How Penile Implants Help men With Erectile Dysfunction
A penile implant is a medical device inserted surgically to help men with erectile dysfunction (ED) achieve an erection. There are two main types of penile implants: inflatable and non-inflatable. Both types have their uses and considerations.
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Types of Penile Implants
Inflatable Penile Implant
This type includes a pump placed in the scrotum (the skin pouch behind the penis). When you press the pump, it moves fluid from a reservoir located in the lower abdomen into cylinders in the penis, creating an erection. To deflate, you press a valve on the pump to return the fluid to the reservoir.
Non-Inflatable Penile Implant
This implant consists of flexible silicone rods placed inside the penis. You manually adjust these rods to achieve an erection and return them to a flaccid state after use. This type does not involve a pump or fluid.
How Does a Penile Implant Work?
Inflatable Implant
The device includes two cylinders, a fluid reservoir, and a pump. The cylinders are inserted into the penis, and the reservoir is placed under the abdominal muscles. The pump, which is located in the scrotum, moves fluid into the cylinders to create an erection. After sexual activity, a valve on the pump deflates the implant by returning the fluid to the reservoir.
Non-Inflatable Implant
The device consists of bendable silicone rods inside the penis. You can manually position these rods to achieve an erection and bend them back when done. The hardness remains constant throughout use.
Who Should Consider a Penile Implant?
Penile implants are typically recommended for men who have ED or Peyronie’s disease that does not improve with other treatments, such as medications or vacuum devices. They may also be used as part of gender affirmation surgery following procedures like metoidioplasty or phalloplasty.
How Common Are Penile Implants?
Penile implants are increasingly common. Between 2005 and 2012, over 63,000 penile implants were performed worldwide, with about 86% of these procedures taking place in the United States.
How Long Does a Penile Implant Last?
On average, penile implants last around 20 years. If an implant malfunctions or wears out, it can be replaced with a new one.
Do Penile Implants Increase Penis Size?
Penile implants do not increase the size of the penis beyond its pre-surgery size. The penis may even appear shorter than before surgery because the head of the penis does not become engorged. However, modern implants may slightly enhance length, thickness, and stiffness over time.
What to Expect During the Implant Procedure
The penile implant procedure is performed by a team of healthcare professionals, including a urologist (surgeon), an anesthesiologist, and nurses. You will be given general anesthesia, so you will be asleep and pain-free during the surgery. A catheter may be inserted to manage urine flow and will typically be removed after the surgery.
The surgeon makes an incision in the genital area to insert the implant into the corpora cavernosa, which are the two tubes in the penis that fill with blood during an erection. For an inflatable implant, the reservoir and pump are placed, and small incisions are closed with dissolvable stitches. Surgical drains might be used to remove excess fluid.
Risks of Penile Implant Surgery
While penile implant surgery is generally safe, some risks include:
Infection: There is a risk of infection, particularly for those with certain conditions like diabetes or spinal cord injuries.
Implant Issues: Implants may malfunction, requiring repair or replacement.
Internal Erosion or Adhesion: The implant may cause skin issues inside the penis, such as erosion or sticking to internal tissues.
Possible Complications
Complications, though rare, can include:
Uncontrolled bleeding needing additional surgery.
Damage to the urethra, which requires repair.
Infection leading to implant removal.
Excessive scarring or erosion of the skin.
Displacement of the pump or reservoir.
Mechanical failure.
Perception of a shorter penis length.
Decreased blood flow to the head of the penis.
Despite these risks, most men who receive penile implants and their partners report high satisfaction with the results. Penile implants offer a reliable solution for men with ED who do not benefit from other treatments.
How Does the Penile Prosthesis Work?
The inflatable penile prosthesis is a device designed to help men achieve an erection. It includes two main types: a three-piece and a two-piece system.
Three-Piece Inflatable Prosthesis
Components
This system has two cylinders implanted in the penis, a reservoir filled with saline located under the abdominal muscles, and a pump placed in the scrotum.
Function
Pressing the pump transfers saline from the reservoir into the cylinders, causing an erection. To return to a flaccid state, pressing a valve on the pump moves the saline back into the reservoir.
Two-Piece Inflatable Prosthesis
Components
This version combines the reservoir and pump into a single unit, which is placed inside the scrotum. It does not require placement of a reservoir in the abdomen.
Advantages
The surgery is simpler and quicker, with no abdominal incision required.
Disadvantages
The smaller combined reservoir may not provide as firm an erection for some men.
Both systems offer a solution for erectile dysfunction, with the choice depending on individual needs and medical advice.
Is the Prosthesis Noticeable?
Men who have undergone prosthesis surgery may observe a small surgical scar where the base of the penis meets the scrotum or in the lower abdomen just above the penis. However, this scar is generally not noticeable to others. Most men feel comfortable using public facilities, such as locker rooms or restrooms, without concern that others will detect the presence of an inflatable penile prosthesis.
What Is Sex Like With the Prosthesis?
When inflated, the prosthesis provides a firm and full erection, similar to a natural erection. Although many men find this erection to be shorter than their typical natural erections, advancements in prosthesis design have led to newer models with cylinders that can enhance length, thickness, and firmness.
A penile prosthesis does not alter skin sensation or a man’s ability to achieve orgasm. Ejaculation remains unaffected. However, once the prosthesis is in place, it may eliminate the natural erection reflex, meaning that men usually cannot achieve an erection without inflating the implant. If the prosthesis is removed, natural erections may not return.
How Effective Are the Implants?
Approximately 90% to 95% of inflatable penile prostheses provide erections that are suitable for intercourse. Satisfaction rates are notably high, with about 80% to 90% of men reporting that they are pleased with the results and would opt for the surgery again if given the choice.
Is the Implant Safe?
As with any surgical procedure, there are potential risks associated with penile implants. Possible complications include:
- Uncontrolled bleeding, which may necessitate re-operation
- Infection
- Formation of scar tissue
- Erosion, where the tissue surrounding the implant may break down, requiring removal
- Mechanical failure, which could lead to the need for re-operation and possibly removal of the implant
