Why would a surgical penile implant (penile prosthesis) be used?
A surgical penile implant (also called a penile prosthesis) is a treatment option for men with erectile dysfunction (ED). The simplest type of prosthesis consists of a pair of bendable, silicone rods surgically implanted within the erection chambers of the penis. Today, many men choose a hydraulic, inflatable prosthesis that allows a man to have an erection whenever he chooses.
A penile implant is usually used when there is a clear medical cause for ED and when the problem is unlikely to resolve or improve naturally or with other medical treatments. Sometimes a penile prosthesis is implanted during surgery to reconstruct the penis when scarring has caused erections to curve.
How does a penile implant work?
The inflatable penile implant consists of two cylinders, a reservoir, and a pump that are placed surgically in the body. The two cylinders are inserted in the penis and connected by tubing to a separate reservoir of fluid. The reservoir is implanted under the lower abdominal muscles. A pump is also connected to the system and sits under the loose skin of the scrotal sac, between the testicles.
To inflate the prosthesis, the man presses on the pump. This does not put any pressure on the testicles. The pump transfers fluid from the reservoir to the cylinders in the penis, inflating them. Pressing on a deflation valve at the base of the pump returns the fluid to the reservoir, deflating the penis.
What is sex like with a penile implant?
When the penis is inflated, the prosthesis makes the penis stiff and thick, similar to a natural erection. Most men rate the erection as shorter than their normal erection. However, newer models have cylinders that may increase the length in addition to the thickness and stiffness of the penis. Another difference is that the glans, or head of the penis, does not become engorged or hard with the inflation of the device.
A penile prosthesis does not change sensation on the skin of the penis or a man's ability to reach orgasm. Ejaculation is not affected. Once a penile prosthesis is put in, however, it may destroy the natural erection reflex. Men usually cannot get an erection without inflating the implant. If the implant is removed, the man may never again have natural erections.
Risks / Benefits
Do penile implants work?
About 90% to 95% of inflatable prosthesis surgeries are successful, meaning the implants produce erections suitable for intercourse. Satisfaction rates with the prosthesis are very high, and typically 80% to 90% of men are satisfied with the results and say they would choose the surgery again.
Are penile implants safe?
No surgery is totally free of possible complications. Complications associated with penile implants include:
- Uncontrolled bleeding after the surgery; this condition may require an additional surgery
- Scar tissue formation
- Erosion (of implant)
- Pump or reservoir displacement
- Mechanical failure
Recovery and Outlook
Is a penile implant noticeable?
While men who have had the prosthesis surgery can see the small surgical scar where the bottom of the penis meets the scrotal sac, other people probably will be unable to tell that a man had an implant. Most men would not be embarrassed in a locker room or public restroom, for example.
Will insurance cover the cost of a penile implant?
Insurance coverage for these operations is often good, as long as a medical cause of ED is established. Medicare covers the surgery, and Medicaid may in selected cases.