Penile Implants for Erectile Dysfunction: A Q&A With an Implant Specialist

A penile prothesis, or penile implant, is a device that is surgically inserted into the penis to treat erectile dysfunction (ED). Getting a penile implant is a big decision, but one that can restore an individual’s sexual function and, in many cases, improve his sexual quality of life.

Naturally, men who are considering getting a penile implant often have a lot of questions. Tobias S. Köhler, MD, MPH, a urologist and physician trainer for penile prothesis surgery at Mayo Clinic in Rochester, Minnesota, shared answers to some of the most common questions regarding penile implants.

Who is a good candidate for a penile implant?

Penile implants are generally recommended after other ED treatment options like oral medications fail. “Any man who is healthy enough to climb a flight of stairs and who has failed pills or can’t take pills for whatever reason is a good candidate,” said Dr. Köhler.

In the past, a penile implant was sometimes viewed as a “last resort” because other ED treatment options are no longer possible after getting an implant. However, the most recent American Urological Association (AUA) ED guidelines acknowledge that it is valid for men to begin with any treatment they choose, as long as they have a clear understanding of the benefits, risks, and burdens involved.

“The recent AUA ED guidelines update basically says, once men fail pills and decide they want a penile implant, they should be able to get one if they wish. Maybe they don’t want to try shots or injections to get erections, maybe they don’t want to try a vacuum device, maybe they don’t want to try all the other stuff because the fact of the matter is, a lot of times when the ED is so severe, nothing else except surgery will be effective,” Dr. Köhler explained.

Will my penis look different after getting an implant?

A penile implant does not change the look of one’s penis. Once it has healed after the operation, the implant is invisible, and nobody would be able to tell that it is there.

What about size? Will the length of my penis be affected by an implant?

No, a penile implant will not change the length of the penis. However, it is worth noting that some men perceive that their penises seem shorter after getting an implant. This may be because the conditions that contribute to problems with erection and lead a man to get an implant can cause penile shortening before the procedure.

What types of penile implants are there? How do they work?

There are three main types of penile implants: the three-piece inflatable device, the two-piece inflatable device, and the singular malleable device.

The inflatable devices both include two inflatable cylinders in the penis with a fluid reservoir in either the base of the cylinder (2-piece devices) or as a separate unit (3-piece devices). When a man wishes to achieve an erection with an inflatable implant, he uses a pump located in the scrotum to fill the cylinders in the penis with fluid. Afterwards, he is able to deflate the device to allow it to return to a non-erect state.

To use the malleable implant to attain an erection, a man simply bends the semi-rigid rods until the penis is straight. When completed, the rods may be bent downward. Unlike inflatable devices, the semi-rigid rods are always firm.

How soon after getting the implant can I resume sexual activities?

“It depends on the surgeon’s preference,” said Dr. Köhler. “Typically, between 4 to 8 weeks or so.”

Are most men satisfied with their penile implants?

Yes. Many studies have been done on penile implant satisfaction and have shown consistently high rates of satisfaction ranging from 75-98%, depending on the study in question.

How do partners feel about penile implants?

In general, partners are also very satisfied with penile implants and would recommend them to other partners. Implants provide natural-feeling erections that are strong enough for all forms of intercourse, and partners generally cannot see or feel the difference.

Will my sensation change during sex? Will I still be able to orgasm?

Most of the time, sensation to the penis is not affected by a penile implant and sex feels the same. Additionally, men with implants are still able to orgasm. However, Dr. Köhler cautioned that if a man has been experiencing issues with orgasm before getting an implant, it is not likely to improve with the implant. He also mentioned that there may be a break-in period while a man adjusts to the sensation of having a foreign body in his penis, but “for the vast majority of men, when you’re looking at this number of 85-95% satisfaction, obviously their orgasms must be okay.”

What other factors should I consider before getting an implant?

As with any surgery, it is important to know the risks, benefits, possible complications, and most likely outcomes before going into a penile prothesis procedure. A penile implant can restore a man’s sexual function, which can have a remarkable effect on his self-esteem, sexual satisfaction, and when applicable, his partner’s sexual satisfaction.

The majority of inflatable implant surgeries are successful. Nevertheless, there are some risks to consider including infection, implant problems, and/or possible injury to adjacent structures like the urethra, bladder, bowel, or major blood vessels of the pelvis.

“Whenever you have a foreign body put in, [it could become infected],” explained Dr. Köhler. The current average rate of infection after penile prosthesis implantation is between 0.3-2.7%. Men with diabetes are more likely to experience infection than nondiabetic men.

While mechanical failure of the device is possible, one long-term study of 2,384 men with inflatable implants indicated that 88.9% of the implants were working at 5 years, 79.4% were working well at 10 years, and 71.2% were working well at 15 years. “The reality of the situation is that for the majority of men, of which the average age of implantation is around 65, the device will outlive them,” said Dr. Köhler.

So, what’s the bottom line?

“[Penile implants are] a very restorative surgery,” said Dr. Köhler. “For anybody who wants to have it fixed, it can be, and that’s a big deal to a lot of guys.”

Nonetheless, he stressed the importance of the patient knowing his surgeon and having a good understanding of the risk-benefit ratio before going into surgery. Having accurate expectations of what a penile implant can and cannot do is paramount to satisfaction.

Resources:

Burnett, A.L., Nehra, A., Breau, R.H., et al. (2018). Erectile dysfunction: AUA guideline. J Urol 200: 633. https://www.auanet.org/guidelines/guidelines/erectile-dysfunction-(ed)-guideline.

Cleveland Clinic. Medically reviewed by a Cleveland Clinic medical professional. (2016, May 11). Surgical Penile Implants. https://my.clevelandclinic.org/health/treatments/10054-surgical-penile-implants.

Gon, L.M., de Campos, C.C.C., Voris, B.R.I., Passeri, L.A., Fregonesi, A., & Riccetto, C.L.Z. (2021). A systematic review of penile prosthesis infection and meta-analysis of diabetes mellitus role. BMC Urol 21(35). https://doi.org/10.1186/s12894-020-00730-2.

Manfredi, C., Fortier, E., Faix, A., & Martínez-Salamanca, J.I. (2021). Penile Implant Surgery Satisfaction Assessment. The Journal of Sexual Medicine, 18(5), 868-874. https://www.jsm.jsexmed.org/article/S1743-6095(21)00311-8/fulltext#%20.

Mayo Clinic. (2019, December 10). Penile Implants. https://www.mayoclinic.org/tests-procedures/penile-implants/about/pac-20384916.

WebMD. Medically reviewed by Nazia Q. Bandukwala, DO. (2019, October 1). Erectile Dysfunction: Penile Prosthesis. https://www.webmd.com/erectile-dysfunction/guide/penile-prosthesis.

Wilson, S.K., Delk, J.R., Salem, E.A., & Cleves, M.A. (2007). Long-Term Survival of Inflatable Penile Prostheses: Single Surgical Group Experience with 2,384 First-Time Implants Spanning Two Decades. The Journal of Sexual Medicine, 4(4), 1074-1079. https://www.jsm.jsexmed.org/article/S1743-6095(15)31605-2/fulltext.