by LeRoy A. Jones, MD
"Minister’s sex implant opens
neighbor’s garage door,”
reads the headline on a
news clipping that I share during my
community health seminars.
That slide always elicits chuckles
from the audience. They know better
than to believe the tabloids. But
beyond the outrageous, few know the
first thing about “sex implants” or the
inflatable penile prosthesis, as it is
termed in the medical field.
Less than one percent of urologists
perform more than ten of the surgical
implant procedures a year, a fact that
leads to a dearth of physicians prepared
to train residents in the technique, thus
creating a cycle of obscurity for this erectile
dysfunction treatment.
Certainly, a penile implant is not as
glamorous as Viagra and the other oral
ED medications that came to the market
almost ten years ago, but even in
the era of the little blue pill, the penile
implant still plays an important role in
the treatment protocol for ED. In fact,
the popularity of the device has increased
in recent years, largely due to
the pills’ role in lifting the taboo that
patients feel about speaking to their
physicians about sexual performance.
Most men who muster the courage
to discuss sexual health with their doctors
expect to receive samples of the
oral medications, and, except for men
in whom the pills are specifically contraindicated,
this is an appropriate and
often effective front-line therapy.
However, contrary to the messages
prevalent in society, 30 to 40 percent
of men do not respond to the pills.
These patients tend to be diabetics,
those with poor cardiovascular health,
men who have had traumatic pelvic or
spinal cord injuries, and/or those who
have been treated for prostate cancer.
For this group of patients, non-surgical
treatments like the vacuum erection device or penile injections may
be appropriate. Some patients are
pleased with these therapies, which
tend to work in almost all men, but
others discontinue them, citing their
cumbersomeness in the bedroom.
For these men, the penile implant
is often an effective and satisfying
solution.
The inflatable penile prosthesis
works by implanting two cylinders in
the penis. A pump the size of a marble
goes in the scrotum and a salinefilled
reservoir is placed in the abdomen.
The user squeezes the pump to
inflate the cylinders with fluid, mimicking
the effect blood has when it
engorges the penis during an erection.
After intercourse, a release
mechanism in the pump allows the
saline to flow back into the reservoir.
When deflated, the device is impossible
to detect in the bedroom or
locker room.
Implanting the prosthesis is usually
a 40 to 50 minute outpatient procedure.
All of the components of the
device are inserted through a one-inch
incision in the scrotum. The infection
rate is less than one percent in nondiabetics,
and the device is mechanically
reliable for ten to fifteen years, at
which time it can be revised. The costs
associated with the procedure are covered
by Medicare and many private
insurance companies.
Patient and partner satisfaction rates
for the penile implant are greater than
96 percent. Moreover, the restoration
of a man’s sexual health has an immeasurable
impact on his quality of
life and sense of well being.
LeRoy A. Jones, MD
is a board-certified
urologist who specializes
in male and
female sexual medicine.
He is recognized
internationally
by his peers for his
pioneering work in
the field of sexual medicine, and, in particular,
is noted for his expertise in placing
penile prostheses. Dr. Jones practices
with Urology San Antonio.
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