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Do Penile Implants Need a Tune-Up?

Posted on by Akash Kapadia, MD in ,

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“When can I have sex with it?”

“How long does it last?”

“What happens if I use it too much?”

“What happens if I don’t use it enough?”

“How often should I see my doctor?”

Penile implants are a game-changer for men with erectile dysfunction, and these are common questions that come up. Curiosity is a good thing, and implants perform best when you understand the basics. To keep your game fresh, it helps to pay attention to proper use, catch problems early, and keep your tune-ups in check.

Time to Activate

If you think you’ll be able to jump back into your nighttime extracurriculars right after surgery, your expectations will need an adjustment. After surgery, the soft tissues and incision areas need time to heal. Usually, about four to six weeks after surgery, you’ll be allowed to “activate.” Activation refers to the first intentional inflation of the prosthesis after the surgical site has healed and swelling has resolved.

The initial activation often happens in the surgeon’s office, allowing the patient (and partner) to learn proper pump technique and ensure the device works as intended. During the activation session, the surgeon demonstrates how to operate the pump-deflation mechanism and addresses any questions you may have to make sure you’re comfortable with the process. This education is pretty important, since proper technique can prevent mechanical issues and early mishaps that could stress the device or tissue.

Once you’ve been cleared for activation, it’s important to cycle the device regularly. Cycling refers to inflating and deflating the implant to keep the internal components moving. Regular cycling also helps maintain the health and elasticity of penile tissue.

Resuming sexual activity is an exciting milestone, and as soon as your healthcare provider has cleared you, game on. The timeline varies based on individual healing and comfort levels, but it’s usually around the same time as activation. A month or more may seem like a long time to wait, but be patient – jumping the gun could increase the risk of infection, wound dehiscence (rupture), or cylinder migration.

Whatever you come to them with, your provider has likely heard it before, so communicate openly about any concerns or questions during this period.

Know the Limits

You’ve gotten through surgery, you’ve been cleared for resuming activity, and now the fun begins. Is it possible to have too much fun with a prosthesis?

Not really…. If you’re using it properly. An inflatable penile prosthesis (IPP) is designed to withstand sexual activity without damage, and the concept of “overuse” is more about misuse than frequency. Behaviors such as forcing the cylinders against resistance during inflation, bending the device at extreme angles, or using it before complete healing can lead to mechanical issues or injury to the penis.

Underuse also occurs, and yes, it can be problematic in more ways than one, but we’ll focus on just one. If the inflatable cylinders remain deflated for extended periods, especially in the early months post-surgery, the surrounding tissue may contract, making future inflation more challenging. We often recommend scheduled early cycling, inflating and deflating the device regularly after activation. This keeps the cylinders flexible and maintains a healthy range of motion.

After the healing period, occasional use is fine – most patients don’t need to inflate daily once comfortable with the device and satisfied with their sexual routine.

Maintaining

IPPs don’t require routine tune-ups like a car, but some practical steps help keep the device working well:

  • Proper use: Learn pump mechanics and avoid unnecessary stress on the device.
  • Early cycling: Being consistent helps the device settle and prevents corporal contraction (the tightening of smooth muscle cells in the penis).
  • Monitoring: Watch for signs of complications, such as pain, swelling, or malfunction.

Regular follow-up appointments with your healthcare provider can also minimize long-term complications and ensure the implant functions reliably.

Even after healing, IPPs can encounter issues. And while many implants function well for years, revision surgery could become necessary. Potential complications and reasons for revision include:

  • Infection: Persistent redness, swelling, drainage, or fever signals urgent evaluation. Although rare, infections can occur and may require device removal.
  • Mechanical problems: Cylinder leaks or pump malfunction may require replacement, and sometimes parts just wear out over time.
  • Erosion or migration: The implant may shift or move through surrounding tissue, but proper sizing and avoiding early trauma usually prevent this; treatment usually involves explantation (surgical removal of the implant).
  • Fibrosis: A lack of early cycling can lead to scarring that limits the expansion of the cylinder.

The Weeks and Years Post-Op

Routine follow-ups help catch potential issues early, ensuring the IPP continues to function optimally. Follow-up schedules vary, but a typical timeline includes:

  • 1 Week Post-Op: Initial check-up to assess the surgical site.
  • 4-6 Weeks Post-Op: Activation session and functional assessment.
  • 3-6 Months Post-Op: Evaluate implant function and patient satisfaction.
  • Annually: Long-term follow-up to monitor implant condition and address any concerns.

These visits are also a chance to review technique, ask questions about changes in your sexual routine, and talk through any new symptoms. Even years after surgery, most patients benefit from maintaining contact with their provider to ensure a smooth operation.

Managing chronic health conditions such as diabetes, high blood pressure, or cardiovascular disease also plays a significant role in long-term implant success. Good control of these conditions supports proper blood flow and healing, reducing the chance of complications. Lifestyle factors, such as maintaining a healthy weight, staying physically active, and not smoking, further support overall penile and vascular health.

It’s worth noting that most inflatable penile implants last well over a decade, with high satisfaction rates among patients and their partners. Knowing that your device has a strong track record of durability can provide peace of mind as you return to normal life.

If you’re considering a penile implant or want long-term guidance with your device, consult with an experienced specialist. Dr. Kapadia has been designated as a Coloplast Titan and Boston Scientific AMS 700 Center of Excellence surgeon for penile implants – one of the few surgeons in the nation to achieve this dual designation. His expertise ensures patients receive the highest level of care from surgery through long-term follow-up.

Rebuilding Connection: Penile Implants & Quality of Life for Patients and Their Partners

Posted on by Akash Kapadia, MD in ,

Couple embracing outdoors during sunset

Sex isn’t just about sex. It’s about closeness, confidence, desire, and feeling like yourself. When erectile dysfunction (ED) enters the picture, it can take a toll far beyond the bedroom. Patients often describe a quiet erosion of connection, marked by less eye contact, increased distance, and fewer shared moments. Partners feel it too – frustrated, concerned, or unsure how to help.

For couples dealing with ED, the strain is both physical and emotional. Research shows ED can significantly impact mental and emotional well-being, not just for the individual, but for their partner, too. Many patients experience a dip in self-esteem, confidence, and even depression. Partners often report feeling unwanted, rejected, or isolated in response.¹ And when pills or pumps don’t work (or stop working), it’s easy to feel like hope is off the table.

But it’s not.

Inflatable penile prostheses (IPPs), also known as penile implants, are a highly effective, discreet, and long-lasting solution that’s helping men restore their sexual function and reclaim their quality of life. And research shows that both patients and their partners are overwhelmingly satisfied with the results.

Information about the mechanics of penile implants is widely available. But let’s focus on what really matters: how people feel afterward.

What the Numbers Say

Psychological factors such as stress, negative self-talk, or fear of failure in the moment are almost the worst part about ED – what researchers call “cognitive interference.” A penile implant eliminates the need to mentally manage the timing and success of medication, removing a significant source of anxiety.¹

In one study, more than 83% of patients were satisfied with their implant a year or more after surgery and said that they’d recommend it to a friend.² Another review noted satisfaction rates as high as 90%, putting penile implants on par with other life-enhancing surgeries like knee replacements and breast augmentation.³

Why so high? There’s the obvious reason, of course – regaining an erection. But it also brought people back to a place of comfort, connection, and spontaneity. For many couples, the implant removes the performance anxiety and pressure that often comes with ED. Intimacy becomes possible again, without the clock ticking on medication or external devices.

Men, as well as women, just want to be close to their partner again, and 85% of partners reported satisfaction with the results, alongside the men themselves.⁴ The better the partner feels, the more satisfied the patient is, and vice versa. Restoring erectile function helps restore emotional equilibrium for both partners.

Partners play a huge role in recovery, communication, and emotional healing. That’s why more urologists now encourage couples to come to consultations together to ask questions, express concerns, and start rebuilding trust as a team.

More Than an Erection

Sure, regaining sexual function is important. But the benefits of a penile implant often reach well beyond the bedroom. Patients frequently report improved confidence, reduced stress and anxiety, increased relationship satisfaction, and a return to physical closeness that had been absent for months or even years.

And while not every couple discusses these feelings out loud, many describe a quiet shift in their relationship – hand-holding comes back, affectionate jokes return, and emotional intimacy starts to feel easier again.

Some men worry the implant will “feel fake” or that their partner won’t accept it. In reality, most partners are grateful to regain intimacy and connection. Many couples report that once they adjust, the experience feels natural and emotionally freeing. And while the idea of surgery can seem daunting, the procedure itself is straightforward. Most patients return to light activity within a few days, and sexual activity within 4 to 6 weeks – just a brief recovery when you consider the months or even years of frustration that came before. Even better? Most implants last 10 to 15 years or more, making them a long-lasting solution to a long-standing challenge.

Most implants today are inflatable, discreet, and completely concealed within the body. Once healed, there’s no visible sign, and the function is entirely under your control. That means no waiting for pills to kick in or worrying about timing. It’s there when you want it, and completely undetectable when you don’t.

And with satisfaction rates this high, you’re investing in so much more than a medical device – you’re investing in quality of life, for yourself, and your partner.

Penile implants offer men and their partners a chance to reclaim something deeper. Whether ED has been a lingering issue or a recent frustration, you deserve to know your options and to have a partner in that conversation.

If you’re ready to talk about what life after ED could look like, Dr. Kapadia is here to help. He is a Coloplast Titan and Boston Scientific AMS 700 Center of Excellence for penile implants, and one of the few centers in the nation to achieve this dual designation.

He can offer expert guidance to patients and couples exploring treatment options, and has helped many people find their way back to a satisfying, connected life.

The earlier the ED is addressed, the less emotional distance builds between partners. Don’t wait until things feel unmanageable – many couples say they wish they’d explored treatment sooner.

References:

  1. Allen, M. S., Wood, A. M., & Sheffield, D. (2023). The Psychology of Erectile Dysfunction. Current Directions in Psychological Science, 32(6), 487–493. https://doi.org/10.1177/09637214231192269.
  2. Jorissen, C., De Bruyna, H., Baten, E., & Van Renterghem, K. (2019). Clinical Outcome: Patient and Partner Satisfaction after Penile Implant Surgery. Current Urology, 13(2), 94–100. https://doi.org/10.1159/000499286.
  3. Barton, G. J., Carlos, E. C., & Lentz, A. C. (2019). Sexual Quality of Life and Satisfaction With Penile Prostheses. Sexual Medicine Reviews, 7(1), 178–188. https://doi.org/10.1016/j.sxmr.2018.10.003.
  4. Jorissen, C., De Bruyna, H., Baten, E., & Van Renterghem, K. (2019). Clinical Outcome: Patient and Partner Satisfaction after Penile Implant Surgery. Current Urology, 13(2), 94–100. https://doi.org/10.1159/000499286.

Penile Implant as A Fix for Both Peyronie’s Disease and Erectile Dysfunction

Posted on by Akash Kapadia, MD in ,

Older couple smiling and laughing, woman laughing into older man with beard shoulder

The sex life of a middle-aged man is under threat from any number of urological conditions. One of the most psychologically and physically debilitating is erectile dysfunction. And while we have excellent first-line options in the form of medications like Viagra and Cialis or their generic versions, Sildenafil and Tadalafil, as well as penile injections, eventually, patients with erectile dysfunction, will not be able to achieve the erection they want, even with these arrows in their quiver.

Unrelated in cause but certainly related in function is a curvature or deformity of the penis known as Peyronie’s disease. There are several possible causes of Peyronie’s curvature, many of which we don’t understand fully. However, the general consensus, or at least a going theory, is that micro-traumas to the penis over time can cause the buildup of penile plaque that ultimately underlies the curvature of the penis. Penile plaque can accumulate anywhere around the penis, and therefore the curvature is not necessarily upward but can also be downward or even to the sides.

Peyronie’s disease has several potential treatments and options. About 5-10% of cases will improve independently. This leaves most patients needing some intervention for relief. The only FDA approved medical treatment for Peyronie’s is a medication known as Xiaflex that can be injected into the penile plaque and, along with manual traction, can soften the plaque and help remodel the penis to a more normal state. Xiaflex can be effective in nearly 75% of patients that undergo treatments, leaving some needing more invasive intervention. Penile plication to straighten the penis with a counter-suture or plaque removal and grafting, which allows the surgeon to remove the penile plaque mechanically, are a couple of options for more significant diseases.

However, if patients are suffering from severe erectile dysfunction as well that does not respond to medications, then they must consider a penile implant. A penile implant can be used to straighten Peyronie’s curvature. Call it a 2-for-1 curative option. This surgical option is, of course, a very personal decision that must be made in consultation with an expert in both conditions, like Dr. Kapadia.

When a Penile Implant Is Indicated

It is worth understanding that a penile implant may not be performed on patients who are responding to ED medications. On the other hand, patients with severe erectile dysfunction need not have severe Peyronie’s to benefit from an implant to address both conditions. In other words, erectile dysfunction is the primary diagnosis and justification for an implant.

The Bottom Line

In the case of both Peyronie’s Disease and Erectile Dysfunction, the most significant limiting factor in men finding the proper treatment is fear and embarrassment. However, it’s essential to know that Dr. Kapadia works with men of all ages and all severity levels to treat both disorders. So, the first step is making an appointment with Dr. Kapadia to learn more about this and other potential treatment options.

Comparing Viagra/Sildenafil to Cialis/Tadalafil

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When patients find that they need erectile dysfunction/ED medication, their mind often goes straight to which medication is best. This decision can be challenging with all of the marketing swirling around ED treatment. Ultimately, however, the two most commonly known medications on the market are Sildenafil, the generic version of Viagra, and Tadalafil, the generic version of Cialis. Other than the dosages – 100 mg maximum for sildenafil and 20 mg maximum for Tadalafil, the two drugs have similarities and differences that every patient should know and understand.

For one, both are PDE5 inhibitors, which relax and widen blood vessels to allow for increased blood flow. This is the primary mechanism of their effectiveness, and it’s why they are so good for mild to moderate ED.

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Eroxon Topical Erectile Gel

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Man squeezing gel out of tube into hand

You may have heard of a new erectile dysfunction therapy known as Eroxon (MED 3000) that the FDA recently approved for over-the-counter use. It is a topical gel marketed in Europe and the UK as a faster way to gain an erection versus Viagra or Cialis, and their generic forms sildenafil and tadalafil, respectively. However, while this sounds like a fantastic erectile dysfunction therapy, does it work?

Before determining whether this particular gel works, we should discuss the history of topical erectile dysfunction gels and formulations. This very short discussion centers around the fact that we have tried to create topical versions of several medical therapies, including, for example, trimix, which is otherwise used as an injection into the penis, without any success – the simple fact is that, to date, we do not have a reliable therapy that functions topically.

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P-Shots for Erectile Health. Legit?

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Doctor with gloves filling injection

You may have heard of the term biohacking. It’s a colloquialism now used for a practice that is centuries, if not millennia, old – fine-tuning the body to extract the highest and best performance. A favorite therapy of Biohackers is known as platelet-rich plasma therapy, posited as a rejuvenation therapy, and is used in several applications. Orthopedic surgeons use it to help rejuvenate joints. Hair loss specialists claim it may assist with regrowth, especially in those with androgenic alopecia or male pattern baldness. Plastic surgeons use it for facial skin rejuvenation – the list goes on.
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Will My ED Treatment Cause Priapism?

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woman handing man meds in bed

When discussing erectile dysfunction, or ED, most men are laser-focused on treatments to eliminate the embarrassment and lack of function. Because erectile function plays a significant psychological and physical role in our lives and lifestyles, we are often predisposed to trying almost everything to eliminate it, sometimes with little regard for the consequences. From supplements to pills and injections to implants, there is no lack of options when choosing how to treat ED.

Of course, each of the erectile dysfunction treatment options on the market today has side effects. Fortunately, due to the number of studies and funding put into these treatments, most options are relatively safe with minor side effects. However, a significant issue, considered an emergency, can arise from specific erectile dysfunction treatments. That concern, albeit rare, is priapism – an erection lasting more than four hours.

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When to Consider a Penile Implant for Erectile Dysfunction

Posted on by Akash Kapadia, MD in ,

Man and wife walking down path holding hands

Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for sexual satisfaction. It is a prevalent condition affecting up to 30 million men in the United States and 150 million worldwide. ED can significantly impact a man’s quality of life and intimate relationships. Luckily, numerous treatment options exist for ED, which range in invasiveness and cost. These include oral phosphodiesterase type 5 (PDE5) inhibitors (e.g., sildenafil, tadalafil), intraurethral alprostadil, penile injections, and vacuum devices. However, if these methods fail to provide satisfactory results or are contraindicated due to medical conditions, a penile implant may be worth considering. However, it can also be regarded as a first-line treatment through shared decision-making. This article explores the circumstances under which patients could contemplate a penile implant as a treatment option for ED, discussing the procedure, benefits, and potential risks involved.

Some situations that may warrant the consideration of a penile implant include:

  1. Non-Responsiveness to Medications: If oral medications or other ED treatments do not produce the desired results, a penile implant may be a viable alternative.
  2. Anatomical Abnormalities: Certain anatomical abnormalities, such as Peyronie’s disease (scar tissue formation in the penis) or severe congenital penile curvature, can coexist with refractory ED. In such cases, a penile implant can help overcome these physical limitations.
  3. Underlying Medical Conditions: Individuals with medical conditions like diabetes, spinal cord injuries, or prostate cancer treatments (e.g., radical prostatectomy) may experience persistent ED that does not respond well to conservative treatments. A penile implant can offer a solution in these cases.

There are two primary types of penile implants: inflatable and malleable.

  1. Inflatable Implants: This type consists of inflatable cylinders placed in the penis, a fluid-filled reservoir, and a pump. The cylinders fill with fluid by squeezing the pump in the scrotum, creating an erection. After intercourse, the liquid is transferred back to the reservoir, deflating the implant. The reservoir is typically placed within the pelvis through the same incision used to place the implant.
  2. Malleable Implants: Malleable implants, also known as semi-rigid implants, consist of bendable rods inserted into the penis. They allow the individual to position the penis for sexual activity manually. Unlike inflatable implants, malleable implants do not require a pump or reservoir. However, the same level of natural flaccidity is not achieved with a malleable.

Penile implants offer several benefits for individuals with persistent ED:

  1. Reliability: Penile implants provide a reliable and on-demand solution for achieving and maintaining erections.
  2. Spontaneity: Unlike other treatment options that may require planning or timing, penile implants allow for spontaneous sexual activity.
  3. Improved Satisfaction: Across multiple studies, penile implants have been shown to have up to a 90% patient and partner satisfaction rate. This high satisfaction rate makes sense as penile implants can restore sexual function and enhance overall well-being.

However, it is essential to consider the potential risks associated with penile implants, and discussing these factors with a physician is crucial before making a decision:

  1. Infection: While rare, the risk of developing an implant infection is between 1 and 3%. Infection risk is higher in the following situations: replacement or revision of penile implant, immunosuppression, poorly controlled diabetes, and pre-existing infection anywhere else in the body. In case of penile implant infection, the device must be removed, the cavity washed out, and new placement.
  2. Mechanical failure: As with any mechanical device, there is a chance of breakdown of the components over time, requiring reoperation. The risk of mechanical failure is 5% at five years after device placement.
  3. Intraoperative complications: Complications during the operation are exceptionally rare. However, one notable complication is an injury to the urethra, which requires abandoning the surgery and waiting to place the implant when the urethra has healed.

When traditional treatment options for ED prove ineffective or unsuitable, a penile implant can be considered a viable solution. It offers individuals a reliable and on-demand method to regain sexual function, improving quality of life and intimate relationships. However, the decision to pursue a penile implant should be made after carefully considering the individual’s unique circumstances in consultation with Dr. Kapadia.

Related Topics:

Nitric Oxide and Its Role in Erectile Dysfunction

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Man eating healthy trying to increase nitric oxide in body

Several potential issues can cause or worsen erectile dysfunction. Many of these are discussed on our website. However, some are less discussed yet worthy of mention and attention; one such potential cause is a deficiency in nitric oxide. Nitric oxide, or NO, is a gas molecule that most cells in the body produce. It is an integral part of how our body functions and plays a role in activating the enzymes in blood vessels that, among other things, help make a normal erection. As we age, however, the body produces less nitric oxide (which is the case for many essential bodily functions).

While the prevalence of erectile dysfunction continues to be researched, studies have shown that about 20% of the United States male population and 50% of those aged 40 to 70 years may suffer from moderate ED. Greater than 60% of men over 70 may suffer as well. This data is from the early 2000s, and the obesity epidemic, for example, has significantly worsened so those prevalence figures may be even higher.

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Could How You Grow Your Hair Be Causing ED?

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Man looking in mirror touching hair

One of the most concerning issues that male patients discuss with their friends or physicians is hair loss. For many, hair is a sign of virility, and despite the inevitability of male pattern, baldness, which ultimately comes down to genetics, we still fight for that hair tooth and nail. It’s no wonder that hair restoration has grown to be such a huge industry and is rife with therapies that work and others that many claim to be effective but don’t have much data to support the assertion. From micro-needling rollers to caffeine ointment, red light therapy, various essential oils, and medication, there’s an overwhelming amount of information to process and seemingly impossible decisions to make.

Enter Finasteride

Finasteride is a drug known as a five alpha reductase inhibitor. Its main claim to fame is the very effective blockage of dihydrotestosterone (DHT (finasteride blocks upwards of 90% of DHT in the prostate and 70% in the blood)). DHT is essential to the normal workings of our bodies and is instrumental in developing male characteristics. However, excess DHT on our scalp later in life can cause hair follicles to shrink and ultimately die. By controlling the DHT systemically via the oral intake of finasteride or locally through topical applications, we see some of the very best hair regrowth results of any therapy.

It’s worth understanding that finasteride was not developed as a treatment for hair loss but rather to slow the growth of the prostate to fight a natural process known as benign prostatic hyperplasia (BPH) that affects most men later in their lives. However, it soon became clear that men taking this drug grew more hair on their scalps, and you have the ubiquitous drug we are used to hearing about today.

The Side Effects of Finasteride

For all its benefits, Finasteride has some potentially significant side effects. They mostly revolve around the effects of very low DHT, including low libido, reduced general function, depression in some, and even erectile dysfunction. These effects seem more pronounced when finasteride is taken orally, but the topical version can also be problematic. Younger men seem to have greater side effects than their older counterparts. As such, if you are currently using finasteride therapy for hair loss and having difficulty maintaining an erection, you may wish to speak to Dr. Kapadia to understand more about the systemic effects that both the oral drug and, to a lesser extent, topical application can cause.

What Is the Answer?

If you look up the recommended dosages of oral finasteride, you may be shocked to see how varied they are. Dosages from .5 mg up to 5 mg are routinely prescribed. Why so much variance? We all react differently to finasteride; no single dosage makes sense for every patient. However, as with most drugs, we strongly encourage working with your primary care physician, urologist, and hair loss specialist, to take the minimum effective dose. This helps ensure the drug can take effect while minimizing its potential, side effects, and considerations. This dosage can, of course, be modified to find a sweet spot. And patients should be aware of how their body reacts in the days and weeks after changing their dosage.

It’s also important to remember that finasteride may not cause erectile dysfunction and that aging is making it more difficult for you to achieve and maintain an erection during intercourse. In this situation, we can work with you to develop an erectile dysfunction treatment plan, including medication like sildenafil (generic Viagra) or tadalafil (generic Cialis), or for more severe erectile function, problems, course of injections, or even a penile implant.

Most importantly, speak to us about this and any other erectile function issues he may have. While it may feel awkward to have that conversation, we’ve helped thousands of men with the same problem, and want you to rest, assured that it is nothing to be ashamed of. Ultimately, erectile function can be achieved, no matter how bad your condition.