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ED: Penile Prostheses (Erectile Dysfunction)

View a PDF of our "Erectile Dysfunction: Surgical Treatment Options" fact sheet.

Erectile dysfunction (ED) is the inability of a man to attain and/or maintain an erection sufficient for sexual activity. Fortunately, most men who have ED only lose the ability to have satisfactory erections. In other words, for most of these men, penile sensation is normal and the ability to have an orgasm and ejaculate remains. Today, there are several treatment options available to men suffering from this disorder. Lifestyle changes are the first line of treatment with weight loss, smoking cessation and exercise associated with improved erections. For most men, the initial medical treatment will be an oral medication such as Sildenafil citrate. If this treatment is unsuccessful, second-line treatment options are ordinarily considered. These include using a vacuum erection device, intra-urethral medication or penile injection therapy. If these second-line treatments fail or if the patient and his partner reject them, then the third-line treatment option, penile prosthesis implantation, is considered.

What are penile prostheses?

Penile prostheses are devices that are implanted completely within the body. They produce an erection-like state that enables the man who has one of these implants to have normal sexual intercourse. Neither the operation to implant a prosthesis nor the device itself will interfere with sensation, orgasm, ejaculation or urination.

What are the different types of penile prostheses?

There are two erection chambers (corpora cavernosa) in the penis. All penile prostheses have a pair of cylinders that are implanted within both of these erection chambers. The simplest penile prostheses consist simply of paired flexible cylinders that are usually made of medical-grade silicone, and produce a degree of permanent penile rigidity or firmness that enables the man to have sexual intercourse. These devices are either malleable or inflatable. A malleable cylinder prosthesis can be bent downward for urination or upward for intercourse. Inflatable penile prostheses are fluid-filled devices that can be inflated for erection. They are the most natural feeling of the penile implants, as they allow for control of rigidity and size.

The inflatable devices have fluid-filled cylinders that are implanted within the erection chambers. Tubing connects these cylinders to a pump that is implanted inside the scrotum, the sac that contains the testicles. In the simplest of these inflatable devices, the pump transfers a small amount of fluid into the cylinders for erection, which then transfers out of the cylinders when erection is no longer needed. These devices are often referred to as two-component penile prostheses. One component is the paired cylinders and the second component is the scrotal pump.

Three-component inflatable penile prostheses have paired cylinders, a scrotal pump and an abdominal fluid reservoir. With these three-component devices, a larger volume of fluid is pumped into the cylinders for erection and out of the cylinders when erection is no longer needed.

What does penile prosthesis implantation involve?

Penile prostheses are usually implanted under anesthesia. Usually one small surgical cut is made either above the penis where it joins the abdomen or under the penis where it joins the scrotum. No tissue is removed, blood loss is small and blood transfusion is almost never required. A patient will typically spend one night in the hospital.

Most men have pain after penile prosthesis implantation for about four weeks. Initially, oral narcotic pain medication is required and driving is prohibited. If men limit their physical activity while pain is present, it usually resolves sooner. Men can often be instructed in using the prosthesis for sexual activity one month after surgery, but if pain and tenderness are still present, this is sometimes delayed for another month.

What are the complications of penile prosthesis surgery?

Infection occurs in 1 to 3 percent of cases. This is a significant complication because in order to eliminate the infection, it is almost always necessary to remove the prosthesis. In 1 to 3 percent of cases, erosion occurs when some part of the prosthesis protrudes outside the body. Erosion often is associated with infection and removal of the device is frequently necessary.

Mechanical failure is more likely to occur with inflatable than with a malleable or semi-rigid prostheses. The fluid present inside the inflatable prosthesis leaks into the body; however, these prostheses contain normal saline that is absorbed without harm. After mechanical failure, another operation for prosthesis replacement or repair is necessary if the man wants to remain sexually active. Today's three-component inflatable penile prostheses have about a 10 to 15 percent likelihood of failure in the first five years following their implantation.

Frequently asked questions:

Is penile prosthesis implantation covered by insurance?

Although all third-party payers do not cover penile prosthesis implantation, most including Medicare do if the prosthesis is implanted to treat erectile dysfunction caused by an organic disorder.

Will a penile prosthesis interfere with urination?

It normally does not.

Where can I get more information?

ED: Non-Surgical Management

ED: Surgical Management

Hormone Health Network's Erectile Dysfunction Fact Sheet

Urology Care Foundation Patient Brochure:
Sexual Health Series: Erectile Dysfunction

Urology Care Foundation Fact Sheets:
Erectile Dysfunction
Diagnosing Erectile Dysfunction
Treating Erectile Dysfunction: Medical Options
Treating Erectile Dysfunction: Surgical Treatment Options
Preventing Erectile Dysfunction: What You Should Know

Reviewed: January 2011

Last updated: April 2014

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ED: Penile Prostheses (Erectile Dysfunction) Glossary
  • abdomen: Also referred to as the belly. It is the part of the body that contains all of the internal structures between the chest and the pelvis.

  • abdominal: in the abdomen, the cavity of this part of the body containing the stomach, intestines and bladder.

  • anesthesia: Loss of sensation in any part of the body induced by a numbing or paralyzing agent. Often used during surgery to put a person to sleep.

  • blood transfusion: The transfer of blood from a healthy donor into the bloodstream of somebody who has lost blood or has a blood disorder.

  • citrate: A salt of citric acid.

  • corpora: Plural of corpus. The main portion of something, such as an organ or other body part, or a mass of tissue with a distinct function.

  • corpora cavernosa: Two cylinder-shaped bodies that lie side by side in the penis and that, when filled with blood, enlarge to cause the penis to swell and become erect.

  • ED: Also known as erectile dysfunction or impotence. The inability to get or maintain an erection for satisfactory sexual intercourse.

  • ejaculate: The fluid that is expelled from a man's penis during sexual climax (orgasm). To release semen from the penis during an orgasm.

  • ejaculation: Release of semen from the penis during sexual climax (orgasm).

  • erectile: Capable of filling with blood under pressure, swelling and becoming stiff.

  • erectile dysfunction: Also known as ED or impotence. The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence.

  • erectile dysfunction: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence.

  • erection: Enlargement and hardening of the penis caused by increased blood flow into the penis and decreased blood flow out of it as a result of sexual excitement.

  • erection: Enlargement and hardening of the penis caused by increased blood flow into the penis and decreased blood flow out of it as a result of sexual excitement.

  • erosion: The wearing away of surface tissue by disease, ulceration, cancer or the chemical processes associated with inflammation.

  • gas: Material that results from: swallowed air, air produced from certain foods or that is created when bacteria in the colon break down waste material. Gas that is released from the rectum is called flatulence.

  • infection: A condition resulting from the presence of bacteria or other microorganisms.

  • ions: Electrically charged atoms.

  • malleable: Able to be shaped or bent.

  • orgasm: The climax of sexual excitement, consisting of intense muscle tightening around the genital area experienced as a pleasurable wave of tingling sensations through parts of the body.

  • penile injection therapy: Treatment for impotence that utilizes a combination of drugs that are injected into the side of the penis. The drugs relax the muscles and increase blood flow to create an erection.

  • penile prostheses: Semirigid or inflatable devices that are implanted into penises to alleviate impotence.

  • penis: The male organ used for urination and sex.

  • prosthesis: Artificial body part.

  • saline: Containing salt.

  • scrotal: Relating to the scrotum, the sac of tissue that hangs below the penis and contains the testicles.

  • scrotal: Relating to the scrotum, the sac of tissue that hangs below the penis and contains the testicles.

  • scrotum: Also referred to as the scrotal sac. The sac of tissue that hangs below the penis and contains the testicles.

  • testicle: Also known as testis. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • tissue: Group of cells in an organism that are similar in form and function.

  • transfusion: Transfer of whole blood, blood components or bone marrow from a healthy donor into the bloodstream of somebody who has lost blood or who has a blood disorder.

  • urethra: A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.

  • urethral: Relating to the urethra, the tube tha carries urine from the bladder to outside the body.

  • urge: Strong desire to urinate.

  • urination: The passing of urine.

  • vacuum erection device: A device used for treatment of impotence that features a pump that draws air from a plastic cylinder placed over the penis and creates a vacuum that allows increased blood flow to the penis which causes and erection.

  • vas: Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

ED: Penile Prostheses (Erectile Dysfunction) Anatomical Drawings

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