What do you imagine when you hear the word “bionic?” Let us guess, you think of a cyborg from the future, with a metal hand and super powers. In fact, you are right, as this term means the combination of organic and electromechanical parts in one creature. As you see, the future is already here, as bionic hands, legs, and hearts are not science-fiction anymore. What about a robotic dick, you may ask. Well, you are not the first one to come up with this idea. There are several types of such devices, and they all serve men who could not find any other way to cope with erectile dysfunction (ED).

What Is a Penile Implant?

Let’s give a better understanding of a “prosthesis” in general. It is an artificial device, internal or external, which either assists the performance of some organ or replaces it. Thus, a penile implant is a mechanism which is completely embedded in the man’s body to aid with erection. The ideal mechanical penis would imitate an erection so that it would not differ from a natural one, including all stages of the process, sensations, and appearance. Unfortunately, such a bionic tool has not been invented yet. The available implants are either always erect, or require certain manipulations to get hard, and then they go flaccid again.

You will be surprised to know that the first documented references to an artificial phallus are almost 500 years old. The royal barber surgeon Ambroise Pare, who lived in Paris in the 16th century, manufactured a wooden shaft for his patient to help him urinate. Much later, in the 1930s and 40s, doctors tried to use rib cartilage to facilitate a boner in ED patients, but those experiments were not successful. The material they used was prone to infections and caused severe deformations of the penis, moreover it got absorbed in a couple of years.

The modern prostheses for ED treatment started their history in 1973 and 1974. The older model was represented by an American urologist, Dr. F. Brantley Scott. The design of this implant was rather complicated and employed a hydraulic pump to maintain an erection. A year later, two other doctors, Dr. Small and Dr. Carrion, suggested another solution for the male sexual problem — a silicon rod concealed in the man’s shaft. This much simpler construction was easy to install and did not require a complex surgical intervention, but had one huge downside — the recipients of such tools were doomed to have a permanent erection.

When Implants Are Applicable?

There are several common indications for penile implants. The most prevalent one is erectile dysfunction. When a man’s best buddy does not want to rise and shine, so to speak, or flakes out before the job is done, this man should think about some medical treatment. But the implantation is not the first remedy to try for erection problems. First of all, the therapist must find out the nature of the dysfunction. If a man cannot have sex because of problematic relationships, stress at work, depression, or any other psychological reason, he should visit a mental health professional. Sometimes, it helps better than any pills and surgeries.

The second question would be if he has tried any ED medications. For sure, the pharmaceutical drugs are much less invasive and safer than any prosthetics. Such tablets as Cialis and Viagra release most men from their sexual ailments quickly and effectively. In fact, more than two-thirds of ED patients are successfully cured with tadalafil or sildenafil in America. Still, these medicines have certain contraindications, like high blood pressure, strokes, heart attacks, oncology diseases, severe curvature of penis, etc. Moreover, sometimes they simply do not help.

So, when is the right time to choose a penile implant? Here are the main factors that make it a good decision for you:

• you suffer from chronic impotence;
• you have tried all other options, including pills, injections, psychiatrist, and a vacuum penis pump;
• the causes of your ED do not leave you any other way to treat it.

The latter comprises such cases as various genital traumas, birth defects, or complications after some treatment or surgery. The implantation is also applied during phalloplasty. Transgender people, as well as victims of medical malpractice, child abuse, malicious or accidental emasculation, etc., can obtain fully functional penises with the help of this procedure.

The cases when the prosthesis is not for you are as follows:

• the ED is rooted in your mind;
• it passes with time;
• there is an infection in the urinary tract;
• you have low libido or lack of sensation in the penis. In this case, you should check if the sexual malady is not the result of some drug intake, diabetes, or nerve damage;
• the skin of the genitals is inflamed, has lesions, rashes, etc.

All sources we have looked through while writing this review suggest the common idea that a penile implant should be the last thing to try. You can consider this option when everything else is either ineffective or not applicable for any reason.

Types of Implants Offered Currently by Clinics

The two major designs of penile implants are:

• malleable rods, which are placed inside the corpus cavernosum and can be arranged in two positions — for the intercourse and concealment. Such devices are the evolution of the Small-Carrion prosthesis. The further development of their idea included the soft midsections, which made the whole construction more flexible and able to be bent down in order to imitate the flaccid state;
• inflatable implants, which can be further divided into three-piece and two-piece devices. The former consists of inflatable cylinders inside the penis body, the pump with the outlet valve in the scrotum, and the reservoir with normal saline in the abdominal cavity. A man or his partner has to work on the pump to fill the cylinders with the fluid in order to get it up. It can take a minute or more, depending on the size of the penis. Two-piece construction has the same principle of action, but is comprised of fewer details, as the saline solution is contained inside the pump bulb.

Each type has its pros and cons. For instance, the semirigid prostheses are handier and cheaper. Patients with some dexterity limitations caused by a mental disease, stroke, arthritis, injuries, etc., can use them without any problems. Such tools require a simpler operative procedure as compared to other penile implants. The disadvantages of non-inflatable rods are also notable. Due to a permanent boner, the painful sensations and discomfort may occur, especially during the first couple of weeks after the surgery. It can also result in the injuries of the pelvic muscles, inflammations, and shrinkage of phallus. With time, the rods may lose their rigidity. This type of implants is popular in countries with developing economies, and only 20% of them are sold in the USA.

Inflatable implants provide a more natural erection and flaccidity. At the same time, the surgical intervention is much more complicated, and their maintenance requires certain dexterity. Due to a larger number of components, these devices are prone to malfunction and damage. Two-piece prostheses use less fluid, so the erection is not as hard as it could be naturally. The penis with such a device always stays partially full, as you cannot deflate all the fluid from the cylinders. In spite of these disadvantages, the implants without a reservoir are the only possible ones for patients with the history of major pelvic or abdominal surgeries.

Three-piece implants are the most comfortable for patients, and they provide the most natural look and functioning of the penis. Thanks to enough saline solution in the reservoir, the erection is hard and looks completely the same as a natural one. This construction allows the complete removal of fluid from the implant in order to make the flaccid state really flaccid. Thus, there is no risk of pressure atrophy of the flesh of the penis.

High Risks of Surgical Treatment

The whole construction of all types of penile implants can be inserted into the body through a single incision, which can be made in the scrotal sac. The procedure rarely lasts for more than an hour, and when everything is set in its place, the doctor closes the opening in the skin. You may need a couple of days before you can go back to work. As for leaving the hospital, you’ll probably have to stay there for one night. The doctor will prescribe you some pain-relievers and antibiotics.

19 of 20 men with penile implants report that their surgery went well, meaning that they are able to have sex afterward. Only 80-90% of all men who have had this procedure claim that they are satisfied. This difference can be explained by the contrast between the expectations and reality. It is important to understand that the penile prostheses do not erect the glans, neither do they add any pleasurable sensations. In fact, some users report the reduction of pleasure and intensity of ejaculation during lovemaking.

There are a couple of risks allied with the surgery that you have to know about:

• you may develop an infection. It is a very common complication after the operative treatment. This is why the antibiotics are usually administered;
• the chances are extremely low, but sometimes the implants can break inside of your body. They do not perform their actions and may cause much inconvenience, or even injuries. In this case, a surgeon will have to do another procedure to remove the device and replace it with an intact one;
• such adverse consequences as the erosion of the tissues inside the penis or internal adhesion may occur as a result of inflammation. There were a few cases when the cylinders broke through the skin.

The doctor must provide the patients with all necessary instructions about the usage and maintenance of the penile implants.

Bionic Penis Has Lost Its Popularity

Nowadays, the number of ED cases is much higher than it was ten years ago. At the same time, the use of penile implants has decreased. Some experts say that it is a strange tendency, as these devices are the best way to get rid of the problem once and for all. With multicomponent prostheses, a man can have an erection when it is needed, without taking any meds. Why then have they lost half of their popularity in recent years? The major reason for this is the invention and appearance on the market of such pills as Cialis and Viagra. This happened at the end of the 20th century, and these drugs have helped a lot of men cure their sexual ailments.

Anyway, this is not the only reason. The famous urologist, Dr. Montague from the Cleveland Clinic, said that not all medical providers recommended their patients to have surgery even after the medications did not help. They preferred choosing simpler methods, avoiding operative interventions due to the complexity of the procedure and possible risks. Patients themselves also rarely ask for the penile implants, simply because they are not aware of them. Thus, if they fail with Viagra, they give up hoping and get depressed and apathetic. This is why it is very important to inform men about this option on the early stages of treatment.

Latter-Day Research

The modern technologies of penile implantation employ safe materials that work for a long time and do not cause any discomfort. The same goes for the up-to-date surgical procedures, they became minimally invasive, short-term, and outpatient. Can it be any better? Yes, novel research is going on, as scientists and engineers are continuously working on new models with advanced characteristics. The ideas of tomorrow include metals with memory, remote controls, and who knows how far they are going?

This is not a joke, because actually, a bionic penis with a remote will appear on the market in several years. And it promises to be a real quantum jump in penile prosthetics. Dr. Brian Le, together with his colleagues, decided to use nitinol in penile implants. Nitinol is the alloy of titanium and nickel, which has a shape memory. This means that this metal literally remembers one form and configuration, and takes this shape when it is heated. It was discovered in 1959, and now is widely used in various spheres, e.g. to produce dental braces, optics for photography, thermal valves, etc. In medicine, it is employed in cardiovascular and neurological surgery.

As for the NiTi penile implants, the idea of Dr. Le et al. was to make an exoskeleton which would stay flaccid at a normal body temperature but grow in length and girth when heated. The working temperature will be 10 degrees Fahrenheit higher, this way the patient will not feel any pain or discomfort. An experimental model of this implant already exists, and the only thing left to do is to create a remote-control construction, which will activate the alloy and induce an erection. In theory, this device will be comprised of a metal coil inserted into the root of the penis.

The clicker stays outside the body. When it is close to the groin and turned on, it generates an electromagnetic field in the coil, inducing the current and heating it up. The coil in its turn warms up the nitinol, and there you go, the penis is ready for lovemaking! When the job is done, you can turn off the remote control and cool down the implant. It will become flaccid until you are ready for intercourse again. Seems very easy, but Brian Le claims that he and his collaborators need about five to ten years to find better technologies and make experiments in vivo.

Hold Your Horses and Try ED Medications

The bionic penis is a new dawn for penile implantation. This technique is less intrusive than all current existing ones, so it suits men better who underwent abdominal surgery, as their users are not going to be exposed to the risks of infections and injuries. They function and look better than the inflatable or semirigid tools, and are much more handy. Still, most experts say that the surgery is the last resort for men with ED. Dr. Lue from the University of California emphasizes that he recommends an operative treatment to his patients only after they have tried psychotherapy, medications, and holistic treatment. Still, there are a lot of men who are impatiently waiting for new bionic implants, as no other remedy can help them.

Statistics show that almost every second man over forty years of age suffers from erectile dysfunction. One in three ED patients do not respond to drugs and therapy. This is a huge number and therefore penile implants are really necessary. Still, the majority of sexual problems can be cured with sophisticated, safe, and powerful tablets, such as Cialis, or Viagra. They work at the molecular level, inducing the performance of necessary mechanisms in the human body.

What actually happens when a man has an erection? First of all, in response to all kinds of sexual stimulation, the male body releases nitric oxide into the vessels of the penis. Further chemical reactions lead to an increased level of cGMP, which stands for cyclic guanosine monophosphate, a second messenger that relaxes the muscles in vasculature, thus providing better blood flow to corpora cavernosa. It makes a penis erect. CGMP-specific phosphodiesterase type 5, or simply PDE5, is an enzyme that breaks down cGMP. Normally, they all work at the right time, and men can get a boner as long as they are sexually aroused.

Sildenafil, vardenafil, and tadalafil are the active ingredients of the most popular ED pills. They help when the chain of chemical reactions mentioned above goes wrong. These drugs suppress the action of PDE5, promoting a healthy erection. Unfortunately, in order to purchase them in the pharmacy next door, you have to go to your doctor, do all his tests, and answer all his questions, and only then can you get a prescription. Moreover, certified Viagra is very expensive.

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