Below is a brief overview of impotence, and of penile implants, what they are and how they work. We hope that if there are errors or omissions in this information, you will be kind enough to point them out in a comment below, so that they can be corrected.
In a normal erection, when a man is sexually stimulated, blood flows to the penis. There are two spongy areas, throughout the length of the penis that fill with blood, one on each side. At the same time as this happens, valves which normally would allow blood in these spongy areas to leave the penis when a man is NOT sexually aroused, close. The result is that these spongy areas fill with blood and blow up like two long balloons. That is what causes the penis to lengthen and become larger in girth, and causes the hard erection.
This is, however, a very complex process, and a lot can go wrong with it. First, as would be expected, this whole process is controlled by the brain, so there is "psychology" involved. In the past, when little real research had been done on sexual problems, and little real information existed about them, it was inferred that most sexual problems, including problems with erections, were caused by psychological issues. It was thought that these problems were "all in your head". Now we know that only in a very small percentage of cases do problems with erections result from psychological issues. Most erection problems have physical causes. We will detail some of them below:
Many drugs, and alcohol, can cause erection problems, and / or problems with ejaculation. Heavy smoking has also been implicated. Some of these drugs are those that are prescribed for us by our doctors because of physical conditions that we have, such as high blood pressure or heart problems. If we don't take these medications we can become very ill, have strokes, and die. If you have erection problems and take medications, you should discuss this with a urologist or pharmacist to see if another medication is available which will be medically effective, but will not have the sexual side effects.
Many erection problems are caused directly by diseases that we might have, such as diabetes, which can cause neural and blood vessel problems.
Some kinds of surgery can also cause erection problems. The most notorious being some surgeries of the prostate. The prostate is a gland which surrounds the tube which carries urine and semen. It is located at the base of the urinary bladder. It is surrounded by relatively stiff tissue which does not expand. As men get older, our prostates sometimes swell. Since the prostate can not easily expand, it presses on the urinary tube flowing through it making it difficult to urinate. As a result, your physician may recommend surgery to remove some or all of the prostate tissue. Nerves which control erections run through this area, and can be damaged during this surgery. Another common prosate problem is prostate cancer. The largest risk factor for prostate cancer is age. As we get older, it becomes more likely that we will get prostate cancer. By age 80, nearly 80% of men have some form of prostate cancer. This type of cancer is variable, and some of it is aggressive and dangerous, and some kinds of it are much less dangerous, and can simply be monitored by you and your physician. That said, your physician may recommend removal of your prostate, or some other treatment which damages the nerves which control your erection, if you get prostate cancer.
In this regard, it is also likely that one of the most common erection problem treatments, injections into the penis, can cause scar tissue to form, which can cause the penis to bend, and can make erections difficult and /or painful.
Also, the penis, testicles and / or nerves controlling erection can be physically injured. This has become more common in this era of almost continuous war, particularly since explosive devices planted in the ground have become more common.
Finally, as we age, our blood vessels get filled up with gunk adhering to the blood vessel walls and getting in the way of normal blood flow. The common term for this is hardening of the arteries.
Any of these causes which injure the nerves which control blood flow, or the blood vessels themselves, can get in the way of a normal erection, and, as we have seen, most of these problems, just like gray hair, or no hair at all, become more common as we age.
So what can be done about erection problems? A number of things may help, at least temporarily.
First of all, if you are having erection problems, see an endocrinologist and have your testosterone levels checked. Testosterone controls the "sex drive" of men and women. It also has a role in creating erections. There are daily or weekly treatments for men and / or women that one can use at home which will help with this problem.
Second, find a good urologist. She or he may recommend pills such as Viagra, Levitra, or Cialis which are a great help to many. The fact is, however, that many of us have found that these pills became less effective, or completely ineffective after a few years.
Note that I have recommended that you see specialists for these problems. If you have a friend who is a physician, ask him or her how much time was spent in medical school training them to deal with sexual issues. If they are truthful, the answer will likely be less than one afternoon. It is hard enough to find a qualified specialist, much less a general practitioner or internist qualified to deal with sexual issues.
So, if you have tried the pills, and they have become less effective, what is next?
There are drugs which you can insert into the tube in your penis which urine normally flows through, or which you can inject directly into the penis. Some men find these drugs effective. Most find them somewhat painful, and as mentioned above, injecting drugs into the penis can cause scar tissue to form which can cause bending of the penis and difficult or painful erections.
Many men have tried vacuum devices. The user puts lubricant inside the device, and puts a strong rubber ring, like a very strong rubber band around the end of the device. The device is then slid over the penis and pressed tightly to the body. The man then actuates a lever on the device which creates a vacuum inside of it. This causes the penis to fill with blood and expand, much like a normal erection. Finally the rubber ring/band is slid off of the device onto the base of the man's penis, trapping the blood inside it, and maintaining the erection. Many men find this useful for intercourse, but there are problems. The band/ring can pull pubic hair, and be otherwise painful. If one is not careful, the blood can leak out of the penis before the ring is in place. Finally, since there is not blood flow to the penis, wet with lubricant, it quickly becomes cold. One woman referred to it as "making love to a wet mullet".
So, what's next?
Many men have found that penile implants work well for them. So what are penile implants, and how do they work?
Penile implants are devices that are placed surgically inside the two spongy areas inside of the penis. They come in three basic types.
The first type is somewhat flexible and causes one's penis to be semi erect at all times. The penis is bent down when not being used for intercourse, and bent up for intercourse. As you might expect, this partially erect penis is somewhat "in the way" most of the time, when not being used for intercourse, and is also somewhat visible at all times. Many men also find that this type of implant produces a smaller and less useful erection than normal. Finally, this type of implant can wear on the inside of the penis. It can sometimes be painful and even wear through the penis requiring surgical repair.
The second type of implant comes in two parts. a balloon like device is surgically placed in the spongy area on each side of the penis. A small pump, reservoir, and valve are placed surgically in the scrotum (the bag which contains the testicles). When the man wants to have intercourse, he, or his partner, pumps a solution from the reservoir into the balloons inside the penis. This causes the penis to have an erection which lasts until the release valve is activated. When that happens, the fluid moves back from the balloons to the reservoir, and the penis deflates. Because of the necessarily small size of the reservoir, this device results in a somewhat smaller erection than normal.
The third type of implant is very similar to the second type above, except that instead of placing the reservoir in the scrotum, it is placed surgically inside the abdomen, behind the pubic bone. This allows for a larger, more satisfactory erection, but requires a more involved surgery.
Recovery from penile implant surgery takes from 4 - 6 weeks before intercourse is again possible, and up to 2 or 3 months to become completely healed and to be able to perform all normal physical activity. After recovery is complete, there is no pain from the devices, and you feel "normal".
Some additional important comments:
Penile implants allow a man to have normal ejaculations and orgasms. The penile implants create erections that are there whenever needed, and for as long as desired! Somewhere between 90% and 97% of people are very satisfied with them.
On the down side, there is about a 3% infection and complication rate with them. When an infection or complication occurs, it is frequently necessary to remove the device, at least temporarily. When the device is removed, it is impossible to have a normal erection.
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