What are penis implants or penile implants?

A penis implant (also known as a penile implant or penile prosthesis) is a device implanted under the skin of the penis as a remedy for erectile dysfunction (ED) or for penile enlargement.

There are two main uses for penile implants: ED and penis enlargement.

Erectile dysfunction

The first modern penile implants were developed to treat erectile dysfunction, and they're still in use today, despite the development of Viagra (generic name sildenafil) and other ED medications. In 2017, a study published in the journal Translational Andrology and Urology noted that penis implants had remained popular despite the prevalence of less invasive options. "Sales of penile prostheses continue to stay high, as many men became refractory to medical therapy and/or seeking a more effective and permanent therapy," wrote the study's author (Chung, 2017).

Penile implants are sometimes used for the treatment of a condition called Peyronie's disease, in which scar tissue builds up in the penis, causing it to become unnaturally bent and potentially resulting in ED.

Enlargement

In 2004, a new type of penile implant joined the party no one is super-psyched to be invited to: The FDA cleared Penuma, a silicone sleeve, for penis enlargement. The device is implanted over the top of the penis, enhancing its girth and length by about one to two inches. 

A 2018 study published in the Journal of Sexual Medicine—peer-reviewed but written by the surgeon who developed Penuma—looked at 400 men who had gotten the implants. They experienced a 56.7% increase in girth, on average, and two years later, 81% of them reported "high" or "very high" satisfaction (Elist, 2018).

The history of the penile implant dates back to the 16th century when a French surgeon named Ambroise Paré fashioned a contraption out of wood so a man who had lost his penis in an accident could urinate. The first penile implant that worked for both sex and peeing was performed in 1936 by Nikolaj Bogoraz, a Russian surgeon who used the skin from a soldier's abdomen to reconstruct a penis for him after he had lost his penis in war (Rodriguez, 2017). 

The modern penile implant came about in 1973, thanks to NASA, which developed a high-grade silicone that was used by a urologist at Baylor University to develop the first inflatable penile prosthesis (IPP). At the same time, competitors developed other non-inflatable options—and a new kind of space race was on.

Today, there are three main types of penis implants used for ED treatment:

• Non-inflatable (also called semi-rigid or malleable)

• Inflatable two-piece 

• Inflatable three-piece

Malleable/semi-rigid (non-inflatable) 

A semi-rigid penis implant usually consists of two wire or silicone rods (Chung, 2017), which are surgically inserted into the penis and bent upward for sex, then tucked downward to be concealed behind clothing. They're called "malleable" because they're able to be bent and "semi-rigid" because the penis always appears semi-erect.

Two-piece inflatable device

Inflatable penis implants were designed to resemble the natural erection. They consist of two cylinders that are implanted into the two rods of spongy tissue that run down the sides of the penis and usually fill with blood during an erection (an area known as the corpus cavernosum) that is connected to a pump and small reservoir of saline fluid hidden in the scrotum. When the pump is squeezed, the cylinders fill with saline, simulating what happens during a normal erection (Chung, 2017). 

Three-piece inflatable device

A three-piece implant consists of a reservoir of saline fluid implanted inside the abdomen, which is connected to a pump and release valve hidden in the scrotum. This provides the most rigid, natural erection but has more parts that can potentially malfunction (Mayo Clinic, 2019).

Because a penis implant is placed in erectile tissue well below the surface of the penis skin, it doesn't change the sensation on the skin of man's penis or impair the ability to reach orgasm.

Satisfaction rates for penile implants are high. According to one study published in the Journal of Sexual Medicine, 79% of men who had undergone penile implant surgery reported being fairly or very satisfied with it (Carvalheira, 2015). Sixty to 80 percent of the devices last more than ten years (Mayo Clinic, 2019).

A 2019 study evaluated the satisfaction of 883 men with ED who had received penile implants. The researchers found that two-piece and three-piece inflatable prosthesis recipients were more satisfied with their choice than semi-rigid prosthesis recipients (Çayan, 2019).

Another 2019 study evaluated the longer-term effectiveness of three-piece inflatable penile implants. The researchers interviewed 51 people who had received the implants and found that "almost half of the devices still worked properly 20 years after the original penile implant, as 60% of patients were still using the device with high satisfaction" (Chierigo, 2019).

You may be a good candidate for penile implant surgery if you have persistent ED that has not responded to other treatments, such as 

• Oral medications for ED (called PDE5 inhibitors) include sildenafil (brand name Viagra), tadalafil (brand name Cialis), vardenafil (brand name Levitra), and avanafil (brand name Stendra).

• Penis pumps. Also known as a vacuum erection device (or VED), a penis pump consists of a plastic chamber into which the penis is inserted and a pump powered by hand or battery. The suction increases blood flow to the penis, causing an erection. 

You may not be a good candidate for a penile implant if your ED is potentially reversible or if you haven't tried other treatment options first.

"Penile implants are appropriate in men who have erectile dysfunction that doesn't respond to more conservative therapies," says Landon Trost, MD, a urologist with the Mayo Clinic in Rochester, Minnesota. 

Trost is less sanguine about implants for purely cosmetic reasons: "The issue with penile fillers or implants is that they have many side effects," he says. "Fillers and Penuma are generally not recommended by the far majority of sexual medicine specialists."

Penile implant surgery is performed under general anesthesia. During a penis implant procedure for ED, the surgeon inserts the device's inflatable cylinders within the corpora cavernosa, two tubes of spongy tissue that run down the length of the penis. For inflatable implants, the surgeon inserts the pump and valve into the scrotum. For three-piece implants, the fluid reservoir is implanted in the lower abdomen.

During surgery to place a Penuma implant, a one-inch incision is created at the top of the penis, closest to the abdomen. The implant is stitched into the penis just above the corpus cavernosum.

After penile prosthesis surgery for ED, most patients can return to work within a day but are advised to avoid heavy activity for two weeks after surgery. Typically, pain medication can be taken as needed. Four to six weeks after surgery, you will typically return to your healthcare provider to learn how to operate the device, after which sexual intercourse is permitted (UVM, n.d.).

Penile implants for ED may be covered by insurance, depending on your plan. Medicare covers the devices when they're determined to be medically necessary; Medicaid does the same in some states.

Penuma is considered to be cosmetic surgery, which is not covered by health insurance.

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Current version

September 23, 2020

Written by

Michael Martin

Fact checked by

Mike Bohl, MD, MPH, ALM

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About the medical reviewer

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.