Penile implants or prosthesis
Having a penile prosthesis or implant fitted is an option to help with erections if other treatments for erectile dysfunction have not been successful.
Experts at The British Association of Urological Surgeons say this is usually considered a last resort as complications are possible from the surgery, and regular specialist follow-up appointments are needed for as long as the device remains fitted.
The penile implants are either inflatable, or semi-rigid but bendy.
With the inflatable implants, the man decides when to pump up the device for sex, while the semi-rigid type stay relatively hard.
How do penile implants work?
The inflatable device has a reservoir and a pump implanted in the body, and inflatable cylinders in the penis. There's a manual pump control in the scrotum.
To create an erection, the man activates the pump which then moves fluid from the reservoir to the cylinders in the penis. To end the erection, a deflation valve is pressed and the penis goes flaccid again.
Semi-rigid implants or rods are an option which may be more suitable for older men who do not have sex regularly. These devices are 'pointed' up for sex and down at other times, such as for urination.
Penile implants are not usually available on the NHS and may be costly.
Assessment for a penile implant
A GP will discuss the risks and benefits of this approach to treat erectile dysfunction before making a referral to a specialist for an assessment and to discuss the appropriate type of device.
If an implant procedure is to go ahead, screening will be done to help avoid complications. This will include the man's general health, other conditions he may have, and a check for the 'superbug' MRSA.
Penile implant procedure
The operation to fit the device will be done under general anaesthetic (completely asleep) or spinal anaesthetic (no feeling from the waist down).
Incisions are made in the penis and scrotum ready for the device to be implanted.
After the penile implant operation
After the procedure, checks will be made for discomfort, painkillers may be given, and a catheter may be used for urination.
An inflatable device will be left pumped up after the operation but deflated before the man goes home - usually a day after the operation.
The device should not be pumped up until this is done under supervision at a follow-up appointment around 2 weeks later where training will be given on its use.
Temporary side-effects after the operation include bruising and swelling of the penis.
The procedure does carry the risk of infection, bleeding, nerve damage, unplanned inflation because of faults, and mechanical problems needing a further operation to replace parts or the whole device.
Having the implants may prevent any natural erections.
Is the penile prosthesis noticeable?
There may be some scars from the operation, but the inflatable penile prosthesis is not very noticeable when deflated.
The semi-rigid device stays at the same level of rigidity at all times.
What is sex like with a penile prosthesis?
Research suggests there is not much difference in satisfaction rates between men having semi-rigid or penis pump implants.
In a study of 425 British men who'd had penile implants, 89% were able to have sex and 81% were satisfied with their implants.
Despite the costs, the NHS says that around three-quarters of men having implants say they are satisfied with the results.
Although the devices make erections possible, this does not guarantee more satisfying sex for the man.