Erectile dysfunction: what is sex like with an inflatable penile prosthesis?

Erectile dysfunction can be a fairly common problem, particularly amongst older men. Whilst there are several treatment options, some cases can benefit from having a penile prosthesis inserted surgically. Mr Rowland Rees, a leading urologist and male genito-urethral surgeon, explains what is involved in this procedure and what patients can expect post-op.

What is a penile prosthesis and why is it used?

A penile prosthesis is used to treat erectile dysfunction when medication and other less invasive treatments have failed to be effective, or are not suitable. The aim of the implant is to assist the penis into maintaining an erection.

There is no age limit for the prosthesis, though the incidence of erectile dysfunction does increase with age. Older men requiring a penile prosthesis may have blood flow (vascular) related issues or a history of prostate cancer treatment, while younger men may have diabetes, Peyronie’s disease or perhaps have suffered a priapism (prolonged erection).

Are there different types?

Yes – there are inflatable and malleable (or semi-rigid) prostheses available. The inflatable implant is a fluid-filled system, while the malleable implant is bent upward or downwards as required. There are two main companies that make prostheses; Boston Scientific and Coloplast. The commonest type of implant inserted in the UK is the three-piece inflatable prosthesis with a cylinder in the penis, pump in the scrotum and a reservoir in the tummy.

Is the implant noticeable to sexual partners?

The implant isn’t necessarily noticeable as it’s all concealed under the skin.

What is sex like with a prosthesis?

Sex is essentially the same. The sensation, orgasm and ejaculation works as it would with a penis that doesn’t have a prosthesis. All the implant does is help to generate an erection. It’s reliable, safe and can remain inflated for as long as the patient wants it to. Satisfaction rates with a penile prosthesis are higher than that of other ED treatments.

Does an erection last as long as usual?

An erection can last as long as you want it to as there is a button that can be pressed when you want to deflate the prosthesis.

What does the procedure involve?

The operation lasts for about one hour, is performed under general anaesthetic and is fairly straightforward. The usual rules apply for the anaesthetic, which means not eating for up to six hours before the operation. A small cut is made in the scrotum which heals quite quickly. The patient generally stays in the hospital for one night, but can also be done as a day-case procedure.

Post-op instructions

Patients must be fairly inactive for the first 12-24 hours after the operation, and a dressing will have to be worn for a few days to absorb any discharge from the wound. The drain tube is then removed and all being well, you can be discharged home with antibiotics for a week, to prevent infection.

Bruising, swelling and discolouration of the penis and pelvic region can be expected. As healing occurs, the swelling and pain will go down. It’s important that the pump is brought down to the bottom of the scrotum daily, so that it can be felt easily when the time comes to use it. The penis should remain in a straight position with tight underwear helping to keep the penis facing the belly button.

What about complications?

As with every procedure, there’s always a risk of complications. There’s a revision rate over time of 30% over a ten year period, however the risk of infection is currently as low as 2%.

Are there any side-effects to the procedure?

Possible side-effects that may occur can include:

• Infection
• Minor issues such as a less stable erection and a floppy glans (head of the penis).

Call for emergency help if you experience the following:

• Excessive bleeding or the passing of large clots
• Inability to urinate
• Fever
• Nausea
• Tenderness and swelling of the legs
• Shortness of breath or chest pain

For more information check out Wessex Andrology for detailed pictures of what a penile prosthesis looks like. EDTreatments.com is also a useful site to learn more about erectile dysfunction and treatment options.

If you are considering a penile prosthesis and would like to book a first consultation, contact Mr Rowland Rees.