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3rd September 2014

Erectile dysfunction: what if the drugs don’t work?

Viagra has become a household name and a fixture of pop culture. But medication does not always solve erectile dysfunction. Penile implants are usually a last resort.

Nowadays, it’s still difficult to have a clear and open conversation on erectile dysfunction. It’s only after the release of Viagra in 1998 that it started to be more openly discussed in society and healthcare, with the drug becoming a bit of a pop culture fixture.

There are many possible causes for erectile dysfunction, ranging from psychological issues and the use of certain drugs (like antidepressants) to hypertension.

These days, there is a more open dialogue about sexual health, and people are more willing to discuss concerns about their sex life with doctors. But ED is still quite a taboo subject among men, as men may not be as willing to discuss their personal frustrations openly and also because it involves the perception of one’s sexual performance and virility.

“You know what I missed the most? The emotional intimacy with my wife,” says Bob*, a man who had ED. “Because normally you wanna give her a hug, give her a kiss, but you tend not to do that. It’s a very gradual withdrawal. Because you’re saying: I give her a kiss, but then what happens?”

John, who also had ED, reports that it used to cause him the same amount of anxiety. “I would spend so much time getting an erection that it would take my mind completely away from the lovemaking [itself].

Sometimes, addressing the underlying cause resolves the issue. Other patients rely on drugs and injections to manage the issue. And finally, there are penile implants, a solution provided to patients that don’t respond to other treatments, or find the implant to be more convenient.

Two versions exist: one has a reservoir containing fluid that goes to the implant inside the penis, creating an erection, and the other is simply a flexible rod inside the penis that can be adjusted to an erection, and then be put back down.

What does it feel like?

According to John, who got the implant in 2008 and describes himself as a “very particular guy,” it feels like nothing at all: “I could not even tell on me that I have this in me. I wouldn’t know. I don’t see any scarring. If I have a look at myself, I see myself as a 21-year-old. When I look down, I’m pretty proud of this now.”

For Bruce, who got the implant to treat the ED he developed after having prostate cancer, it was a matter of not having anything to lose with the treatment.

“I based my decision to get the implant with the thinking that I’m already in the situation where I have ED and with having had prostate cancer and having had a radical prostatectomy; my chances of getting an erection are slim to none,” he says, “(…) with the implant I had everything to gain and nothing to lose.”

The surgery is not without its inherent risks. While it is not known to affect ejaculation or sensation, it is considered an option of last resort and only for irreversible ED, as the corpora containing spongy tissue – the part of the penis that fills with blood to create an erection – is removed in order to make room for the implant.

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Header image: Lacey Raper via Unsplash

Wood panel image: Keith Misner via Unsplash