The history of ED treatment from rooster talismans to readily available cheap sildenafil has been far from straightforward, involving many pivots, repositionings and incredibly unusual characters who have played a vital role.

It is rare for the story of any medical discovery to include figures as unusual as a medical charlatan-turned-politician, a Pentecostal preacher and the greatest footballer who ever lived, but a major part of the battle to treat erectile dysfunction was to know it was a condition that could and should be treated.

One of the biggest leaps forward, when it came to the former, was the result of one of the most unusual medical presentations in the history of urology, if not the entire field of medicine at large.

It proved that ED could be treated in perhaps the most shocking and striking way possible.

Down Trousers Time

An exceptionally unusual polymath, Professor Giles Brindley was an innovative physiologist as well as a keen composer, composing several pieces for wind instruments and even inventing an electronic bassoon.

He developed some of the first ever functional visual prostheses in the 1960s, which whilst impractical given the extremely basic visual sensations they provided were nonetheless groundbreaking and helped forward eye surgery and potential implants.

Professor Brindley also developed a system that stimulated the anterior root of paraplegic patients to help with bladder control. He would later develop further research into the system to allow for sexual function and stimulation as well.

His achievements in ophthalmology, urology and neurology were impressive, particularly since a lot of them were discovered in his back bedroom by himself.

This likely led in no small part to his idiosyncratic research and demonstration style, which reached its absolute zenith at a 1983 meeting of the American Urological Association in Las Vegas.

Professor Brindley had developed a method of chemically inducing erections using a mixture of phenoxybenzamine and saline that he injected directly into his penis.

His evening lecture was set to take place in front of around 80 urologists and consisted of a slide-based talk featuring many different pictures of his penis having been injected with doses of not just phenoxybenzamine but also papaverine and phentolamine.

He also wore a pair of tracksuit bottoms that were intended to demonstrate the effect, which was seen as somewhat inappropriate given that many of the guests were wearing formal suits and dresses.

The idea was that whilst the photographs could simply reflect a state of sexual arousal, being in front of a live crowd of his peers is not a situation where someone could maintain an erection.

The cause of what happened next, and why the presentation has remained infamous for over 40 years, has been a source of disagreement.

According to Laurence Klotz, who attended the event and bumped into him in a crowded lift just before the lecture, Professor Brindley claimed that the effect was not visible enough by pulling his trousers tightly around his penis and lamenting this fact, subsequently dropped his trousers to demonstrate that this clearly worked.

He then subsequently waddled down the stairs from the stage, inviting the audience to “confirm the degree of tumescence” leading to screams from several women in the front few rows and causing the presentation to be abruptly ended.

According to Professor Brindley himself, the chairman of the AUA noted that it was difficult to see and if he would not mind uncovering his erection. Professor Brindley, after being assured that there were no journalists in attendance to see the 57-year-old’s genitals and assuming that a crowd of urologists would not be shocked at seeing a penis, did so.

Regardless of the truth, which may lie between several different accounts, the event was exceptionally shocking and had lengthy ramifications far outside of the field of urology.

The Brindley Lecture was seen as one of the most shocking lectures ever and as one of the biggest disasters in an academic presentation by somewhat less charitable accounts of the events in question.

However, whilst the methods of showing the effect were extremely unorthodox, the result was extremely important and came at the exact right time to make a difference.

Even into the 1980s, whilst medical consensus had shifted away from treating what was then known as “impotence” as an exclusively psychological phenomenon, there was no clarity or idea of what caused erectile dysfunction.

Professor Brindley had figured it out and created what turned out to be the first legitimate pharmacological treatment for erectile dysfunction, even if injecting it directly into the penis meant it had limited appeal.

The general principle that allowed Professor Brindley’s lecture to end the way it did is also the mechanism that allowed sildenafil to work.