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Help for Men with Erectile Dysfunction Who Don’t Respond to Medication

You or a loved one may have experienced erectile dysfunction but have been too embarrassed to talk about it. First, know that you’re not alone. Erectile dysfunction, or ED, is a common type of male sexual dysfunction. Second, know that it can be treated.

We talked to UNC Medical Center urologist Brad Figler, MD, to learn more about one such treatment for ED, an inflatable penile implant.

How Inflatable Penile Implants Work

A penile implant is a medical device surgically placed into your penis that gives you considerable control over your penis. Made of either silicone or polyurethane, it has three components: a hydraulic pump, which goes in the scrotum, a reservoir in the abdomen filled with saline solution, and a set of inflatable cylinders running down the underside of the penis.

Implants use these cylinders to create rigidity for sexual intercourse. To achieve rigidity, you squeeze the pump in the scrotum, sending saline solution from the reservoir in the abdomen into the cylinders in the penis.

After sex, you press a button on the pump to deflate the cylinders and lose penile rigidity. With inflatable implants, the sensation, orgasm and ejaculation are the same as with a natural erection.

To implant the device, physicians make a small incision in the scrotum to access the underside of the penis and place the cylinders. Then they use the same incision to put the reservoir in the abdomen and the pump into the scrotum.

The surgery takes one to two hours and requires general anesthesia. You will need someone to drive you home. While there are no catheters or drainage to worry about, patients usually stay home for a week or two to recover. Patients must wait a month before using the pump.

Candidates for Inflatable Penile Implants

To treat ED, urologists first recommend one of four medications, including Viagra and Cialis. The medications don’t tend to cause problematic side effects, but if a man has issues with one pill, it’s a good idea to try another before deciding medication doesn’t work for him, Dr. Figler says.

If pills aren’t effective or stop being effective, options include injections and surgery. The drawback with injections is that they tend to interfere with spontaneity in ways that pills don’t—you need to inject the medicine into your penis before having sex—and they need to be refrigerated.

Implants can also be a viable option for men who have ED with Peyronie’s disease, which causes curvature of the penis because of scarring. An implant can both straighten the penis and solve ED.

Dr. Figler says his patients who get inflatable penile implants are among the happiest in his practice.

“Patients who get the surgery have often dealt with erectile dysfunction for a long time, and this allows them to regain spontaneity in their love lives and to focus more on intimacy and less on the act of getting an erection,” Dr. Figler says.

Another benefit to implants? They’re virtually unnoticeable.

“We like to say that the inflatable penile implants are ‘locker-room concealable,’ meaning that most people wouldn’t notice that you have it, even in a locker room,” Dr. Figler says.

He says insurance usually covers the surgery.

Notes of Caution

While inflatable penile implants can be life-enhancing, it’s important to know that an erection achieved with an implant will differ from a natural erection in some ways.

For example, the head of the penis will not become rigid. The implanted, inflatable cylinders span to the tip of the penis and support the head of the penis, but the head doesn’t become engorged. You may notice this difference, but it has no effect on sensation.

Men who have had ED for a long time might experience shortened tissue in the penis because it hasn’t been stretched out through erections. The implanted prosthesis, even when fully inflated, doesn’t return lost length. But men who are concerned about length can use a vacuum device or injections before surgery to restore length.

Finally, there is a slight chance of infection with an inflatable penile implant. While devices have antimicrobial components to reduce infection risk, about 1 in 100 men experience infections, Dr. Figler says.

“We obviously do everything we can to minimize the risk of infection, but an implant is a foreign body, so if it gets infected, it needs to be removed and replaced with a new one,” he says. In this case, you would not be able to go back to using medications, via pills or injection, because the surgical insertion of the prosthesis damages the erectile tissue. A new implant can go in as the old one is being removed, or it can be placed later, Dr. Figler says.


Make an appointment with a UNC Medical Center urologist.