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In a nutshell: what is a penile prosthesis?
When the best piece doesn’t work the way it should, you quickly get frustrated. However, the desperation is particularly great when such an erectile dysfunction becomes the norm and even medically prescribed treatment methods do not work.
In this case, however, there is a solution: the penile prosthesis: Penile prostheses are cavernous implants that are surgically inserted into the penis and thus enable penis enlargement or a stiff penis. As a result, you can finally have satisfying sexual intercourse again and keep your erection even after the orgasm!
Who are penile prostheses suitable for?
A penile prosthesis is usually considered for men who suffer from severe erectile dysfunction over a long period of time and who do not feel any improvement in their ability to have an erection with any other form of therapy. The entire penis is not replaced, but only the erectile tissue that is no longer functioning properly. This makes penile prostheses very discreet and hardly recognizable from the outside. In addition, the penile prosthesis can contribute to the construction of an artificial limb – for example after penile injuries or in transsexual people.
How does the penile prosthesis help with erection problems?
In the case of erectile dysfunction or impotence, men are unable to get or keep an erection for a variety of reasons. The implantation of a penile prosthesis can solve this problem: the penis becomes stiff due to the artificial erectile tissue implants and you can have sex again without any problems – as often and as long as you want. Because even after an orgasm, the penis remains stable. The erection is usually even harder than it would be in its natural state. Penile prostheses can not only cure erectile dysfunction, but even improve erectile function.
Despite this plus point, the penile prosthesis is usually the last resort for men with erectile dysfunction, as there are numerous less invasive and risky treatment methods. These include, for example, taking potency pills or hormones, using the penis pump, injecting active ingredients directly into the erectile tissue or psychotherapy.
What types of penile prostheses are there?
Not all penis prostheses are the same: There are different types, which differ in terms of the naturalness of the erection and the number of components used. The most popular type of penile prosthesis is the hydraulic one, but the semi-rigid penile prosthesis is also frequently used.
➤ Rigid penile prosthesis
The rigid penis prosthesis is a hard implant that keeps the penis permanently erect. Since many patients find this very impractical and stressful, especially in everyday life, the rigid penis pump is no longer used today.
➤ Semi-rigid penile prosthesis
The flexible (semi-rigid) penile prosthesis is a further development of the rigid penile prosthesis and usually consists of silicone with a metal mesh embedded in it. The penis is permanently artificially erect. When not in use, the penis prosthesis can simply be bent down and is therefore easy to conceal in everyday life. The penis can then be bent into the desired position before intercourse.
➤ Hydraulic penile prosthesis
The most modern and natural type is the hydraulic penile prosthesis (three-part implant). In this model, a pump is inserted into the scrotum, which, under pressure, pumps fluid from an artificial reservoir next to the bladder into an artificial erectile tissue in the penis. This causes the penis to erect and become hard. If the penis is to relax again, all you have to do is press a small valve on the pump. Accordingly, the penis prosthesis does not interfere with everyday life and can be used flexibly for sexual intercourse.
Penile prosthesis surgery: How is the penile prosthesis inserted?
The penile prosthesis must be installed in the penis in the form of an operation.
The most modern technique is an operation in which the internal connective tissue is first removed by means of a small incision in the area of the penis root and then the entire prosthesis is inserted into the natural erectile tissue. With the hydraulic penis pump, the liquid reservoir must also be installed next to the bladder and the pump in the scrotum. These two components are then connected to the artificial erectile tissue using a thin tube. All this takes about 1-2 hours. During the operation, the patient is usually under general anesthesia and is therefore not aware of anything.
After the penile prosthesis implantation, the patient should keep bed rest and stay in the hospital for a few days. In the case of a hydraulic penile prosthesis, the patient is not instructed in how to use the penile prosthesis until 3-4 weeks after the operation. the first sexual intercourse should be around 5 weeks – depending on the condition of the surgical wound – are a long time coming and must be enjoyed with caution. Once the surgical wound has healed, attention should still be paid to pain and redness around the sutures to prevent inflammation. After that, however, the implants are no longer visible from the outside. It can be assumed that the implants will hardly wear out and will still be functional and effective decades later.
https://www.youtube.com/watch?v=ICop1UR67_Y Penile prosthesis: implantation of a prosthesis for erectile dysfunction (Dr. Franklin Kuehhas)
Penile prosthesis: implantation of a prosthesis for erectile dysfunction (Dr. Franklin Kuehhas)
What are the risks and side effects of implanting a penile prosthesis?
In addition to the well-known risks of an operation under general anesthesia, the implanted penile prosthesis itself can also cause complications.
The most common complication is the Infection of the penile prosthesis with bacteria or other germs. Such an infection manifests itself in the form of swelling, redness, pain and difficulty in handling the penile prosthesis. This is where antibiotics can help. If that doesn’t help, the implants usually have to be removed.
Another risk of cavernous implantation is that during the operation the urethra or the nerve tracts in the abdomen are injured. A curvature or visible scarring of the penis after the operation is also possible.
Basically, the implantation of the hydraulic penile prosthesis is associated with a higher risk of complications than that of the semi-rigid penile prosthesis. This also applies to use and sexual intercourse: since only the erectile tissue and not the glans itself becomes stiff with a hydraulic penile prosthesis, the glans can be injured during sexual intercourse. Another risk when using the hydraulic penile prosthesis is that the penile implants are overfilled. Paraplegic patients or diabetics are particularly at risk because they only perceive the implant pressure to a lesser extent. Consequences of “overfilling” can be tissue damage in the form of bleeding or ulcers as well as injuries to the urethra. It is therefore important to slowly approach the use of the penile prosthesis and test step by step how much the implants can be filled without causing pain or injury.
Who bears the costs for the penile prosthesis?
Those with statutory health insurance usually have to pay the entire amount for the implantation of the penile prosthesis; Privately insured, on the other hand, can normally count on a cost sharing of 50%. How much the health insurance will cover should be clarified before the operation, since the operation is about €11,000 costs.
The explanations and lists of possible treatment options are purely informative and do not replace consultation with your doctor or the explanations about the intake, mode of action and side effects from the product-specific leaflet.
Isabel D White
Isabel led the Royal Marsden Hospital (London) psychosexual therapy service until 2019. She works in partnership with individuals & couples to explore physical, emotional & relationship factors that contribute to sexual difficulties after cancer. These include: low desire, erection, arousal or orgasmic difficulties, sexual pain & sexual avoidance. She adopts an integrative approach to personalized therapy using psychosexual therapy (sensate focus framework), biomedical management (erectile dysfunction medication & devices, menopause & vaginal health strategies, sexual aids) & psychoeducation.
