If you want to go beyond this and reduce your exposure to chemicals even further, then there is more that you can do. You can avoid contaminants in water and food, avoid using plastics and you can avoid synthetic fibres and fabrics. You can also, if you are prepared to do it, stay indoors totally for the elimination programme and place conditions on what the people who live with you, or come into your home, use and wear. This is really hard-line and does not make you popular, but it can sometimes bring results.

To avoid contaminants in water, use a jug filter for water for drinking, cooking, food preparation, and for washing as far as you can. Alternatively, use bottled water – Malvern, Evian and Buxton are good choices (in glass bottles, if possible).

To avoid contaminants in food, eat fresh, unprocessed food -organic, if possible. To reduce your use of plastics, stop using plastic containers, wraps and bags for food – use glass or ceramic containers, if possible. Cellophane poses no problems. Do not use plastic carrier bags – old ones are usually little problem, but avoid new ones particularly.

To avoid synthetic fibres and fabrics, wear pure cotton clothes, for preference. Make sure these are well washed if they are new. Avoid pure synthetics where possible – polycotton blends are usually better tolerated than synthetics if you have no pure cotton clothes at all. For bedding, use a pure cotton pillowcase, well washed before use, and lay a well-washed pure cotton cloth or sheet over the top of the duvet or blankets if you cannot borrow or replace a synthetic duvet or blankets with others of a different material.

If you are allergic to cotton.

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For wall and ceiling linings, you can use plasterboard which is made from a layer of gypsum dried and hardened on paper. This does not cause sensitivity. You can also use hardboard in some uses. For solid floors, you can use concrete, wood or stone.

In general, it is better to avoid built-in furniture, or surfaces with veneers if you can, since these will usually be constructed with particle boards. If you instal fitted furniture, do so on solid wood frames, and use glass or solid wood doors and sides. If you need to replace a fitted kitchen and cannot afford to use solid wood throughout, one way to cope is to leave the old gassed-out chipboard frame in place, and to replace doors with glass and solid wood doors. Alternatively, you could use boards such as fibre building boards, plywood or block-board. These are much less troublesome than particle boards and cheaper than, and sometimes technically preferable to, solid wood.

Fibre building boards (such as hardboard, medium board or soft-board) are made with a natural bonding process, using the lignin present in wood fibres as an adhesive. They contain no formaldehyde resins and generally very few chemical additives (except for some which contain bitumen as a water repellent – avoid using these). They can only be produced in relatively thin widths – up to 4 mm (1/8 inch) – and thus have limited applications, such as linings for walls or ceilings, or thin work on furniture. Medium-density fibreboard (MDF) is a particle board, not a fibre building board and has a high resin content.

Plywood is made from thin sheets of wood, usually softwood, bonded together with resins under heat and pressure. The grain of each sheet is set at right angles, so that it provides a very strong and stable material at low thicknesses. The resins used are formaldehyde resins, at very much lower concentrations than those used in particle board. Plywood uses a different process of manufacture and if the manufacture has been correct, it does not release free formaldehyde as particle boards do and thus can be used without problems. A well-aired plywood sheet, used in moderate quantities, should not give problems. Plywood is available in thicknesses similar to chipboard and has similar applications.

Blockboard is made by glueing a veneer with resin to a core of solid wood blocks, usually of softwood. Like plywood, formaldehyde resins are used but, if manufacture is correct, do not release free formaldehyde at all. Blockboard can be used for kitchen cupboards and built-in furniture.

If you are sensitive to pine wood, you can obtain plywood or blockboard made of hardwood from DIY shops. If you want to specify a particular wood, you can order woods of your choice through the trade.

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Of the higher efficiency filters, two medium-size ones receive very positive reports, the Biotech 500 and the Anatomia Filtaire 300.

The Biotech 500 is an oblong, desktop device – compact and light, more portable than the Anatomia Filtaire 300. It has an electrostatic filter, and a thicker carbon layer than the smaller devices. It has an optional ioniser, which is useful if you want the possibility but do not want one in operation the whole time. It is very quiet in operation, with no vibration, and its hard plastic case does not give off fumes. It is noticeably effective on particles and good on chemicals. It makes a very real difference to air quality. It is large enough to clean the air effectively in a large bedroom or living room. Prices are quoted at between £110 and £135 (1992), with replacement filters costing £8, renewable every six months. It is available from Air Improvement Centre or The Healthy House. The Anatomia Filtaire 300 is made of a plastic casing which does not give off fumes once aired well. It is circular, about 30 cm (12 inches) in diameter and 23 cm (9 inches) in height. It draws in the air through round, revolving thick fabric filters, and pushes it out into the room through a thick wad of activated carbon. It has two speeds of operation. It is extremely effective for its size and price, and receives consistently the best reports for removing both particles and chemicals. Some people find it very noisy and do not like to run it if they are in same room. The noise is probably more subdued than a fan heater, but louder in volume. This device is more bulky and heavier than the Biotech 500, or the smaller filters, but is still readily portable by car, or in a strong bag.

The fabric filters need vacuuming and washing once every two to three months, unless you are very sensitive, when you should wash them as often as you need. The fabric filters need replacing every nine to twelve months and cost £7. The carbon filter needs replacing every eighteen months to two years and costs £18.

The Anatomia Filtaire 300 is priced at between £155 and £165, available from Ascot Heath, The Healthy House and Patent Filtration.

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House dust mites are tiny living creatures that co-habit in human environments. They are about a third of a millimetre in size and can just be seen with the naked eye, although they are indistinguishable from a speck of dust. Their features and movements cannot be detected without magnification. They are one of the most common causes of allergy, resulting from inhaling minute debris from their body or of their droppings. Tests have shown that over 80 per cent of people with allergies show positive skin test results to house dust mites (although only a share of these may have positive clinical symptoms of allergy).

The most common symptoms resulting from house dust mite allergy are nasal symptoms, including sneezing, runny nose, rhinitis (hay fever), as well as sinusitis, with related headaches and ear blockages. Breathing symptoms, such as wheezing, dry persistent cough, tightness of breath and asthma, also commonly result. Eczema and dermatitis are frequently caused by house dust mites. Some people sensitive to dust mites report joint pain, swelling of tissues, and muscle aches.

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In theory, any substance can be an allergen. In practice, some substances are inherently more ‘allergenic’ (likely to cause allergy) than others and consistently cause more problems. The antibodies of the immune system need a physical handle to grasp on to, and certain chemical structures provide this better than others – proteins, in particular, are more allergenic than other types of molecule. Wool, for instance, is a protein, as are pollens, and these cause allergies more readily than molecules such as cotton, which is not a protein. In the case of foods, proteins are more likely to cause trouble than, say, fats or oils.

A molecule has to be above a certain size for the immune system to react to it. Chemicals are too small to trigger the immune system by themselves, but they can combine with other, larger molecules and form ‘haptens’, which can then trigger the system.

Anything that can be absorbed into the bloodstream can be an allergen. This means anything inhaled, swallowed, injected or absorbed through the skin or mucosa. It was commonly believed that the place where your symptoms occurred was the site of initial sensitisation. This is not now thought to be the case, since symptoms such as asthma can, in some individuals, be shown to result from substances that have been swallowed rather than inhaled. Allergens are carried by the bloodstream until they meet the place where the mast cells are located, and it is there that the reaction occurs. The most common allergens are shown in Table 1 (see Part 4 for further details). In this book, the word ‘allergen’ is used wherever possible to mean a substance that causes true allergy. If a food or other substance causes intolerance, or some other sensitivity reaction, they will be called ‘substances that cause reactions or sensitivity’.

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While semirigid implants do seem to work miracles for some men, they also have drawbacks. If the implant is too long for the penis, the penis can curve, with painful results. Left uncorrected, the implant can actually work its way out of the corpora cavernosa, damaging the penis. And implants that are too short cause problems too. The head of the penis may bend down because it isn’t getting proper support—the result is often termed an SST deformity, after the jet airplane that’s famous for its turned-down nose. Obviously, too short a prosthesis can make intercourse difficult.

On a person with a very stretchy penis, selecting the right size can be a judgment call. In such a situation, the surgeon may opt for a little too short vs. a little too long because complications from too long an implant are the riskiest.

Men who have extensive scarring in their penises may have corpora cavernosa which resist implants, because the space where the prosthesis fits is scarred partially shut. In this case, a smaller (especially in diameter) prosthesis may be required.

A man who has very poor tissue surrounding the prosthesis is at risk for a “traveling” implant. Rarely, the implant may move out of the end of the penis into the urethra or out the back of the corpora cavernosa. Pressure from the implant just wears a hole in the weak tissue. A reasonably healthy man with a correctly sized implant needn’t worry about this complication, and even men with diabetes or other problems which may cause weak tissue should take comfort from the fact that this problem is quite rare.

Another rare complication is when a man finds his penis is less sensitive to pleasure and to pain after surgery. If the nerves on top of his penis are scarred and must be stretched during surgery to implant the prosthesis, they may be damaged. Normal sensations may return to this area after several months or the numbness may be permanent.

On the other hand, after recovery, a few patients continue to experience pain without any obvious cause. In such rare cases, removal of the prosthesis may be the only alternative.

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Your doctor should ask a lot of detailed questions about your general health habits, like how much you smoke or drink now, or if you were a heavy consumer in the past, it’s important for you to be as accurate with your answers as possible. Don’t underestimate your past consumption just because you want to “look good” to the physician.

Some physicians ask their patients to fill out a questionnaire. Your answers help your doctor determine what issues are particularly important. Something essential and unique to your situation may not be covered in detail on the questionnaire, so if you have concerns that aren’t addressed, write them down or tell the doctor directly.

You should always let your doctor know about any present or past medical illness, even if it’s not bothering you right now; any surgery you’ve had; and any injuries you’ve suffered, especially to the back or pelvic area.

You should expect to be asked in great detail about the specifics of your problem. This information can be crucial to making a correct diagnosis and providing the best treatment for you. That’s why if s vital that you feel comfortable talking with the doctor you select.

Your wife can also provide valuable information, and some doctors now ask or even insist that married patients bring their spouses. Your wife may recall certain details you forget, and she has a different perspective to offer. Making up a list of questions to ask the doctor can be a joint project that will help keep the lines of communication open between you and your wife.

If there is information you prefer not to share with your wife (for example, if you’re able to have an erection with another woman, you might not want your wife to know), make sure you do tell your doctor over the telephone or when you are alone with him. “My doctor knows things about me nobody else does,” one man told us.

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Sometimes a couple may decide to work on their relationship before they try to fix the man’s potency. If your doctor suggests that you go to a counselor, he might be giving good advice. If you fix the erection problem, but because of emotional difficulties in the relationship, your partner isn’t happy with the result, you might have taken the wrong approach. Howard did.

Howard, a 55-year-old successful businessman and former professional athlete, arrived at the doctor’s office with his fiancee, Christina, a slightly plump, attractive widow of 45. Howard and Christina looked like a happy couple about to embark on a second marriage after knowing each other for several years. But their facade crumbled within a very short period of time.

Howard explained with some hostility that he had come to see the doctor only at his fiancee’s insistence. She thought he had a problem. The short blonde woman smiled, but she refused to participate in the conversation, and all the doctor’s attempts to involve her yielded nothing. Finally, Christina excused herself.

Once his partner was out of the room, Howard reiterated that Christina was the problem, not him. He was perfectly satisfied with his ability to get and maintain an erection. Furthermore, he explained that he took great pains to sexually satisfy his fiancee. He appeared quite knowledgeable about male and female physiology and talked about many different ways to achieve sexual pleasure.

At this point, the confused physician decided he would talk with Christina alone. She was somewhat reluctant, but she agreed. First Christina double-checked the door to the doctor’s office to make sure it was securely shut. Then she sat down, looked the physician straight in the eye, and declared, “He doesn’t get a good erection. He thinks he does, but he doesn’t!” Christina’s shy, somewhat timid manner disappeared: She insisted that Howard was fooling himself about his ability to function; she was sure that her partner’s erections were not satisfactory.

The doctor decided that a complete physical examination of Howard was in order. Howard turned out to be in excellent physical condition. He had no chronic diseases which could cause erection problems; he had normal blood pressure, and wasn’t taking any medications which were known to cause potency difficulties.

To test Howard’s ability to get an erection, the doctor gave him a penile shot. Within a short period of time, Howard obtained a full, firm erection, demonstrating that his essential-to-erection blood-flow system was in good working order. “This is just like the erections I normally get,” Howard declared with obvious satisfaction.

The doctor was curious to see if Christina would agree with Howard’s assessment. But although she came into the room, Christina refused to look at the erection.

What was going on here? How could Howard and Christina differ so radically about what happened between them? The doctor was puzzled, but he was sure of one thing: Howard and Christina were not communicating, and that problem needed to be solved before any possible erection difficulty was addressed.

The doctor pointed out that since Howard and Christina had strong differences in perception they might benefit from some counseling. Somewhat to the physician’s surprise, they agreed this was a good idea. On the doctor’s recommendation, they made an appointment with a psychologist who was also a well-trained, experienced sex therapist.

The therapist saw Howard and Christina together, and separately. She also gave them some tests to determine their attitudes towards sex and gauge their sexual experience.

All the results pointed to much unresolved conflict between Howard and Christina that was due to problems other than sex. She was very upset at her fiancee, but she was unable to express it directly. Instead, even with the evidence of his erection, she denied that he was able to function sexually as he thought he did—something which was of great importance to him.

In this case, the physician was able to determine in fairly short order that Howard’s erections were not the major problem, but were just singled out as the target. If the doctor had concentrated his efforts on “fixing” Howard’s erections (which didn’t even seem to be “broken”), the communication problem would have remained unresolved, leaving Howard and Christina unhappy and at odds with each other. Instead, the couple agreed to see a professional counselor who would help them deal more directly with their anger.

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Jason, a 60-year-old, first noticed a problem with erections when he was in his teens. When he was with a woman, he could not maintain an erection, although he felt very aroused. And even when he masturbated, his erection would disappear before he could ejaculate.

Jason went to numerous doctors, seeking help. Although his testosterone level was normal, Jason was given shots of the hormone—but there was no improvement in his erections. Jason got married after a doctor said it would solve his problem, but that didn’t help either. Only very rarely could he maintain an erection for enough time to allow him to have intercourse. His wife was frustrated, depressed and hurt by the situation, and so was Jason.

The couple went to more doctors, seeking help. One psychiatrist tried to persuade Jason that he could live without sex, saying that companionship was all that really mattered. But the suggestion didn’t go over very well with Jason and his wife. They wanted to enjoy sex.

Other doctors, unable to identify a physical cause for Jason’s problem, told him he had a psychological problem. “Everyone told me it was psychosomatic,” says this soft-spoken, well-dressed man, who looks younger than he is. But although no one could find a physical cause, Jason was reluctant to believe that his problem was indeed “all in my mind.” Over many years, Jason paid a high price for his leaky veins—and the lack of medical knowledge about erections that existed during most of his life. He felt his self-esteem and confidence slipping away, and believes this contributed to problems at work. He was often depressed and withdrew from social activities to spend more and more time alone. After several years, Jason and his wife stopped having any type of sexual relationship. They were too frustrated.

But recently, new tests found that leaky veins were the source of Jason’s impotence. He had surgery to correct his malfunctioning veins, and for the first time in many, many years, Jason reports that he wakes up in the morning with an erection. (More about the surgical treatments for vein problems is found in chapter 8.) After some adjustment to their new physical relationship, Jason and his wife are able to enjoy intercourse.

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What is the magic behind the mystery? While erections seem to just “happen,” erection is really a very complicated process that involves hidden nerves, arteries, veins, hormones and, of course, some more visible parts of a man’s body like the penis and testicles. Although a lot is known about the intricacies of erection, it is still veiled in mystery.

Lifting the veil is important, because understanding how erections happen can help explain why they sometimes don’t. And this knowledge will also help you and your partner understand why it’s normal for a man’s erections to vary somewhat in size, firmness and duration—or even, on occasion, fail to appear.

Since the subject is anatomy, you may find it helpful to examine yourself or your partner while reading this chapter. In fact, couples might benefit from reviewing the material together to see for themselves just what we are describing.

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