Penile implants - what you need to know

Reviewed by our clinical team

Erectile dysfunction (ED) is a very common condition, around half of men aged 40-70 will have experienced the condition. But it can still be very stressful, and impact the mental and physical well-being of those who experience it.

There are a range of medical treatments available for ED, ranging from pills such as Viagra, penile pumps, therapy and/or lifestyle changes.

However, if these treatments are unsuccessful, in very rare circumstances, men might be offered penile implant surgery.

In this article, we will look at what is involved in penile implant surgery, who might qualify and what it means for you in the long term.

What is ED?

ED is a condition that makes it difficult or even impossible for males to achieve or maintain an erection. It can be caused by a number of things, from physical conditions such as high blood pressure and diabetes to mental health conditions like anxiety and depression. 

What is a penile implant?  

Penile implant surgery, referred to clinically as a penile prothesis surgery, is a last resort option for treating ED. It’s an option rarely used in the UK – with only 1071 operations happening in the NHS between January 2016 and Dec 2018. It’s only offered to men who have ‘end-stage ED’, meaning their bodies have failed to respond to any kind of medical, mechanical or psychological treatment.

This surgery involves inserting a prosthesis into the penis which are then manipulated or activated to enable you to have penetrative sex. 

How does a penile implant work?  

Penile prosthesis work by simulating an erection when your body isn’t able to do so naturally, nor with the aid of medications/mechanical devices (like pumps). 

Types of a penile implant  

There are two types of penile prosthesis, semi-rigid and inflatable. If you’re referred to a specialist team for surgery, they will decide which kind of prosthesis might work for you and your body.

Inflatable implants

Inflatable penile implants are the most common type of implant in the UK. This prothesis consists of pair of cylinders inserted into the penis, connected to a pump located in the scrotum. To ‘activate’ the device, you use the pump to send liquid into the cylinders and simulate an erection.

Inflatable prostheses are available in two slightly different forms. Two-piece devices, which are the standard, and three-piece implants, which include a reservoir placed next to the bladder. 

Semi-rigid prosthesis (malleable prosthesis) 

An alternative to inflatable implants, semi-rigid prostheses (malleable prostheses), which don’t change shape or size. They work a bit like a pipe cleaner or goose neck lamp, meaning they hold a certain shape but can be manipulated to bend up or down. So, they can be put in a downward position when you’re going about your day, but bent upwards to enable you to have sex.    

Who might qualify for a penile prosthesis?  

In the UK penis prosthesis is only available to men who have severe ED, which hasn’t been responsive to any of the usual treatments for the condition. The NHS estimates that there’s only around 7000 patients in England who would qualify for this surgery. 

Men who’ve had pelvic surgery or intervention for bladder cancer have a 20% risk of developing this ‘end-stage’ ED, so this might make you more likely to qualify for a prosthesis. 

To even be considered for the surgery, you would have to be assessed by a specialist, multidisciplinary team and fulfil all of the following: 

• Have end-stage ED 
• Lifestyle changes, medicines, mechanical devices and psychosexual counselling have all been tried and don’t work 
• Have been assessed with regards to diabetes, steroid use and BMI 

Average age for a penile implant 

A recent review of penile implant surgery in the UK, the mean age for a penile implant was 55 years. Penile surgery is considered to be the last resort for the treatment of ED. 

In the UK penile implant surgery is performed relatively rarely, and the numbers of centres within the NHS that are offering the procedures are declining. In 2018 there were 328 recorded procedures. 

Effectiveness of a penile implant  

Although this kind of surgery is fairly rare, it does seem to have fairly high patient satisfaction rates, with 90% of patients demonstrating improved erectile function. 

Risks of a penile implant  

As with any surgery, penile implants do come with some potential risks and side effects. Although these are very rare, you should take them into consideration. Risks include: 

Infection 

One of the main potential risks of ED surgery is infection. Infection is almost always a risk with surgery, but the risks tend to be low, at just 2-3%. 

Prosthesis can be coated in antibiotics prior to insertion, but a 2011 study found that there isn’t much difference in the infection rates between regular implants and those that are coated. 

Nerve injury 

There is a small risk of nerve injury, which can result in temporary or permanent numbness of the penis. 

Mechanical failure 

Rates of mechanical failure have reduced over the years, but it’s still worth remember that it’s possible. It’s thought that at five years nearly 80% of patients won’t have experienced mechanical failure, and at 10 years that figure sits at around 73%. 

If you do experience mechanical failure, there is a chance you’ll have to have further surgery.

Other rare complications 

In very rare instances the bladder and bowel can be injured during insertion. There have also been rare cases of the prosthesis breaking out of its normal position and appearing elsewhere. 

How to prepare for a penile surgery  

The specialist team treating you will give you all the information you need ahead of surgery. You’ll likely have had a number of consultations before arriving at the option of surgery, which will also help prepare you. 

How long does it take to recovery from a penile implant?  

Recovery time after a penile prosthesis insertion varies from person to person. The average time to discharge is just one day, so you could be home very quickly. 

You’ll most likely be asked to not ‘try out’ the prosthesis for the first six weeks – these means avoiding sex and not inflating/manipulating the implant. At this six-week appointment you’ll be shown how to use the device. 

Other ED treatments 

As mentioned above, surgery is often considered as a last resort following other treatments. A penile prosthesis is not your only option. Other ED treatments include: 

Medication 

The best option for many men, erectile dysfunction medications such as Viagra and Cialis are usually very effective at helping you achieve and maintain an erection. 

It's important that you only get medications from a clinician or registered online service like Online Doctor. 

Therapy 

It's thought that up to 20% of erectile dysfunction cases are due to an underlying psychological condition, such as: 

• Stress 
• Performance anxiety 
• Depression 
• Loss of arousal and interest in sex 
• Relationship issues 
• Fatigue 
• Low self-esteem and body image 
• Unrealistic sexual expectations 
• Previous traumatic sexual experiences

In these cases, your doctor might recommend that you try psychosexual therapy or cognitive behavioural therapy (CBT). Both types of therapy are very effective at treating ED caused by psychological factors, and you should speak to your doctor to find the best course for you. 

Non-medical treatments 

You do have other options in the form of devices such as vacuum pumps and constriction rings. These devices are simple and safe to use, creating and sustaining an erection for you. 

The downside to these devices is that they take some time to activate and might interrupt the natural flow of intimacy for some. 

Lifestyle changes 

Erectile dysfunction might be due to lifestyle factors. If this is the case, the doctor might recommend you change your diet and exercise regime. 

Medicines that might cause ED 

Some medications can also contribute to erectile dysfunction. Changing or stopping some medications might help, but you should only ever do this on the advice of your doctor. Some potential contributors to erectile dysfunction are: 

• Diuretics 
• Beta blockers 
• Fibrates – used to lower cholesterol 
• Antipsychotics 
• Antidepressants 
• Steroids 
• H2-antagonists – used to treat stomach ulcers 
• Anticonvulsants 
• Antihistamines 
• Anti-androgens – used to suppress male sex hormones 
• Cytotoxics – used in chemotherapy 

Recreational drugs such as alcohol, amphetamines, cocaine, and marijuana can also contribute to erectile dysfunction, so discontinuing these might help.

You can visit our online erectile dysfunction clinic to go through a discreet online consultation, or to speak to one of our VideoGPs. 

References

https://patient.info/mens-health/erectile-dysfunction-impotence
https://www.mayoclinic.org/tests-procedures/penile-implants/about/pac-20384916
http://www.cambridgewellbeing.org/psychological.html
https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1111/bju.15219 
https://www.england.nhs.uk/wp-content/uploads/2018/07/Penile-prostheses-for-end-stage-erectile-dysfunction.pdf 
https://www.newcastle-hospitals.nhs.uk/services/urology/our-services/erectile-dysfunction-and-andrology/insertion-of-penile-prosthesis-for-erectile-dysfunction/ 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483239/
https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/erectile-dysfunction-impotence#causes-of-erectile-dysfunction