For most men, erectile dysfunction can be successfully treated with medications or use of a penis pump (vacuum constriction device). You might consider penile implants if you aren't a candidate for other treatments or you can't get an erection sufficient for sexual activity by using other methods.
Penile implants can also be used to treat severe cases of a condition that causes scarring inside the penis, leading to curved, painful erections (Peyronie's disease).
Penile implants aren't for everyone. Your doctor might caution against penile implants if you have:
- ED that's situational, the result of a relationship conflict or potentially reversible
- An infection, such as a pulmonary infection or urinary tract infection
- Dermatitis, wounds or skin lesions on your penis or scrotum
Keep in mind that while penile implants allow men to get an erection, they don't increase sexual desire or sensation. Most penile implants also won't make your penis any larger than it naturally is at the time of surgery. In fact, your erect penis might be slightly shorter than it used to be.
Risks of penile implant surgery include:
- Infection. As with any surgery, infection is a possibility. You may be at an increased risk of infection if you have a spinal cord injury or diabetes. Men who need surgery to adjust or replace an implant (revision surgery) are at higher risk of infection than they were with the first surgery.
- Implant problems. New penile implant designs are reliable, but in rare cases the implants may not work correctly. For example, in some semirigid devices, internal parts can break down over time. In inflatable devices, fluid can leak or the pump device can fail. Surgery is necessary to remove, repair or replace a broken implant.
- Internal erosion or adhesion. In some cases, an implant may stick to the skin inside the penis or wear away the skin from inside the penis. Rarely, an implant breaks through the skin. These problems are sometimes linked to an infection.
Treating an infection
An infection can occur at any time after surgery. In rare cases, an infection occurs years later. A serious infection can cause swelling of the scrotum, pus buildup and fever. Surgery to remove the implant is always necessary to treat an infection. Replacing a penile implant can be complicated and costly and can lead to buildup of scar tissue, loss of sensation in the penis and a decrease in penis length.
Initially, you'll talk to your doctor or a urologist about penile implants. During your visit, your doctor will likely:
- Review your medical history. Be prepared to answer questions about current and past medical conditions, especially your experience with ED. Talk about any medications you're taking or have taken recently, as well as any surgeries you've had.
- Do a physical exam. To make sure penile implants are the best options for you, your doctor will do a physical exam, including a complete urologic exam. Your doctor will confirm the presence and nature of ED, and make sure that your ED can't be treated in another way. He or she will also try to determine whether there's any reason that penile implant surgery is likely to cause complications. Your doctor will also examine your ability to use your hands, since some penile implants require greater manual dexterity than others.
- Discuss your expectations. Make sure you understand what the procedure involves and the type of penile implant that suits you best. Your doctor will also explain the benefits and risks, including potential complications. Ideally, you'll include your partner in the discussion with your doctor.
Types of penile implants
There are two main types of penile implants:
- Inflatable implants. Inflatable devices, the most common type of penile implant used, can be inflated to create an erection and deflated at other times. Three-piece inflatable implants use a fluid-filled reservoir implanted under the abdominal wall, a pump and a release valve placed inside the scrotum, and two inflatable cylinders inside the penis. To achieve an erection, you pump the fluid from the reservoir into the cylinders. Afterward, you release the valve inside the scrotum to drain the fluid back into the reservoir. The two-piece model works in a similar way, but the fluid reservoir is part of the pump implanted in the scrotum.
- Semirigid rods. Semirigid devices are always firm. The penis can be bent away from the body for sexual activity and toward the body for concealment. A positionable penile implant is a semirigid device with a central series of segments held together with a spring on each end. It can maintain upward and downward positions better than other semirigid rods can.
Other special designs can provide increased length or fit a shortened penis. Some inflatable penile implants are also available with antibiotic coatings, which might help reduce the risk of infection.
Comparing implant types
When choosing which type of penile implant is right for you, consider your personal preference and your medical history. Your doctor might suggest one type of design over another based on factors including your age, risk of infection, and health conditions, injuries or medical treatments you've had in the past.
Comparing implant types
|Type of implant ||Pros ||Cons |
- Creates the most natural, rigid erection
- Provides flaccidity when deflated
- Requires the most extensive surgery of any implant
- Has more parts that could malfunction than does any other implant
- Requires a reservoir inside the abdomen
- Requires a less complicated surgery than does the three-piece implant
- Provides flaccidity when deflated
- Deflation requires less dexterity than does a three-piece implant
- Requires more extensive surgery than does a semirigid implant
- Is mechanically more complicated than is a semirigid implant
- Provides less firm erections than does a three- piece implant
- Is easy to surgically implant
- Has a low chance of malfunction due to the small number of parts
- Is easy to use for those with limited mental or manual dexterity
- Results in a penis that is always slightly rigid
- Puts constant pressure on the inside of the penis, which can cause injury
- Can be difficult to conceal under clothing
Penile implant surgery is usually done at a surgery center or hospital. Your doctor might give you medication to make you unconscious during the surgery (general anesthesia) or medication that blocks pain in the lower part of your body (spinal anesthesia).
Your doctor will give you IV antibiotics to help prevent infection. The surgery site will also be shaved immediately before surgery to reduce the risk of infection.
A tube (catheter) might be inserted into your bladder via your penis to collect urine at some point during surgery. Your surgeon will make an incision below the head of the penis, at the base of the penis or in the lower abdomen. Next, your surgeon will stretch the spongy tissue in the penis that would normally fill with blood during an erection. This tissue is inside each of the two hollow chambers called the corpora cavernosa.
Your surgeon will choose the correct size implant and place the implant cylinders inside the penis. All sizes are customized to your exact body measurements.
If your doctor is implanting a two-piece inflatable device, a pump and valve are placed inside the scrotum. For a three-piece device, your doctor will also implant a fluid reservoir under the abdominal wall through an internal incision.
Once the device is in place, your surgeon will sew the incisions closed. Penile implant surgery usually takes 45 minutes to an hour.
After penile implant surgery, you'll likely need to take medications to ease pain after surgery. Mild pain might persist for several weeks. You might also need to take antibiotics to prevent infection for one week. Your doctor might recommend keeping your penis up on your lower abdomen and pointing toward your bellybutton during the healing process to prevent downward curvature.
Your doctor will provide specific instructions about when you can resume normal activities. Most men can resume strenuous physical activity and sexual activity about four to six weeks after surgery. At this point, your doctor might recommend fully inflating and deflating inflatable penile implants twice a day to give you practice using them and stretch the area surrounding the cylinders.
Although penile implants are the most invasive and least often chosen treatment for erectile dysfunction, most men and their partners report satisfaction with the devices.