Penile implant surgery is a procedure that helps people have and maintain an erection. Penile implants may be suitable for people with erectile dysfunction that has not responded to other treatments or as part of gender-affirming surgery.

Penile implant surgery involves placing a prosthetic device inside the penis and scrotum. This device helps people achieve an erection and regain sexual function.

In this article, we examine the types of penile implants available and how they work. We also take a look at what a person can expect from having penile implant surgery.

Currently, healthcare professionals will most likely recommend penile implants for those with erectile dysfunction (ED) who have not responded to more conservative therapy, such as ED pills.

Other people who may benefit from penile implants include those with Peyronie disease with ED and transgender people who undergo gender-affirming surgery.

The type of implant that a healthcare professional uses will depend on the needs and preferences of the individual.

There are several factors that people and their doctors will need to consider before deciding which implant will be the most suitable, including:

  • size of the penis, glans, and scrotum
  • any history of previous abdominal or pelvic surgery
  • the presence of a colostomy
  • a history of kidney transplant
  • whether or not the penis is circumcised
  • overall health and well-being

There are two types of implant: inflatable and non-inflatable:

Inflatable implant

Inflatable implants consist of two cylinders in the penis and an inflatable pump in the scrotum. As a person squeezes and releases the pump, the cylinders fill with a saline solution, which mimics an erection.

There are three types of inflatable implants:

  • One-piece inflatable: These implants have a saline solution at the end of each cylinder in the penis.
  • Two-piece inflatable: These implants have a saline solution within the pump in the scrotum.
  • Three-piece inflatable: These implants have a fluid-filled container in the abdomen. Three-piece inflatable implants often act and feel more like a natural erection than the other options.

Inflatable implants for transgender people

Recently, experts have designed a new inflatable implant specifically for those who are transgender. The ZSI-475 FTM implant has a single inflatable pump in the shape of testicles, and a stopper in the shape of a penis glans.

Surgeons anchor this implant to the pubic bone. Research suggests that this new implant has a survival of 80% after 9 months.

Semi-rigid or malleable rods

This type of penile implant involves a surgeon implanting two flexible rods into the penis. The implants never change in size or stiffness and maintain a semi-rigid state. People can, however, set the rods in different positions easily.

While the implants usually bend downward, people can straighten them into an upward position for sexual activity.

However, as these implants cause the penis to always be semi-rigid, it may be more uncomfortable than inflatable implants.

When a person inflates or moves the implant into position, it should have a similar feel to a regular erection, both in girth and stiffness.

Research on the success rates of three-piece inflatable penile implants in 126 people over 5 years found that over 80% of the people with the implants and their partners reported high satisfaction rates and a higher quality of life.

While most people regain sexual function after 6 weeks and find no, or a slight, difference in their orgasms, people may also experience the following adverse effects:

  • mechanical implant failure
  • shortening of the penis
  • postoperative pain
  • a difference in penile sensation
  • floppy glans syndrome, where the head of the penis does not become hard

Additionally, surveys on transgender people who received the ZSI-475 FTM implant report that:

  • 85-93% of participants can have penetrative sex with the implant
  • 60% of people reached orgasm after the implantation
  • 93% of participants were satisfied with the ZSI-475 FTM implant

Knowing what to expect before, during, and after the procedure can be helpful in reducing the anxiety of undergoing surgery.

People may wish to have a list of questions about the procedure, aftercare, and what to expect after surgery, such as:

  • What are the risks of surgery?
  • What are the benefits of surgery?
  • Are there any alternatives to surgery?
  • Which types of implant does the surgeon offer, and which would be the best for me?
  • What precautions should I take after surgery?
  • When can I have sex after surgery?

If a healthcare professional believes a person is a suitable candidate for surgery, they will provide the person with detailed instructions on how they should prepare.

Some instructions may include:

  • not eating or drinking anything for a set amount of time before surgery
  • leaving valuables at home
  • shaving or cleaning the area
  • having someone available to drive home

The procedure itself usually lasts for 1-2 hours and takes place at a hospital or outpatient surgery center. It takes place under anesthesia.

During the procedure, the surgeon will make a cut in the penis below the head, and place the implant inside. It is important to customize the size of the implant based on both body and penis size.

For inflatable implants, the surgeon makes small cuts in the scrotum to place the pump and valve. If the surgeon is implanting a three-piece system, they will also make incisions in the abdomen to put the fluid container in place.

People who have this procedure should be able to go home the same day. They will need to take pain medication to help with discomfort, and doctors may prescribe antibiotics to prevent infection.

The doctor will also provide any additional instructions, which may include:

  • waiting for 4-6 weeks after surgery before resuming sexual activity
  • keeping the penis pointing toward the belly button to prevent it from being curved downward
  • when and if stitches will need to be removed
  • when to resume physical activity, work, and exercise
  • instructions for using the implant

The doctor should also provide information on practice exercises involving inflating and deflating the implant each day. These exercises will help stretch the surrounding tissue.

How long a penile implant lasts depends on several factors. People should ask their surgeon the expected lifespan of the implant before undergoing the procedure.

Research suggests that mechanical failures are the most likely reason why an inflatable penile implant will need replacing. If a surgeon implanted the device 3-7 years before the mechanical failure, they may recommend undergoing surgery to replace the implant with a newer device.

However, the mechanical survival rate of an inflatable penile implant is 78.2-85% after 10 years.

Research suggests that transgender people who receive penile implants may experience a higher failure rate. The 5-year survival of penile implants in transgender persons is 75-78%, and up to 22% will experience mechanical failure.

There has not been enough research on the new ZSI-475 FTM implant survival in the long term. However, this implant has a survival of 80% 9 months after surgery.

Below find the answers to some common questions about penile implants.

Are penile implants effective?

According to one study, over 80% of people who underwent surgery and their partners were satisfied with their implant.

Additionally, after 6 weeks, most people did not find any significant difference in their orgasms.

Can penile implants increase penis size?

Penile implants cannot increase penis size.

A side effect of a penile implant is the shortening of the penis. A person should discuss any concerns over the size of their penis after surgery with their healthcare provider.

Are penile implants covered by insurance?

Private insurance companies may cover part of the cost of penile implants if a doctor determines that the procedure is a medical necessity. People should contact their insurance provider to check their coverage and ensure the hospital and surgeon is in-network.

Medicare and Medicare Advantage plans may also cover part of the cost of penile implants if the procedure is medically necessary. A person should always check their plan carefully before electing to undergo surgery.

Penile implant surgery is invasive and carries several risks, such as postoperative infection and pain. However, most people and their partners are satisfied with the implant and find it effective.

The life expectancy of the implant will depend on the specific device a surgeon uses. Research suggests that up to 85% of inflatable implants will continue to work for 10 years.

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