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While semirigid implants do seem to work miracles for some men, they also have drawbacks. If the implant is too long for the penis, the penis can curve, with painful results. Left uncorrected, the implant can actually work its way out of the corpora cavernosa, damaging the penis. And implants that are too short cause problems too. The head of the penis may bend down because it isn’t getting proper support—the result is often termed an SST deformity, after the jet airplane that’s famous for its turned-down nose. Obviously, too short a prosthesis can make intercourse difficult.

On a person with a very stretchy penis, selecting the right size can be a judgment call. In such a situation, the surgeon may opt for a little too short vs. a little too long because complications from too long an implant are the riskiest.

Men who have extensive scarring in their penises may have corpora cavernosa which resist implants, because the space where the prosthesis fits is scarred partially shut. In this case, a smaller (especially in diameter) prosthesis may be required.

A man who has very poor tissue surrounding the prosthesis is at risk for a “traveling” implant. Rarely, the implant may move out of the end of the penis into the urethra or out the back of the corpora cavernosa. Pressure from the implant just wears a hole in the weak tissue. A reasonably healthy man with a correctly sized implant needn’t worry about this complication, and even men with diabetes or other problems which may cause weak tissue should take comfort from the fact that this problem is quite rare.

Another rare complication is when a man finds his penis is less sensitive to pleasure and to pain after surgery. If the nerves on top of his penis are scarred and must be stretched during surgery to implant the prosthesis, they may be damaged. Normal sensations may return to this area after several months or the numbness may be permanent.

On the other hand, after recovery, a few patients continue to experience pain without any obvious cause. In such rare cases, removal of the prosthesis may be the only alternative.

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Your doctor should ask a lot of detailed questions about your general health habits, like how much you smoke or drink now, or if you were a heavy consumer in the past, it’s important for you to be as accurate with your answers as possible. Don’t underestimate your past consumption just because you want to “look good” to the physician.

Some physicians ask their patients to fill out a questionnaire. Your answers help your doctor determine what issues are particularly important. Something essential and unique to your situation may not be covered in detail on the questionnaire, so if you have concerns that aren’t addressed, write them down or tell the doctor directly.

You should always let your doctor know about any present or past medical illness, even if it’s not bothering you right now; any surgery you’ve had; and any injuries you’ve suffered, especially to the back or pelvic area.

You should expect to be asked in great detail about the specifics of your problem. This information can be crucial to making a correct diagnosis and providing the best treatment for you. That’s why if s vital that you feel comfortable talking with the doctor you select.

Your wife can also provide valuable information, and some doctors now ask or even insist that married patients bring their spouses. Your wife may recall certain details you forget, and she has a different perspective to offer. Making up a list of questions to ask the doctor can be a joint project that will help keep the lines of communication open between you and your wife.

If there is information you prefer not to share with your wife (for example, if you’re able to have an erection with another woman, you might not want your wife to know), make sure you do tell your doctor over the telephone or when you are alone with him. “My doctor knows things about me nobody else does,” one man told us.

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Sometimes a couple may decide to work on their relationship before they try to fix the man’s potency. If your doctor suggests that you go to a counselor, he might be giving good advice. If you fix the erection problem, but because of emotional difficulties in the relationship, your partner isn’t happy with the result, you might have taken the wrong approach. Howard did.

Howard, a 55-year-old successful businessman and former professional athlete, arrived at the doctor’s office with his fiancee, Christina, a slightly plump, attractive widow of 45. Howard and Christina looked like a happy couple about to embark on a second marriage after knowing each other for several years. But their facade crumbled within a very short period of time.

Howard explained with some hostility that he had come to see the doctor only at his fiancee’s insistence. She thought he had a problem. The short blonde woman smiled, but she refused to participate in the conversation, and all the doctor’s attempts to involve her yielded nothing. Finally, Christina excused herself.

Once his partner was out of the room, Howard reiterated that Christina was the problem, not him. He was perfectly satisfied with his ability to get and maintain an erection. Furthermore, he explained that he took great pains to sexually satisfy his fiancee. He appeared quite knowledgeable about male and female physiology and talked about many different ways to achieve sexual pleasure.

At this point, the confused physician decided he would talk with Christina alone. She was somewhat reluctant, but she agreed. First Christina double-checked the door to the doctor’s office to make sure it was securely shut. Then she sat down, looked the physician straight in the eye, and declared, “He doesn’t get a good erection. He thinks he does, but he doesn’t!” Christina’s shy, somewhat timid manner disappeared: She insisted that Howard was fooling himself about his ability to function; she was sure that her partner’s erections were not satisfactory.

The doctor decided that a complete physical examination of Howard was in order. Howard turned out to be in excellent physical condition. He had no chronic diseases which could cause erection problems; he had normal blood pressure, and wasn’t taking any medications which were known to cause potency difficulties.

To test Howard’s ability to get an erection, the doctor gave him a penile shot. Within a short period of time, Howard obtained a full, firm erection, demonstrating that his essential-to-erection blood-flow system was in good working order. “This is just like the erections I normally get,” Howard declared with obvious satisfaction.

The doctor was curious to see if Christina would agree with Howard’s assessment. But although she came into the room, Christina refused to look at the erection.

What was going on here? How could Howard and Christina differ so radically about what happened between them? The doctor was puzzled, but he was sure of one thing: Howard and Christina were not communicating, and that problem needed to be solved before any possible erection difficulty was addressed.

The doctor pointed out that since Howard and Christina had strong differences in perception they might benefit from some counseling. Somewhat to the physician’s surprise, they agreed this was a good idea. On the doctor’s recommendation, they made an appointment with a psychologist who was also a well-trained, experienced sex therapist.

The therapist saw Howard and Christina together, and separately. She also gave them some tests to determine their attitudes towards sex and gauge their sexual experience.

All the results pointed to much unresolved conflict between Howard and Christina that was due to problems other than sex. She was very upset at her fiancee, but she was unable to express it directly. Instead, even with the evidence of his erection, she denied that he was able to function sexually as he thought he did—something which was of great importance to him.

In this case, the physician was able to determine in fairly short order that Howard’s erections were not the major problem, but were just singled out as the target. If the doctor had concentrated his efforts on “fixing” Howard’s erections (which didn’t even seem to be “broken”), the communication problem would have remained unresolved, leaving Howard and Christina unhappy and at odds with each other. Instead, the couple agreed to see a professional counselor who would help them deal more directly with their anger.

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Jason, a 60-year-old, first noticed a problem with erections when he was in his teens. When he was with a woman, he could not maintain an erection, although he felt very aroused. And even when he masturbated, his erection would disappear before he could ejaculate.

Jason went to numerous doctors, seeking help. Although his testosterone level was normal, Jason was given shots of the hormone—but there was no improvement in his erections. Jason got married after a doctor said it would solve his problem, but that didn’t help either. Only very rarely could he maintain an erection for enough time to allow him to have intercourse. His wife was frustrated, depressed and hurt by the situation, and so was Jason.

The couple went to more doctors, seeking help. One psychiatrist tried to persuade Jason that he could live without sex, saying that companionship was all that really mattered. But the suggestion didn’t go over very well with Jason and his wife. They wanted to enjoy sex.

Other doctors, unable to identify a physical cause for Jason’s problem, told him he had a psychological problem. “Everyone told me it was psychosomatic,” says this soft-spoken, well-dressed man, who looks younger than he is. But although no one could find a physical cause, Jason was reluctant to believe that his problem was indeed “all in my mind.” Over many years, Jason paid a high price for his leaky veins—and the lack of medical knowledge about erections that existed during most of his life. He felt his self-esteem and confidence slipping away, and believes this contributed to problems at work. He was often depressed and withdrew from social activities to spend more and more time alone. After several years, Jason and his wife stopped having any type of sexual relationship. They were too frustrated.

But recently, new tests found that leaky veins were the source of Jason’s impotence. He had surgery to correct his malfunctioning veins, and for the first time in many, many years, Jason reports that he wakes up in the morning with an erection. (More about the surgical treatments for vein problems is found in chapter 8.) After some adjustment to their new physical relationship, Jason and his wife are able to enjoy intercourse.

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