Medically reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Last updated 4/30/2021
Dealing with erection problems is stressful in a way many other medical conditions is not. Ultimately, you want to achieve a natural erection, and you don’t want to waste your time with any hopeless ED treatment options.
But the truth is that surgery shouldn’t be your first choice.
And for the record, erectile dysfunction (ED), is probably more common than you think. According to the Massachusetts Male Aging Study, over half of men will experience the sexual disorder at some point in their lives — up to 40 percent by the age of forty.
Erectile dysfunction is defined as the inability to achieve or maintain an erection for sexual activity. While it’s not unheard of in young men, ED gets more common with age.
The condition has psychological, hormonal, vascular, and neurologic causes, and is closely associated with diabetes, high blood pressure, obesity, and testosterone deficiency.
Generally, when you seek medical advice for ED, your healthcare provider will examine you for these other diseases and disorders, too.
Because if your erectile problems are stemming from poor diabetes management, for example, lifestyle changes could be the easiest treatment for you.
Also, it could be pointing to undiagnosed health conditions. Erectile dysfunction has a high predictive value for heart disease.
As with nearly all medical treatments, doctors tend to try the least invasive options first. So surgery is often a last result.
In the case of erectile dysfunction, penis prostheses or implants are the most common surgical solution. There are two general types: malleable and inflatable implants.
In both, the penile implant is surgically placed inside your body.
Malleable implants provide permanent hardness. A surgeon places two semi-rigid rods into incisions at the base of the penis. In all, this surgery takes 30 to 60 minutes, and recovery is several weeks long.
Because malleable implants are always firm, they are more detectable under the clothing, though you can bend the rods to help conceal them.
Inflatable implants are inflated when-needed for sexual activity and then deflated once sexual activity is over.
This surgery takes one to two hours, and takes several weeks to recovery.
For this surgery, the surgeon implants two inflatable cylinders into the penis, and a pump unit into the scrotum.
The cylinders are inflated by squeezing the pump within the scrotum, allowing fluid to move from a reservoir into the penis.
These may be a two- or three-piece implant, depending on the brand of the device.
A less common form of ED surgery is microsurgical penile revascularization. This is generally only used when your erectile dysfunction is caused by traumatic injury.
If such an injury affects the blood vessels in the penis, surgery can be used to bypass the damaged arteries and connect another to restore blood flow.
There are several factors that go into determining the full cost of penis implant surgeries, including what type of surgery you have and whether you have insurance.
A 2019 study in the journal Urology Practice, estimates the cost of inflatable implants runs somewhere between $10,000 and $20,000 for people without medical insurance.
This cost would include the device itself, as well as the bill for the surgeon, the hospital or clinic where the surgery is performed, and other fees.
Of course, insurance coverage could make this price tag much more tolerable. Unfortunately, ED surgery isn’t always covered by insurance.
Medicare is the most common insurer for such surgeries, but Medicare is typically reserved for the elderly and disabled.
Among 127 men seeking commercial (non-Medicare) insurance coverage for their ED surgery, 48 percent were denied, in one study.
Even when covered by Medicare, men must follow certain criteria to have their surgery covered. For example, Medicare Part C coverage offered by BlueCross BlueShield indicates the patient must have a medical condition that directly contributes to their sexual dysfunction and that certain other medical treatments have been tried and failed.
Insurance companies suggest other medical treatments must be tried before approving surgery, because surgery is the most expensive and invasive. Alternatives may be effective, and at a much lesser risk to the patient.
Lifestyle modifications are often effective enough to restore erectile function. Weight loss, regular exercise, and properly managing health conditions can improve sexual function in men suffering from ED.
Medications known as PDE-5 inhibitors are the first-line medical treatment for erectile dysfunction.
These prescription drugs, including those sold under the names Cialis® (tadalafil) and Viagra® (sildenafil, generic for Viagra), work to enhance the effects of nitric oxide to maintain erections.
Going under the knife for any reason should be taken very seriously, and when it comes to ED surgeries, there are alternatives available.
A healthcare professional — namely, a urologist — can help you determine the best line of treatment given your medical history and current situation, but will likely suggest trying a PDE5 or two before throwing in the towel and looking into surgical options.