Peyronie’s Disease: Is a Penile Implant the Best Solution for You?

If you have Peyronie’s disease with erectile dysfunction and penile curvature that hampers your sex life or causes pain, a penile implant could be the best solution.

“Generally, placement of a penile prosthesis will fix the erectile function completely, and it can improve, or in some cases fully resolve, the penile curvature,” says Landon Trost, MD, a urologist specializing in Peyronie’s disease in Orem, Utah, and the president-elect of the Sexual Medicine Society of North America.

“The decision is certainly a big one,” says Sherita King, MD, the director of sexual medicine and prosthetic urology at Augusta University in Georgia. “A lot of men go through this procedure, and they just have to figure out how bad they want to get back to having penetrative intercourse, and if they're willing to go through surgery to get there.”

Typically, men with Peyronie’s turn to implants when other treatments are not working.

Sevann Helo, MD, an assistant professor of urology with the Mayo Clinic College of Medicine and Science in Rochester, Minnesota, describes the ideal candidate as a man who:

• Cannot get or keep an erection firm enough for sex
• Has not had success with other treatments, including injection therapies, medications, vacuum and stretching devices
• Is healthy enough for a minor surgery
• Has realistic expectations about the results and how implants operate.

“The best candidate for a penile implant isn’t the man looking for perfection,” Dr. Helo says. “It’s the man who understands what the implant can realistically deliver and is ready to work with it.”

You may be a poor candidate for a penile implant, however, if you have Peyronie’s and a condition or factor that affects wound healing and increases your infection risk after surgery, says Denise Asafu-Adjei, MD, MPH, the director of men’s health and male reproductive medicine at the University of Chicago. These may include:

• Being immunocompromised
• Obesity
• Smoking
• Poorly controlled diabetes
• Mental health issues

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• Urinary problems

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“Penile changes associated with inserting penile implants can be permanent, so patients should understand these implications,” Dr. Asafu-Adjei says.

Inflatable Devices

This is the most common type of penile implant. Saline solution is pumped from a reservoir implanted in or near the scrotum into inflatable cylinders inside the penis to achieve an erection.

After sex, you release a valve in the scrotum to drain fluid from the cylinders.

Semirigid Devices

“Inflatable devices are generally preferred because they look and feel more natural,” Helo says.

In addition to helping curvature, an implant can help you have a reliable, adequate erection for sex, and it usually does not impact sensation or orgasm, Asafu-Adjei says.

An implant may also reduce or eliminate the need for ongoing medications and injections, which can be cost-effective over time. Helo says that without insurance, costs can be significant (often tens of thousands of dollars), but insurance coverage is common when you are diagnosed with erectile dysfunction.

Penile implants are considered safe, with low probability of complications. There are some potential risks, however, including:

• Infection, which occurs in as many as 3 percent of implant recipients

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• Mechanical failure over time, which may require replacement

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• Temporary pain, bruising, or swelling after surgery

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• Erosion, where part of the device presses through the skin or urethra, often related to infection or prolonged pressure

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• In rare cases, injury to nearby structures such as the urethra, bladder, or bowel

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Here are some common questions people with Peyronie’s disease have about implants.

• Will it feel natural? “I think many men have misconceptions that they will not be able to have normal sensation or orgasm, that the devices will be easily visible to others, and that the act of sexual intercourse will feel very mechanical,” says Trost. “These are not accurate for the majority of men.” Dr. King notes that if you could ejaculate before the procedure, you will continue to be able to do so after the operation.
• Will my partner be able to tell? Generally, implants are designed so partners do not feel any major differences during sex but may be able to feel the device if you are not erect. Implants can remain rigid for as long as needed, which can eliminate much of the anxiety and pressure regarding intercourse. “Men who have partners often come in with them to wade through all the details of the procedure and how the device works,” King says. “By coming in person, partners can have a clearer picture of what to expect with the implant.”
• Will it stop working? “Modern implants are very reliable,” Helo says, “but just like your car, parts can break down over time. Many last 10–15 years or longer, though some men may eventually need a replacement.” About 11 percent of men need another operation after five years, and about 16 percent need one at 10 years.

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The surgery itself typically takes 45 minutes to an hour at a surgery center, hospital, or facility equipped for surgical procedures. You may be able to go home the same day or stay overnight, depending on your and your urologist’s preference.

After surgery, you will learn how to use the device and how to feel comfortable with it, Helo says. Ask your doctor about precautions for future procedures, as well.

• Penile implants are a surgical option that can help treat Peyronie’s disease when other treatments have not shown results.
• The goal of a penile implant is to allow you to have an erection, and it also may reduce painful curvature.
• The most common implants are inflatable devices, and semirigid, adjustable rods also are available.
• Not everyone is a good candidate for a penile implant, and the surgery to insert it can have risks in some cases. Ask your doctor if it’s the right option for you and what your recovery timeline might look like.