Penile Implants and Other ED Treatment Options

The ED Treatment Pathway

Treatment for ED typically follows a step-by-step approach, starting with the least invasive options. If first-line treatments are not effective, your doctor may recommend moving to the next level.

What Is a Penile Implant (Penile Prosthesis)?

A penile implant, also called a penile prosthesis, is a medical device that a urologist surgically implants completely inside the body to treat erectile dysfunction (ED). It lets a man get an erection firm enough for sex when he chooses, and no part of it shows on the outside.

Medical guidelines describe an implant as an option when other ED treatments, such as pills, injections or a vacuum device, have not worked, or when a man prefers a lasting solution [7][8]. The European Association of Urology (EAU) gives this a strong recommendation, as long as patients are fully informed about the benefits and harms [7]. With proper counseling, implants have one of the highest satisfaction rates of any ED treatment: 92–100% of patients and 91–95% of partners in the studies the EAU reviewed [7].

There are two things to know up front. First, an implant is best thought of as permanent. It can be removed, but other ED treatments are unlikely to work reliably afterward [8]. Second, an implant makes the penis firm. It does not change sex drive, and it does not improve orgasm or ejaculation [8]. Talk to your urologist about what an implant can and cannot do for you. Learn more: what a penile implant is and how a penile prosthesis works.

Types of Penile Implants: Inflatable vs. Malleable

There are two main classes of penile implants: inflatable and semi-rigid, also called malleable [7].

• Three-piece inflatable. Two cylinders sit inside the penis, a small pump sits in the scrotum, and a fluid reservoir sits in the lower belly. Squeezing the pump fills the cylinders and creates an erection. Pressing a release lets the penis go soft again. Many men prefer this type because the erection feels more "natural," although no randomized trials have compared satisfaction between types [7].
• Two-piece inflatable. This type has no separate reservoir in the belly. It may suit men for whom a reservoir would be risky, such as after certain abdominal surgeries, and it can be easier to operate [7][8].
• Malleable (semi-rigid). Two bendable rods keep the penis firm at all times. You bend it up for sex and down for daily life. The surgery is simpler and the device is easy to use, which can help men with limited hand strength. The trade-off is constant firmness that is harder to hide [7][8].

No head-to-head studies show that one manufacturer's implant, or one type, is better than another [7]. Your urologist will help you choose based on your body, your health and your preferences. Rigicon makes both inflatable and malleable implants; product availability differs by country.

Penile implants are also used in transgender men after phalloplasty; this needs specialized surgical planning. Learn more in our guide to penile implants for transgender men.

Penile Implant Surgery: What to Expect

How it is done. The surgeon makes one small cut, most often where the penis meets the scrotum or just above the penis. Studies show no clear advantage of one approach over the other [7]. The cylinders or rods go inside the two erection chambers of the penis. For inflatable devices, the pump goes in the scrotum [7].

Before surgery. Any infection in the body, on the skin or in the urine must be treated first [8]. Your team will also review conditions such as diabetes, which raises the risk of implant infection [7].

Risks. The two main problems are infection and mechanical failure [7]. With careful technique and antibiotics, infection after a first implant is about 2–3% in low-risk patients at high-volume centers. With coated devices it can fall to 1–2% [7]. An infected implant usually has to be removed [8]. Less common problems include erosion of the device through tissue (1–6%) [7]. See the downsides and risks of a penile prosthesis.

How long it lasts. In a large review summarized by the EAU, 87.2% of implants were still working at 5 years, 76.8% at 10 years, and 52.9% at 20 years [7][5]. Ask your surgeon about their own experience and results, and see how many years a penile implant lasts.

Recovery and Life After Penile Implant Surgery

Recovery is different for everyone, and your surgeon sets your schedule. In one study at a single center, patients stayed in the hospital a little over one day on average, and the drain was removed the day after surgery [10].

Pain. Some pain is normal at first, and it usually fades over a few weeks. In a U.S. study of 96 men who had a three-piece inflatable implant, about half (47.9%) reported no pain by two weeks. Severe pain dropped from 46.2% of men on day 2 to 11.1% on day 30 [9]. Lingering discomfort was most often in the shaft or head of the penis [9].

Using the device. An inflatable implant is not used right away. In the single-center study above, the surgeon first showed patients how to inflate and deflate it about four weeks after surgery, once swelling had gone down and the wound had healed [10]. Your surgeon decides when you can start using the device and resume sex.

Infection. Infection usually appears within the first three months [8]. Contact your surgeon promptly if anything about your healing worries you. Guidelines recommend talking through pain, healing and the time until you can safely use the device before surgery [8]. See also: whether a catheter is needed after penile implant surgery.

What Does a Penile Implant Look Like?

From the outside, an implant is hidden. All parts sit inside the body.

Inflatable implant. When the device is deflated, the penis is soft and hangs naturally. When it is inflated, the penis is firm and erect [7].

Malleable implant. The penis is always firm. You can bend it down for daily wear, but it cannot be "deflated," so it can be harder to conceal [7][8].

Before and after: what changes and what doesn't. An implant makes the shaft of the penis rigid. It usually does not make the head of the penis (the glans) firmer [8]. Some men feel their erect penis is shorter than their natural erections were years ago. In one study cited by the American Urological Association (AUA), 72% of men said their length had decreased, yet measurements before surgery and six months after were statistically the same [8]. Possible reasons include memories of erections from before ED began, tissue that has lost stretch over time, and weight gain in the pubic area [8]. Men with scarring from an earlier implant or from priapism may also lose some girth [8]. Ask your surgeon what to expect for your own body before surgery, and see whether a partner can tell.

Penile Implant Cost and Insurance

The total cost of a penile implant includes the device, the surgeon, anesthesia, and the hospital or surgery center. It varies with where you live, the type of implant, your health and your insurance plan. The AUA notes that cost can be one reason a malleable implant is chosen [8].

Coverage. Whether a penile implant is covered depends on your country's health system and on your insurance plan, and usually on medical need. Rules differ from country to country and from plan to plan.

Before you schedule: ask your urologist's office to check your benefits, ask whether your plan or health system needs to approve the surgery in advance, and request a written estimate that covers the surgeon, the facility and anesthesia. See also the average cost of a penile implant and whether insurance covers penile implant surgery.