The Different Types of Penile Implants

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Penile implants, or penile prostheses, can help men who experience erectile dysfunction. These implants have the potential to allow men with severe erectile dysfunction to once again experience penetrative sex, orgasm, and ejaculation. (Men who have difficulty with orgasming and ejaculation unrelated to erectile dysfunction will not be helped by penile implants.)

Penile implants can also be used in men who experience other types of erectile problems, such as those caused by Peyronie's disease. As more effective medical treatments have become available, fewer men have received penile implants for erectile dysfunction. However, for some men, they are the only effective option for treatment. This is particularly true for men who have not had success with medications, including pills and injectable medication (such as Trimix), and for those with total phallic construction.

After a phalloplasty (surgical construction of a penis for transgender men or cisgender men who have lost their penis) implants are the only options for achieving an erection.

Types of Penile Implants

There are several different types of penile implants. Broadly speaking they can be broken down into two types. There are inflatable implants. These tend to be used most commonly in the United States. There are also non-inflatable implants.

Inflatable Implants

In general, inflatable implants are used most commonly in the United States. However, this varies depending on where people seek care. There are two types of inflatable implant—two-piece implants and three-piece implants. Neither type of implant inflates with air. Instead, they are filled with fluid from a fluid reservoir that is implanted in the body. The pump is usually implanted in the scrotum.

Two-piece implants are simpler and easier to use. However, there is usually a trade-off between the firmness of the erection and how flaccid the penis can become. Men tend to be more satisfied with their penis in the flaccid or the erect state. This is because the small size of the one-piece fluid pump and reservoir doesn't allow for large adjustments.

Three-piece implants, in contrast, are slightly more complex. In addition to the prosthesis and pump, they also contain a separate reservoir. The added parts allow for several benefits. The flaccid penis is fully flaccid since there is a valve to release pressure in the penis when an erection is no longer wanted. The additional reservoir space also allows erections with this device to be firmer than those with the two-piece implant.

Non-Inflatable Implants

Non-inflatable implants are exactly what they sound like. They are semi-rigid tubes that can be bent to shape. The penis can be pointed down for everyday use. It can be pointed up for sexual intercourse. There are several different types of non-inflatable implants with varying trade-offs. Some offer greater stiffness for sex. However, that comes alongside the potential for more discomfort at other times.

The biggest advantages of non-inflatable implants are cost and ease of insertion. The surgery to implant these devices is much simpler than for inflatables. They are also less expensive. In addition, some men find them easier to use, as there are no mechanical parts. However, men do have to become used to having a firm, rather than a flaccid, penis at all times.

Side Effects

The surgery to place an implant is non-trivial. It can lead to a number of side effects. Some potential side-effects of penile implants include:

  • Problems with the implant
  • Infection
  • Shortening of the penis
  • Changes in a sensation of the penis

Alternatives to Penile Implants

There are several options that doctors may consider before recommending a penile implant for erectile dysfunction treatment. The most well-known treatments for erectile dysfunction are probably PDE5 inhibitors. These are oral medications, such as Viagra, Cialis, and Levitra, that can help with erectile function in some men.

Vacuum pumps, which use suction to pull blood into the penis, and sometimes penile rings to hold the penis, are also effective for some men.

A few companies make external erectile prostheses, which serve as splints during sex. Finally, there is medication (transurethral alprostadil) that can be inserted into the tip of the penis (urethra). The strongest medication option is medication injected directly into the erectile tissue of the penis (typically a cocktail of papaverine, phentolamine, and a prostaglandin called Trimix) to increase blood flow and produce an erection.

A workup with a urologist including possible penile doppler ultrasound may be warranted to better understand blood flow issues with the penis and to customize medication options.

Are People Satisfied With Penile Implants?

Research suggests that most of the men who choose to get penile implants are happy with their choice. So are their partners. This is good news for men for whom penile implants are a reasonable option. These implants can make a big difference in sexual function and satisfaction within a relationship.

However, that doesn't mean that penile implants are the best choice for all men with erectile dysfunction. It is a very invasive procedure. Furthermore, a significant percentage of men who get an implant will need a replacement or revision at some point after implantation.

If you're considering a penile prosthesis, talk to a doctor who is well informed about the risks and benefits. It is important to discuss potential side effects, and less invasive alternatives before choosing this surgery. It is also a good idea to investigate your options for getting an implant placed if you decide to do so.

As has been seen with a number of types of surgeries, the likelihood of successful implantation of a prosthesis is higher at hospitals that do larger numbers of the procedures. You want to get your penis implant from someone who places a lot of them. The experience will be better than with someone who just does the procedure occasionally.

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