If you’ve experienced erectile dysfunction (ED), you’ve probably already tried the usual suspects – pills, pumps, injections. When those stop working or never quite do the job, a penile implant (also called a penile prosthesis) moves from “someday” to “maybe.”
Penile implants are researched and time-tested with high satisfaction rates for the right candidates. What the current medical literature doesn’t do brilliantly – at least not yet – is speak directly to the experiences and outcomes of gay men. Most studies lump everybody together, so specific data by sexual orientation are sparse. Still, we can combine what the evidence shows about implants overall with the practical realities of gay men’s sexual practices to help you make a confident, informed decision.
(A quick note on language: we’ll say “gay men” for readability throughout this article, but we mean that to include any men who have sex with men.)
Penile Implant Basics (The 60-Second Version)
A penile implant is a device placed inside the penis to create a dependable erection on demand. There are two main types:
- Inflatable implants (most popular): Two cylinders are placed in the penis, a fluid reservoir sits internally (usually in the lower abdomen), and a small pump hides in the scrotum. Squeeze the pump for an erection; press the release to deflate. These offer the most natural aesthetic and rigidity or flaccidity when you want it.
- Malleable (semi-rigid) implants: Bendable rods keep the penis firm at baseline; you position it up or down manually. They’re simpler, but less discreet under clothing and less “natural” in appearance.
Across studies, patient satisfaction is typically high – often in the 80 to 90% range for inflatable devices, with partners also reporting improved quality of life. The risk of infection for first-time inflatable implants is low (approximately 1–3%), thanks to antibiotic coatings and modern surgical techniques. Device reliability is strong, with eventual wear-and-tear addressed via revision surgery if needed.¹
There is a small but growing body of work looking specifically at men who have sex with men and penile prostheses, suggesting overall satisfaction as well, though the samples are small and not yet definitive.²
Why Talk About Orientation at All?
Because sexual goals, positions, and expectations can vary – and those details matter when you’re choosing a device, sizing cylinders, and planning recovery. For example, anal intercourse can place higher axial (straight-line) forces on the penis than vaginal intercourse, so rigidity and stability are central to comfort and performance.³ That doesn’t mean you need a different kind of implant; it means your surgeon should customize device choice and sizing with these realities in mind. ⁴
Who’s a Good Candidate?
You’re typically a candidate if:
- ED has been persistent (often 6–12+ months) and medical therapies (pills/injections/vacuum) aren’t working or are not tolerated.
You’re medically optimized for surgery (e.g., diabetes reasonably controlled, smoking addressed, any active infections treated).
You want a dependable erection, value spontaneity, and understand that the implant replaces natural erectile function.
Men with scarring (as in conditions like Peyronie’s disease), post-prostatectomy ED, or long-standing diabetes-related ED routinely do well with implants, though the surgical plan may be slightly altered from a straightforward surgery.
Choosing Your Implant: What Matters for Gay Men?
Rigidity and angle control. Anal intercourse, especially in positions that create higher leverage, requires strong axial rigidity from an implant to prevent “buckling.” Three-piece inflatable devices generally provide the best blend of firmness for penetration and a natural, comfortable flaccid state for daily life and concealment. Device design and cylinder materials differ slightly across brands; some offer greater maximal girth or perceived rigidity at a given length. Your surgeon will match device characteristics to your goals and anatomy. ⁵
Girth vs. length expectations. Implants don’t increase natural penile length; in fact, men can sometimes perceive a slight decrease in size due to long-standing ED and tissue remodeling. The priority is functional length and reliable rigidity. Sizing is individualized during surgery to maximize usable length safely and effectively. Over-lengthening risks erosion; under-lengthening compromises performance.
Glans support and curvature. If you have Peyronie’s disease, your surgeon may correct the curvature at the same time. Some men benefit from techniques that improve glans (head of the penis) support when indicated.
Concealment and day-to-day comfort. Inflatable devices are designed to deflate completely when not in use, allowing the penis to hang naturally and remain discreet under clothing. When you want an erection, the pump in the scrotum allows you to inflate the cylinders on demand, providing rigidity only when needed.
The Operation and Recovery
Surgery is typically performed on an outpatient basis, and the procedure usually takes approximately one hour. You’ll go home the same day with pain control instructions, antibiotics as indicated, and a scrotal support.
Pain and swelling peak in the first few days, then steadily improve. Most men are back to light desk work in about a week, and more physical jobs in two to three weeks (per your surgeon’s guidance).
There may be a bit of a learning curve when it comes to activation. With an inflatable implant, you’ll be taught to cycle the device (inflate/deflate) to get comfortable using it and to keep tissues supple. Many surgeons start gentle cycling around two to four weeks after surgery.
Sexual activity will have to be put on hold for a while as the anatomy heals. Penetrative sex is usually cleared at around six weeks, once tenderness subsides and you’ve mastered cycling, though your exact timeline may vary.
Sex After an Implant
Positions and comfort. Early on, choose positions that let you control depth and angle. High-leverage positions (where the partner’s body weight or angles create greater force) may be more comfortable after you’ve had a few weeks of practice with the device. Remember, anal intercourse can require higher axial forces; that’s normal, and your implant is built for function, but your body and soft tissues are still recovering.
Lubrication and condoms. Use plenty of lube to reduce friction and pressure on soft tissue. Condoms are still a viable recommendation for STI prevention; implants don’t change STI risk. Choose higher-quality condoms that fit your girth comfortably.
Communication. If you’re the insertive partner, communicate about pace and angle. Let your partner know you’re getting used to a new device and may need a gentler start the first few times of resuming sexual activity.
Ejaculation and orgasm. An implant restores erection, not sensation, libido, or the ability to orgasm – those depend on nerves, hormones, and overall health. Many men report stable or improved sexual satisfaction once the anxiety about ED is gone.
Risks, Complications, and How Surgeons Reduce Them
All surgery carries risk. For implants, the big three are infection, erosion, and mechanical failure over time.
- Infection: Modern infection rates for first-time, three-piece inflatable implants are approximately 1–3%, which is reduced by meticulous sterile technique and the use of antibiotic-coated devices. Risk is higher with poorly controlled diabetes and other underlying health conditions. If an infection occurs, the device may need to be removed and later replaced. ⁶
- Erosion or tissue injury: This is rare, but the risk increases if a device is oversized or if tissues are too fragile. This is why careful sizing and experienced surgical technique are imperative.
- Mechanical issues: All devices can eventually wear out, and revision rates naturally increase after many years of use. Your erection is dependable for as long as the device works, and devices can be replaced when needed.
Your surgeon will screen for modifiable risk factors (optimizing blood sugar, encouraging smoking cessation, treating skin infections), choose the right device for your anatomy and goals, and use infection-prevention protocols to reduce complications. ⁷
What About Satisfaction, Specifically in Gay Men?
Research is limited but encouraging. In a study of MSM undergoing inflatable penile prosthesis, men reported a renewed sense of vitality and overall greater satisfaction in daily life. We need larger studies that correspond with sexual orientation, but the available signal aligns with what many patients report in the clinic: once healed and comfortable with the device, sexual function becomes consistent, and confidence returns. ⁸
A penile implant is a durable, on-demand solution for ED with high satisfaction and low infection risk in well-selected patients. For gay men, the key is personalization: choose a surgeon who will talk candidly about your sexual goals, optimize device selection and sizing for strong axial rigidity and comfort, and guide you through recovery so you can return to the sex life you want, safely and confidently.
As a fellowship-trained urologist in men’s sexual health, Dr. Kapadia prioritizes respectful, individualized care. He has been designated as a Coloplast Titan and Boston Scientific AMS 700 Center of Excellence surgeon for penile implants. If you’re considering an implant or just want to understand your options, schedule a confidential consultation. Bring your questions, your goals, and your partner if you’d like. We’ll talk through candidacy, device choices, recovery, and what sex can look like afterward so you can make an informed decision that truly fits you.
Notes on evidence: Research specifically focused on gay men with penile implants is limited but growing; early studies suggest high satisfaction, consistent with broader implant literature. Anal intercourse can involve higher axial forces, which is relevant for device selection/sizing and return-to-sex recommendations.
References:
- Levine, L. A. (2024, April 25). AUA2024 PREVIEW Prevention and Treatment of Inflatable Penile Prosthesis Infection, and Placement Following Explant – American Urological Association. American Urological Association News. https://auanews.net/issues/articles/2024/april-2024/aua2024-preview-prevention-and-treatment-of-inflatable-penile-prosthesis-infection-and-placement-following-explant.
- La, J., Loeb, C. A., Barham, D. W., Miller, J., Chung, E., Gross, M. S., Hatzichristodoulou, G., Park, S. H., Perito, P. E., Suarez-Sarmiento, A., Van Renterghem, K., & Yafi, F. A. (2023). Satisfaction rates of inflatable penile prosthesis in men who have sex with men are high. International journal of impotence research, 35(6), 564–568. https://doi.org/10.1038/s41443-022-00603-2.
- Miller, J. A., Loeb, C. A., La, J., El Khatib, F., & Yafi, F. A. (2023). Penetrative anal intercourse may require high axial loading forces. The journal of sexual medicine, 21(1), 40–43. https://doi.org/10.1093/jsxmed/qdad156.
- Thirumavalavan, N., Cordon, B. H., Gross, M. S., Taylor, J., & Eid, J.-F. (2018). Rear Tip Extenders and Penile Prosthesis Rigidity: A Laboratory Study of Coloplast Prostheses. The Journal of Sexual Medicine, 15(7), 1030–1033. https://doi.org/10.1016/j.jsxm.2018.05.001.
- Chung, E., Bettocchi, C., Egydio, P. H., Love, C., Osmonov, D., Park, S. S., Ralph, D., Xin, Z. C., & Brock, G. (2022). The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant. Nature Reviews Urology, 19, 534–546. https://doi.org/10.1038/s41585-022-00607-z.
- Baird, B. A., Parikh, K., & Broderick, G. (2021). Penile implant infection factors: a contemporary narrative review of literature. Translational andrology and urology, 10(10), 3873–3884. https://doi.org/10.21037/tau-21-568.
- Moukhtar Hammad, M. A., Barham, D. W., Sanford, D. I., Amini, E., Jenkins, L., & Yafi, F. A. (2023). Maximizing outcomes in penile prosthetic surgery: exploring strategies to prevent and manage infectious and non-infectious complications. International Journal of Impotence Research, 35, 613–619. https://doi.org/10.1038/s41443-023-00773-7.
- La, J., Loeb, C. A., Barham, D. W., Miller, J., Chung, E., Gross, M. S., Hatzichristodoulou, G., Park, S. H., Perito, P. E., Suarez-Sarmiento, A., Van Renterghem, K., & Yafi, F. A. (2023). Satisfaction rates of inflatable penile prosthesis in men who have sex with men are high. International journal of impotence research, 35(6), 564–568. https://doi.org/10.1038/s41443-022-00603-2.