Penile Implants

Since as far back as the 1930s, surgeons have been experimenting with ways to produce artificial erections. By now the art of penile implants is highly advanced, and though there are a great many implant models, they can be conveniently put in two groups.

Nonhydraulic (also called semirigid and malleable) implants consist of a pair of silicon rods placed inside the penis. With earlier models, the man always had an erection, and this obviously caused some embarrassment. Newer models are more flexible and can be bent down against the leg. These can still cause embarrassment in locker rooms and public urinals, because the penis is longer than it would be without the silicon rods, but it is easily concealed under clothes.

Hydraulic or inflatable implants come in a variety of styles, but their main distinguishing characteristic is that they mimic the action of a normal erection process. A pair of hollow cylinders is placed inside the erectile tissue of the penis, and when you want to have sex you activate a pumping mechanism, implanted in the scrotum, that inflates the cylinders. Some newer models have the complete mechanism inside the cylinders; when you want an erection, you simply bend or squeeze the head of the penis, and presto — as if by magic — you have an erection.

Hydraulic models have the advantages of seeming more natural, since they mimic what the body does under normal circumstances. The penis is truly soft when it’s soft, and only gets hard when you want it to. But hydraulic models are more complex, and the chances of malfunction are greater. They are also more expensive and the surgery more involved.

Surveys show that although many men with implants have some complaints, a large majority of the men and their partners are generally satisfied with the devices.

ADVANTAGES:

• The ability to have a usable erection whenever you want one without having to give yourself shots and without having to go through sex therapy.
• Although implants are expensive (over several thousand dollars), they are covered by many insurance plans.

DISADVANTAGES:

• Implants should be considered irreversible. They can injure or destroy the natural erection system. This will likely mean you can’t decide to have an implant taken out and try sex therapy or other treatments.
• The erection produced by an implant is not exactly the same as the ones you had naturally. It is smaller, both in terms of length (as much as an inch or two shorter) and circumference. It is also less rigid, and the head of the penis is softer. This should not be a major problem, because implant erections are certainly rigid enough for vaginal insertion and enjoyable intercourse. However, you need to know that what you get may not look like what you had before.
• Implant surgery can take one to three hours, depending on the kind of implant used, and has the same risks as all surgery. Postoperative pain in the groin typically lasts for four to six weeks, and most patients require medication for pain control during some of that period. The risk of infection is small, but if it does occur after surgery, the implant will need to be temporarily removed.
• Mechanical failure is always a possibility in hydraulic devices. If there is such a failure, further surgery is required. The offending component or the whole device must be removed and replaced.

Since implant surgery may be irreversible, involves the risks of surgery and the possibility of additional surgery to correct malfunctions, and is painful and expensive, it should not be entered into lightly. Some men have magical expectations of implants, so I want to dispel them right now. An implant at its best will do only one thing: give you a usable erection when you want it. That may be miraculous enough, but some men expect more. An implant will change only the stiffness of your penis, not your personality, behavior, or lovemaking technique. An implant in itself will not make you desire sex more, will not increase your arousal, will not make you a better lover, will not improve sensation or give you a better orgasm, and it most certainly will not save a failing relationship. All these points may seem too obvious to be worth making, but strange things happen with implants. Some men, for example, have had them put in and then never again had sex; some men have had sex only a few times in the years after surgery. Does it make sense to go through all the trouble and pain for something you’re not going to use or will use rarely? Make sure you and your partner understand, in both your heads and your guts, exactly what an implant will and will not do for you. If you have refrained from sex for a long time because of your erection problem, it may be difficult to get started again after the implant is in place. Even though you know you can now get erect, there may be some shyness or hesitation on your part and perhaps your partner’s as well. This is especially true if there were bad feelings and ugly words exchanged about not having sex. If this doesn’t decrease after a week or two, a few sessions with a sex therapist can help. Don’t forget: An implant is forever (or almost). Make sure you weigh all the options before choosing one.

DRUG THERAPY FOR ERECTILE DYSFUNCTION

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