TMI: Erectile dysfunction testing in the sleep laboratory

Dr. Urspo, on his blog, recently mentioned a couple of objects found in his office desk drawer which may have been used as a method of explaining how to use them. The objects were a cock ring and a condom. This triggered a memory of erectile dysfunction testing as a part of sleep disorders testing. In the old days before Viagra and Cialis, Medicare, Workmen’s Compensation, and some other insurance companies would pay for devices to treat male impotence. However, they needed to establish that the man was not capable of getting an erection.

All males from infancy to old age get penile erections during REM sleep. If a man has erections during REM sleep, then he should be able to get erections while awake as well. If he can get erections during REM sleep, but could not get erections during sexual arousal, it was considered to be a psychological problem. However, if he did not get erections during REM sleep, the lack of erections was considered physiological, such as a result of diabetes or injury, etc.

An early method was to use a strip of postage stamps. The denomination of the stamps was of no use and therefore one would use one cent stamps. One would wrap a long enough strip of the stamps around the flaccid penis to connect them at bedtime. No jokes, now, about who would lick the stamps. If the subject had an erection during the night, then the perforations between the stamps would be separated. Otherwise, without an erection, the stamps would be intact as placed the night before. This was a somewhat crude inexpensive test, and therefore better evidence of an erection was needed.

The method of testing erectile ability during REM sleep, was to place mercury strain gauges at the base of the penis, and also just under the glans of the penis. When the penis became erect and engorged with blood, the strain gauges would be stretched, and send a signal to the polysomnograph. The beginning of the erection as the gauges enlarged was known as T–up. Maximal enlargement was known as T–Max, and this was followed by T–down. [T=tumescence] This tracing on the polysomnograph would then be correlated with REM sleep.

Usually during the second REM period, the technologist would hurriedly go into the patient’s room with a Polaroid camera and a buckling device. The patient would be uncovered, a picture would be taken of the erection, and the buckling device would be pressed against the tip of the penis to determine how many grams of pressure would be needed for the penis to buckle. This procedure could be embarrassing for both the patient and the technologist, especially if she were female.

We once had a female tech who said, “I’m not going to touch any of those penises.” She devised a method of getting the strain gauges on the penis, without having to touch the patient. Going to the local adult bookstore, she purchased a dildo, which was molded from the penis of a well-known porn star.

To instruct the patient, she would place the mercury strain gauges on the dildo in their proper locations. Then she would instruct the patient to put the gauges on his own penis in the same way. That method worked very well for her. One day, the hospital administrator was giving a tour to a group of dignitaries. And wouldn't you know it, one of the dignitaries saw the dildo sitting on the shelf, and wanted to know what that was for!