When is a penile implant considered?

What is a penile implant?

A penile implant, also called a penile prosthesis, is a medical device placed entirely inside the body during an operation. It sits within the two erectile chambers of the penis and allows a man to have an erection whenever he chooses.

There are two main types. Inflatable implants use fluid moved by a small pump hidden in the scrotum, so the penis can be made firm and then returned to a softer state. Malleable (semi-rigid) implants are bendable rods that stay firm and are positioned by hand. We look at how the inflatable kind works in how a three-piece penile implant works.

Nothing is visible from the outside when the device is not in use, and it is not usually noticeable in everyday life.

Is a penile implant the first treatment for erectile dysfunction?

No. Guidelines from both the European Association of Urology and the American Urological Association describe a range of treatment options. For most men, the process starts with a medical assessment, attention to lifestyle and risk factors, and less invasive treatments such as tablets like sildenafil and tadalafil, vacuum erection devices or injections into the penis.

The AUA guideline encourages doctors to discuss all suitable options with men, including surgery, rather than insisting on a rigid order. In practice, though, most men try other approaches first, and an implant comes into the picture when they have not worked well enough.

Who is a candidate for a penile implant?

Situations in which a surgeon may discuss an implant include:

• ED that has not responded to tablets, devices or injections, or where side effects have been a problem.
• When other treatments are unsuitable, for example because of medicines that cannot be combined with ED tablets, or when a man finds injections or devices unacceptable.
• After prostate cancer treatment, when erections have not recovered despite rehabilitation and time.
• Diabetes, where blood vessel and nerve damage can make erections less responsive to tablets. Surgical planning takes infection risk and blood sugar control into account.
• Peyronie's disease with erectile dysfunction. The AUA guideline on Peyronie's disease supports an implant for men with both curvature and ED, sometimes combined with additional steps to straighten the penis.

Can a 70-year-old man have a penile implant?

Age alone is not usually what decides it. A man in his seventies who is otherwise fit for surgery and wants an active sex life may be a suitable candidate. What matters is general health, including heart health and conditions that affect healing, along with a clear understanding of what surgery involves.

What are the risks?

Like any operation, implant surgery carries risks, and an honest conversation about them is part of the decision.

• Infection. This is the most serious complication and may mean the device has to be removed. Surgeons take specific precautions to reduce the risk.
• Mechanical problems. Devices can wear out or fail over time and may eventually need replacing.
• A permanent change. Placing the device alters the erectile tissue. Natural erections and other treatments are unlikely to work afterwards, even if the implant is later removed.
• Changes in perceived length. Some men feel the erect penis is shorter than their natural erections used to be. This is worth discussing openly before surgery.

What should I ask before deciding?

1. Have I tried, or ruled out, the other treatments that might suit me?
2. Which type of implant would suit my body, my hands and my lifestyle, and why?
3. What does recovery involve, and when could I use the device?
4. What is the surgeon's approach to preventing infection?
5. What happens if the device needs repair or replacement in future?
6. How might my partner be involved in the decision?

The choice between types is covered in inflatable or malleable: how men decide.

What to take away

A penile implant is a considered, permanent step, usually taken after other treatments have been explored. For the right man, it can be an effective way back to an active sex life. The decision belongs to the man, ideally together with his partner, after a frank discussion with an experienced surgeon. Our penile implants guide explains the procedure in more detail.

Questions men also ask

Is there an upper age limit for a penile implant?

There is no fixed upper age. Age on its own is not usually the deciding factor. What matters more is general health, fitness for surgery and what the man and his partner want from treatment.

Does a penile implant change sensation or orgasm?

An implant is designed to provide rigidity, not to change sensation, orgasm or ejaculation, which depend on separate nerves. Men should discuss their own situation with the surgeon, including any existing problems with these.

Can I try other treatments after having an implant?

Generally not in the same way. Placing an implant alters the erectile tissue, so tablets, injections and natural erections are unlikely to work afterwards if the device is removed.

Sources & further reading

1. European Urology European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction (opens in a new tab) (2021) Salonia A, et al.
2. Journal of Urology Erectile Dysfunction: AUA Guideline (opens in a new tab) (2018) Burnett AL, et al.
3. Journal of Urology Peyronie's Disease: AUA Guideline (opens in a new tab) (2015) Nehra A, et al.
4. EAU EAU Guidelines on Sexual and Reproductive Health (opens in a new tab) (2024) European Association of Urology.

This article is general health information. It does not replace an individual medical consultation, examination or diagnosis. Read our editorial policy and medical review policy.