Do Orgasm, Ejaculation and Sensation Change After a Penile Implant? Glans Fullness and the Partner's Experience

A man considering a penile implant knows that rigidity will return; the questions he hesitates to ask are different: “Will I still feel pleasure, will I ejaculate, will my partner notice a difference?” In the consulting room these often go unspoken.

A penile prosthesis is an implant placed inside the erectile tissue of the penis to provide the rigidity needed for intercourse; malleable and inflatable types exist. This article looks at what the implant does and does not change, what studies have found about orgasm, ejaculation and sensation, why the head of the penis can remain different, and the partner's experience.

What does a penile prosthesis change, and what does it not?

The cylinders of the implant are placed inside the two erectile bodies of the penis (the corpora cavernosa). Skin sensation, orgasm and ejaculation work through separate pathways. The patient leaflet of the British Association of Urological Surgeons (BAUS) sums it up as follows:

• What changes: rigidity. The implant replaces the body's own erectile mechanism.
• What does not change: sexual desire, penile sensation and the sensation of orgasm. An implant does not increase desire.
• What stays different: the penis does not gain length and width as it would with a natural erection, and the head of the penis may not become as rigid.

The 2015 International Consultation on Sexual Medicine (ICSM) likewise states that an implant allows intercourse without interfering with urination, ejaculation, sensation or orgasm; the same text asks that possible changes in sensation and shape be explained beforehand. Length and the feeling of shortening are covered in a separate article on our site.

Do orgasm and ejaculation stay the same after surgery?

The available studies mostly point to “yes”, but all are small and uncontrolled:

• In an interview study from 1985, 71% of 35 patients could ejaculate and 80% could reach orgasm before surgery. The implant did not interfere with these functions; 2 patients lost ejaculation as their underlying illness progressed, while 5 men previously unable to reach orgasm reported orgasm after surgery.
• In a single-centre study based on the records of 126 patients with a three-piece inflatable implant, the effect on orgasm was reported as “none or minimal”.

These studies do not measure the intensity of orgasm in detail and rely on retrospective interviews. Their shared finding, even so, is that the implant leaves the pathways of orgasm and ejaculation untouched.

Can there be loss of sensation or numbness?

There can, but data on how often are scarce. In the series of 126 patients above, altered sensation was recorded in 8.73%; the study abstract does not say how much of this was temporary. Possible explanations include:

• Incision and swelling: swelling and tenderness in the first weeks can alter sensation temporarily.
• Sensory nerves: a review comparing incision sites found the risk of injury to the nerve on the upper side of the penis to be low, though somewhat higher with incisions above the pubic bone.
• Additional procedures: in complex operations for Peyronie's disease, where grafting or lengthening is combined with an implant, the risk of sensory loss is taken seriously.

Why can the head of the penis stay soft or cool?

The head of the penis (glans) is not part of the erectile bodies that hold the cylinders; it belongs to the separate spongy tissue surrounding the urethra. When the implant is inflated the shaft becomes rigid, but the glans still depends on its own blood filling. Publications call this a “soft” or “cold glans”: the man and his partner notice less fullness and warmth.

Medication for this complaint has been tried in small series. In one study, men in whom an oral PDE5 inhibitor produced glans fullness reported higher satisfaction scores than with the implant alone. In another series, testing a vessel-widening medicine placed in the urethra, 10 of 17 men with reduced fullness were satisfied, while 12 of the 28 men in the whole group stopped because of penile pain. These studies had no comparison group and cannot support a firm recommendation; any decision about medication rests with the doctor.

What is a floppy glans, and how is it managed?

When the head of the penis droops forwards, backwards or to one side while the implant is inflated, this is called a floppy glans or glans hypermobility. A marked forward droop is known as SST deformity, after its likeness to the nose of an aircraft. Frequency depends on the definition:

• The BAUS leaflet puts the risk at between 1 in 10 and 1 in 50 patients.
• A grading study quotes an estimate of 0.04–10% from the literature. In the same study some degree of hypermobility was seen during surgery in 139 of 530 operations (26.2%).
• At one referral centre, 40 of 3,210 implant patients underwent an operation to fix the glans in place (glanspexy).

Slight mobility is not regarded as a problem. According to reviews, it matters when it causes painful intercourse, difficulty with penetration or distress about appearance. Assessment begins with the size and position of the cylinders: the examination is carried out with the implant fully inflated, and MRI or ultrasound is added if needed. Where it is safe, medication can be tried first; if this is not enough, glanspexy or replacement of the cylinders is considered. In a series of 12 patients who had glanspexy, no change in sensation was reported.

Why may ejaculation already be different after prostate surgery or with diabetes?

An implant does not reverse changes in ejaculation and orgasm that were present before surgery, so expectations should be built on the starting point:

• Prostate cancer surgery: the European Association of Urology (EAU) guideline asks that these patients be told about absent ejaculation and changes in orgasm. One review reported inability to reach orgasm after surgery in 5–70%, painful orgasm in 7–14% and leakage of urine at orgasm in 20–93%.
• Diabetes: according to one review, up to 35–50% of men with diabetes have an ejaculatory disorder, including retrograde ejaculation, delayed ejaculation and inability to ejaculate.

Dry ejaculation and delayed ejaculation are covered in separate articles on our site.

What does the partner feel, and what do satisfaction studies say?

Whether a partner will notice the device is covered in a separate article on our site. Satisfaction figures span a wide range depending on how they are measured:

• In 69 couples with an inflatable implant, a validated questionnaire (EDITS) gave a mean score of 75.48 in the men and 70.00 in their female partners; the two scores rose and fell together.
• In a non-validated 9-item telephone questionnaire among one surgeon's 80 patients, 69% of patients and 90% of partners said they had no problems and were satisfied.
• In a systematic review of 33 studies on partner satisfaction, rates ranged from 50–90% and were consistently lower than those of patients.
• In a meta-analysis covering 83 studies and 12,132 people, patient satisfaction was 83% (confidence interval 80–86).

The EAU guideline quotes satisfaction of 92–100% in patients and 91–95% in partners with appropriate counselling. Much of the gap comes from method: in a review of 48 articles, 66.2% of the studies had used non-validated questionnaires. Partners' complaints are on record too: in a 5-year follow-up of 48 patients given a malleable implant for Peyronie's disease, partners mentioned poor girth, a cold glans and pain.

What affects satisfaction, and when can intercourse resume?

One review links satisfaction to modest expectations before surgery, good sexual function in the partner, a body mass index not above 30 and no previous prostate surgery. In a multicentre study of 248 patients, perceived shortening led to some dissatisfaction in 42% and 46% of patients in the two implant groups. The EAU notes that focused psychosexual counselling may improve the sexual well-being of the couple.

The BAUS leaflet advises no intercourse for at least 4 weeks after surgery, with use of the device taught at a check-up 2–3 weeks later. In a survey of 190 patients who had been told to wait 4 weeks, 41% resumed intercourse within the first 4 weeks and 31% at 5–6 weeks. The operating surgeon sets the timing according to healing.

When should you see a doctor?

A man who has had implant surgery should report the following to the operating team or to a urology and andrology specialist:

• Increasing pain, redness, warmth, discharge at the surgical site, or fever
• Bruising, darkening or loss of sensation in the head of the penis (this needs urgent assessment in the early period)
• A device that will not inflate, will not deflate or inflates by itself
• A marked droop of the glans with the implant inflated, or difficulty with penetration
• Pain during intercourse for you or your partner
• Numbness or reduced sensation that does not ease over weeks
• A new change in orgasm or ejaculation

A penile prosthesis provides rigidity; it neither increases sexual desire, orgasm and ejaculation nor, according to the studies, takes them away. Knowing that the glans may stay softer and that existing changes in ejaculation will persist helps to set the right expectations. Assoc. Prof. Dr. Zülfü Sertkaya practises urology and andrology in Istanbul; assessment for a penile prosthesis is individualised and carried out in confidence.

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