Metzler

Shibari (.a.k.a. "Japanese bondage" is an ancient, Japanese, integrated concept of body, mind and spirit.

The objective is to unlock erotic energy through trance or trance-like experiences.

Trance (a different level of awareness) is being achieved through a refined mix of atmosphere, ritual, meditation, love, techniques and intensity of the situation.

Most forms of oriental lovemaking are hardly ever straightforward sexuality, but an intriquing game of exploration and challenges and a delicate combination of subtlety and expliciteness.

Shibari is no different.

What is trance?

Trance is a situation where one is so dedicated to and concentrated on one specific goal or situation, that - through blocking out everything else - the spiritual capacities of the mind are eniterly dedicated to that specific activity. This opens the mind to be able to experience - and use - things it never could under "normal" circumstances, since the brain will be too distracted and too busy.

Certain hormones - endorphins especially - play an important role in trance. Endorphins (morfine-like amino acids produced by the body) are the key factor here. Endorphins are known as the "mood chemicals" in your body. They create your moods, all of them. They come in complex cocktails and also serve other purposes. For example, they are a natural painkiller. Experiencing high doses of endorphins release is called an endorphins rush. This is known as the "runners' high" in athletics and as "subspace" in power exchange activities.

A combination of endorphins, dopamine (known as "the lover's feel good hormone"), enkapheline and adrenaline releases creates "super awareness" and this is the key factor in creating trance. Since experiences such as fear, anxiety, stress and physical impulses such as pain all cause the release of high doses of adrenaline and subsequently endorphins - these impulses are being used to allow you to climb the first steps of the trance ladder. Endorphins have a "sister-hormone" called enkephaline, which works on the spinal cord in the same way enderphines work on the brain.

Since mood is important atmosphere is important, which is why - in Shibari body mind spirit terms - a lot of emphasys is being placed on preparation and the physical area. For this, such things as candle light, aroma therapy (incense or evaporating essential oils), bathing and other rituals and techniques are used to create "makama" - the "circle" (area), the physical area where both partners will experience their intens lovemaking. Meditation helps to focus the mind and eventually Ki energy exchange is being used to further enhance the bonding between partners and the forces of gravity and sensory deprivation techniques are being used to create full trance.

Erogenous zones

There is a widespread misunderstanding: "erogenous zones are directly connected to the genital area and other primary sex-identifying features (such as the breasts)". Fact of the matter is that some 25 percent of the body surface (slightly more on the male body) can be identified as an erogenous zone. And the brain no doubt is the largest sex-organ. Erogenous zones are usually best stimulated through gentle massage, but they are also very receptive to other forms of stimuation, for example pain (if you are into that), or bondage.

The seven patterns of passionate lovemaking

By gently - or more strongly, in order to introduce the element of mild pain - pressing your finger nails into the fleshy parts of your partners' body you can not only leave temporary marks but doing this can also be an erotic game by itself. To do so, even and symmetric patterns are your best choice. This will not only indulge her lust, but it will also leave something to remember for a few hours a maybe a day or two, an effect that - more intensly - usually is also the result of whipping and caning.

Ropemarks are often an essential part of bondage. In a Shibari body mind spirit context they play a role, similar to other ways of leaving lovemarks.

In its original form these patterns should follow specific designs and all serve specific purposes. The idea is to leave physical marks that will function as a "tell tale", which - for example in ancient India - forced the "marked woman" to hide these marks since they indicated lustful, wild love. The more intens the temporary mark, the more intens the lovemaking had been. Complicated, repeated combinations of the seven patterns would indicate that the woman had really suffered during the lovemaking and the complicated patterns make it clear that she had to remain still during a long foreplay, while pain-impulses and excitement increased her lust.

The bite of love

Teeth tenderly or not, sinking into the tender female flesh, is not just a scene taken from a Dracula movie. Many novels and poems tell stories about lovebites. And in fact, like whip marks, bruises and others, bite marks serve as something to remember, to be proud of, to relive the passionate night before - the pain, the extacy, the lust, the love and the intimacy.

The Kama Sutra again is one of the very few sources that describes the combination of marking and pain impulses during lovemaking. Unfortunately, although various other patterns are mentioned, they are not described in sufficient detail to reconstruct them. Various different flower patterns are mentioned for example. These must be combinations of teeth and nail imprints.

The magic of knots

The magical power of the knot is as old as mankind. You will find references to the magical power of the knot in almost any ancient culture, be it Babylonic, Celtic, Oriental, Hermetic, Wicca, Voodoo or other.

Love magic - and there are many forms of that - almost always involves the use of knots and, of course, rope. Actually, we still have some of that left in modern times. Tie a knot in your handkerchief so you will remember something really important

How does it work?

Magic is all about manipulating the energy of life. This energy is called Ki in Japanese, Chi in Chinese or Prana in Sanskrit (the ancient language of India, still used in yoga for example). Conciously tieing one or more knots in a rope is a way to bundle this energy and store it there. Of course this energy will not make your car run. Neither will it make the lights go on. But it will be more than enough to have its influence on the subtle network of Ki energy exchange, that is everywhere.

In Shibari these "energy loaded" knots and ropes will replace the heart and hands of the giver and as such will contribute to the entire physical and spiritual experience. They enable the giver to "still be close to the recipient", even when physically not around. The interaction between the giver's energy - temporarily stored in the knots - and the pressure points on the Ki meridians in the recipients' body is what will release very powerful sexual and spiritual experiences.

Sexual energy is one of the most powerful manifestations of Ki energy. This is the reason why we still refer to whatever happens between love partners as "the magic", "the spark" or "the energy".

Universal love magic

The use of rope and knots, when working with sexual energy, is universal. In ancient Babylon (in the Middle East) seven knots were tied in a rope to invoke love. Wicca has a similar tradition of making three knots in a rope for the same purpose (sometimes with an almond - the "love nut" - inside each knot). African Voodoo works with either seven knots in a rope or with dolls, tied to each other, to invoke love, the Kama Sutra speaks of female love partners, suspended in rope to enhance their sexual energy. These are just a few of many examples.

Is all this strange? Actually not. There are over 50 erotic pressure points (Tsubo) on the human body, each as powerful as the clitoris or the nipples. And there are another 60 hormone-releasing pressure points along the spine, many of which have an erotic/sexual function. Ropes and knots will stimulate all these directly and energy, bundled in a knot, will only enhance their effect.

Dutch former journalist and government spokesman Hans Meijer is the author of the groundbreaking "Shibari Fumo Ryu" series of e-books, the first ever books outside Japan and written in English about Shibari techniques.

I've heard it said that change begins at home. And while we're often reminded that people around the world need our help, it seems to me that all too often we overlook our own neighbors. For most people it's just easier to make an online donation to their favorite charity than to actually go out and volunteer. But making a difference doesn't always entail a lot of money, a long-term commitment or even any real hassle.

Not long ago I was pumping up one of the neighborhood kids tires when his sister comes over with two flats. Before pumping up her 16 tires, I mention that the bike is way too small for her. She shrugs it off since theres not much she can do, though she would of course like bigger bike. I tell her that she can earn a bike that fits at our local bicycle cooperative, and learn how to work on it at the same time.

I already know how to work on bikes, she corrects me. So I hand her the pump. It turns out she does know how to work on bikes, and Im impressed. She goes on to tell me how she used to jump her bike like the local BMX kids, but sadly hers was stolen right off the porch.

Touched by her story, I let her keep the pump and decide to find her a bike. At first I considered giving her my old GT Pro Performer, but like all eight of my bikes, it has too much sentimental value to part with. So I went and talked to my friend Gerry who owns a local community-oriented bike shop, figuring he might have some kind of deal for me. In love with the idea, he gave me a small mountain bike for free. It was a Huffy that had been dropped off for repair and never picked up. Sure, its a cheap bike but the thing was practically brand new, and just the right size.

Of course it occured to me afterwards that Khadijahs parents might be a bit apprehensive about a stranger coming and donating a bike out of the goodness of their heart. So I went over and talked to her father, George. Not only was he totally appreciative, he was concerned about fixing his childrens tires in the future. He asked about buying a tube for his sons bike, and it was just too perfect to be able to hand him a copy of Urban Velo #1 and point out the article on how to patch a tube, instead.

The next day I returned with the mountain bike, a lock and a patch kit. Khadijah was so excited she hardly finished saying thanks before charging up the street on her new ride. For me the real thanks came thirty seconds later when she sped back down to ask her father, Daddy, can I go to the park? What more can you ask for? Well, when I offered to show George how to patch his sons tube, he declined the offer. He had read the entire zine and felt confident that he could fix his kids tires from here on out. Whats more, he plans to get a bike for himself so he can make cycling a family activity.

-Jeff Guerrero
http://www.urbanvelo.org

If you are looking for a vehicle that could be seen as a bright and happy little car, then the Toyota Echo would be the right one for you. The Toyota Echo is a vehicle that is roomy, reliable, and economical. Certainly, this vehicle could be the kind of vehicle that would fit a college students budget. This vehicle has been designed and manufactured so as to compete with the Chevrolet Metro, the Daewoo Lanos, the Dodge Neon, the Ford Focus, the Honda Civic, the Hyundai Accent, the Kia Sephia, the Mazda Protg, the Mitsubishi Mirage, the Nissan Sentra, the Saturn SL, and the Suzuki Swift.

Toyota has changed its marketing strategy for this vehicle. For years, the automotive company has been marketing its vehicles with a heavy and standard kind of strategy. However, with the Toyota Echo, it has changed its mood and marketed this vehicle with fun and economy on its side.

The Toyota Echo has a front end that looks like the Ford Focus headlights and slope, however with the distinction that it is more appealing and is not as stretched as the latter. Overall, the Toyota Echo is a small yet stylish car. As per the Toyota Echos interior, it is interesting to note that the car manufacturer had placed and mounted the vehicles gauges high above the radio in the middle of the dashboard which is far different from the standard, and which the car manufacturer believes will assist in the reduction of eye fatigue and reduce the amount of time needed to switch from watching the road to monitoring speed. This vehicle sports a relatively large interior in the sedan entry level. It has the capacity to take in a maximum of five people in its spacious interior that sports upholstery bearing the color gray. As per its cargo volume, the Toyota Echo has 13.6 cubic feet of this, and adding up more room are the split rear folding seats.

The Toyota Echo comes with standard equipment that includes in its list aerodynamic multi-reflector halogen headlamps, color-keyed front and rear bumpers and door handles, dual black outside mirrors, windshield wipers with mist features, a tinted glass, P175/65R14 tires on steel wheels with full wheel covers, a center instrument cluster with a speedometer, a fuel gauge, a digital LCD odometer with twin tripmeters and warning lights, dual sun visors with mirror, fabric-trimmed 4-way adjustable front and rear seats with adjustable headrests, a tilt steering wheel, driver and front passenger air bag Supplemental Restraint System, center console storage compartments, dual glove compartments, a front passenger seat under-seat storage tray, dual front and rear cup holders, and a deluxe AM/FM ETR with four speakers.

Toyota Parts Online

Toyota Echo parts

rear bumper

---------------------

Mark Clarkson is a 35 year old marketing consultant for a leading auto parts store. This native of Denver is also an offroad enthusiast.

We are sexual beings, throughout the lifespan. This includes the later years of life, which are often overlooked in discussions of sexuality. In this article I want to address some misconceptions about aging and sexuality; report some survey information on sexual behavior among seniors; describe physical, psychological and medical changes that may accompany aging; and suggest positive and affirming ways for seniors to continue to enjoy their sexuality to the fullest.

I. Some Myths about Aging and Sexuality

Many cultural "truths" convey the message that sexuality is for the young. If seniors are interested in sex there is something wrong with that. How many of the following myths and stereotypes have you heard?

- Older people don't have sex, don't want sex, don't think about sex.

- It's perverted for an older person to have sexual thoughts; perhaps he is a "dirty old man".

- Women don't want sex, aren't interested in sex, and are only going along with what men want.

- When you get "old", you can't have sex.

- Sex is for younger adults. (I saw a cross-stitched sampler once which said "Kissing don't last - cooking do".)

- If you can't have sex like a porn star, you have no business trying it at all.

These are all misleading and incorrect stereotypes. It is important to recognize that sexuality is a central part of healthy living - all our lives!

II. Survey Information: What's Happening Out There?

Three recent national surveys of older Americans have focused on sexuality and sexual behavior. "Healthy Sexuality and Vital Aging" (1998) was funded by Pfizer and sponsored by the National Council on the Aging (NCOA) and surveyed over 1300 people. The American Association of Retired Persons (AARP) sponsored national surveys in 1999 and again in 2004. "Sexuality at Midlife and Beyond" looked at a nationally representative group of 1700 adults aged 45 and older.

The NCOA survey found that almost half of seniors over sixty are sexually active; 39% want sex more often. The majority of respondents reported having sex less often now than when they were in their forties - 82% of men and 63% of women.

61% of men and 62% of women find sex equal to or more physically satisfying than it was in their forties. With regard to emotional satisfaction, 76% of men and 69% of women found sex to be at least as emotionally satisfying as in their forties.

72% of men and 47% of women consider sex important to their relationship with their partner. Men, however, were more than twice as likely as women to report wanting sex more frequently. This was true in all age segments - even in men 80 and older.

The AARP study found that the proportion of men who've tried potency-enhancing medicines, hormones, or other treatments has doubled since 1999. The majority (68%) report the treatments have increased their sexual satisfaction. Their wives also reported increased pleasure for themselves.

63% of men and women with partners described themselves as either extremely satisfied or somewhat satisfied with their sex lives. 51% of men and women surveyed reported having sexual thoughts, fantasies, or erotic dreams at least once a week.

50% of women in the 45-49 age range reported that they masturbate; 20% of women 70 and older said they masturbated. A majority of all women - even those 70-plus - told AARP that self- stimulation is an important part of sexual pleasure at any age.

Both these surveys, based on scientifically randomized samples, indicate that seniors are having sex, thinking about sex, enjoying sex - and taking steps to increase their enjoyment and pleasure. Clearly sexuality is important to older Americans, contrary to popular stereotypes!

III. Natural Changes Occurring With Aging

Most of us reading this are not twenty years old any more! Our bodies are constantly changing - though many of us are in denial. Orthopedic medicine is one of the fastest-growing medical specialities, treating rotator cuff injuries, tennis elbow, injured backs, torn cartilage, blown ACLs - in aging baby boomers. We're not ready to give it up!

Your body changes as you age, and these changes can affect your sexual relationships.

A. Physical Changes

Testosterone regulates your sex drive whether you're a man or a woman. Most aging men and women produce enough testosterone to maintain their interest in sex, though patches and creams can provide an alternative source of the hormone to boost desire if needed.

Men and women experience different changes in their bodies as they age.

-- Women --

Most physical changes are linked to menopause and reduced estrogen levels. As you age, it takes longer for your vagina to swell and lubricate when you're sexually aroused. Your vagina also loses some elasticity. Together these can make intercourse less comfortable or even painful.

What to do:

- Longer foreplay increases natural lubrication.

- Use water-based lubricants, such as Astroglide, Probe or Silk.

- Estrogen creams or hormone replacement therapy can rejuvenate vaginal tissue.

- Regular intercourse helps maintain lubrication and elasticity.

- Do Kegel exercises to keep the pelvic floor muscles toned.

- If you haven't had intercourse for a while, realize it takes time to stretch out - go slowly!

- Minimize any pain or discomfort. Desire usually returns once any discomfort is relieved.

-- Men --

As you age, it might take longer to achieve an erection; it may be less firm and it may not last as long. Aging also increases the time between possible ejaculations.

What to do:

- Relax, stop worrying about it! Anxiety makes it worse.

- Let go of performance expectations. American media is filled with messages implying that masculinity and virility is equated with youthful performance.

- Kegel exercises are very helpful for men also, to tone the pelvic floor musculature.

- Take longer with sexual activities. You may also need more direct physical stimulation.

- Try different positions, for comfort and extra stimulation.

- Focus on pleasurable sensations, rather than on hurrying towards orgasm and ejaculation.

- Viagra, Cialis or Levitra may help intensify erections.

- Other medical devices, such as pumps, drugs and implants have been developed. I would encourage a natural and relaxed exploration of sexual possibilities before submitting to an expensive and invasive medical procedure.

Intercourse is Not the Only Way to Have Sex!

Helen Gurley Brown, author of Sex and the Single Girl, has said, "When people say they can't have sex because they have a bad back, or arthritis, or all of the things that can affect our bodies as we get older, I think what they're really saying is they're looking for an excuse not to have sex. When you care, you find that there are all sorts of ways to express sensuality."

Sexual ignorance, cultural values and media images combine to "sell" the story that sex = intercourse - and having an orgasm is the way to tell if you're accomplishing anything!

This mindset gets everything backwards. The purpose of having huge concentrations of nerve endings and pleasure receptors in our genitals is to experience pleasure. While orgasms are wonderful, when sex becomes goal-driven to "achieve" climax, it short-changes both partners' pleasure and places enormous performance expectations and demands - which can turn sex from playful, spontaneous, pleasurable sensual intimacy between two people who care about each other into something like a chore.

I highly recommend Marty Klein's book Let Me Count the Ways: Great Sex Without Intercourse as an excellent guide and encouragement in your creativity. (For more information about Marty Klien's book look on: http://www.books4selfhelp.com/sexuality.htm )

Passionate kissing, oral sex, mutual masturbation, telling erotic stories to each other, massage, hugging, touching, cuddling -- all of this can be great sex!

What is most important is pleasure - giving and receiving physical and emotional pleasure. We are all hungry to be touched. We need touch. Without touch, babies do not thrive, and may even die. Grownups need to be touched too. (If you're reading this and do not have a partner in your life, remember that self-pleasure can be a very important aspect of self-care and nurture. It is always possible to choose pleasure for oneself!)

B. Psychological Changes

The aging process may have psychological and emotional effects - particularly as we live in a culture that glorifies youth and extols youthfulness as the epitome of physical beauty. (I would remind us all that this is market-driven: marketers learned long ago that younger people are more likely to spend disposable income, and are more influenceable by advertising.)

- We may be embarrassed or ashamed of our sexual needs as an older adult.

What to do: Get over it! Join the party. You deserve pleasure in your life, from birth until the day you die.

- Changes in appearance affect how we feel about ourselves. Bodies no longer match the idealized body images we see in advertising and the media.

What to do: Realize that media has created the youthful ideal of beauty. Celebrate and love the body you have! Every wrinkle, stretch mark, gray hair, rounded contour, ache and pain is a mark of your ever-increasing maturity and wisdom! Bette Midler once said that if you are a woman and consider yourself unattractive -- visit another culture for a wake-up call. American stereothypes of physical attractiveness are insane dreams invented by marketers who are playing on our anxieties and insecurities in order to sell us more products.

- Worrying about sexual performance may actually reduce the body's ability to perform sexually; men may experience erectile dysfunction, women an inability to lubricate.

What to do: Relax! Relax... Enjoy your partner. Look into his or her eyes. Breathe together. Cuddle, stroke, gently massage each other. Sexuality is about pleasure, playfulness, and spontaneity.

- Depression may reduce energy, optimism and desire.

What to do: Exercise, do pleasurable activites, get sun on your face every day. Talk with your doctor about an antidepressant medication. See a therapist. Talk with your friends. Write your feelings in a journal. Any positive action taken - even drinking a glass of water! - is a step towards moving out of depression.

C. Changes Due to Medications and Surgery

Chronic pain or surgery and illness that cause fatigue can make sexual activities more challenging or painful.

What to do: Talk about it. Slow down, focus on simple pleasureable activities. Experiment with different positions or activities to discover what is most pleasureful.

Some commonly used medications can interfere with sexual function. High blood pressure medications can reduce desire and impair erection in men and lubrication in women. Some antihistamines, antidepressants and acid-blocking drugs can have side effects that affect sexual function.

What to do: Talk with your doctor about how to minimize these effects. It may be possible to substitute alternative medications that work as well as the original, but without affecting sexual function.

IV. Improving Sex as You Age

David Schnarch, in his book Passionate Marriage emphasizes that people become better lovers as they age. This runs counter to cultural stereotypes which hold that sex is for the young. Older persons have learned a few things over time, and no longer struggle with youthful anxieties and ignorance about sexuality. (For more information about David Schnarch's book, look on: http://www.books4selfhelp.com/intimate-relationships.htm )

With age and maturity, it is more possible to slow down and deeply experience all the pleasure that sensual sexuality has to offer. It is possible to learn how to combine deep relaxation with high states of arousal in order to have more intense, longer-lasting sexual experiences.

- Expand your definition of sex. Sex is more than intercourse!

- Communicate with your partner. Talk about what you need and what you like. Discuss the changes you're going through. Ask your partner about his or her needs and how to be accomodating. Communication itself can be arousing!

- Make changes to your routine. Change the time of day in which you have sexual activity. Mornings or afternoons may be better than at night when you are tired or achy. Take more time to set the stage for romance: romantic dinners or an evening of dancing or a special time or place for lovemaking. Try a new sexual position.

- Manage your expectations. If you didn't have sex very often as a younger adult, don't expect to have lots of sex as an older adult. Partners who enjoy frequent sex when they are younger are more likely to continue that as they age.

- Take care of yourself. Eat a healthy diet and exercise regularly, at least 30 minutes a day. Avoid alcohol as it decreases sexual function in both men and women. Do your Kegel exercises every day.

- Practice safe sex. If you have a new partner, get tested. Use condoms. People over 50 make up about 10% of AIDS cases in the United States

Most of all, simply enjoy the pleasureful sensations which your body is amply equipped to experience. Take time to nurture your relationship with your partner so that you are feeling emotionally connected. Approach your sexual relationship with playfulness, humor, patience and love.

Sexual pleasure is part of the birthright of being human - and it is a lifelong resource for joy, health and personal growth.

For further resources on Seniors and Sexuality - books, magazine articles, films and Internet resources - see my Resource page at http://www.DavidYarian.com/resources.htm.

More resources are listed in The Guide to Self-Help Books, http://www.Books4SelfHelp.com. Relevant sections of the Guide include Sexuality, Men's Sexual Health, Women's Sexual Health, Intimate Relationships, Gay and Lesbian Concerns and Tantra.

------------

Attention Publishers & Webmasters:

(c) 2005. Permission is granted to reprint this article in its entirety in your ezine or on your website as long as you leave all links in place, do not modify the content and include our resource paragraph above. If you do use the material please drop me a note so I can take a look. Thanks!

David Yarian, Ph.D. is the creator of The Guide to Self-Help Books, http://www.Books4SelfHelp.com and co-author of Self-Help Central, an ezine to help you build a better life with self-help resources. He is a Licensed Clinical Psychologist and Certified Sex Therapist in private practice in Nashville, TN.

Staging

The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors to decide on the best treatment for you.

* Stage 1 The cancer only affects the skin covering the penis, the head of the penis (glans) or the foreskin.

* Stage 2 The cancer has begun to spread into the shaft of the penis or into one of the lymph nodes in the groin.

* Stage 3 The cancer has spread deep into the shaft of the penis or to many lymph nodes in the groin.

* Stage 4 The cancer has spread to lymph nodes deep in the pelvis, or to other parts of the body.

If your cancer comes back after initial treatment, this is known as recurrent cancer.

Grading

Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop. Low-grade means that the cancer cells look very like normal cells; they are usually slow-growing and are less likely to spread. In high-grade tumors, the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.

Treatment

There are many types of treatment for penile cancer including surgery, radiotherapy and chemotherapy. Surgery of the penis has now advanced to a stage now where it doesnt mean the loss of the penis. It is also possible to now reconstruct a penis that has been operated on.

The type of treatment that you are given will depend on a number of things, including the position and size of the cancer, whether or not it has spread, the grade of the cancer, and your general health.

Men with cancer of the penis should be treated in a specialist cancer center.

Surgery

Small, surface cancers that have not spread are treated by removing only the affected area. The cancer can be removed with conventional surgery, using laser or by freezing (cryotherapy). Cryotherapy is carried out with a cold probe, which freezes and kills the cancer cells.

If the cancer is affecting only the foreskin, it may be possible to treat it with circumcision alone.

All the above treatments can usually be given to you as an outpatient. They may be done under local or general anesthetic, depending on individual circumstances.

Wide local excision If the cancer has spread over a wider area, you will need to have an operation known as a wide local excision. This means removing the cancer with a border of healthy tissue around it. This border of healthy tissue is important as it reduces the risk of the cancer coming back in the future. The operation is done under general anesthetic and will involve a short stay in hospital.

Removing the penis (penectomy) This may be advised if the cancer is large and is covering a large area of the penis. Amputation may be partial (where part of the penis is removed) or total (removal of the whole penis). The operation most suitable for you depends on the position of the tumor. If the tumor is near the base of the penis, total amputation may be the only option.

The surgeon may also remove lymph nodes from the groin if there is evidence that cancer cells have spread to these nodes, or a possibility that they may have.

Re constructive surgery It is often possible to have a penis reconstructed after amputation. This requires another operation. The techniques that may be used include taking skin and muscle from your arm, and using this to make a new penis. Sometimes it is also possible for surgeons to reconnect some of the nerves, to provide sensation and the necessary blood flow to allow the reconstructed penis to become erect. This type of surgery is carried out by surgeons who have specialist experience, and you may need to travel to a specialist hospital to have the surgery done.

Radiotherapy

Radiotherapy treats cancer using high-energy rays to destroy cancer cells, while doing as little harm as possible to healthy cells. It can be used before or after surgery. Radiotherapy may also be given to treat symptoms, such as pain, if the cancer has spread to other parts of the body, like the bones.

External radiotherapy is normally given as a series of short daily treatments in the hospital's radiotherapy department. High-energy x-rays are directed from a machine at the area of the cancer. The treatments are usually given from Monday to Friday, with a rest at the weekend. Each treatment takes 1015 minutes. The number of treatments will depend on the type and size of the cancer, but the whole course of treatment for early cancer will usually last for up to six weeks. Your doctor will discuss the treatment and possible side effects with you.

Before each session of radiotherapy, the radiographer will position you carefully on the couch and make sure that you are comfortable. During your treatment you will be left alone in the room, but you will be able to talk to the radiographer who will be watching you carefully from the next room.

Radiotherapy is not painful, but you do have to lie still for a few minutes while your treatment is being given. The treatment will not make you radioactive and it is perfectly safe for you to be with other people, including children, after your treatment.

Radioactive implants Radiotherapy can be given using a radioactive implant. This is also known as brachytherapy. Under a general anesthetic, small radioactive wires are very carefully positioned in the affected area of the penis. The wires stay in place for about 45 days and are then removed. This method of treatment is usually used for smaller cancers on the end of the penis (the glans). While the implant is in place, you need to stay in an isolated room in the hospital so that other people are not exposed unnecessarily to the radiation.

Side effects of radiotherapy

There are sometimes side effects from radiotherapy treatment to the penis. Towards the end of your treatment, the skin on your penis can become sore and may break down. Long-term, radiotherapy can cause thickening and stiffening of healthy tissues (fibrosis). In some men, this can result in narrowing of the tube that carries urine through the penis (the urethra) and so can cause difficulty in passing urine. If narrowing of the urethra does develop, it can usually be relieved by an operation to stretch (dilate) the area. This is done by passing a tube into the urethra and is performed under a general anesthetic.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It can be one drug or several drugs used together. It is not commonly used to treat cancer of the penis. Chemotherapy cream may sometimes be used to treat very small, early cancers that are confined to the foreskin and end of the penis (glans).

Chemotherapy may also be given as tablets, or by injection, into a vein for more advanced cancer. It may be given along with surgery or radiotherapy (or both).

John Helios has a website what is the average size of a penis that is a valuable penile cancer resource. John had a scare a year back and wanted to help others by creating an online resource with is website. John used ProSolution Gel to help him in older life to keep up his sex life.