Trans men interested in undergoing gender confirming surgery, specifically phalloplasty, often find themselves wondering which penile implant is right for them. Penile implants, also known as penile prosthetics, are devices placed inside the penis to allow trans men to get an erection. The FtM phalloplasty procedure offers three kind of penile implants to consider from: the non-inflatable or semi-rigid implant, the 2-piece inflatable implant, and the 3-piece inflatable implant. Before we get into pros and cons of each penile device, lets consider some medical research.
A long-term study documented the outcome in 129 FtM transgender individuals with a neophallus after the implantation of an erectile inflatable prosthesis from March 1996 until October 2007 (Hoebeke et al. 2010). Of 129 patients, 76 patients (58.9%) still have their original implant in place as of the date of the study’s publication in February 2010. Fifty-three patients (41.1%) needed to undergo either removal or revision of the prosthesis due to infection, erosion, dysfunction, or leakage. Despite high complication rates, the study authors concluded, implantation of an inflatable erectile prosthesis remains the best option for achieving the possibility of sexual intercourse in FtM transgender (Hoebeke et al. 2010).
In regards to the quality of sexual life, an observational study (De Cuypere et al. 2005) observed more than 80% of patients reported improvement in sexuality. Patients with penile prosthesis were more able to attain their sexual expectations than those without prosthesis, although the group with prosthesis more often reported pain during intercourse (De Cuypere et al. 2005). In addition, the study concluded that trans men reported masturbating significantly more often than trans women and experiencing greater sexual satisfaction, more sexual excitement, and greater ease in reaching orgasm.
NON-INFLATABLE or SEMI-RIGID PENILE IMPLANT
This type of penile implant consists of one or two bendable rods inserted into the penis made of an outer coating of silicon and an inner stainless steel core of interlocking plastic joints. The semi-rigid implant can be bent into different positions for erect and flaccid states. It works simply by bending the penis into the erect position to achieve the look of an erection and by bending penis down to end an erection. Because non inflatable implants are always firm, one should note that the look of a flaccid penis may appear as a semi-erection.
-Can be conveniently used by individuals with manual dexterity issues
-Simplest procedure to perform and is least expansive
-Less vulnerable to mechanical failure than inflatable implants and can last more than 20 years
-The rigidity of erection is less
-Downside of having a permanent semi-erection, which can feel and look awkward
-Can be difficult to conceal even when beneath several layers of clothing
2-PIECE INFLATABLE PENILE IMPANT
This type of penile implant has a reservoir that holds salt water at the beginning of the cylinders (base of the penis) with the pump and release valve located in the scrotum. It works by gently squeezing the concealed pump iseveral times to move the saline solution from the reservoir into the cylinders. As the cylinders fill, the penis becomes erect and firm. To transfer fluid back into the reservoir to end the erection, one has to gently bend the penis down for 6 to 12 seconds.
-Easy to use
-Totally concealed in the body
-More easily concealed under clothing
-Likelihood of malfunctioning or developing leaks
-The penis is not as rigid as with a three-piece penile implant due to smaller amount of fluid being transferred into the cylinders
-The pump can be felt more in the scrotum to sexual partners compared to the softer pump of the 3-piece penile implant
AMS Ambicor is a popular brand for a 2-piece inflatable penile implant.
3-PIECE INFLATABLE PENILE IMPLANT
This type of penile implant has the cylinders in the penis, the reservoir in the belly, and the pump and release valve in the scrotum. To use, gently squeeze the concealed pump in the scrotum several times to move the saline solution form the reservoir into the cylinders. To end the erection, press a “deflation site” on the pump, transferring the fluid back to the reservoir resulting in a flaccid penis.
-Easy to use
-Easier to inflate than a 2-piece device due to larger, softer pump
-Offers best rigidity
-Offers best flaccidity when not in use
-Totally concealed in the body
-More easily concealed under the clothing
-Highly vulnerable to leakage and dysfunction
-Requires the user to have good skills for operating it
-Most involved implant surgery and most expensive out of the three options
-Can last as little as 3 years before needing replacement
-Highest complication rate
Given the limited research on the post-op individuals, it may be a challenge to contemplate phalloplasty as part of one’s transition, not to mention deciding which penile implant, if at all, to consider. The combination of a neo-urethra and penile prosthesis in a single neo-phallus remains a challenge for medical professionals. Of course there is always the future. Animal studies have shown the potential implantation of tissue engineering for penile reconstruction with bioengineered tissue being used for penile reconstruction in rabbits (Chen et al. 2010; Yoo et al. 1999). Other options are future use of tissue-engineered human cartilage rods as penile prostheses (Kim et al. 2002).
References & Sources
Chen, K.L., Eberli, D., Yoo, J.J., & Atala, A. (2010). Bioengineered Corporal Tissue for Structural and Functional Restoration of the Penis. Proc. Natlk Acad. Sci. U.S.A. 107(8): 3346-3350.
De Cuypere, G., T’Sjoen, G. Beerten, R., Selvaggi, G., De Sutter P., Hoebeke, P., Monstrey, S., Vansteenwegen, A., & Rubens, R. (2005). Sexual and Physical Health after Sex Reassignment Surgery. Arch. Sex. Behav. 36(6): 679-690.
Hoebeke, P., Decaestecker, K., Beysens, M., Opdenakker, Y., Lumen, N., Monstrey, S. (2010). Erectile Implant in Female-to-Male Transsexuals: Our Experience in 129 Patients. European Urology. Volume 57, Issue 2, 334-341.
Kim, B.S., Yoo, J.J., & Atala, A. (2002). Engineering of Human Cartilage Rods: Potential Application for Penile Prosthesis. Journal of Urology. 168(4 Pt 2): 1794-1797.