Surgery

When there is a clear medical cause for erectile dysfunction that is unlikely to resolve or improve naturally, another treatment option for men might be a surgical penile implant or vascular reconstruction.

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Penile implant. The simplest type of prosthesis consists of a pair of malleable rods surgically implanted within the spongy erection chambers of the penis. Today, many men instead choose a hydraulic, inflatable prosthesis that allows a man to have an erection whenever he chooses. The penile prosthesis is also an option for men whose erections are curved due to scarring.

The inflatable penile prosthesis consists of two cylinders that are inserted in the penis and connected by tubing to a separate reservoir of fluid implanted under the groin muscles. A pump is also connected to the system and sits under the loose skin of the scrotal sac, between the testicles. To inflate the prosthesis, the man presses on the pump (which does not require putting pressure on the testicles). The pump transfers fluid from the reservoir to the cylinders in the penis, inflating them. Pressing on a deflation valve at the base of the pump returns the fluid to the reservoir, deflating the penis.

The prosthesis does not change sensation on the skin of the penis, a man's ability to reach orgasm, or ejaculation. Scars from the surgery are small; most people won't notice that a man had an inflatable penile implant. Between 90 and 95 percent of inflatable prosthesis surgeries result in implants that produce erections suitable for intercourse. Possible complications from the surgery include uncontrolled bleeding, infection, scar tissue formation, and mechanical failure. Men usually cannot get an erection without inflating the implant, and if the implant is removed, the man may never again have natural erections.

Vascular reconstructive surgery. During this procedure, an option when blood flow to the penis is blocked, surgeons transfer an artery from an abdominal muscle to the penis. This technique creates a path for blood to flow to the penis that bypasses the area of blockage.

Only a small percentage of men, mostly young men with trauma leading to the penis, may be candidates for this surgery. The technique is technically difficult, costly, and not always effective.