The gout business was irritating enough before my urologist added another ailment to the pile: Peyronie's disease. This news came in the wake of my first colonoscopy, which was a shock itself. I had gone to the urologist because my penis, when erect, had started to assume a scimitar curve, and other strange, contortionist shapes. ("It points north," as a friend of mine says: "You'll never get lost!")
The urologist looked at me with that doctor's expression that says gravely, "I'm afraid it's true," and, simultaneously, "Cheer up -- you have everything to live for!" As he explained, "You may have noticed that when you get an erection," he said, "it makes penetration difficult." I wanted to tell him that I wouldn't know, as it's been years since I've tried to "penetrate" anything or anyone, being HIV-positive. But I played along.
Peyronie's disease, the doctor then told me gently, is also called "partial penile disassembly." It is a condition of "uncertain cause," characterized by plaque, or a hard lump, or scar tissue, that forms in the penis and causes an abnormal curvature when the member is erect. Cases range from mild to severe. Peyronie's isn't "rare," exactly, but it's not "common" either. And it may or may not have anything to do with HIV or the medications.
"It afflicts men mainly in middle age," the urologist shrugged. "The sexual problems that result can disrupt a couple's physical and emotional relationship and lead to lowered self-esteem."
While I was stuck on the phrase "middle age," he carried on: "It's just the roll of the dice for middle-aged men. My guess is your penis has suffered some kind of trauma."
"Oh, Doc, you don't know," I answered, thinking of my whole checkered sexual history. "But the 'trauma' would have to have occurred some time ago, because my penis hasn't suffered anything in about three years."
Apparently there are only a few treatments for it, and my doctor tells me that none of them will work effectively for me. The first line of defense is massive doses of vitamin E, which the doctor can't, in good conscience, give at the levels he would normally prescribe, as vitamin E would contribute to "hepatic toxicity" (liver problems), brought on by the other pills I'm on. The second option is injections of some kind -- needles to the dick -- "which hurt like hell," the urologist said, "and they don't work, either." The third is penile implants, "but who wants a lead weight between his legs?" (I refrained from comedy here -- I knew all too well what he meant.) And the fourth, and most drastic, is surgery. "But I warn you," said the doctor, "you'll lose two or three inches. No more Peyronie's, but no penis, either."
In the meantime, the doctor gives me his own simple prescription: "I want you ejaculating all the time." It was a tempting thought, but I wondered how it was supposed to be accomplished, short of nights at the baths in the dark, since I have not voluntarily visited myself sexually on anyone in many years. Lamely, I stammered, "What is it about HIV infection you don't understand?"
Suddenly, the doctor became very calm: "Peter, all I'm saying is, if you want your weenie to look like something other than a compass or a pretzel, you'll do what I say. You can do the ejaculating on your own. But you must do it."
As I left the doctor's examining room, the receptionist addressed me. "He told you to jerk off a lot, didn't he?" she said, wincing.
"Yes. How did you know?"
"Oh, he tells that to everyone over 50. You're over 50, right?"
And I had to think: Dammit, I am!
So here I am, a middle-aged man with gout and a permanently crooked erection, commanded to jerk off (whether I want to or not). And yet I can't help thinking, Count your blessings, as your grandmother told you. Count your ejaculations, too, as Hemingway told you (he was afraid he might run out of them). And count me lucky to still be here under a bright sky in Vermont, when the wind in the trees is blowing in great, beautiful waves as summer turns to autumn, years after I pledged to Jon that we never would grow old.
About the writer
Peter Kurth is the author of "Isadora: A Sensational Life." He lives in Burlington, Vt.
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