doesn't include any who may have left the program
or don't use his chat line. IMEW stated that the drop out rate has
decreased and that the complaints are usually related to client's not
staying with doing the program daily, as designed.
The Survey Besides the empirical data of actual measurements the other stated data
compiled is subjective as to the individuals' own understanding of their
drive, control, and confidence. The subjective data is not considered to
be unreliable, due to the program's approach to these aspects being
fundamental issues to each individual. Even though these are subjective
feelings of the participants, they do show the personal effects each
individual has experienced in using the program.
The sample group was selected at random and at various times during the
day and evening from IMEW's chat line, which is associated with his
program. This sample group's data expresses their experiences with IMEW's
program and an evaluation of the program with this group. Inability to
sample other populations and to increase the size of the sample population
is a limitation of this survey. Data from this sample group was correlated
and charted so as to find averages, means, variances, and standard
deviations of the survey questions, including other statistical data.
These statistical calculations were graphed for comparisons between the
sample population group.
The data was collected as follows: age in years, prior length and girth
in inches, present length and girth in inches, time allotted to program
per day in minutes, sex drive prior and present (with a scale of 1 to 10
with 1 being the least and 10 being the most), sexual control prior and
present (with a scale of 1 to 10 with 1 being the least and 10 being the
most), and sexual confidence prior and present (with a scale of 1 to 10
with 1 being the least and 10 being the most). The data is charted with
each sample subject being assigned a number and logged accordingly, with
their information following.
This study uses a survey approach to assessing
the various affects, psychologically and physiologically , of the
International Male Enhancement Website (IMEW) web site's penile fitness
program on the present participants, by randomly sampling the male
population at the IMEW web site chat line. In this manner all areas
relevant to the program are assessed by sampling questions relating to
age, penile length, and girth before using the program, penile length and
girth at present time of survey, length of time (in minutes) per day using
the program, any increase/decrease in sex drive, any increase/decrease in
sexual control, any increase/decrease in self-confidence, and amount of
days using the program. A summary of the program will be included and
other known methods of penile enhancement are explored and compared and
contrasted with IMEW's regime. In this manner all possible avenues are
explored and presented, so as to give a clear picture of the possible pros
and possible cons of the program from every viewpoint of the program
participants.
IMEW has put together a
step-by-step easy to follow procedure for penile enhancement and
functioning based on a Sudanese Arabic method called jelqing, which is
stated as being hundreds of years old. This method contains exercises
performed by hand, daily, and contains no mechanisms which could injure
the penis. Additionally, IMEW has added other various hand and muscle
exercises in the program to assist in penile enhancement, control,
sensitivity, and sex drive. IMEW's program is guaranteed, if the client
isn't satisfied after six months of using the program he will receive his
money back without question.
Male self-confidence in relationships and
sexual performance is directly affected by the male's penis size and
performance capabilities, as stated in the Miller study (2000).
Additionally, it has been shown that males and females believe, falsely,
that a male's sex organ is determined genetically and can't be affected
without surgery. This assumption places the male in a "no win" situation,
without surgical options, and if he isn't endowed with a substantial penis
size at birth then he automatically feels inadequate and this will
definitely affect his "performance anxiety" when in a sexual or pre-sexual
situation (Lidz, 1976). Also, it has been found that as the human body
ages it decreases tendon and ligament lengths throughout the body, which
causes it to shrink and this causes decreased body height, length, and
penis size in the male (Mader, 1994).
Recent trends in
advertising, psychotherapy, medicine, and herbal treatments have been
moving in the direction of dealing with sexual dysfunction and it's
ramifications. This advertising of medicines, herbal applications,
mechanical devices, and therapy have been inundating the pages of our
magazines, our television commercials, and our junk mail. Impotence, penis
size, performance anxiety, and sexual intimacy are age old problems, which
until the last few years was kept secret and not talked about. However,
with the advent of new techniques and the all important marketing dollar
these difficulties have been exploited in all areas of society, due to the
overwhelming money making availability. Males all over the world have
lived with these issues and have been miserable in all aspects of their
lives, due to them. It's no surprise that they will go to any extent,
financially and physically, to alleviate these overwhelming dilemmas.
IMEW's
program approaches all of the above problems with more natural and less
invasive techniques. The self-help program IMEW is offering uses a regime
of various hand and muscle exercises to alleviate these difficulties. The
problem of ED and sex drive, excluding medical causes, are attacked by
having the client do numerous kegels, flexing the Urogenital diaphragm and
adjoining muscle groups, daily and also massaging and stimulating the
testes daily. Survey results show that 90% of the sampled population found
their sex drive, after performing the program for 3 to 4 weeks, to have
increased from a rate of approximately once every two weeks to daily + and
that they found no problems in attaining an erection during sexual
intimacy. IMEW's program approaches all of the above problems with more
natural and less invasive techniques. The self-help program IMEW is
offering uses a regime of various hand and muscle exercises to alleviate
these difficulties. The problem of ED and sex drive, excluding medical
causes, are attacked by having the client do numerous kegels, flexing the
Urogenital diaphragm and adjoining muscle groups, daily and also massaging
and stimulating the testes daily. Survey results show that 90% of the
sampled population found their sex drive, after performing the program for
3 to 4 weeks, to have increased from a rate of approximately once every
two weeks to daily + and that they found no problems in attaining an
erection during sexual intimacy.
This survey was done over a 3 week period and
included sampling the population of males who are presently using the
program and visit IMEW's chat line, which is associated with the program.
Sampled group was 62 males of various ages, ranging from 16 to 76, with
various backgrounds, various time allotted to doing the program per day,
and varying results with the program. The areas which were surveyed are:
age, penis length and girth prior to program, penis length and girth
presently, time in the program, time allotted per day for using the
program, sexual drive prior to program, sexual drive presently, sexual
control prior to program, sexual control presently, self-confidence prior
to program, and self-confidence presently (as relates to sexual confidence
in self).
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The statistical data shows that on average if a man who is approximately 40 years of age engages in the use of IMEW's penile enhancement program for an average of 70 days and performs the program for approximately 45 minutes per day he should see an increase in his penis size by approximately 1 inch in length and an increase in girth by approximately 1/2 inch to 3/4 inch. In addition, this man's sex drive should increase by almost two times what he previously had and his sexual control should increase by approximately the same. The sexual confidence variable also showed an approximate doubling of effect with the use of this program.
Surveyed individuals showed an increase in all of the variables to various degrees and two of them advised that one variable, each, was not applicable to their lifestyles and therefore couldn't answer that particular part of the survey. However, they did show gains in all other areas of the survey and were highly satisfied with their results. All surveyed men advised they were pleased with their results and are going to continue with the program, so as to attain the results they are looking for. Each individual surveyed had different results they were looking for and also different areas of the program that they were more interested in obtaining maximum results. However, all participants were looking for penis length and girth increase, but some were looking more for length due to already having (in their view) a sizable girth. Additionally, every surveyed person expressed a flaccid length and girth increase, which wasn't posted or surveyed for results. They also advised that their respective sexual partners were very pleased with the results they are obtaining.
One of the surveyed individuals stated having difficulties in the areas of sleeping on his stomach, due to his flaccid length increase being so great that he would roll over on his penis at night and his pelvic bone would pinch his penis. He also expressed that he had been used to wearing pants without wearing underwear and that he would get looks and comments on his size to the point of embarrassment. Therefore, he has started wearing underwear, so as to limit this situation. He additionally said that when not wearing underwear, especially when wearing jeans, that due to the increased flaccid length his penis would be stimulated from the rubbing. Finally, he had experienced other males making comments to him when he would be using the urinals in mens' rooms, some men would ask if they could hold his penis, which would embarrass him. However, only one of the surveyed men expressed this and his flaccid length was 8 plus inches and his erect length was 11 inches, from an original of 71/2 inches. This individual stated he is going to continue using the program and hoping to possibly obtain a 14 to 15 inch length, or possibly only use the program on a maintenance level so as to maintain his obtained results at the present time.
There were no other complaints observed from any of the other participants and one individual surveyed had used other devices which had caused his penis to have a permanent bend which caused him discomfort. However, since using IMEW's program this bend has been alleviated, along with increase in length and girth of his penis. This participant was extremely pleased with his results, so far, and his unexpected side effect of alleviating the previously expressed bending problem.
The surveyed results show no true negative side effects, possibility of alleviation of previous difficulties in all areas, and an ability for the practitioner to obtain all desired gains by continued usage of IMEW's penile enhancement program. The statistical data obtained through usage of the survey results support this conclusion. However, as previously expressed, the survey was limited to 62 males who are presently using the program and does not include any males who may have been dissatisfied with the usage of the program, or why they may have been dissatisfied. Furthermore, the statistical data from the survey shows that time using the program daily and amount of days are a factor, along with individual physiological makeup, in the participants' obtained gains and the time it takes to make these gains. No damage to the penis or testicles were observed in any of the men surveyed.
Age does not appear to be a factor in the gains obtained, only time per day and amount of days using the program. However, due to the physiological effects of a younger man's body being more flexible and pliable, in addition to extra high hormones of testosterone levels in the blood, this could possibly effect the speed of which desired results are obtained. This would be because the Fundiform ligament can stretch easier in a younger male and the corpora cavernosa should also be able to heal and stretch easier. In addition, men at the upper levels of age, 60's and 70's, found no problem with obtaining their gains or in using the program, but it was expressed that stretching was a vital part of the program for them.
References
Agur, Anne M.R., "Grant's Atlas of Anatomy". Baltimore: Williams and Wilkins, 1991.
Berne, Robert M., Levy,; Matthew N., Koeppen, Bruce M., and Stanton, Bruce A., "Physiology Fourth Edition". St. Louis: Mosby, Inc., 1998.
El-Sakka, Ahmed I. and Lue, Tom F., "Penile Augmentation: Myths and Realities". Urology International. Feb. '97.
Finger, W.W., Lund, M., and Slagle, M.A., "Medications that may Contribute to Sexual Disorders: a Guide to Assessment and Treatment in Family Practice". Journal of Family Practice. 1997: 44 (1): 33-43.
Lidz, Theodore, "The Person His and Her Development Throughout the Lifecycle". New York: Basic Books, 1983.
Lue, T.F., "Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction and Priapism". Campbell's Urology. 7th ed. 1998: 1157-79.
Mader, Sylvia S., "Introduction to Biology". Dubuque: Wm. C. Brown Communications, Inc., 1994. Martini, Frederic H., "Fundamentals of Anatomy & Physiology". London: Prentice Hall, 1998.
Martini, Frederic H., "Fundamentals of Anatomy & Physiology". London: Prentice Hall, 1998.
Masters, W. and Johnson, V., "Human Sexual Response". Boston: Little & Brown, 1966.
Miller, Thomas A., "Diagnostic Evaluation of Erectile Dysfunction". American Family Physician. Jan. 2000: Vol. 61 (1) 95-104.
This study, survey, and statistical analysis was conducted and performed by Dennis Rockwell, Ph.D, in concert with EMARC, Inc., and was completed on April 1, 2000. Dennis Rockwell, Ph.D Senior V.P. EMARC, Inc. 301 Southwest 1st Street Suite 508D Boca Raton, Florida 33432