A penile implant (also called a penile prosthesis) is a surgically placed, mechanical device that helps a man get an erection—and keep it—for as long as he likes. It’s one of several treatment options for men with erectile dysfunction (ED). And it has high satisfaction rates.

Still, men need to weigh some important pros and cons before getting an implant. Read on to learn more about the different types of implants, the surgery involved, and what men can expect afterward.

Why do men choose penile implants?

Erectile dysfunction—the inability to get an erection firm enough for sex—is a common problem. While there are several treatments available, such as pills, self-injections, and vacuum devices, they’re not suitable for all men. For example, men who take nitrates for heart conditions cannot use ED medications because of a dangerous drug interaction.

Success with ED treatments can vary, too. What works for one man may not work for another. Generally, men try other ED treatment options before deciding on an implant.

Men with Peyronie’s disease may also get penile implants. This condition causes the penis to bend, sometimes to a point where intercourse becomes quite difficult. An implant can straighten the penis and help with any erection problems.

Transgender men may get penile implants as they undergo gender affirmation surgeries. During these procedures, surgeons create a penis and may implant a prosthesis to aid sexual activity.

Types of penile implants

In general, there are two different types of implants:

Inflatable implants

The most common type of implant is a 3-piece inflatable implant. The three parts are connected by tubes. They include:

• A pair of inflatable cylinders that are inserted into the shaft of the penis
• A fluid-filled reservoir placed in the abdomen
• A pump placed in the scrotum

When a man wishes to have an erection, he simply activates the pump in his scrotum. Saline fluid from the reservoir then moves into the cylinders and inflates them, creating the erection. When the man is done with sexual activity, he presses on the pump again. The cylinders deflate and the fluid moves back to the reservoir.

A 2-piece inflatable implant is also available, but it’s less common. This type works in a similar way, but the reservoir and the pump are in the same piece.

Malleable (semirigid) implants

These implants are flexible silicone rods that are inserted into the penis. When a man wants an erection, he can simply lift his penis up into position, then move it back down when he is finished with sexual activity. Malleable implants are not common nowadays, but they might be suitable for men who may have trouble activating a pump in the scrotum.

Advantages of penile implants

• The man has full control. A man can get an erection and keep its firmness for as long as he likes. He can also have as many erections in a day as he wishes.
• They have high satisfaction rates. Studies have shown that the satisfaction rate among men with 3-piece implants is 90% or higher.
• Sex can be more spontaneous. A man does not have to worry about timing the dose of a pill or stopping sexual activity to give himself an injection or use a vacuum device. Instead, he can create an erection in the moment.
• Implants last for years. Some men get 15 to 20 years of use from the same implant before it needs replacing.
• They’re discreet. The penis looks natural. People usually can’t tell if a man has an implant by looking at his penis. (Malleable implants may be an exception, as the penis is always somewhat firm.) During intercourse, partners usually cannot tell that a man has an implant.
• They don’t affect sexual desire or performance. For most men, sexual sensations, ejaculation, and orgasms feel the same as they did before the implant.
• They may boost a man’s sexual confidence. Men may feel less anxious about intimacy knowing that they can get a firm erection every time they have intercourse.

A man can get an erection and keep its firmness for as long as he likes.

Disadvantages of penile implants

• A surgical procedure is involved. Like any surgery, penile implant surgery has risks, such as infection, bleeding, and injury to surrounding areas. However, surgeons take special precautions to lower the risk of complications. Infection rates are estimated to be 1% to 2%. If there is an infection, the device is usually replaced.
• Implants can malfunction. There are times when a penile implant can malfunction, although this is rare.
• They are permanent. Because of the nature of implant surgery, a man can no longer have natural erections once he has an implant. Other ED treatments, such as pills or injections, will no longer be options.

What happens during penile implant surgery?

Before surgery, a man’s doctor will tell him how to prepare. The man may receive special instructions for taking medications or supplements, eating and drinking, and bathing beforehand.

The surgery itself is performed under general anesthesia and takes about one to two hours. It may be done as an outpatient procedure, and many men can go home the same day. However, some men may need to spend a night in the hospital.

To implant the device, the surgeon makes a small incision in the genital area. The inflatable cylinders (or bendable rods, if a malleable implant) are inserted into the shaft of the penis. If it is a 3-piece inflatable device, small incisions are made so that the reservoir can be placed in the abdomen and the pump can be placed in the scrotum. The pieces are then connected and the incisions are closed. The man may have a temporary surgical drain.

Men having implant surgery will need to have someone drive them home. They should also have someone stay with them for the first day or two.

Note: Not all men are good candidates for implant surgery. Men who are at higher risk for complications and those who have heart disease or poorly managed diabetes may not be able to have surgery.

Recovering from penile implant surgery

Back at home, men recovering from implant surgery may experience swelling, pain, or discomfort for the first week. These symptoms may be managed with medicines and ice packs. If there is a drain, it will be removed in the first few days after the procedure.

Men will need to avoid heavy lifting and vigorous activity, including exercise, for up to four weeks. If they work a desk job, they can return to work after a week or so. Men with more physical jobs may need to wait up to four weeks before returning to work.

Sex—both intercourse and masturbation—will need to wait four to six weeks while the body heals. At this time, the man’s doctor will teach him how to use the implant.

Men who have the following symptoms during recovery should call their doctor right away:

• Heavy bleeding
• Fever
• Worsening pain
• Infection

Adjusting to a penile implant

It may take time to adjust to sex with a penile implant. However, many men find that their sex life improves, knowing that they can now count on having a firm erection. Men who have problems with their device or have further questions should talk to their doctor.

Resources

Cleveland Clinic

“Penile Implants”
(Last reviewed: November 11, 2022)
https://my.clevelandclinic.org/health/treatments/10054-surgical-penile-implants

EAU Patient Information (European Association of Urology)

“Penile Implants”
https://patients.uroweb.org/treatments/penile-implants/

“Penile Implants”
https://patients.uroweb.org/penile-implants2/

Medscape

Hellstrom, Wayne John G., MD, FACS
“Penile Prosthesis Implantation”
(Updated: June 14, 2022)
https://emedicine.medscape.com/article/446761-overview

Urology Care Foundation (American Urological Association)

“Penile Implant”
https://www.urologyhealth.org/healthy-living/urologyhealth-extra/magazine-archives/spring-2020/insights-penile-implant-x8259

“What to Know about Penile Implants with Dr. Melissa Mendez”
(Urology Care Podcast. 2021)
https://www.urologyhealth.org/healthy-living/urology-care-podcast/sexual-health-podcasts/what-to-know-about-penile-implants-with-dr-melissa-mendez

Sex can be a sensitive topic for any couple. Some people are shy about their bodies or feel embarrassed discussing a subject so private and personal. But there are times when sexual issues need attention, and Peyronie’s disease can be one of those times.

Peyronie’s disease can make intercourse difficult—and sometimes impossible. Plaques (scar tissue) form just beneath the skin of the penis, which becomes less flexible. As a result, the penis starts to bend. The extent of the curvature varies, but it can be as high as 90 degrees.

If there are lots of plaques, the penis might take on an hourglass shape. It could also narrow at the tip (a “bottleneck” deformity) or at the base (a “cobra head” deformity). For some men, there is a “hinge” effect that could make the penis unstable during an erection

Peyronie’s disease can be painful, too. And some men develop erectile dysfunction. They may have sex less often or stop having sex altogether.

There’s an emotional component to Peyronie’s disease as well. Men may feel ashamed of the way their penis looks, have doubts about their masculinity, and worry that their partner will think they’re less attractive. They may also feel anxious about their partner’s sexual satisfaction and fear changes in the relationship. Depression is common, as many men miss the robust sex life they once enjoyed.

And Peyronie’s disease impacts partners. They often notice that the relationship has changed and miss what used to be. If the man with Peyronie’s withdraws, partners may feel isolated or neglected.

Fortunately, like many sexual problems, Peyronie’s disease can be treated in several ways. The process starts with a conversation. And good communication between partners can make treatment more successful.

Broaching the subject

Couples might start the conversation when they’re alone and feeling relaxed.
Here are some sample openings:

There’s something that’s been on my mind lately—something sexual—and I was hoping we could talk about it.

• I really enjoy our intimate times together, but there’s something troubling me. Can we talk?
• It’s okay to admit to feeling nervous or awkward. Often, the subject has been on the partner’s mind, too, but they haven’t been sure how to approach it. Starting the dialogue might bring a sense of relief.

Opening up

Peyronie’s disease comes with a range of emotions, and it’s good to get those out in a constructive way. Frustration, depression, fear, anxiety—they’re all valid. When such feelings are out in the open, couples gain some perspective. They can listen to each other, reassure each other, and approach the future together, as a team.

Keeping the conversation going

Talking about Peyronie’s disease doesn’t need to be a “one and done” conversation. Over time, and as treatment progresses, feelings and perceptions might change. Checking in with each other from time to time can enhance the overall dialogue.

Learning together

Peyronie’s disease isn’t a term people hear every day. For some, it might be brand new. Researching the topic together is another way to keep the conversation going. Some couples share what they discover online, on television, or in magazines. They might also attend doctor’s appointments together and ask questions.

Exploring together

Peyronie’s disease doesn’t have to stop a couple from being intimate, and sex is more than intercourse. Couples can focus on what is possible and enjoyable. This part of the conversation can be creative and fun.

Staying supportive

Encouragement is important for couples facing Peyronie’s disease, and each partner can be a cheering section of sorts. For example, after a man finishes a round of
treatment, a partner might say, “That couldn’t have been easy. I’m proud of you!” Or if a man has trouble keeping an erection during a sexual encounter, the partner might say, “That’s okay. I love what we do together.”

Considering counseling

Even when they have the best of intentions, couples may still struggle with communication. This is when a couples counselor might help. A trained therapist can teach strategies for expressing thoughts clearly, listening respectfully, and responding constructively. Urologists can make referrals for therapy.

For single men

For single men with Peyronie’s disease, starting new sexual relationships can be especially daunting. If they are still getting to know a new partner, they may be unsure of what to disclose and when.

Much of the advice above can apply to single relationships. Building trust takes time, but couples just starting out can still have similar conversations about Peyronie’s disease and its effects on intimacy.

A man might say, “Before we take the relationship further, there’s something I want to talk to you about.” If the relationship has been supportive and based on trust up to this point, chances are the partner will respond positively and be open to discussing other options for intimacy while the man seeks treatment.

Wrapping up

Sometimes the hardest part of having a sexual discussion is starting it. But all it takes is a deep breath. It may not be perfect or go exactly as planned, but starting the conversation is usually better than not having it at all.

Resources

Association of Peyronie’s Disease Advocates

“Impact on Relationships”
https://www.peyroniesassociation.org/living-with-peyronies/impact-on-relationships/

“Talking to Your Partner”
http://www.peyroniesassociation.org/living-with-peyronies/talking-to-your-partner/

“Psychological Impact of Peyronie’s disease”
Video available at: https://www.peyroniesassociation.org/living-with-peyronies/impact-on-relationships/

Saga.co.uk

Green, Siski
“Living with Peyronie’s disease: the impact on sex and relationships”
(Updated: March 17, 2021)
https://www.saga.co.uk/magazine/relationships/love-sex/living-with-peyronies-disease-impact-on-sex-relationships

Sexual Medicine Reviews

Kern, T., et al.
“Peyronie’s Disease: What About the Female Sexual Partner?”
(Abstract. Published: December 17, 2020)
https://www.smr.jsexmed.org/article/S2050-0521(20)30117-7/fulltext

Translational Andrology and Urology

Terrier, Jean E. and Christian J. Nelson
“Psychological aspects of Peyronie’s disease”
(Full text. June 2016)
https://tau.amegroups.com/article/view/10542/11177

Peyronie’s disease occurs when areas of hard scar tissue called plaques form on your penis, just below the surface of the skin. In fact, you might be able to feel them.

Technically, the plaques form on the tunica albuginea, the “wrapping” that surrounds the erectile chambers, your corpora cavernosa (two spongy cylinders that fill with blood when you have an erection). The corpora cavernosa sit “on top” of the urethra and the surrounding corpus spongiosum where urine and semen flow. The tunica albuginea that covers the corpus spongiosum is not as thick as that covering the erectile chambers.

When plaques form, the penis becomes less flexible, and you might notice a distinct bend in your penis when it’s erect. Sometimes, the curve is slight and not much of a problem. But in other cases, it’s severe enough to make intercourse difficult. Some men with Peyronie’s disease can’t have intercourse at all.

Fortunately, there are treatments available, and we’ll go over all your options with you.

What causes Peyronie’s disease?

Scientists aren’t completely sure what causes Peyronie’s disease, but many experts believe it’s a wound healing disorder. In other words, you might have injured your penis and it’s having trouble healing. How might an injury happen? It could be from especially energetic sex that might bend your penis. But it can also happen if you’ve had some kind of penile trauma, such as from an accident or a sport injury.

Men with connective tissue disorders (such as Dupuytren’s contracture) may be at higher risk for developing Peyronie’s disease. It might also run in families.

What are the symptoms of Peyronie’s disease?

The curved penis and plaques are the most obvious symptoms of Peyronie’s disease

The curved penis and plaques are the most obvious symptoms of Peyronie’s disease, but there are others as well:

• Deformities. Extensive plaques all around the tunica albuginea can make the penis shaft look indented in the middle, like an hourglass – i.e., an “hourglass” deformity. If the tip of the penis is narrower, it’s called a “bottleneck” deformity. If the base (closest to the body) is narrower, it’s called a “cobra head” deformity. There might also be a “hinge” effect that causes the penis to be unstable when erect.
• Bumps on the penis. Because of the plaques beneath the skin, the surface of the penis can become bumpy.
• Pain during erections.
• Weak erections.
• Erectile dysfunction.
• Trouble with intercourse.
• Penile shortening.

Peyronie’s disease can affect men emotionally and psychologically, too. Having a sexual problem can be distressing. You may feel embarrassed by the curve and anxious about the cause. If you have a partner, you may worry about your ability to sexually satisfy them. If you don’t, you may have concerns about dating and sex with a new partner. If you sense changes in your relationships, you may feel depressed, confused, or frustrated.

Many men with Peyronie’s disease don’t seek treatment because they feel ashamed. But remember, as urologists, we see a lot of delicate conditions, and are here to help.

Note that Peyronie’s symptoms typically emerge over time. It can be helpful to consider Peyronie’s occurring in stages.

What are the stages of Peyronie’s disease?

The treatment path we take depends on the stage of your Peyronie’s disease.

Peyronie’s disease typically progresses in two stages: active and stable.

During the active stage, symptoms start developing. Some common characteristics of the active stage are:

• Glandular pain or discomfort, with or without an erection.
• Penile curvature.
• Penile buckling during intercourse.
• Other deformities, such as penile shortening, narrowing, indentation, hinge effect, or hourglass effect.
• Painful erections.
• Difficulty getting an erection.
• Psychological and emotional distress.

The active stage usually lasts between 5 and 7 months, but may be longer for some men. Your symptoms can change during this time, too.

By the stable stage, the situation settles down. In fact, we consider you in the stable phase once your symptoms have remained unchanged for at least 3 months. Here’s what you might expect during the stable stage:

• Plaques stop forming, but they can still be detected in a physical exam or through an ultrasound.
• Penile deformities, including curvature, don’t worsen. For example, if your penis starts narrowing during the active phase, it shouldn’t narrow any further during the stable phase.
• You may still have pain, but it might be less frequent or severe.
• Getting and keeping an erection may still be difficult.
• Intercourse may be difficult due to pain and penile deformity.
• Psychological and emotional distress may continue.

It may take 12 months or even longer to have stable disease.

How is Peyronie’s disease diagnosed?

When you come see us, we’ll start by asking you about your medical history, especially about your penis health. We’ll want to know if you have any pain or distress. We’ll also ask you about sex and whether you can penetrate a partner. These questions might sound intrusive, but the answers help us determine the right treatment path for you. So it’s important to be completely candid with us.

We’ll also do a physical exam and check your penis for plaques. We will also plan an intracavernosal injection test (also called an ICI test). For this test, we’ll inject medicine that induces a short-term erection. Since the curve associated with Peyronie’s disease happens when your penis is erect, the ICI test will give us a clearer picture of your situation. (Note: The ICI test might not occur at the same time as your physical exam.)

You might also have a duplex Doppler ultrasound. This imaging test uses sound waves to show us where the plaques are and how well blood is flowing in your penis.

It might help us to take pictures of your penis, too. Photographs can help us monitor your progress. Rest assured that we will never take photos without your permission, and any photos we do take will remain private and secure.

How is Peyronie’s disease treated?

Do all men with Peyronie’s disease need treatment? Not necessarily. If you’re situation isn’t causing you any distress and you can still have intercourse, you may decide to wait and see what happens. Also, some cases of Peyronie’s disease resolve on their own. This isn’t that common; it happens in about 13% of men. But for this reason, we usually start with more conservative treatments during the acute stage.

Treatment options include injections, traction therapy, Shock Wave Therapy, and surgery

Injections

Injections have a good track record for success in many men. Medicine is injected directly into the plaque. You’ll be given a numbing agent beforehand, so you shouldn’t feel much. The specific medication we’ll inject will depend on the particular characteristics of your case.

Collagenase clostridium histolyticum (CCH)

This treatment is typically used for men who have stable disease and curvature between 30 and 90 degrees. In the United States, CCH injection therapy is marketed under the name of Xiaflex^®.

Collagenase is an enzyme that helps your body heal wounds. As a Peyronie’s treatment, it can help break down the plaques on the tunica albuginea.

This route takes time. We generally give CCH injections in cycles over the span of several months. During the first cycle, you might have 2 injections during one week. Then, you’ll take a 6-week break with no injections. Then, you’ll have another 2-injection cycle, take another break, and so on. Most men receive 4 cycles, but additional cycles can be scheduled as needed.

Sometimes, CCH treatment is combined with a technique called modeling. At this time, we’ll gently stretch the penis into a straight position with our hand and hold it in place for 30 seconds. We might give you modeling exercises to do at home, too. We’ll teach you how to do them.

Side effects of CCH injections may include bruising, swelling, pain. Penile fracture, while not common, is also possible. Call us immediately (or go to your local emergency department) if you hear a “popping” sound or experience severe pain, bruising, swelling, difficulty urinating, or a sudden inability to maintain an erection.

Interferon

Interferon is a protein that may break down the plaques. Side effects of this approach are sinus infections, flu-like symptoms, and minor swelling.

Verapamil

Verapamil is a drug that is usually used to treat high blood pressure. Side effects of this treatment include bruising, dizziness, nausea, and pain at the injection site.

Penile Stretching Devices (Traction Therapy)

Some men benefit from penile stretching devices, either on their own or in conjunction with other treatments. (This method is also called traction therapy.) Specific instructions depend on the model used, but typically men wear the device on their penis for a specified period of time, from 30 minutes to several hours. The stretching device pulls the penis into a straight position and holds it in place. Studies have shown penile stretching to be safe and effective, with few side effects. We will show you how to use your device correctly.

One example of a penile traction device is Restorex. This device allows you to straighten the penis and bend it in the opposite direction of your Peyronie’s curve. The device clamps on to the flaccid (not erect) penis, and you control the amount of traction and bending desired. If you use Restorex, you’ll start your traction session by wearing the device in a straight position. After a specified time (up to 15 minutes), you’ll adjust it to an angled position. Depending on your situation, you may have up to an hour of therapy time each day (for example, two 30-minute sessions). For greater comfort, you might wrap your penis with gauze before clamping the device.

It can take some time to get used to using a penile traction device, but don’t get discouraged. We are here to answer all your questions.

Shock Wave Therapy

Another option for treating Peyronie’s-related pain is extracorporeal shock wave therapy (ESWT). With this approach, urologists use a special device to deliver shock waves to the plaques. (Extracorporeal means “outside the body.” The device will be outside your body at all times.) Past studies have reported side effects like pain during treatment, hematoma (similar to a bruise), and petechiae (small, round purple spots that form on the skin when small blood vessels bleed). However, these side effects went away on their own.

Surgery

If your curvature is severe, you might need surgical treatment. Typically, surgery is not recommended until Peyronie’s enters the chronic stage, when symptoms have stabilized. This could be several months after your diagnosis.

Depending on your situation, we may recommend one of these 3 surgical approaches:

Tunical plication

This method involves placing sutures on the plaque-free side of your penis to straighten it. There are a couple of ways to do this. One is to cut out a small piece of tissue and stitch the area closed. Another is to fold over the tissue and suture it in place. Both of these techniques pull the penis into a straight position. The advantage of this technique is that the erection’s quality is not typically affected. The disadvantage is that although the penis gets straightened, the side without the plaque gets shortened to make it the same size as the affected side.

Incision/excision and grafting

With this technique, we cut into the plaque and stretch the penis out. Then, we fill the area with tissue called a graft. Graft material might come from another part of your body or from an animal. We might also use a synthetic material as a graft. The grafting approach is usually recommended for men with more severe cases of Peyronie’s disease. The advantage is that length is preserved. The disadvantage is that there is a higher rate of future erection problems or, rarely, sensory changes, as compared with the plication techniques.

Penile prostheses (implants)

A prosthesis is a medical device that allows you to have an erection. If you’ve developed erectile dysfunction, this might be an option for you.

During an implant procedure, we place inflatable cylinders that get filled with saline into the corpora cavernosa (the spongy cylinders in your penis that normally fill with blood to make a firm erection. In this way, the penis stays erect. The penis can be straightened during the operation after placement of the cylinders (modeling procedure). We also place an easy-to-access pump in your scrotum.

When you want to have an erection, you simply press a button on the pump, and the cylinders inflate with fluid that is stored in a special reservoir. When you are finished with sexual activity, you can press the button again and the cylinders deflate.

The process might sound cumbersome, but most men are highly satisfied with their prostheses. For many men, sexual sensations, orgasm, ejaculation don’t change, and sexual partners often can’t tell that a man has a prosthesis.

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After your surgery, we’ll give you detailed information on what you can expect during recovery and when you can have intercourse again. If you have any questions, just give us a call.

 

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Resources

American Urological Association

“Peyronie’s Disease (2015)”
(Published: 2015)
https://www.auanet.org/guidelines/peyronies-disease-guideline

HealthCommunities.com

“Basics of Peyronie’s Disease”
(Last modified: September 29, 2015)
https://web.archive.org/web/20200206181531/http://www.healthcommunities.com/peyronies-disease/overview-of-peyronies.shtml

International Society for Sexual Medicine

“Girth Changes May Not Bother Men With Peyronie’s Disease”
(August 16, 2020)
https://www.issm.info/news/sex-health-headlines/girth-changes-may-not-bother-men-with-peyronies-disease/
“Generally, how satisfied are men with their penile implants?”
https://www.issm.info/sexual-health-qa/generally-how-satisfied-are-men-with-their-penile-implants/

The Journal of Sexual Medicine

Alom, Manaf, MBBS, et al.
“Efficacy of Combined Collagenase Clostridium histolyticum and RestoreX Penile Traction Therapy in Men with Peyronie’s Disease”
(Full-text. Published: April 4, 2019)
https://www.jsm.jsexmed.org/article/S1743-6095(19)30432-1/fulltext
Joseph, Jason, MD, et al.
“Outcomes of RestoreX Penile Traction Therapy in Men With Peyronie’s Disease: Results From Open Label and Follow-up Phases”
(Full-text. Published: November 20, 2020)
https://www.jsm.jsexmed.org/article/S1743-6095(20)30939-5/fulltext

Mayo Clinic

“Peyronie’s disease – Diagnosis & treatment”
(April 4, 2020)
https://www.mayoclinic.org/diseases-conditions/peyronies-disease/diagnosis-treatment/drc-20353473

MedlinePlus

“Duplex ultrasound”
(Page last updated: January 5, 2021)
https://medlineplus.gov/ency/article/003433.htm

Sexual Medicine Reviews

Krieger, Jordan R., MD, et al.
“Shockwave Therapy in the Treatment of Peyronie’s Disease”
(Full-text. Published: March 26, 2019)
https://www.smr.jsexmed.org/article/S2050-0521(19)30007-1/fulltext

Sexual Medicine Society of North America

“Having CCH Injections for Peyronie’s Disease? Don’t Give Up!”
https://www.smsna.org/patients/news/having-cch-injections-for-peyronie-s-disease-don-t-give-up

Up To Date

Khera, Mohit, MD, MBA, MPH
“Patient education: Sexual problems in men (Beyond the Basics)”
(Last updated: February 10, 2020)
https://www.uptodate.com/contents/sexual-problems-in-men-beyond-the-basics

Urology Care Foundation

“What is Peyronie’s Disease?”
(Updated: September 2020)
https://urologyhealth.org/urology-a-z/p/peyronies-disease