Erectile dysfunction is a not uncommon occurrence for men, happening to more than half of guys over the age of 40 according to some data. While lifestyle alterations and prescription medications can commonly alleviate the problem, sometimes more drastic interventions are necessary.
Surgery is perhaps the most drastic step to resolve the condition, and while it's generally not necessary, some patients find that they benefit more from surgery than less invasive methods of treatment.
If you’re experiencing moderate to severe erectile dysfunction, it's important to understand all of the options available to you. Before you book an appointment with a surgeon, make sure the option you’re choosing is ideal for you and your sexual wellness in the long run.
Why Choose Erectile Dysfunction Surgery?
There are plenty of safe and effective erectile dysfunction medications like Viagra® and Cialis® that have been providing satisfactory solutions for millions of men for nearly 20 years. In most cases, these medications are convenient, affordable, and easy to use. They work for the majority of men.
Some men find that these medications don't provide the solution they’re looking for. Men who are using nitroglycerin or nitrate-based medications, for example, cannot take the most common erectile dysfunction medications, PDE5 inhibitors. Taking nitrates in conjunction with PDE5 inhibitors can be dangerous.
Men who have experienced injury or trauma that resulted in erectile dysfunction may find that these medications aren’t sufficient either. They may need reparative or restorative procedures to help restore erectile function.
For these men and many others with underlying health conditions, surgical intervention may be the only feasible or necessary solution available.
What is Penile Revascularization?
Penile revascularization is a major surgery performed on younger patients who experience erectile dysfunction as a result of a severe injury below the waist. If the cause of erectile dysfunction is damaged blood vessels or arteries, they can be bypassed to restore adequate blood flow to the penis and allow erections to occur with the body’s natural arousal cues.
Penile revascularization is a type of microsurgery performed under general anesthesia. It’s a serious procedure that will require carefully managed aftercare. If you have vascular damage to your groin, speak to a doctor about penile revascularization and your physician can help to assess your candidacy for the procedure.
What Are Penile Implants?
A penile prosthesis is a device that helps a man to achieve a spontaneous erection without diminishing sensation or reducing the potential for orgasm. These devices are potentially excellent for men with heart conditions who cannot use erectile dysfunction medications, men with diabetes, or men with vascular conditions.
Some men prefer the convenience offered by a penile implant, as the implant allows for on-demand erections. Medications usually take a few hours to work, but the implant can work whenever a man needs it to.
The following are both major surgical procedures that involve extensive recovery times.
Inflatable Penile Implants
Inflatable penile implants are implants that go inside of your penis, scrotum, and lower abdomen. Several parts are connected and designed to work together. Two inflatable cylindrical parts are placed inside of the penis and connected to a fluid reservoir installed near the bladder. A pump is placed in the scrotum and is easy to locate by touch.
By squeezing the pump mechanism inside of the scrotum, a man can inflate the cylindrical implants in his penis to achieve an erection manually. The penis remains somewhat flexible, and should not feel rigid or painful when the cylinders are filled to their ideal capacity.
The recovery process from a penile implant surgical installation can take six weeks and will involve regular check-ins with a doctor and medication to manage the pain. Once the surgical sites are fully healed and the implant tested for functionality, your doctor will give you the green light to proceed with sexual activity.
Penile implants are considered an effective solution to erectile dysfunction, though they are costly and invasive to install. Although these devices work well, they’re mechanical in nature, and if they break or malfunction, the only way to repair them is surgically.
Malleable Penile Implants
Malleable penile implants are flexible rods that are surgically inserted into the soft tissue of the penis, leaving the penis in a permanent semi-erect shape. These rods make your penis malleable. Similar to a pipe cleaner, a malleable penile implant can be shaped and re-shaped. You can bend it into an erect shape, an upward curved shape, or a downward curved shape.
Recovery from surgery for malleable penis implants can take about six weeks. The procedure is performed under general anesthesia and usually takes about an hour. Your doctor will tell you when your implants have healed enough for you to safely resume sexual activity.
Malleable penile implants can also be an effective solution to ED, but they require some thought and care once in place. For example. you’ll need to adjust the position and curvature of your penis depending on the clothes you’re wearing. Pointing the penis head downward will make the implant less noticeable in jeans or other form fitting clothing. Loose-fitting drawstring gym shorts tied at the waist will usually be sufficient for athletic activity.
Treating Erectile Dysfunction Without Surgery
Surgery is only necessary under exceptional circumstances. Most men are satisfied with the results of medications or vacuum pumps, which work in different ways to help men achieve and maintain an erection.
With Vacuum Pumps
Vacuum penile pumps work by using suction to draw blood into the penis. A cylindrical device is placed over the penis and a pump draws out the air by a hand pumping mechanism or a battery powered pumping mechanism. As the air is drawn away, the suction creates enough force to cause the penis to swell with blood.
Then, the user places a constricting band over the base of your penis to make it difficult for the blood to escape once you’ve released the suction. Safe penile pumps will come with a feature that allows for quick release of the vacuum mechanism, preventing any mishaps that may occur from a pump that is difficult to remove.
The band can be worn for up to half an hour. After that time, it's imperative to remove the band. Leaving it in place for too long can damage the penis by restricting blood flow. Pumping can sometimes cause bruising at the base of the penis which usually resolves within a few days. The constrictive band can prevent ejaculate from freely exiting the penis. This is not harmful, but it may feel unusual.
With Erectile Dysfunction Medications
If you are otherwise healthy or if your health conditions are successfully managed with the use of medications that won't interact negatively with ED meds, erectile dysfunction medications may be a viable solution for you.
Most erectile dysfunction medications work within 30 minutes to an hour. As a result, some men opt to have surgery because they want spontaneity in their sex lives. Though PDE5 inhibitors typically work for a few hours (and up to 36 hours in the case of Cialis®), some men don’t want the hassle of timing their medication with their intimacy.
If spontaneity is your main concern, surgery is not the only answer. One erectile dysfunction medication is designed to be taken daily in order to provide men with the spontaneity that they crave. The biggest difference between the “as needed” medications like Viagra and Cialis (tadalafil) that you may be familiar with is dosages.
Cialis Daily (tadalafil) is available in a 2.5 and 5 mg dose, much smaller than the typical 10 and 20 mg doses used "on demand." These low doses allow some men to take them every day as a primer, meaning they can have sex any time with no medication administration in the hour beforehand. You take them regularly, they accumulate in your system, and the quality and frequency of your erections will improve over time.
ED medications are simple, accessible, affordable, and don’t require any invasive procedures or downtime, and low-dose tadalafil
Before you consider a major surgery, talk to a physician about an on-demand or daily medication.
The Takeaway: Most men will be satisfied with the common erectile dysfunction medications, and surgeries for erectile dysfunction are only necessary in severe cases or those where medications are not safe. ED surgeries include revascularization and penile implants.
If you’d like to discuss your options, REX MD can help you connect with a physician for prescription ED meds delivered to your door, if prescribed.
