Penile implant: how it works, types of implants and the insertion procedure

Introduction

Severe erectile dysfunction affects many men, often after a long medical journey marked by progressively less effective treatments. When pills, injections, or external devices no longer allow for a sufficient erection, a penile implant now represents the most reliable and lasting solution.

This procedure has been performed for several decades and benefits from major technological advances: stronger materials, more discreet devices, extremely low infection rates, and very stable results. The goal is not to alter the patient’s anatomy, but to replace a failing biological mechanism with a discreet and effective internal system.

The aim of this article is to present in a clear and comprehensive manner the functioning of the penile implant, the different models available, the procedure and the expected benefits, while answering the most frequently asked questions from patients.

What is a penile implant?

A penile implant — also called a penile prosthesis — is a fully internal device placed inside the corpora cavernosa. It replaces erectile function when natural mechanisms fail.

Contrary to some misconceptions, the implant does not change:

• the sensitivity of the penis
• the ability to reach orgasm,
• ejaculation (except in cases of pre-existing disease),
• the external appearance of the penis.

Its sole purpose is to ensure sufficient rigidity during intercourse. This device is invisible, undetectable, and does not alter the appearance of the penis at rest.

The implant is now considered the standard treatment for severe erectile dysfunction resistant to medical treatments.

For which men is a penile implant indicated?

The indication depends on the patient’s history, their state of health, and their expectations.
The implant is generally recommended in the following situations:

1. Severe erectile dysfunction resistant to treatment
   
   When oral treatments become ineffective, poorly tolerated, or contraindicated.
2. Failure or loss of effectiveness of intracavernous injections
   
   Certain pathologies lead to fibrosis of the corpora cavernosa, making injections ineffective over time.
3. Post-prostatectomy or pelvic surgery
   
   After a radical prostatectomy for cancer, erectile function may be permanently impaired. An implant is then a particularly suitable solution.
4. Peyronie’s disease associated with erectile dysfunction
   
   In cases of severe curvature with an inability to obtain a rigid erection.
5. Complicated diabetes (vascular involvement of the penis)
   
   Diabetic patients are common among candidates for penile prosthesis.
6. Neurological disorders
   
   Spinal cord injury, multiple sclerosis, neuropathies.
7. Older men but in good general health
   
   There is no real age limit. Many men over 60 or 70 years old benefit from this procedure with excellent results.

Each case is analyzed individually during the urology consultation.

The different types of penile implants

Today, there are two main types of penile implants:
the malleable (or semi-rigid) implant and the hydraulic (or inflatable) implant .
Both models allow for a rigid erection, but their operation, daily comfort, and natural appearance differ.

The choice of implant model is always made during a consultation, taking into account the patient’s age, medical condition, manual dexterity, anatomy, and preferences. The goal is to offer an implant that is both reliable and suitable for daily life.

1. The malleable (semi-rigid) penile implant

The malleable implant is the simplest system from a mechanical standpoint. It consists of two flexible rods implanted in the corpora cavernosa. These rods remain in a semi-rigid position at all times.

How does the malleable implant work?

The penis remains in a state of moderate rigidity.
For everyday life, the patient can discreetly point the penis downwards; for intercourse, it is enough to reposition it forwards.

There is no complex handling , no button to press, no internal mechanism: this is precisely what makes it a very reliable model.

In what cases is a malleable implant preferred?

This model is often recommended by:

• patients with reduced mobility or limited dexterity ,
• men who want a robust and very easy-to-use solution,
• patients with severe fibrosis of the corpora cavernosa,
• men who have had multiple pelvic surgeries,
• patients at risk of infection or with significant comorbidities.

Advantages of the malleable implant

• Extremely simple to use : no pump, no reservoir.
• Virtually no mechanical risk : very few parts, therefore very few breakdowns.
• Shorter surgery than for hydraulic implants.
• Long-term reliability , particularly in frail patients.

Points to know

• The penis remains in a semi-permanent state of rigidity , which may be uncomfortable for some men.
• The appearance at rest is less natural than that obtained with a hydraulic prosthesis.

Despite this, the malleable implant provides excellent rigidity and great ease of use.

2. The hydraulic (inflatable) penile implant

Hydraulic implants are the current gold standard technology.
It allows for the reproduction of an erection much closer to the natural mechanism, with a penis that is soft at rest and rigid on demand.

There are two main types:

• 2-piece hydraulic implants,
• 3-piece implants , which are the gold standard in terms of naturalness and comfort.

How does the hydraulic implant work?

The system consists of:

• two cylinders implanted in the corpora cavernosa,
• a pump concealed in the scrotum,
• a reservoir filled with liquid (for 3-piece implants),
• a valve allowing deflation.

To get an erection:

The patient presses the pump located in the scrotum → the liquid is transferred into the cylinders → the penis becomes rigid.

To return to a flaccid state:

Pressing the valve allows the liquid to return to the reservoir → the penis becomes soft again.

All of this is completely invisible.

Advantages of the hydraulic implant

• A very natural flaccid state : maximum flexibility at rest.
• Rigid erection on demand , close to a natural erection.
• Optimal aesthetic result , ideal for everyday life.
• Total discretion : nothing is visible or palpable without a specific examination.
• Very high satisfaction rate among patients and their partners.

Preferred indications for hydraulic implants

This model is often recommended when the patient is looking for:

• a rendering as close to nature as possible,
• a spontaneous and comfortable sexuality,
• total control of the erection,
• a high-end device with excellent comfort at rest.

Points to know

• A little learning is required in the first few weeks.
• The mechanism contains more parts, and therefore a very low but existing long-term mechanical risk.
• The procedure requires a slightly longer surgery.

Quick comparison between the two models

Criteria	Malleable Implant	Hydraulic Implant
Appearance at rest	Semi-rigid	Very natural
Activation	No manipulation	Pump in the scrotum
Discretion	Good	Excellent
Complexity	Very simple	More sophisticated
Rigidity	Permed	On request
Duration of surgery	Shorter	Moderate
Patient satisfaction	High	Very high

Procedure, hospitalization and recovery

Penile implant surgery is a specialized procedure, expertly performed by urologists trained in andrology. It follows a clear process, with successive steps designed to ensure a safe, effective, and patient-friendly procedure.

Pre-operative consultation: an essential step

Before any decision is made, a thorough consultation is conducted to understand:

• the history of erectile dysfunction,
• the treatments tried and their results,
• the patient’s expectations
• any associated pathologies,
• preferences regarding the type of implant.

The surgeon explains in detail the procedure of the operation, the usual after-effects, the possible risks and the expected benefits.
An anesthetic assessment is then carried out, as well as a pre-operative assessment (blood test, ECG…).

This step allows the patient to approach the procedure with confidence.

Procedure of the intervention

The procedure takes place in the operating room, under general or spinal anesthesia depending on the medical file. It lasts on average between 30 minutes and 1 hour , depending on the type of implant inserted.

Here are the main steps:

1. The incision

The surgeon makes a 3 to 4 cm incision:

• at the base of the penis (penoscrotal route),
• or at the level of the perineum (perianal route),

depending on the anatomical characteristics and the type of prosthesis.

This incision allows direct access to the corpora cavernosa.

2. Preparation of the corpora cavernosa

The corpora cavernosa are opened and then gently dilated to create the space needed for the implant.
This step is precise and meticulous: it aims to preserve as much fabric as possible and avoid any tension on the surrounding structures.

3. Implant placement

The components of the prosthesis are then positioned:

• Malleable stems in the case of a semi-rigid implant.
• Cylinders, pump and reservoir in the case of a hydraulic implant.

Each part is carefully adjusted to ensure optimal performance.
The surgeon specifically ensures:

• the correct positioning of the cylinders,
• comfortable mobility of the pump within the scrotum,
• due to the absence of tension on the tissues,
• of the patient’s future comfort.

4. Implant Test

Before suturing, the system is tested:

• pump activation (for hydraulic implants),
• rigidity check,
• return to a flaccid state,
• evaluation of the aesthetic result.

This check ensures proper functionality before closing.

5. Closing the incision

A fine suture is performed, then a compression dressing is put in place to reduce postoperative edema.

Hospitalization

The length of hospital stay is generally one to two nights .

Meanwhile, the medical team is keeping watch:

• to the proper management of pain,
• to monitoring the scar,
• in the absence of fever or infection,
• to ensure the patient’s comfort during the initial movements.

Simple painkillers are usually sufficient.
A suspensory is sometimes recommended to support the penis and limit swelling.

Recovery: timelines and recommendations

Recovery is gradual. It depends on the type of implant, the patient’s medical history, and the healing rate, but generally follows these stages:

1. The first few days

Swelling, some bruising and discomfort are normal.
They fade within one to two weeks.

The patient is able to walk the very next day.
It is advisable to avoid sudden movements, long periods of sitting, and strenuous activity.

2. Resumption of activities

• Sedentary work : 7 to 10 days
• Physical work : 3 to 4 weeks
• Sport : gradual return after 4 to 6 weeks
• Driving : usually after a few days

In all cases, the urologist adapts the recommendations to the patient’s profile.

3. Resumption of intimate life

Resumption of sexual relations is possible 4 to 6 weeks after the procedure, once healing is complete and the swelling has subsided.

For hydraulic implants, an initial training session is often conducted so that the patient can handle the pump naturally and with confidence.

When to consult a doctor?

Although complications are rare, you should contact a urologist if you experience:

• Intense, persistent pain
• significant redness
• suspicious leak
• fever,
• unusual difficulty in operating the pump.

Care is always provided quickly, and careful follow-up is ensured.

Results, satisfaction, psychology and impact on intimate life

Penile implant surgery is more than just a technical procedure; it very often transforms patients’ quality of life, far beyond erectile function. The results are long-lasting and reliable, and satisfaction rates, measured over several decades, are among the highest in urological surgery.

Expected results after penile implant surgery

After the recovery period, the implant allows you to obtain:

1. Sufficient rigidity for satisfactory ratios

Current implants provide effective, stable and controlled rigidity.
Whether equipped with a malleable or hydraulic model, the objective is the same: to restore a fully usable erectile function.

2. An erection on demand (hydraulic implants)

Hydraulic implants offer a function very close to that of a natural erection:

• Subtle flexibility at rest
• rigidity when desired,
• the ability to prolong the erection for as long as desired.

3. A natural aesthetic finish

Modern models are designed to respect the patient’s anatomy.
The shape of the penis at rest is natural, and the erection obtained is harmonious.

4. A stable long-term solution

Implants have an average lifespan of 10 to 15 years , sometimes longer depending on the model and use.
Some studies show functional devices more than 20 years after implantation.

Patient satisfaction rate

International studies report a satisfaction rate of over 90–95%.

These results can be explained by:

• the recovery of a satisfying sex life,
• the reliability of the device,
• the absence of drug dependence,
• spontaneity restored
• Comfort for the couple.

Very often, patients report the same phrase:
“I should have done it sooner.”

Positive psychological impact

Prolonged erectile dysfunction creates a loss of confidence, frustration, and sometimes a form of shame or withdrawal.
The penile implant therefore also has an effect on the psychological dimension.

1. Improving self-image

Regaining stable sexual function improves self-esteem.
The men describe a feeling of a return to “normality”.

2. Reduction of performance anxiety

One of the most burdensome elements is the fear of failure.
With an implant, this anxiety almost completely disappears: rigidity is guaranteed.

3. Easing of emotional burden

Many men live long lives in silence, sometimes isolating themselves.
The possibility of reliving relationships without uncertainty brings lasting peace.

4. Improved mood and overall well-being

The positive consequences often extend beyond the private sphere:

• renewed energy,
• better confidence in public
• sleep improvement,
• disappearance of a heavy mental burden.

Impact on couple’s life

A penile implant can profoundly transform the dynamics of a couple, especially when erectile dysfunction was a source of tension or avoidance.

1. A more serene sexuality

Spontaneity returns, without stress, without calculation, without apprehension.
The relationships have become fluid and natural again.

2. Improved communication

Many couples explain that this intervention reopened a dialogue they no longer dared to initiate.

3. Rebuilding complicity

Renewed intimacy fosters a more stable emotional connection.
Some couples even speak of a “second intimate life”.

4. Role of the partner in the process

It is often beneficial to involve the partner in the decision-making process.
Understanding how the implant works, knowing what to expect, sharing fears… all of this helps to strengthen harmony in the couple.

Intimate life after 60

Sexuality does not end with age.
Many men over 60 or 70 years old continue to have legitimate expectations regarding their intimate lives. Penile implants are a particularly suitable solution for seniors in good general health.

The observed benefits are often very significant:

• renewed vitality,
• improved confidence,
• feeling of regained youth,
• improved relationship quality.

The procedure lasts approximately 30 minutes and recovery is relatively quick, making it a perfect option for older men.

Testimonies often reported by patients

Throughout the consultations, the feedback is recurring:

• “I’ve returned to a normal life.”
• “I no longer have that paralyzing fear.”
• “My relationship is better.”
• “I thought it was too late for me, but no.”
• “That’s a huge weight off my shoulders.”

These testimonials confirm the overall impact of the implant, both on sexual function and on emotional well-being.

Risks, complications, implant lifespan and medical follow-up

Like any surgical procedure, penile implant surgery carries risks, although these are now very well managed thanks to modern techniques and aseptic protocols. The majority of patients recover quickly, without major complications, and benefit from a reliable implant for many years.

Possible risks and complications

Complications remain rare, but it is essential to know their nature in order to make an informed decision.

1. Infection (rare)

This is one of the main risks, even though it affects less than 1 to 3% of patients in specialized centers.
Modern implants often have antibacterial coatings, and surgery is performed under strict aseptic conditions, which greatly limits this risk.

In the event of a confirmed infection, it may be necessary to temporarily remove the implant before inserting a new one once the area has healed.

2. Transient pain or discomfort

Moderate discomfort is common in the first few weeks, while the swelling subsides.
The pain is usually well controlled with simple analgesics.

3. Hematoma

A hematoma may appear in the scrotal or penile area.
It disappears in a few days or weeks with appropriate local care.

4. Mechanical malfunction

Primarily concerned with hydraulic implants, this risk remains low thanks to the current quality of the devices.
It could be a fault in the pump, cylinder, valve or reservoir.
In this case, a second intervention is sometimes necessary.

5. Erosion or extrusion (exceptional)

In rare cases, the implant can exert excessive pressure on the tissues, leading to weakening of the skin.
This complication is very rare and more frequent in frail patients or those with an infection.

Overall, serious complications remain exceptional, especially when the procedure is performed by a specialist surgeon.

Penile implant lifespan

Penile implants are designed to last for several years.
The average lifespan is estimated at:

• 10 to 15 years for hydraulic implants,
• sometimes more depending on the model and use.
• Malleable implants may have an even longer lifespan due to the absence of an internal mechanism.

Patients can sometimes keep their implant for much longer, particularly in the absence of mechanical problems or infection.

When the implant reaches the end of its life or if a mechanical component shows signs of weakness, replacement surgery may be considered.

Maintenance and upkeep

The majority of implants do not require any special maintenance.
For hydraulic implants, learning how to operate the pump is essential in the first few weeks.
Once this phase is over, its use becomes intuitive.

It is recommended:

• to regularly operate the pump (for hydraulic implants) once healing is complete,
• to follow the urologist’s instructions,
• to attend the follow-up consultations.

Medical follow-up after implantation

Regular monitoring is essential to ensure patient comfort and proper functioning of the device.

Here is the usual schedule:

1. Early postoperative monitoring
   
   In the days following the procedure, to check the healing, the absence of infection and the correct positioning.
2. Consultation at 1 month
   
   Initial functional assessment.
   For hydraulic implants: introduction to pump operation.
3. Consultation at 3 months
   
   Evaluation of comfort, sexual relations, overall satisfaction.
4. Follow-up appointment at 6 months (if necessary)
   
   Final assessment of the first semester.
5. Annual monitoring
   
   A simple clinical examination is sufficient to ensure that everything is functioning correctly.
   The follow-up is an opportunity to ask all questions and adjust some advice if necessary.

Price and refund in France

In France, penile implants are fully reimbursed by the national health insurance system as part of medical coverage:

• cost of the implant,
• surgical fees,
• hospitalization costs.

Fee overruns may occur, particularly in private clinics.
The patient can request a quote and check the reimbursement conditions of their health insurance.

Alternatives to penile implants, FAQ & conclusion

Alternatives to penile implants: what options are there before resorting to them?

A penile implant is a particularly effective solution, but it is only considered after other treatments have failed or are impossible. Here are the alternatives that are generally offered as a first-line treatment:

1. Oral treatments (PDE5 inhibitors)

Sildenafil, tadalafil, vardenafil…
These medications are often the first line of treatment.
They can be effective when vascular mechanisms are still partially functional.

2. Intracavernous injections

Alprostadil is injected directly into the corpus cavernosum.
This method provides a satisfactory erection in some patients, but is not always well tolerated (pain, fibrosis) and may lose its effectiveness over time.

3. Vacuum devices (vacuum pumps)

They allow for the creation of a mechanical erection through a cylinder and a penile ring.
A useful but often restrictive, less spontaneous and sometimes uncomfortable solution.

4. Psychosexual therapies

Indicated when the origin of the disorder is psychological or when performance-related stress aggravates the problem.
They can be complementary to a medical approach.

5. Hormone therapy

If a testosterone deficiency is identified, treatment may be offered.
However, these are specific cases.

When these treatments fail or are not possible, the penile implant becomes the most reliable and lasting solution.

Frequently Asked Questions (FAQ)

Here are the most frequently asked questions from patients and their partners.

Is the implant visible?

No. The device is entirely internal.
At rest, there is no visible difference compared to a natural penis.

Is the procedure painful?

Moderate discomfort may persist for a few days, but simple painkillers are usually sufficient to control it.
After 2 to 3 weeks, the majority of patients no longer feel any pain.

Is it possible to have an orgasm with a penile implant?

Yes.
The placement of an implant does not affect:

• orgasm,
• the sensation,
• ejaculation (unless a pre-existing pathology already impairs it).

Does the implant increase penis size?

No.
The goal is to restore functional rigidity, not to increase size.
The surgeon chooses the implant size that best matches the patient’s natural anatomy.

Can I do sports after the procedure?

Yes, but not immediately.
Most activities can be resumed after 4 to 6 weeks, once healing is complete.

Can a penile implant malfunction?

Malleable implants have an extremely low mechanical risk.
Hydraulic implants, which are more sophisticated, may present a very low risk of long-term malfunction.
In this case, surgical revision may be considered.

Can I travel or go through security checks with an implant?

Yes.
The implant does not trigger any detection systems (airports, security gates, etc.) and does not interfere with any daily activities.

How long should I wait before resuming an intimate life?

Sexual intercourse is usually possible 4 to 6 weeks after the procedure, when all structures are fully healed.

Videos by Dr. Sébastien Beley to learn more

To better visualize how the penile implant works and the procedure itself, you can watch these explanatory videos by Dr. Sébastien Beley:

• How does a hydraulic penile implant work?
  
  https://www.youtube.com/watch?v=tO_EuTapdK4
• Penile implant: can it be broken? Risks and reliability
  
  https://www.youtube.com/watch?v=jYmSl1pVXwo
• Sexuality after penile implant: what to expect?
  
  https://www.youtube.com/watch?v=dPZIG1BgKxY

Conclusion: a reliable, discreet and durable solution

The penile implant is currently the most effective solution for restoring an erection in men suffering from severe erectile dysfunction resistant to treatment.
It is a safe, reliable procedure, offering one of the highest satisfaction rates in urology.

Patients particularly appreciate:

• the reliability of the result,
• the complete discretion of the device,
• spontaneity rediscovered in intimate life,
• the positive impact on confidence and well-being,
• the lasting improvement of the couple’s relationship.

Each situation is unique, and the choice of an implant should always be guided by an open dialogue with a specialist urologist.
With current techniques, the placement of a penile implant not only restores satisfactory sexual function, but also improves overall quality of life.

Sources and references:

Manchester Urology – Penile implants: patient information
https://www.manchesterurology.com/patient-education/penile-implants/

European Association of Urology (EAU) – Management of erectile dysfunction
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/management-of-erectile-dysfunction

Mayo Clinic – Penile implants: indications, types and procedure
https://www.mayoclinic.org/tests-procedures/penile-implants/about/pac-20384916

Cleveland Clinic – Surgical penile implants: objectives, risks and recovery
https://my.clevelandclinic.org/health/treatments/10054-surgical-penile-implants