Before you begin pursuing penile prosthesis for erectile dysfunction, know that ED can be symptomatic of many underlying problems more serious than erectile dysfunction. Please read “What is low testosterone?” and “If you feel your testosterone petering out, do something.”
If your erectile dysfunction is the result of prostate surgery, an array of treatment options will help you to best adjust, including psychological therapy and education on managing expectations. With this said, having the inability to get erections sufficient for intercourse is a serious issue. This has wide ranging downstream effects including its effect on interpersonal relationships and your own self esteem. Are erections necessary – no. But are they important – absolutely yes. With this in mind there is a long list of less invasive treatments, but when they fail… this is the ultimate option.
Why choose penile prosthesis?
Penile prosthesis, or a penile implant, is one of several erectile dysfunction therapies available. And because it requires surgery, it is usually the last option men choose. Often the first option is medication, but you cannot take medication if you already take nitrate drugs (Nitro-Dur, Nitrostat and others, Monoket, or isosorbide dinitrate), have high or low blood pressure, have severe liver disease, or are on kidney dialysis.
If you dislike the lack of spontaneity associated with vacuum devices, then penile prosthesis implantation may be the right choice for you. But, be sure to go to an experienced implanter practice for your surgery.
Please note that in certain circumstances, penile implants might not be a solution. They are not advisable if you have an infection such as a pulmonary or urinary tract infection, or if you have diabetes that is not well-controlled or significant heart disease. If your ED might be reversible, you are not a good candidate, nor if your ED is caused by emotional issues, or you lack sexual desire or sensation.
Penile implants enable you to get an erection and maintain it. They do not:
- affect sexual desire or sensation.
- change the ability to ejactulate.
- make your penis look different.
At best a penile implant will maintain your penile length and size, but it’s likely that an erect penis with an implant will be slightly smaller than your original penis. However, this is made up by the rigidity and the fact that it stays firm until you deactivate it (all night?).
When you and your partner go to a urologist to ask about penile prosthesis, be prepared to answer many questions. Your answers help the doc prescribe the best option for you. Bring a list of your prior illnesses, surgeries, especially urological surgeries, your meds, and other ED treatments you have tried.
You will also get a complete urologic exam; you will get your ED confirmed; your manual dexterity will also be evaluated, since some implants require greater dexterity than others. You will hear about the risks and benefits, and be able to talk about your expectations.
Two kinds of penile prosthesis are available.
Malleable implants
The surgeon implants a semi-rigid rod in the penis shaft. (Some techniques use one rod; some use two.) The procedure is done under general anesthesia and takes 30-60 minutes. Most men can go home the same day. It is advisable to avoid sexual activity for six weeks after surgery. The rod is always rigid. You bend it away from the body for sex, and against the body to conceal it in clothing.
Another type of malleable prosthesis is one that you can position; it has spring-loaded segments in the middle that stay in position either up or down better than semirigid rods do.
Inflatable implants
This surgery is called inflatable penile prosthesis, IPP, and is more common than malleable implants. This type of prosthesis is an apparatus consisting of two inflatable cylinders, a reservoir (like a balloon) filled with salt water, a pump, and a release valve. Tubing connects all of these components.
The surgeon implants the cylinders into your penis and the pump between your testicles. The reservoir goes under your lower abdominal muscles. Surgery takes one to two hours under general anesthesia.
A two-piece implant is similar, but combines the reservoir and pump. It is implanted in your scrotum. It’s like having a third nut- it’s there, but can’t be seen unless someone is feeling for it.
Recuperation is four to six weeks with no sexual activity. Some men go home the same day, and some stay overnight. Mechanical devices can break down eventually and may need to be removed and repaired, or replaced. The average length that a device lasts is 8-10 years before the components need to be replaced.
To use, you activate the pump in your scrotum, which allows fluid to flow from the reservoir into the prosthesis in your penis, creating an “erection.” If the implant has been placed by an experienced surgeon, the result is almost identical to a normal erection. The only minor difference is that the head of the penis does not become hard, as with a natural erection. You deflate the prosthesis with the release valve after sex.
Furthermore, be aware that a penile implant is a commitment. Once an implant is placed, you will never have normal erections again, even if it is removed.
This surgery is done under general anesthesia. You must be healthy enough to undergo anesthesia to have this surgery performed.
Risks
- Infection is the most serious risk. A medical literature review of infection after IPP reveals rates are lowest during the winter and highest during the summer and fall. To minimize your chance of infection, schedule your surgery during the winter months (March can be considered winter, if you want to hang with all your buddies getting vasectomies at this same time). If you do develop an infection, you will probably require another surgery.
- The implant sticks to the skin inside the penis or wears away the skin. This condition is rare, but may be linked to an infection.
- You have bleeding after the surgery.
- Scar tissue forms.
- Your implant malfunctions, which would necessitate a replacement (rare).
After surgery
You will probably feel pain after surgery for a few weeks. Take the pain medications and antibiotics your doctor prescribed and refrain from sexual activity for as long as your doctor recommends.
Your penis and scrotum will likely swell and become bruised. A lot. It may look like it’s going to fall off, but it wont. It gets better, we promise.
It’s best to avoid tight underwear or clothing until the incision heals.
You will feel discomfort, bruising, and swelling for a few weeks.
The reward part
Penile implants, requiring surgery as they do, are the most invasive ED treatment of all. But from informal surveys of men and their partners regarding penile prosthesis, this option is also rated most highly of all ED treatments in satisfaction.
It works, every time, and it stays rigid until you deactivate it. Penile implants have a 95% partner satisfaction rate. It’s a big leap to take, but few patients regret it.