Penile Prosthesis

I recently came across a TED talk by Aimee Mullins. Truly inspirational! This 38-year-old American athlete, actress and fashion model has accomplished a great deal in her life, despite born with missing fibula bones. Her debility resulted in the amputation of both her lower limbs at the age of one.

Mullins is in demand around the world, delivering talks on self-identity and innovation. Despite her shortcomings, she launched her modelling career with Alexander McQueen, by opening his London show on a pair of wooden lower limb prosthesis. She was well known for changing her height in the runway from 5ft 8in to an instant 6ft 1in.

Her eloquence made her a global L’Oreal Ambassador in 2011 and was named one of the 50 most beautiful people in the world by People magazine.

Despite her disability, Mullins was the first person in the world on the iconic carbon-fibre cheetah and regarded around the world as a sports pioneer. I guess that earned her the title of the “One of the Coolest Girls in sports” by Sports illustrated. 

Mullins once said: “At some point in every person’s life, you will need an assisted medical device. Whether it is your glasses, your contacts. Or as you age and you have a hip replacement or a pacemaker. The prosthetic generation is all around us.”

It is true, the world is a very different place compared to Lee Major’s the Six Million Dollar Man in the 70s. We are accepting synthetic replacement to enhance our ability or to rectify our incapacity. How accepting are we when the prosthesis is not for the replacement of deformed limbs, but a wilting penis?

Dear Dr G,

I am a 54- year-old man who has type I diabetes since my adolescence.

Despite sticking to stringent diet and careful monitoring of my glucose, I continue to have problems with diabetic complications.

My specialist told me that my nerve and blood vessels have been damaged due to diabetes.

Sadly, this is causing a worsening of my sexual function.

I first experienced erectile dysfunction in my 40s, and I was so pleased the problem was solved with the magical blue pills.

I began to notice the medicine losing its effectiveness after several years and the increase in dosage and change to other medications also had no effect.

My doctor asked me to use injections into the penis, truthfully, I simply find this impossible!

Don’t get me wrong. I am not scared of needles.

I mean I’ve been injecting insulin into myself since I was 17. But, injection to the penis? Seriously?

My urologist saw me last week and suggested penile prosthesis.

I have heard about such surgical intervention, but always assume this is an urban myth. Now, I have checked it out. I simply cannot image how do the implants work.

Can you please tell me what options I have and what are the complications of penile prosthesis?

JK

Many of us are born with physical or functional defects in our bodies. This may affect us in our youth or later in life. Type I diabetes, for example, is a hormonal flaw that may result in nephropathy, neuropathy, vasculopathy and retinopathy.

The impact of the nerve and vascular damage usually induces the irreversible damages to organs, such as penis, even the mighty blue pills will eventually “potong steam”.

In fact, the use of penile prosthesis is actually one of the oldest form of treatments for erectile dysfunction since the 70s.

This surgical implant is incorporated into the body of the penis (corpora cavernosa) by surgical means, and is commonly performed for men suffering from pelvic trauma, diabetes and prostate cancer.

In gender reassignment, such procedure will also ensure a functioning genitalia in female and male operations.

Essentially, there are two types of implants: Inflatable and non-inflatable devices. You heard correctly: Inflatable! This hydraulic expandable device was invented in 1973, by Brantley Scott, which is filled with saline.

It consists of inflatable double cylinders (yes, double cylinders as the chambers of the penis is indeed made up of two chambers) activated during sex, by squeezing the pump to transfer fluid from reservoir into the erectile chambers.

The pump is usually cocealed in the man’s scrotum and the reservoir in the pelvis. Naturally, after intercourse, the device is deactivated and the deflated chambers will ensure a flaccid penis. Scott was truly ahead of his time as inflatable penile prosthesis is still widely used forty years after its invention.

The non-inflatable implants are fundamentally two malleable metallic rods, surgically inserted into the body of the penis (ouch!) This device can be bent into required position (in fact, any position for that matter) as needed for penetrative intercourse.

Although penile prosthesis has provided many men with happy sexual relationships, the device may not be the answer for all ED patients. Some men complain of altered sensation and the displeasure of having a permanently semi rigid penis.

Others find the activation and deactivations cumbersome. Like any other devices, inflatable penis prosthesis may also have device malfunctions at some point.

Sigmund Freud once said: “Man has, as it were, become a kind of prosthetic God. When he puts on all his auxiliary organs, he is truly magnificent; but those organs have not grown on him, they still give him much trouble at times.”

I guess when it comes to the treatment of ED, the penile prosthesis is as godly and magnificent as it goes if all else fails!