Erectile dysfunction (ED) means not being able to get an erection firm enough for sex. In the video above, urologist Dr. Bryan Kansas gives one piece of advice above all: please don’t be embarrassed to talk to your doctor about it, or see a urologist who specializes in erectile dysfunction. As he puts it, there are a lot of things that can be done, and you don’t have to live with ED.
This article covers the usual treatment steps and what to know if a penile implant is being considered.
Why it’s worth seeing a doctor
ED can be a sign of other health problems. The American Urological Association advises that men be counseled that ED is a risk marker for underlying cardiovascular disease and other health conditions that may need evaluation and treatment. NIDDK, part of the National Institutes of Health, lists heart and blood vessel diseases, such as atherosclerosis, high blood pressure and stroke, as well as diabetes, among the conditions that can lead to ED.
The patient in the video found that his ED developed gradually, and that it came alongside a diagnosis of heart disease.
Treatment usually goes step by step
Dr. Kansas says treatment options vary, and he likes to “start low and go high.” In the video, he describes the usual order:
- Oral medicines. These are PDE5 inhibitors (phosphodiesterase type 5 inhibitors). NIDDK explains that they improve blood flow to the penis and may help you get and keep an erection.
- A vacuum erection device. This device draws blood into the penis. NIDDK describes three parts: a plastic tube placed around the penis, a pump that creates a vacuum, and an elastic ring that helps keep the erection.
- Injections. Dr. Kansas describes an injection of a prostaglandin-based medicine mixture into the side of the penis about 10 minutes before sex.
- A penile implant. For patients for whom the other treatments haven’t worked, or who can’t use them, an inflatable penile prosthesis is the next choice.
NIDDK notes that most people with ED don’t need surgery. The American Urological Association recommends that men be told about all the treatment options that are medically suitable for them, and that the choice be made together with their doctor.
What a penile implant is
According to Mayo Clinic, penile implants are devices placed inside the penis by a surgeon. They’re most often a choice for people who can’t use other ED treatments, or after other treatments haven’t worked. There are two main types:
- Inflatable implants are the most common type. In a three-piece implant, two cylinders go inside the penis, a pump and release valve go in the scrotum, and a reservoir of salt water is placed under the belly wall or in the pelvis. Using the pump moves the fluid into the cylinders to create an erection; the release valve lets it drain back.
- Semirigid rods are always firm. The penis is bent away from the body for sex and toward the body at other times. They have fewer parts and may be easier to use.
Inflatable implants make the most natural erection and become soft when deflated, but have more parts that could go wrong. Semirigid rods are simpler but keep the penis slightly firm all the time and can be harder to conceal under clothing.
Things to know before deciding
Mayo Clinic points out a few things to understand before surgery:
- An implant can create an erection, but it doesn’t increase sexual desire or sexual feelings.
- It won’t make the penis larger than it was before surgery. The erect penis may even seem slightly shorter than it used to.
- The procedure can’t be reversed. After it, a natural erection is no longer possible.
- Implants aren’t for everyone. Your doctor may suggest other treatments if you have an active infection, poorly controlled diabetes or serious heart disease.
Mayo Clinic suggests that both you and your partner talk with your doctor if possible.
Surgery and recovery
According to Mayo Clinic:
- Surgery is usually done at a surgery center or hospital, under general or spinal anesthesia, and you may stay overnight.
- You receive antibiotics to help prevent infection. The surgery usually takes 45 to 90 minutes.
- Afterward, you may have mild pain for several weeks.
- Most people can do hard physical activity and have sex about 4 to 6 weeks after surgery. You’ll be taught how to use the device.
Risks
Mayo Clinic lists these risks:
- Infection. As with any surgery, infection is possible, and the risk may be higher with diabetes or a spinal cord injury. Infections most often happen within three months, and treating one may require removing the implant.
- Implant problems. Modern designs work well, but rarely an implant can fail and may need surgery to repair or replace it.
- Adhesion or erosion. An implant can stick to scar tissue inside the penis, or wear away the skin from inside the penis. Rarely, an implant breaks through the skin. These problems may be linked to an infection.
Results
Mayo Clinic says most people who have penile implants for ED, and their partners, are happy with them, and that implants have the highest satisfaction rating of all ED treatments.
The patient in the video says the medicines weren’t really working, and wanting more intimacy with his wife is what made the implant a real option. Dr. Kansas says the patient later wrote to thank him and is enjoying the device. One patient’s experience doesn’t predict anyone else’s results.
Questions to ask your doctor
- What might be causing my ED, and should I be checked for heart disease, diabetes or other conditions?
- Which treatments should I try first?
- Am I a candidate for a penile implant? Which type would suit me, and why?
- What will surgery and recovery involve, and when can I have sex again?
- What is my risk of infection or device problems, and how would they be treated?
- How many implant surgeries do you perform?
- How do I use the device, and who do I call if something doesn’t feel right?
Dr. Kansas is a urologist in Austin. See Dr. Kansas’s Best Docs Network profile for more about the practice.
This article is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
