Alan Schrager, M.D., F.A.C.S.

Urology and Urologic Surgery


Male Sexual Dysfunction and Penile Prosthetics

Definitions and Statistics

Impotence is defined as the inability to obtain and/or sustain an erection that is satisfactory for sexual intercourse. It is estimated that 30-35 million men in the United States suffer from this problem. You are not alone. Every man above age 40 or 45 has had some problem with erections on occasion and no man over 50 performs as he did when he was 19 or 20. We cannot run as fast, we cannot exercise as long nor can we have the erections we once did.

Most sexual dysfunction is caused by a physical problem. We formerly believed that psychological problems were the primary cause. More recently, sophisticated testing and research has shown that the majority of cases are physical in etiology. Causes of male sexual dysfunction include blood vessel disease, neurological diseases such as spinal cord problems, multiple sclerosis, stroke, and diabetes.

Sexual dysfunction is diagnosed by a detailed history, a physical exam, and by laboratory studies which for the most part are painless and non-invasive.

The treatment of male sexual dysfunction depends upon patient and partner desires or needs and the degree of dysfunction. Treatments available include injection therapy, oral medication, vacuum devices, and penile prosthetics.

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Prosthetics

The "gold standard" by which all other treatment methods are judged are penile prosthetics. These devices were developed by urologists and bioengineers in the early 1970s. Since this time, they have been perfected and improved and work just about flawlessly in most patients today. There are several types of penile prostheses including semirigid rods and self-contained inflatable devices. The prosthesis that I favor is the multi-component inflatable prosthesis which gives the most natural appearance and feel both in the flaccid (soft) and erect (hard) states.

Penile prostheses are a permanent solution to a permanent problem. Using a prosthesis is spontaneous, easy, and immediate. The erection obtained will last as long as you like and the penis becomes soft immediately when the device is deactivated. The implant operation is performed easily and safely through an incision less than two inches long. The results are uniformly excellent. Patient and partner satisfaction is very high.

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Misconceptions About Penile Prostheses

I and other colleagues have heard many stories and misconceptions about penile prosthetics. Here are a few:

Misconception #1
The operation to implant a prosthesis is long and dangerous?

The operation to implant the prosthesis takes less than an hour. It is "skin level" surgery without entrance into a body cavity. The operation is quite safe and may be done as an outpatient and rarely requires a prolonged hospital stay.

Misconception #2
If I have a prosthesis, everyone will know?

A penile prosthesis is invisible to the naked eye. You can safely walk disrobed through a men's locker room for example and no one will know you have an implant. The only way an implant is detectable is by a careful physical examination of the genitalia.

Misconception #3
Some components of a prosthesis are outside my body?

All components of the prosthesis are placed inside the body and are not detectable except by a careful physical examination.

Misconception #4
Penile prostheses can be rejected by my body?

Penile prostheses are made of inert materials and are not rejected.

Misconception #5
Infection is a common problem with penile prosthetics?

Infections are extremely rare in penile prosthetics. Many precautions are taken before and during the procedure to prevent infection. In my experience, infections are extraordinarily rare.

Misconception #6
Penile prostheses are expensive?

The cost of a penile prosthesis is no more expensive than a gallbladder or prostate operation. Just about all insurance companies pay for the implantation of these devices.

Misconception #7
Penile prostheses can break easily?

Penile prosthetics are manufactured under the most strict rules and regulations. Malfunction of a penile prosthesis is extremely uncommon and, in my own experience, represents less than 5% of cases. If a prosthesis does malfunction, it can easily be repaired by a very short outpatient surgical procedure which replaces the offending component. The procedure to replace a penile prosthesis component is also paid for by insurance. The few patients with mechanical malfunction want their implant repaired as soon as possible.

Misconception #8
Sensation is altered by a penile prosthesis?

Sensation remains the same with a penile prosthesis. A prosthesis only produces an erection on demand. Ejaculation is also preserved after penile prosthesis surgery.

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The Female Partner of a Patient With Male Sexual Dysfunction

The female partner of a patient with sexual dysfunction may blame herself for the problem. She may fear that her partner finds her unattractive, is no longer interested in her, or may be going elsewhere. Discussion about the realities and causes of sexual function helps allay these fears. Women also may fear that the erection obtained with a prosthesis will be too large to too hard or uncomfortable. In reality, the erection obtained with a prosthesis is very similar to a natural erection.

Female partners often wonder why a man would undergo a surgical procedure in order to restore sexual function. Sexual functioning is an important part of a man's lifestyle. A man who becomes unable to perform can become depressed and distraught about this problem. One can compare the implantation of a prosthesis for sexual dysfunction to a breast reconstruction performed for a woman who has had a mastectomy. Even though the reconstruction is not medically necessary, it makes a woman who has had a mastectomy feel whole, normal, and feminine again. A prosthesis can do the same thing for a man with a chronic impotence. My happiest patients are those whose sex life has been restored by a prosthesis.

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What to Expect Following Penile Prosthesis Surgery

Following a surgical procedure to implant a prosthesis, there will be minor swelling, discomfort, and bruising. The discomfort does not last long. It is controlled with medication in the hospital and oral analgesics at home. The swelling and bruising usually disappear within a week or two. The prosthesis can be used approximately a month from the date of surgery. Instructions to inflate and deflate the device usually begin in the fourth week following surgery. The learning process is quick and easy.

If you have sexual dysfunction, you are not alone. You can successfully be treated regardless of the cause or severity. Do not hesitate to discuss your problem. Treatment is available for you. You do not have to be impotent.

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Refer a Friend

Alan Schrager, M.D., F.A.C.S.
1600 Harrison Ave.
Suite 102-G
Mamaroneck, New York 10543
Tel: 914.698.8106
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Rye Brook, New York 10573
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