My Penis Stuff

Penile implants to treat erection problems (erectile dysfunction) replace the spongy tissue (corpora cavernosum) inside the penis that fills with blood during an erection with rigid, semirigid, or inflatable cylinders. The implants come in a variety of diameters and lengths.

Rigid and semirigid implants are always firm. The semirigid models can be bent into different positions (outward to have sex; back toward the body to conceal under clothing).

The cylinders in an inflatable implant are hollow. You get an erection by pumping them full of saltwater, or saline, stored in a reservoir in your lower abdomen. A release valve on the pump drains the saline out of the cylinders and back into the reservoir.

See an illustration of a penile implant below

Surgery will be done using regional or general anesthesia. The implants are inserted through an incision made in the penis, lower abdomen, or scrotum. A thin, flexible tube is inserted briefly up the urethra and into the bladder to drain urine.

A three-chamber implant (with a cylinder in the penis, a reservoir in the abdomen, and valve in the scrotum) is usually more reliable than a two-chamber implant (with a reservoir and valve in the scrotum). Inserting the three-chamber implant is a slightly more complicated surgery.

What To Expect After Surgery

Generally, you stay 1 or 2 days in the hospital. You will take antibiotics for up to 2 weeks after surgery to prevent infection.

The urinary catheter is used for about 1 day after surgery.

Do not wear tight underwear or clothing until the surgical incision has healed. Men with inflatable implants may need to avoid tight clothing for 6 weeks to avoid pushing the saline reservoir out of position.

You can generally return to strenuous physical activity and sex after about a month. Inflatable implants usually are not inflated for a month.

Why It Is Done

Penile implants are an option when other, less invasive treatments for erection problems have not been successful and further treatment is desired.

Implants may be the treatment of choice for young and middle-aged men with erection problems from physical causes. Penile implants may be appropriate treatment for men with erection problems caused by:

• Diabetes.
• Pelvic surgery.
• Blood vessel disease.
• Injury to the pelvis, genitals, or spinal cord.
• Peyronie’s disease, curvature of the penis caused by scar tissue.

Because implants permanently change the tissue in the penis, they are not used for men whose erection problems are psychological.

How Well It Works

The satisfaction rate for most men is high for both noninflatable and inflatable implants. ¹ An erection with a properly working implant may seem more natural than one from other, nonsurgical methods, such as a vacuum device. The head (glans) of the penis is not made fully rigid by the devices. Semirigid implants do not increase the size of the penis or produce the fullness of a natural erection.

Implants do not interfere with ejaculation, though ejaculation and orgasm are not ensured. Implants neither increase nor decrease sexual desire.

Noninflatable implants and inflatable devices can last indefinitely.

Risks

The site of the implant may become infected. The risk of infection is higher in men with diabetes, spinal cord injuries, or urinary tract infections. If the infection is severe, the implant must be removed.

Pain may occasionally require removal of the implant.

The most common cause of failure is leakage from the cylinders. Other, less common complications include the following:

• Tissue near the implant (erosion) may be injured.
• The implant may break through the skin.
• The implant may break.
• The implant may be positioned incorrectly.
• The implant may be defective and not work.

What To Think About

When considering surgery for erection problems, it is important to include your partner in your decision.

It is important that you have realistic expectations about the type of erections you can have with an implant. The use of penile implants is declining as men consider the risks of surgery—including infections—and as other options become available, such as vacuum pumps, injections, and medications.

No problems have been reported from the shedding of silicone particles from the implants.

Semirigid implants are the least expensive option. This surgery is usually covered by insurance policies and by Medicare.

Surgery to repair blood vessels may be done for some men who have erection problems (erectile dysfunction).

Venous ligation

In an erection, blood fills chambers in the penis, causing it to expand and become rigid. The veins that would normally drain blood from the penis are constricted, trapping the blood inside and maintaining the erection. Some men are unable to sustain an erection because the blood drains out too quickly through the veins. If this occurs, the veins that drain the penis may be tied off. This surgery is called venous ligation.

The surgery generally works only when the veins that are not working can be identified. However, the results of tests used to assess blood vessel problems are difficult to interpret, and it is difficult to know which men will benefit from this surgery. Success of this surgery depends on the severity of the problem and the experience of the surgeon.

Penile revascularization

This surgery generally is done in younger men who have injuries that affect blood flow to the penis. During surgery, a portion of a blood vessel from elsewhere in the abdomen is used to bypass the damaged portion of artery that supplies blood to the penis.

In some cases you can treat occasional episodes of erection problems (erectile dysfunction) at home, without a health professional’s help. However, involve your partner in the process, and don’t be embarrassed about seeking professional help if erection problems are consistent and troublesome. You may be able to help yourself by:

• Changing lifestyle factors that may affect erections. These factors include alcohol, smoking, and using illegal drugs.
• Examining your relationships and life events.
• Talking with your partner.
• Trying sensual exercises with your partner.

Some men may try methods available in health food stores or through magazine advertisements. Most of these methods have never been medically proven to work, may be unsafe, and are often expensive. They are not recommended.

Sensual exercises may help with erection problems (erectile dysfunction). Doing these with your partner may help you relax and focus more on the pleasurable touching of lovemaking than on the erection itself. Focusing too much on having an erection may make it difficult to have one.

Sensual exercises may be most helpful if done in a soothing, relaxing, and playful atmosphere. Put on some pleasant music, turn off the phone, and concentrate on your partner.

• Nongenital pleasuring. Remove your clothes. Have your partner lie face down. Beginning at your partner’s neck, slowly caress and/or kiss from head to toe. Then, have your partner turn over. Repeat the caressing and kissing. Avoid touching the nipples or any part of the genitals. Concentrate on how good touching your partner feels. Then, trade places. Lie on your stomach while your partner caresses you. Do not have intercourse the first day. Enjoy holding, relaxing, and laughing.
• Genital pleasuring. After you and your partner are comfortable with nongenital pleasuring, include genital touching as part of the exercise. Again, do not have intercourse. If sexual tension from any erection that occurs is too much to stand, masturbate to relieve the tension.
• Nondemanding intercourse. When both partners are ready, continue a session of genital pleasuring by having intercourse. Do not force lovemaking too soon. Rather, fully enjoy the genital pleasure leading up to it.

Talking with your partner may help your erection problems (erectile dysfunction). Couples often assume that they each know what the other person likes when it comes to sex. Sometimes they are wrong.

• Don’t assume. Tell your partner what you do and don’t find pleasurable.
• Make time outside of the bedroom to talk about your sex life together. If you withdraw sexually because you are afraid of having erection problems, your partner may worry that you are no longer interested or that you are involved in another sexual relationship.
• In some cases, you may find that your partner is less concerned about intercourse and is more concerned and interested in foreplay and other forms of sexual satisfaction.
• Discuss the strong and weak points of the whole relationship, not just the sexual relationship. Identify positive areas, areas of conflict, and areas that need improvement. Come to agreement on how or if you will both make changes.
• If you have difficulty discussing sex with your partner, see a person who can help facilitate communication, such as a certified therapist.
• Read books with your partner on sexual health.

Looking at events in your life, your relationships, and your feelings can often help you determine factors that may contribute to erection problems (erectile dysfunction).

Review the following events and concerns. Did your erection problems begin at this time? If so, this may be a factor. Talk to your partner or others about how this affected you and your relationship.

Events that are sometimes associated with erection problems include:

• Getting a new job or losing a job.
• Getting ready to retire or retiring.
• Entering a new relationship.
• A significant change in an existing relationship, such as the birth of a child or an older child leaving home.
• The death of a longtime sex partner.

Fears and concerns may also contribute to erection problems, including:

• Worry about aging.
• Worry about a partner with health problems.
• Worry about finances.
• Concerns about poor communication between you and your partner.

All of these situations and others—especially when associated with stress, depression, anger, or anxiety—can cause temporary stress leading to erection problems. Give yourself time to adjust to changes. It is okay if sex is not a priority for a while. Generally after a few weeks, the erection problem may pass.

The following lifestyle changes may reduce the risk of erection problems (erectile dysfunction):

• Limit alcohol to fewer than 2 drinks per day, or eliminate alcohol if it seems to interfere with erections. Even small amounts of alcohol can result in erection problems.
• Stop smoking. Smoking interferes with the ability of the blood vessels in the penis to relax and allow blood to flow in, which can affect your ability to have an erection.
• Avoid the use of cocaine, heroin, and other illegal drugs.
• Check your medications. Many medications can cause erection problems. Ask your doctor or pharmacist whether the medications you are taking have any sexual side effects.
• Relax. Worrying about sexual performance may only worsen erection problems.
• Talk to your partner about your problems and concerns. Sexual intimacy is a form of communication. If you and your partner aren’t talking outside of the bedroom, it’s unlikely that you will have good sexual intimacy.
• Reduce stress. A heavy workload or stressful job can reduce your interest in and energy for sex. Regular exercise and other stress-relievers can help.

You may be able to avoid erection problems (erectile dysfunction) related to anxiety and stress by taking a more relaxed approach to lovemaking. Talk to your partner about your problems and concerns. Sexual intimacy is a form of communication. If you and your partner talk about your lovemaking, it will help reduce your stress and anxiety and you may become more relaxed.

Erections may gradually become more difficult to get and maintain as you get older. However, foreplay—erotic stimulation before intercourse—and the right environment can help increase your ability to have an erection, regardless of your age.

Other things you can do that may reduce your risk for developing an erection problem include:

• Quitting smoking.
• Avoiding use of excess alcohol and illegal drugs.
• Keeping your cholesterol level low to reduce the risk of hardening of the arteries (atherosclerosis).
• Treating high blood pressure.
• Keeping your blood sugar in a safe range if you have diabetes.
• Exercising regularly.
• Lowering stress in your life.

Treatment for an erection problem (erectile dysfunction) depends on the cause of the problem, which may be psychological, physical, or a combination of both. Erection problems that have one or more major physical causes also often have psychological factors that make the problem worse and make treatment more complicated.

Many doctors take a stepwise approach to treating erection problems, using the least invasive treatments first. These steps are:

1. Discovering and then eliminating medications that may be causing your condition. In some cases a different medication can be tried.
2. Trying an oral medication (such as phosphodiesterase-5 inhibitors [Viagra, Levitra or Cialis]), unless an easily treated cause—such as a medication side effect or testosterone deficiency—has been identified.
3. Trying a vacuum device and getting counseling if a psychological cause is suspected.
4. Trying medications that are injected or inserted into the penis.
5. Trying penile implant surgery or an external penile splint.

Counseling (also called psychotherapy) or behavioral therapy may be appropriate even if your erection problem has a physical cause. It may be offered if your health professional suspects psychological issues play a role in your erection problems.

What To Think About

It is important to involve your partner in your decision regardless of the treatment you choose.

Oral medications have revolutionized the treatment of erection problems, and they are commonly tried first before other medication or surgery.

Although phosphodiesterase-5 inhibitors have relatively few side effects, they can be dangerous in certain men. If you are taking nitrate-containing medications, such as nitroglycerin, you cannot use Viagra, Levitra, or Cialis. You also should not take certain alpha-blockers—used to lower blood pressure and to treat an enlarged prostate gland—with these medications because of the risk of a dangerous drop in blood pressure. Check with your health professional to see whether you can take Viagra, Levitra, or Cialis with your alpha-blocker.

Many men overestimate how important being able to have erections is to their relationships. Some men find that once they are able to have erections again, the hassle of using the treatment is not worth the effort. Other men may find that being able to have erections doesn’t change their relationship as much as they or their partner had expected.

Seek care immediately if you use medication to treat an erection problem (erectile dysfunction) and the erection lasts longer than 4 hours.

Seek care immediately if you have taken phosphodiesterase-5 inhibitors (such as Viagra, Levitra, Cialis) in the past 24 hours and are having chest pain. Tell your health professional you are taking this medication. Do not use any form of nitroglycerin if you have chest pain and have taken Viagra, Levitra, or Cialis in the past 24 hours.

Call a health professional if erection problems occur with:

• Any type of injury to the back, legs, buttocks, groin, penis, or testicles.
• A loss of pubic or armpit hair and an enlargement of the breasts.

Make an appointment to see a health professional within 1 to 2 weeks if an erection problem occurs more than 25% of the time and the problem:

• Occurs with a persistent backache.
• Occurs after you start taking a new medication or change the dose of a medication.
• Is affecting your self-image or sense of well-being.
• Has not improved despite self-care.

If your erection problem is occasional, there is no reason to call your health professional. If it occurs frequently but does not bother you or your partner, you may or may not choose to call your doctor. However, an erection problem that develops suddenly may be a sign of a disease; it is recommended that you see your doctor.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. A single episode of an erection problem is often a temporary and easily reversible problem. Do not assume it will happen again. If possible, forget about it and expect a more successful experience the next time. If you or your partner is concerned about it, talk about the problem and openly discuss your fears and anxieties.

If self-care has not helped after 2 weeks and you are concerned about your inability to have an erection, see a health professional who has experience in dealing with erection problems.

Who To See

Some health professionals, including doctors and mental health professionals, may not feel comfortable discussing sexuality and erection problems. Ask your health professional if he or she feels comfortable with and has experience in working with men who have erection problems.

The following health professionals can evaluate symptoms of erection problems:

• Family medicine doctor
• Internist
• Nurse practitioner
• Physician assistant
• Urologist

If it is possible that a psychological problem is contributing to your erection problem, your doctor may refer you to a health professional such as a:

• Psychiatrist.
• Psychologist.
• Certified licensed social worker.
• Counselor with special training in sexuality or relationship problems.