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Can This Radical Surgery Fix Erectile Dysfunction?

An aging population and increased awareness have led to an increase in ED diagnoses.

An aging population and increased awareness have led to an increase in ED diagnoses.

Reported incidence of erectile dysfunction (ED) has nearly doubled over the past decade.

This doesn’t necessarily mean that twice as many men today have ED as had it in 2005. Part of it is because people are simply more knowledgeable about ED, thanks to extensive advertising of the prescription medications used to treat it. Talking about ED with a doctor is more common today, so it only makes sense that more men are diagnosed with it.

At the same time, the prevalence of obesity and diabetes has increased, and these are major contributors to ED. And as the average population ages, one would expect the incidence of ED to increase as well. Basically, the prevalence of ED correlates most strongly with age and cardiovascular condition. If something is bad for your heart (smoking, obesity, high cholesterol, diabetes), then it’s bad for erections.

Ideally, doctors would like for their patients with ED or risk factors for it to improve their lifestyle habits by quitting cigarettes, exercising regularly, losing excess weight, and eating a healthier diet. But sometimes factors add up over the years, and lifestyle changes may not be enough to address ED to a man’s satisfaction. One treatment for ED that you don’t hear much about is penile implant surgery.

Penile Implants Decline in Popularity

Penile implant surgery has been around for more than 40 years, but since the advent of drugs like Viagra, Cialis, and Levitra, it has been used less often. A study of Medicare records found that from 2002 to 2010, the use of penile implant surgery for erectile dysfunction dropped by half, from 4.6% of cases in 2002 to 2.3% of cases in 2010. The decline was uniform across ages, ethnicities, and geographic locations.

But even though the popularity of the surgery decreased significantly, use of this surgery actually increased in patients who had significant other medical conditions, like diabetes and obesity. Men who were older than 65 were also more likely to have the surgery. The most likely candidates for the surgery tended to be from the southern and western US (possibly due to higher rates of obesity and diabetes), and were more likely to have other health conditions that contribute to their ED.

Advantages of Penile Implants over Medications

Technological advances have made penile implant surgery successful and satisfying for the overwhelming majority of patients. Around 25,000 of the procedures take place every year, and about 94% say they’re satisfied with the results of the surgery two years later.

One advantage the surgery has over oral medications is that it allows for more sexual spontaneity compared to taking a pill and waiting for it to work, then getting in sexual activity before the effects wear off. With the surgery, a man can have on-demand erections whenever. This can be enough to relieve much of the anxiety and loss of confidence that men with erectile dysfunction feel. And since the surgery provides the capacity for on-demand erections, a man can have a second or third go-around with his partner if he wants.

Another advantage of penile implant surgery is that many insurance policies (including Medicare, but not Medicaid) offer coverage as long as a medical cause for ED has been diagnosed. Prescription coverage for ED drugs is not as common.

What the Surgical Procedure Is Like

Penile implant surgery is still surgery, and that’s enough to discourage many men. However, techniques have advanced to where it’s not as invasive as you may think. The surgeon places two cylinders inside the penis, along with a small pump that stays in the scrotum. A little reservoir filled with sterile water is placed behind the abdominal wall. This water is what creates the erections, when a man presses on the pump.

The surgery takes about 45 minutes, and is usually performed by urologists who specialize in penile implant surgery. With any surgery, there is a slight risk of infection, but complications are rare. Recovery from surgery until a man can “test drive” his surgically enhanced penis takes about four weeks.

Two Main Types of Implants

There are two basic types of penile implants: inflatable and non-inflatable. The non-inflatable implants are semi-rigid. With these, the penis is always semi-rigid, and a man simply positions it properly when he wants to have sex. This is a better choice for someone who doesn’t have the best manual dexterity, and the surgery itself is simpler with non-inflatable implants. That said, not every man is comfortable having a permanent erection, and some men experience thinning of the flesh over the penis over the long term. A non-inflatable implant takes more getting used to after surgery than an inflatable one.

Two types of inflatable penile implants exist: two-piece and three-piece. The two-piece inflatable implants are relatively easy to use, though the pump is small. Only a small amount of sterile water is transferred into the cylinders with this type of implant, so erections are not as hard as they are with a three-piece inflatable device. These implants too can cause thinning of the flesh of the penis over time.

The three-piece inflatable implant has a release valve above the pump that is used to make the erection deflate, and the pump is larger and softer than the pump with the two-piece devices. They transfer more fluid into the cylinders, giving a man the most rigid erection of all surgical options. When not in use, men find this type of pump to be more comfortable. Basically, the penis looks and feels “normal” whether erect or flaccid. Atrophy of penile flesh is less common with three-piece inflatable devices too. The surgery is more complicated, however, and should only be performed by someone with experience implanting this type of device.

Most couples are very pleased with sexual function after implant surgery.

Most couples are very pleased with sexual function after implant surgery.

How Does Sex With an Implant Work?

There’s a small surgical scar where the base of the penis meets the scrotum, but this scar is basically unnoticeable, so men don’t have to worry about feeling self-conscious in a locker room, for example. A penile implant doesn’t change the sensation a man experiences in his penis, nor his ability to have an orgasm and ejaculate. However, in some men, the natural erection reflex diminishes after surgery, meaning that inflation is eventually always necessary for sex, and if the implant is removed, natural erections may not return. Most men with the implants, nonetheless, are happy with performance and enjoy sexual spontaneity that they can’t always get with medications.

Lifestyle, Then Medications, Then Surgery

Generally speaking, doctors prefer a holistic approach to treating erectile dysfunction. That’s because the lifestyle changes that can improve erectile function (exercise, eating right, not smoking) are also good for the cardiovascular system and over all mental and physical well-being. In some men, however, lifestyle changes simply aren’t enough, and in these cases the next line of defense against ED is typically medication like Viagra, Levitra, or Cialis. These medications have been successfully used by millions of men worldwide, and millions of men are perfectly satisfied with how they work.

If lifestyle modification and medication aren’t able to treat ED to the patient’s satisfaction, surgery may then be proposed. Surgery, obviously, is the most drastic of the treatments for ED, and though techniques have evolved, it’s still surgery. It’s not something a man or his doctor should take lightly. But the vast majority of men who make the considered decision to have implant surgery are in fact happy with the results afterward.

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Don Amerman has spent more than three decades in the business of writing and editing. During the last 15 years, his focus has been on freelance writing. For almost all of his writing, He has done all of his own research, both online and off, including telephone and face-to-face interviews where possible. Don Amerman on Google+