In some cases, men might have an organic problem which would restrict blood flow to the penis. This might cause erectile dysfunction, wherein the person is not able to have a satisfactory erection or cannot hold the erection for a long time, thus leading to an unsatisfactory sexual experience for him and his partner.
Also, if the veins in the penis cannot prevent blood from leaving the penis during an erection, an erection cannot be maintained. This condition is known as a venous leak. Venous leakage may occur with vascular disease, but it also can occur as a result of poor muscle relaxation of the penis.
Difficulty with smooth muscle relaxation of the penis can occur with ailments such as heart disease, obesity and diabetes. Venous leak also can occur when neurological diseases or high levels of anxiety are present because these conditions can prevent adequate smooth muscle relaxation. Sometimes, these conditions can be quite painful, says Dr Mohan Keshavamurthy, Consultant Urologist, Fortis Hospitals. Such conditions and those like premature ejaculation, or ED due to a urethral injury or accident may require a penile prosthesis.
A penile prosthesis is a medical device implanted in the penis requiring a surgical procedure. "A penile implant is used when there is a medical need and when the problem is unlikely to resolve or improve naturally or through medications. There are two types of implants available - inflatable and maleable. The simplest type of prosthesis consists of a pair of malleable rods surgically implanted within the erection chambers of the penis. With this type of implant the penis is always semi-rigid and merely needs to be lifted or adjusted into the desired position.Inflated prosthesis are filled with fluid and can be inflated or deflated as desired. "Two titanium rods are inserted into the penis.They are attached to a pump placed in the scrotum and a reservoir fitted just below the groin muscles. To inflate, one has to push a button and the cylinders fill with a saline solution from the reservoir to create an erection. After intercourse, use the pump to empty the cylinders."
Dr Keshavamurthy has successfully done penile prosthesis on many patients with varied problems. For Viren (name changed), college life was full of complexities and gawkiness as would be for any teenager exploring new things in life.But when he got into a steady relationship, he realised that there was a serious problem.
"When you are very young and in college, you have a lot of complexes and if you are exposed half-baked information and facts of life, you tend to get the wrong impression about sex, your body and about relationships. That is what happened to me. But when I started a steady relationship, I realised that there was a bigger problem -- I had premature ejaculation, and this led to an unsatisfactory sexual experience. I was very unhappy and worse still in those days; it was a topic that was mostly taboo to talk about. I tried reaching out to many people who could give me informed advice but was met with only disappointment. This made me frustrated and I would have constant fights with my girlfriend."
Apart from PE, Viren had a complex about the size of his penis and was worried because he could not keep the erection for long. All this drove him into depression, because he couldn't seem to find a solution to his problem. "All this had a huge psychological impact on me and my relationships also suffered. I was struggling both physically and emotionally. I realised that the problem was more psychological than organic, but it was having a huge physical impact. I went to many sexologists, but did not get much help. They all counselled me that once I got married I could do better and address the problem then but I wanted to set it right before getting married.
Around two years ago, when he had started to work and gotten into another relationship with a more understanding partner, Viren met Dr Mohan who examined his condition and counselled him on what options I had. He was suggested to go for circumcision and also put on anti-depressants. But that did not work. "Finally, I took the decision of going for penile prosthesis and though it was a huge decision, I felt that was the best solution for me. The recovery took me three weeks. I'm happy to say that I am quite satisfied with the result. It has also had a positive psychological impact on me and I'm happy that my partner, who has been very supportive, and I have a healthy sexual relationship now."