The malleable penile prosthesis is a therapeutic alternative used in the management of erectile dysfunction. It has a simple activation and a resistant structure, which may contribute to greater practicality in everyday life. Learn more below.
After several negative experiences during sexual intercourse caused by erectile dysfunction and after trying treatment with medications and injections, this option may be considered for men who experience an important impact of erectile dysfunction on their sexual life.
Unlike other treatment options, such as medication or vacuum devices, penile prosthesis implantation is often considered for men who cannot achieve or maintain an erection that is sufficient for satisfactory sexual intercourse, despite other lines of treatment.
To understand how the malleable penile prosthesis works and whether it may be an option in your case, see below what Dr. Paulo Egydio explains about it.
What is a malleable or semirigid penile prosthesis?
The malleable or semirigid penile prosthesis is a flexible cylinder inserted into the corpora cavernosa of the penis, which can be manually positioned in an erect position for sexual activity.
The malleable prosthesis keeps the penis elongated. In addition, its malleability allows the organ to be placed downwards or to the side when not in use, so that it can be accommodated inside the underwear with discretion and comfort.
The main objective of penile implant surgery is to provide sufficient axial rigidity for penetration in selected patients, always according to medical indication.
There are different sizes, models and diameters of penile prosthesis, and the choice of implant must respect the anatomical particularities of each patient.
If the penis is shortened and thinned because of internal fibrosis, it may be necessary to place a smaller and thinner implant than would be considered ideal. Therefore, placing a prosthesis larger than the patient’s penis is not possible.
What is the difference between a malleable penile prosthesis and an inflatable prosthesis?
The main difference between a malleable penile prosthesis and an inflatable prosthesis is that the former keeps the penis constantly elongated, whereas the inflatable prosthesis allows the user to control the timing and duration of the erection by activating a pump.
Although both are options used in the treatment of erectile dysfunction, the malleable penile prosthesis has a simpler structure, as it does not require additional mechanisms to work.
The inflatable prosthesis is more complex: to obtain an erection, the man activates the pump, filling the cylinders with saline from the reservoir; to obtain flaccidity, the pump must be depressurized.
When is a malleable penile prosthesis indicated?
The malleable penile prosthesis is usually indicated for men with severe erectile dysfunction who do not respond satisfactorily to other lines of treatment, such as oral medications and penile injections.
The urologist will guide the patient in understanding whether this model is the most appropriate for his needs and expectations, or whether an inflatable implant should be considered instead.
Profile of patients eligible for a malleable penile prosthesis
In general, the malleable penile prosthesis has a broad indication in selected cases. However, the profiles below may benefit more from this model:
- Patients with a long and thin penis, who need more diameter to obtain sufficient firmness for penetration
- Patients with a longer life expectancy, since there is no pump or reservoir that might fail mechanically – although it can also be indicated for older patients
In addition, there are contraindications for patients with certain conditions:
- When there are restrictions to the expansion of the penile cylinder
- When there is motor limitation or lack of dexterity that may impair the activation of inflatable devices
- When the patient is in poor overall health
How does the malleable penile prosthesis work?
The prosthesis acts as a complement to axial rigidity, providing resistance for penetration.
The functioning of the malleable penile prosthesis is entirely mechanical. The patient manually positions the penis, which contains inside it a silicone cylinder with flexible metal rods.
Daily life
The rods keep the penis in a permanent or semirigid state. Some men prefer to conceal the penis as much as possible and, to do so, they usually wear tighter underwear and position the penis close to the groin.
It is important to remember that, regardless of the type of implant, the penis will not have the same degree of flaccidity as before.
Is a malleable penile prosthesis noticeable under underwear?
In many cases, a malleable penile prosthesis can be discreet under underwear, swimwear, shorts or trousers, especially when tighter underwear is used.
When wearing boxer-style underwear, for example, it is possible to keep the penis more supported, close to the groin, in the position the man finds most comfortable (to the side or downward).
Is it possible to feel the penile prosthesis to the touch?
In some cases, it is possible to notice the presence of a penile prosthesis to the touch, but this usually occurs only in very intimate contact.
Since the penile tissues are not removed for prosthesis placement, when the man is sexually aroused the corpora cavernosa can still fill with blood, which makes the penis feel warmer and sensitive. Thus, on touch, both the man and his partner may perceive sensations similar to those of natural erection.
The main difference is that the penis tends to remain firm throughout the sexual activity, according to the positioning adopted.
During sexual intercourse
During sexual activity, the man positions the penis forwards or upwards in order to perform masturbation or penetration in the most comfortable way.
With the malleable penile prosthesis, the penis maintains axial rigidity independent of the natural erection mechanisms, which may help provide stability during penetration.
Advantages of the malleable penile prosthesis for men
The main objective of the implant is to provide axial rigidity sufficient for penetration, according to medical indication. Erectile dysfunction can have a significant impact on self-confidence and well-being.
For some patients, a penile prosthesis is one of the options considered when other treatments have not been effective, and it may help them feel more secure about their ability to have and maintain an erection during sexual activity.
Below are some possible advantages of the penile prosthesis for men:
- Long-term option: unlike other treatment options for erectile dysfunction, the penile prosthesis may work as a long-term alternative in selected cases. Once implanted, it provides mechanical rigidity independent of natural erection mechanisms.
- Simplicity of use: implants are designed to be simple to handle and require little effort from the user.
- Perceived quality of life: some men report an improvement in their perception of sexual life after the implant, although results and experiences vary from person to person.
Does the prosthesis have any disadvantages?
Malleable penile implants are one of the options used to address sexual function in men, but depending on the point of view, they may be associated with some disadvantages:
- Permanent rigidity: the penis remains in a constant semirigid state, and some men may feel uncomfortable, especially when wearing tighter clothing.
- Less natural appearance: as this model does not allow full flaccidity compared with the inflatable prosthesis, the appearance of the penis at rest may look less natural.
- Higher risk of erosion: in rare cases, the rod may exert more pressure than the tissues can tolerate, which may favor this surgical complication, mainly in patients with a history of penile surgery, poorly controlled diabetes or prolonged catheter use.
How is malleable penile prosthesis surgery performed?
The surgery to implant a penile prosthesis is considered relatively simple when compared with other urological surgeries:
- Preparation: before surgery, the patient receives specific instructions from the surgeon on how to prepare. This may include fasting from food and liquids for a certain period and stopping certain medications.
- Anesthesia: prior to surgery, the patient will undergo general or regional anesthesia, depending on the preferences of the surgeon and the patient.
- Incision: the surgeon makes an incision in the penis to access the corpora cavernosa, the spongy tissues responsible for erection. The location and size of the incision may vary depending on the type of penile prosthesis to be implanted.
- Implantation of the prosthesis: once the corpora cavernosa are accessible, the surgeon places the penile prosthesis. For malleable prostheses, a flexible rod is inserted into the corpora cavernosa, providing rigidity when positioned upwards.
- Closure of the incision: after inserting the prosthesis, the surgeon closes the incision with stitches or absorbable sutures. This helps promote proper healing and prevent infection.
- Recovery: after surgery, the patient is taken to the recovery room, where he is closely monitored while waking up from anesthesia. Depending on the type of surgery and the individual response, full recovery may take a few weeks, with postoperative follow-up by the surgeon.
Implantation of the malleable prosthesis with the Egydio Technique
The implantation of the malleable penile prosthesis with the Egydio Technique is carried out after penile reconstruction. This technique aims to optimize penile dimensions so that the anatomy is adequate to obtain good rigidity and penetration.
During surgery, the tunica albuginea is expanded up to the limit of the nerves, which makes it possible to implant cylinders with greater diameter and length, without using grafts or extenders.
The choice of the ideal prosthesis size is made during the procedure, according to the limit of optimization of the tissues.
How is the adaptation after surgery?
In general, adaptation to the semirigid penile prosthesis may take up to 6 months for some patients.
In the postoperative period, men may feel some pain. Thanks to the anesthetic block used for the surgery, this pain usually decreases over the first days and, if necessary, painkillers may be prescribed for relief.
A few days after the procedure, the patient returns to the urologist to check how recovery is progressing.
In many cases, around 60 days after surgery, the patient may be cleared to gradually return to daily activities, including sexual intercourse, according to medical evaluation.
One of the main changes the patient may notice is increased vertical firmness of the penis. This can help reduce the risk of bending or slipping during penetration.
The prosthesis is designed to provide axial rigidity independently of the natural erection mechanisms.
What happens to penile girth after the prosthesis?
Penile girth depends on anatomical and functional factors.
One of them is the capacity to receive blood so that the erection can occur and then return to the natural state.
When there is difficulty maintaining the erection or when the penis bends during penetration, the prosthesis is often considered with the aim of providing greater firmness.
Another factor that influences penile girth after the prosthesis is the width of the penis before the implant.
In the video below, Dr. Paulo Egydio explains this topic in more detail.
Post-implantation care and restrictions
After surgery to implant the penile prosthesis, it is essential to follow specific care measures and respect some restrictions to favor a smoother recovery.
In the first days after surgery, it is important to rest and avoid strenuous physical activities. This helps proper healing of the incision and reduces the risk of complications. Other important care measures after penile prosthesis implantation include:
- Keeping the area clean and dry, and avoiding getting the region wet in the first days until the doctor allows it.
- Avoiding sexual activity for a few weeks after surgery to allow complete healing of the incision and surrounding tissues.
- The doctor may prescribe medications to help control pain and prevent infection after surgery.
- Attending all scheduled follow-up appointments with the surgeon to monitor recovery and check for complications.
- Being alert to signs of possible complications, such as fever, intense pain, excessive bleeding or problems with prosthesis functioning.
Following postoperative care and restrictions is essential to favor a smoother and safer recovery. Each person is unique and may have individual needs during this process.
Possible surgical complications
Possible surgical complications of the malleable penile prosthesis include:
- Infection at the implant site;
- Risk of erosion;
- Glans drooping.
These complications may be reduced with appropriate measures adopted during surgery, such as the use of antibiotic solution and support of the corpora cavernosa and the glans.
In addition, immediately after surgery the patient may experience temporary complications, such as bleeding, bruising or pain.
Men with chronic diseases such as diabetes are at higher risk of complications.
Importance of medical follow-up
After placement of the malleable penile prosthesis, the patient should continue follow-up with the doctor, as this helps monitor recovery and the functioning of the prosthesis.
In the first weeks, the doctor evaluates healing, identifies possible signs of infection or rejection, and advises the patient on adaptation and use of the prosthesis. In addition, the doctor may also discuss sexual health, quality of relationships and emotional aspects during this period.
In the long term, the professional helps monitor the durability of the prosthesis, adjust expectations and evaluate new changes in penile anatomy.
Patient expectations
Expectations regarding the malleable penile prosthesis need to be well guided in order to avoid frustration.
It is very common for men to expect not only functional improvement, but also aesthetic changes or increase in size. However, it is essential to clarify that the prosthesis is not intended to enlarge or thicken the penis, but to provide the rigidity needed for penetration.
From a functional standpoint, the malleable penile prosthesis offers vertical firmness to the penis, which may help reduce bending during sexual activity. It does not change libido, ejaculation, orgasm, temperature or tactile sensitivity.
On the emotional side, some patients report an impact on self-esteem and relationships after resuming sexual activity. Psychological support and open dialogue with health professionals and partners can be important in this process.
How long does a malleable penile prosthesis last?
So far, studies have not been able to precisely determine how long a malleable penile prosthesis lasts in all patients. However, according to research published in the journal Asian Journal of Andrology, this type of implant tends to be less expensive and may have a longer durability when compared with some inflatable models.
Schedule an appointment with Dr. Paulo Egydio
Men who are looking for treatment options for erectile dysfunction or impotence should know that there are different approaches that can be considered according to each clinical history. The malleable penile prosthesis is one of the possibilities in specific situations.
This type of implant requires indication and evaluation by an experienced urologist who understands the patient’s expectations and clinical condition. Dr. Paulo Egydio is a urologist dedicated to penile surgery and to the treatment of erectile dysfunction and penile deformities.
If you wish to obtain more information about malleable penile prosthesis and other treatment options, you can contact the medical team through the pre-assessment form: access the pre-analysis platform.
Read more:
- Penis enlargement with penile prosthesis
- Type of anesthesia and duration of penile prosthesis surgery
- Types of inflatable penile prosthesis: how to choose the model
- Sex with penile prosthesis
- Penile prosthesis price: current values
- Erectile dysfunction and penile prosthesis: questions and treatment options
