How Does a Penile Prosthesis Work?

A penile prosthesis (also known as a penile implant) is a medical device implanted into the penis to allow men with erectile dysfunction (ED) to achieve an erection suitable for sexual intercourse. It is typically recommended when other treatments like medications or vacuum erection devices are ineffective or not desired.

There are two main types of penile implants:

• Inflatable Penile Prosthesis (IPP): This is the most common type and consists of three parts—two inflatable cylinders placed inside the penis, a fluid reservoir implanted in the abdomen, and a pump located in the scrotum. To achieve an erection, the patient presses the pump, transferring fluid from the reservoir into the cylinders. To deflate, a release valve allows the fluid to return to the reservoir. This system creates a natural-feeling erection and allows the penis to return to a flaccid state afterward.
• Semi-rigid (Malleable) Prosthesis: This device consists of bendable rods inserted into the penis. The penis remains semi-firm and can be manually positioned for sexual activity. This option is simpler and may be more suitable for men with limited manual dexterity or specific health conditions.

Penile implants are effective and durable, with satisfaction rates reported between 92% and 100% in patients and 91% to 95% in partners. Mechanical reliability is high, especially with modern devices. For example, the mechanical failure rate of three-piece implants is less than 5% at 5 years.

There are risks, as with any surgery, including infection, device malfunction, and discomfort. Infection risk is minimized with antibiotic-impregnated or hydrophilic-coated implants and proper surgical technique. The prosthesis typically lasts 10–15 years, but durability may decline over time (implant survival drops from 93.3% at 1 year to 52.9% at 20 years).

This procedure can also be used in specific cases of Peyronie’s disease with ED or for men who experience priapism that has led to penile damage. However, penile lengthening should not be expected from the prosthesis itself, although some models may help preserve length in cases of penile fibrosis.

Ultimately, the decision to get a penile prosthesis is personal and should be guided by a urologist, taking into account patient preferences, medical history, and manual ability.