Medicine: Aiding Nature

Help for the impotent

It happens to every man sooner or later: eager to have sex, he finds himself impotent, unable to achieve or sustain an erection. For most men such disappointments are fleeting episodes in otherwise successful sex lives. But for perhaps as many as 10 million American males impotence is a devastating chronic condition. When the cause is psychological, which may be true in about half of all cases, counseling and sex therapy can often help. But for most impotence resulting from physical problems, only one remedy is available: the penile implant. Though the public is generally unaware of these mechanical devices, which can mimic a natural erection, they have been implanted in tens of thousands of U.S. males ranging in age from under 19 to over 80.

A normal erection results from a complex interaction of forces. Mental or physical stimulation sets off a series of nervous reflexes that increase blood flow to the penis. As the blood fills the corpora cavernosa, two rod-shaped bundles of spongy tissue running the length of the organ, the penis expands, becoming hard and erect. But the sexual response is fragile; it can easily be disrupted by emotional or physical problems (some, like an excess of alcohol, temporary).

For men facing permanent impotence resulting from surgery for cancers in the pelvic region, diabetes, spinal cord injuries or other physical causes—and for those whose problem is psychological in origin and is not helped by therapy—two kinds of penile implants are available. In one operation, which takes about an hour, an incision is made in the penis or just behind the scrotum and a semirigid silicone rod is inserted into each of the corpora cavernosa. Another technique is to implant only one rod between the two structures. The most popular device, developed in 1972 by Urologists Michael Small and Hernan. Carrion of the University of Miami School of Medicine, has a somewhat inconvenient result: a permanent erection. But a jock strap or tight shorts make it undetectable under street clothes. Some doctors now insert bendable rods that can be turned downward.

The other, less widely used implant is an inflatable prosthesis, developed in 1973 by Baylor University Urologist F. Brantley Scott, Neurologist William Bradley and Bioengineer Gerald Timm. It too requires only a short operation, usually about an hour and a half. Through an incision in the abdomen or the scrotum, two expandable balloon-like cylinders are slipped into the corpora cavernosa. The cylinders are connected by tubing to a small spherical reservoir filled with fluid (which is placed near the bladder under the muscles of the abdominal wall) and to a pump (inserted into the scrotum). To achieve erection, a man squeezes the pump several times, forcing fluid into the cylinders and distending the penis. The process is reversed by pressing a release valve on the pump.

Potency does not come cheap. Rod implant surgery runs around $3,500, including hospitalization; for the inflatable prosthesis the cost can go as high as $9,000. Despite the expense, which some medical insurance does not cover, the operations are becoming increasingly popular, and doctors performing them say that implanted men are among the happiest patients they have ever seen.