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Penile implants for erectile dysfunction have been been continually improved and refined over the last 40 years. More than 300,000 cis gender and trans gender men have had penile implant surgery, with approximately 20,000 penile implant surgeries a year. 1
Penile implants provide an erection by serving as a replacement for the spongy tissue (corpora cavernosum) inside the penis that normally fills with blood during an erection. They come in a variety of diameters and lengths.
Penile implant surgery is typically performed at stage 2 or 3 of a multi-stage phalloplasty (a minimum of nine months following stage 1.) Recovery time is typically 6 to 8 weeks. Patients can resume sexual activity after physician consultation.
Note On Terminology: Penile implants are also known as penile prosthetics. However a penis “prosthetic” or “prosthesis” commonly refers to a non-surgical “ packer ” — a polymer or silicone penis that’s worn in a harness or affixed with medical adhesive. Similarly, “erectile device,” which is also sometimes used interchangeably with “penile implant,” can refer to external devices that assist with erections via vacuum pressure, vascular constriction, nerve stimulation, stretching, etc. This article will use the term “penile implant” exclusively to describe those penile prosthetic devices that are surgically implanted.
There are three basic kinds of penile implants used in FTM phalloplasty : the non inflatable or semi-rigid implant (malleable and non-malleable), the 2-piece inflatable implant, and the 3-piece inflatable implant.
(Includes semi-rigid malleable and non-malleable rods.)
One or two bendable and “positionable” rods are inserted into the penis. The rods have an outer coating of silicone and inner stainless steel core or interlocking plastic joints. Non inflatable (or semi-rigid) implants are always firm. They can be bent into different positions for erect and flaccid states. These implants are used the least of all types, in approximately 10% of cases. 2
How it works: For an erection, simply bend the penis in the erect position. To end the erection, bend the penis down. Erections can be of various degrees depending on how the penis is bent.
Popular Brands of Semi-Rigid Penile Implants:
Inflatable penile implants have two cylinders in the shaft of the penis, a reservoir that holds salt water, and a hydraulic pump to move the salt water from the reservoir to the cylinders, providing an erection.
The release valve on the pump drains the salt water out of the cylinders and back into the reservoir.
A 2-piece inflatable implant has the reservoir at the beginning of the cylinders (at the base of the penis) and the pump and release valve in the scrotum. These are used in about 15% of cases. 3
How it works: Gently squeeze the concealed pump in the scrotum several times. This moves the saline solution from the reservoir into the cylinders. As the cylinders fill, the penis becomes erect and firm. To end the erection, gently bend the penis down for 6-12 seconds. This transfers fluid back into the reservoir.
Popular Brands of 2-Piece Inflatable Penile Implants:
A 3-piece inflatable implant has the cylinders in the penis, the reservoir in the belly, and the pump and release valve in the scrotum. Compared to 2-piece inflatable implants, the reservoir in this type of implant is larger and separate from the cylinders. These are the most common of the penile implants, used in approximately 75% of cases. 4
How it works: Gently squeeze the concealed pump in the scrotum several times. This moves the saline solution from the reservoir into the cylinders. As the cylinders fill, the penis becomes erect and firm. To end the erection, simply press a “deflation site” on the pump. Deflating the cylinders transfers the fluid back to the reservoir and the penis becomes flaccid.
Popular Brands of 3-Piece Inflatable Penile Implants:
Choosing a type and brand of penile implant can be difficult as several factors need to be considered:
While the 3-piece inflatable penile implants are the most commonly used implants today, there are compelling reasons for trans men to consider the semi-rigid non-inflatable devices.
While improvements over the years have made the penile implant more reliable, no mechanical device is 100% free of malfunction, and that includes penile implants.
As with any surgical procedure, there always is the chance of post-operative infection. If the infection is severe, the implant must be removed.
Chronic pain may occasionally require removal of the implant.
Leakage from the cylinders can also require removal or replacement of the implant.
Less common complications include tissue erosion (particularly in the glans), implant malfunction (such as pump or reservoir failure) or defectiveness, and incorrect positioning or migration or the implant.
Erectile Implants in Female-to-Male Transsexuals: Our Experience in 129 Patients
Piet B. Hoebeke, Karel Decaestecker, Matthias Beysens, Yasmin Opdenakker, Nicolaas Lumen and Stan M. Monstrey. European Urology, February 2010.
Penile implantation in Europe: successes and complications with 253 implants in Italy and Germany.
Natali A, Olianas R, Fisch M. J Sex Med. 2008 Jun;5(6):1503-12. doi: 10.1111/j.1743-6109.2008.00819.x. Epub 2008 Apr 10.
This report provides data on the most commonly used penile prostheses in cis gender men: the American Medical Systems [AMS] series: AMS 700CX, AMS Ambicor, and AMS 600-650.
Phalloplasty: a valuable treatment for males with penile insufficiency.
Lumen N, Monstrey S, Selvaggi G, Ceulemans P, De Cuypere G, Van Laecke E, Hoebeke P. Urology. 2008 Feb;71(2):272-6.
Long-term survival of inflatable penile prostheses: single surgical group experience with 2,384 first-time implants spanning two decades.
Wilson SK, Delk JR, Salem EA, Cleves MA. J Sex Med. 2007 Jul;4(4 Pt 1):1074-9.
Long-term revision-free survival, greater than 10 years has never been reported for inflatable penile prostheses. This is the first report on long-term reliability of inflatable penile prostheses. Fourteen different inflatables were examined including Mentor Alpha 1, Mentor Alpha NB, AMS 700 CX, and AMS 700 Ultrex. Researchers estimated that 60% of these virgin implants would survive 15 or more years without revision or extraction. Newer enhanced models are currently available, and even better long-term survival for these devices is predicted. (Note: Study looked at cis gender men.)
Obtaining rigidity in total phalloplasty: experience with 35 patients.
Hoebeke P, de Cuypere G, Ceulemans P, Monstrey S. J Urol. 2003 Jan;169(1):221-3.
The combination of a neourethra and erection prosthesis in a single neophallus in the female-to-male transsexual remains a challenge. In this report, experience with 35 patients is described, and 1- and 3-piece hydraulic models are compared.
Penile prosthesis implantation in a transsexual neophallus.
Tan HM. Asian J Androl. 2000 Dec;2(4):304-6.
Successful insertion of an inflatable prosthesis is described. The AMS CX prosthesis is used in a 45 year old transsexual, who had a large bulky neophallus constructed from the anterior abdominal subcutaneous fat 9 years previous.
More journal articles: Phallo.net , NIH.gov
Footnotes:
1. Source: Erectile Dysfunction Institute (EDI)
2. Source: EDI
3. Source: EDI
4. Source: EDI
Good article, although I think your list of journal articles needs editing. The most recent study, which has the highest number of FTMs with erectile implants ever reported (129), was published in 2010 by Hoebeke et al. out of Belgium.
(Hoebeke PB, Decaestecker K, Beysens M et al. 2010. Erectile implants in female-to-male transsexuals: our experience in 129 patients. European Urology;57(2):334-340.
http://www.ncbi.nlm.nih.gov/pubmed/19303200 )
It’s worth noting that the first two articles you have listed are reports of cisgendered men with erectile dysfunction, which is very different from trans men. The first article you have listed has a reported complication rate of 20%, compared to a rate of 41% in the 2010 article by Hoebeke et al. According to the Hoebeke et al. article, there are several significant differences between cisgendered men and trans men with regards to erectile implants:
“First, there is no serviceable crus penis or corpora cavernosa roots in female-to-male transsexuals. This may contribute to a higher risk of malposition. Second, the tissue of the constructed neophallus is totally different from the tissue in a normal male penis. This may cause a higher risk of prosthesis protrusion and infection. Third, the prosthesis is implanted in an area that was previously operated on extensively, causing a lot of scar tissue, which is less vascularised and, thus, probably the origin of a higher infection rate. Finally, most female-to-males transsexuals are young (mean age: 34.1 yr), so one may presume that they are sexually more active than older males who show erectile dysfunction. This may lead to more mechanical failure of prostheses.”
I would also consider getting rid of the last two or three articles you have listed (from 2000, 1997 and 1993) – the technology and experience has changed so much since then, that I think they are obsolete and unhelpful for someone considering an erectile implant today.
Thanks for your comments. Much appreciated.
Thank you for your helpful suggestions! The journal articles links you provided have been added, and the older ones removed.
The studies that reference cis gender men and not trans men are marked as such, but I appreciate the extra detail you provided regarding the differences between penile implants in cis gender vs trans gender populations.
[…] With phalloplasty, there are different types of implants that can be used that has its pros and cons as far as cost and functionality. As with any sort of surgery, there’s always a risk of infection, loss of sensation and basically a non working penis. It’s not cheap to have a penis surgically made for you. ( http://www.trans-health.com/2013/penile-implants-guide/ ) […]
[…] Re: Having Sex after Transitioning to Male Knowing a few friends who are into medicine/surgery and having actually talked about the topic of SRS, if one is talking about phalloplasty there are some limits to what it is capable of. You cannot get an erection via the standard route of blood engorging the phallus, instead a system of artificial pumps and pressure cylinders can be employed, some methods put the mechanism that operates the system within the scrotum. Using this method of pumps though it is possible to create a penis that is capable of being both flaccid and erect as a biological penis is, albeit it requires manual operation to change from state to state. There are also other options such as the insertion of a semi rigid rod that can be used to give the penis increased firmness. Both of these options are limited by the fact that the neo-phallus created in phalloplasty is not capable of increasing in size to the same extent as a biological penis. In terms of Sexual satisfaction I have not read too much, from just cursory reading it seems to be that people still retain sensation, but in anything as permanent and big as surgery, more than simply cursory reading should be done. In terms of a website that has some interesting information, I have found this one to be particularly enlightening (warning: probably NSFW): Penile Implants: The Total Guide For Transsexual Men […]
How about spread the word about Patent US8126558 B2?
It’s a genius device, and it’s possible during our generation.
Basically, a controlled penile prosthesis able to remotely control erections. Either by an external device or chemical sensor signals. Check it out! & GOOD LUCK!
I had a great surgy in the late 80’s no complications at all, I couldburinate from myenis as soon as I was out. The only thing is they didn’t put my silicone testi cels in, and no stiffteng rods at the time I’m getting married to my beautiful fiance soon, and need this now, we have had for lay and thank god she wants to wait until we’re married to make love. I need and want this more then ever, help me pleas. Thank you, Austin Rust
I have one question, do they feel the pleasure on their dick while having sex or not?
If they’ve had a microsurgical phalloplasty procedure, yes.
Wow…..so in terms of exact costs for this procedures. , how much do they cost and how long does the prosedure take? What age is it most favorable for one to go for it and is it available in south africa?
Costs will vary greatly depending on where the surgery is done and what your needs are. Age may impact the type of implant used. Trans men from SA typically travel to Thailand or Serbia for the surgery (while cis gender men can have it done in SA.)
[…] Read the original article on boingboing, and on the British Journal, and find further research on trans-health.com […]
Hello,
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