A penile implant, or penile prosthesis, is a definitive surgical solution for men experiencing Erectile Dysfunction (ED) that has not responded to non-invasive treatments. This medical device is completely concealed within the body, providing a permanent way to achieve an erection sufficient for sexual intercourse. Modern technology has advanced the design, making them reliable, durable, and discreet. The goal of this surgical option is to restore sexual function and confidence.
Categories of Modern Implants
Modern penile implants are categorized into two primary designs: the non-inflatable (malleable) prosthesis and the inflatable penile prosthesis (IPP). Both types are designed to be entirely internal, with advancements focusing on improving function, longevity, and infection prevention. The choice between them often depends on a patient’s dexterity, medical history, and preference for rigidity and flaccidity.
Non-inflatable, or semi-rigid, implants consist of two flexible rods placed inside the erectile chambers. These rods contain an internal wire or hinge system that allows the penis to be manually bent upward for intercourse or downward for concealment. This design is valued for its mechanical simplicity and reliability, as there are no internal hydraulic parts to malfunction. Malleable implants are often preferred by men who desire a straightforward solution or those with limited hand dexterity.
The inflatable penile prosthesis is the more technologically advanced option and is considered the standard for achieving the most natural feel in both the erect and flaccid states. This category is predominantly represented by the three-piece system, which includes two cylinders, a pump, and a fluid reservoir. A less common alternative is the two-piece system, which combines the reservoir and pump into a single scrotal unit, resulting in a slightly less firm erection compared to the three-piece model.
Modern devices incorporate advanced materials and coatings designed to improve patient outcomes. Many inflatable prostheses feature an antibiotic coating, such as minocycline and rifampin, which elutes into the surrounding tissue after placement to reduce infection risk. Other devices utilize a hydrophilic coating that absorbs antibiotic solutions during surgery, preventing bacteria from adhering to the implant surface. These innovations have reduced infection rates to below one percent.
Functionality and Operation
The inflatable penile prosthesis is a closed hydraulic system that uses saline fluid to create rigidity on demand. The three components of the system—the two cylinders, the scrotal pump, and the abdominal reservoir—are connected by thin tubing. When the device is in the flaccid state, the cylinders within the penis are empty, and the saline fluid is stored in the reservoir.
To achieve an erection, the user operates a small pump placed discreetly within the scrotum by repeatedly squeezing or compressing it. This mechanical action manually displaces the saline fluid from the reservoir, pushing it through the tubing and into the cylinders located inside the penis. As the cylinders fill with fluid, they expand both in length and girth, creating a firm erection. The erection is maintained until the user chooses to deflate the device.
To return the penis to a flaccid state, the user activates a release valve, which is also integrated into the scrotal pump. Pressing this valve opens the system, allowing the fluid to flow back out of the cylinders and return to the reservoir. This hydraulic process ensures the penis is firm when inflated and soft when deflated, providing high discretion. The reservoir is placed in the lower abdomen, typically behind the pubic bone, and remains undetectable during normal activities.
Surgical Placement and Post-Operative Expectations
The placement of a penile implant is a surgery typically lasting between one and two hours, and is performed under general or regional anesthesia. Surgeons commonly use a penoscrotal approach, making a small incision at the junction of the penis and scrotum, or an infrapubic approach just above the base of the penis. Through this opening, the surgeon accesses the corpora cavernosa, the twin chambers responsible for natural erections, to place the cylinders.
The pump component is carefully positioned within the scrotal sac, beneath the skin, where it is easily accessible to the patient but remains concealed. The fluid reservoir is placed either in the retropubic space, deep within the pelvis, or in an ectopic location in the lower abdominal wall, depending on the surgeon’s preference and patient anatomy. All tubing connecting the components is run internally, ensuring the entire system is hidden beneath the skin.
Following the procedure, most patients can expect a short hospital stay, often limited to an outpatient procedure or overnight observation. Pain management is controlled with oral medication for the first week. Patients are advised to avoid strenuous activities, heavy lifting, or swimming for four to six weeks following the surgery to allow internal healing.
A mandatory waiting period is required before the device can be used for sexual activity. This time, generally four to six weeks, allows internal swelling to resolve and the implant components to settle securely into place. Once this period has passed, the patient attends a training session with the physician to learn how to properly operate the pump for inflation and deflation. Patients can resume sexual activity after this period, with satisfaction rates for both patients and partners reported to be high.