Being able to have and maintain an erection during sexual intercourse can be important to a man’s ego and a source of self-confidence. It can also affect intimacy for a couple. However, men should know they are not alone. An estimated 30 million middle-aged and older U.S. men have erectile dysfunction (ED). This condition, which is the inability to get and keep an erection firm enough to have sex, is often treated with medications such as Viagra, Cialis and Levitra, as well as other treatment options that include penile injection therapy, a vacuum erection device, and a pellet that is inserted directly into the urethra (urine tube). But these options may not help everyone. 

For some of these men, a surgical procedure called the penile implant (or penile prosthesis) may be an option. The penile implant allows men to achieve an erection through an implanted device. These devices can be effective in restoring sexual activity for a man and his partner. According to Yale Medicine urologist Stanton Honig, MD, the penile implant has a satisfaction rate of 95%, in part because it allows for spontaneous relations with a partner at any time.

“Penile implants are an effective way to restore spontaneous sexual activity for men when other treatment options have failed or are not well tolerated,” says Dr. Honig. “In my practice, they have a very high satisfaction rate.”

There are two types of penile implants: inflatable devices and semi-rigid rods. 

• Inflatable devices: An inflatable penile device involves surgical implantation of several connected parts. Two cylinders are placed into the penis and connected by a tube to a pouch of saline water, located in the lower abdomen. The container is connected to a pump, implanted in the scrotum. When the pump is squeezed, the saline water fills the inflatable cylinders. The cylinders can be deflated by pressing a button above the pump.

• Semi-rigid rods:Rods made of metal wires or coils and covered in a silicone jacket are implanted in the penis. With this type of implant, the penis remains erect at all times. These are most suitable for men with reduced manual dexterity, who may have trouble using a pump-based prosthesis.

Both of these devices will not affect orgasms or ejaculation. However, many couples find it takes a while to get used to the device.

Because much of the erectile tissue needs to be removed to implant the device, a man will not be able to achieve an erection on his own after surgery. For this reason, the penile implant should be considered only after other treatment options have failed or patients are not happy with side effects of other treatments.

A penile implant may be appropriate and helpful for men with erectile dysfunction that has failed to respond to (or tolerate) medication and other treatments. Severe cases of erectile dysfunction are often caused by a serious medical issue, such as diabetes, heart disease, or the effects of prostate cancer. Penile implants may also help men with a condition causing a deformity in the penis (such as Peyronie’s disease, a condition in which scar tissue can cause the penis to bend). Age is not a limiting factor for patients who desire a penile implant.  

Both types of penile implant surgery are outpatient procedures, and are performed in 90 minutes or less. The patient can go home on the same day. To ensure adequate healing, the device should not be used for at least six weeks following the procedure. 

Complications are rare, but the most common include mechanical failure, infection, incorrect sizing, and reservoir migration.

• Mechanical Failure: This complication is more likely to occur with inflatable prostheses when they stop inflating. “This is not a dangerous situation at all,” says Dr. Honig, but notes that to correct the problem the patient will need to undergo revision surgery. Mechanical failure usually occurs years after the procedure and can be fixed by removing and replacing the device.

• Infection: Infections, although rare, usually occur within 6 weeks of surgery. Antibiotics alone generally don’t work for these types of infections, so the implant usually needs to be removed. In mild to moderate infections, the device may be removed, the wound cleaned, and a new device can be placed with a “salvage” of sexual function in about 75 percent of patients, says Dr. Honig.

• Incorrect Sizing: An implant that is too short may result in drooping of the head of the penis, whereas implants that are too long may cause tissue erosion. Incorrect sizing requires revision surgery. “This is rare,” says Dr. Honig, “especially in centers of excellence like Yale with significant experience in the placement of penile implants.”

• Reservoir migration: In some cases, the reservoir that holds the saline water in an inflatable penile implant can move. If this occurs, it can be fixed with a surgery to move the pouch back to the correct location.

Yale Medicine Urology, named one of the nation’s best urology programs by U.S. News & World Report, provides the most advanced treatment with state-of-the-art technology. As a team, we believe in the importance of the patient-doctor relationship and strive to provide compassionate, quality urologic care to every patient.

Stanton Honig, MD is the doctor who performs penile implant surgery. Dr. Honig has over 25 years experience with placement of penile prostheses. His state-of-the-art technique includes the “no touch technique,” implant-specific antibiotic irrigation and antibiotic usage, and a precise placement of the reservoir depending on the particular condition that caused the erectile dysfunction. He is a regional referral doctor for the most complicated cases, such as patients with prior infections, Peyronie’s disease, and priapism (a condition that causes a prolonged erection of the penis without sexual arousal).