Men who do not respond satisfactorily to oral medications or self-injection medications may find the surgically-implanted prosthesis to be a more satisfactory alternative. Following a careful evaluation of a man's history and presenting symptoms (medical, psychological, neurologic, and sexual), the physician will work with the person to determine which type of treatment would be most beneficial. A spouse or long-term sexual partner should be included in the decision to get an implant, as well as in the selection of the type of prosthesis to be used.
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| Ways To Improve Sexuality For MS Symptoms |
There are two types of penile prostheses - semirigid and inflatable. With the semirigid type, a flexible rod is implanted by a urologic surgeon in each of the erection chambers (corpus cavernosa) of the penis. These rods can be bent upward when an erection is desired and bent downward at other times. Following insertion of the rods, the penis remains somewhat enlarged, with a permanent semierection.
With the inflatable type of prosthesis, an erection is created by fluid that is pumped from a reservoir into balloons inserted in the corpus cavernosa. The fluid is pumped into the chambers when an erection is desired and transferred back to the reservoir when it is no longer wanted. The reservoir is surgically implanted behind the abdominal wall; the pump is implanted in the man's scrotum. Silicon tubing is used to connect the reservoir, pump, and balloons. Because the pump is inserted through a single, relatively invisible incision in the scrotum, this type of prosthesis is barely noticeable. However, operating the pump through the scrotum wall can be difficult for individuals who have reduced hand sensation or strength.
Extensive presurgery consultation with a urologist or a physician who is familiar with MS will help to ensure that the man and his partner have realistic expectations after the surgery. Research has shown that upward of 80% of men (and their partners) who use these types of prostheses find them satisfactory. Many men experience normal erectile sensations and normal orgasm. In addition, they are able to have an erection for as long as they choose to do so.
Complications associated with penile implants include those associated with surgery in general (i.e., problems with anesthesaa and bleeding). Infection occurs in approximately 2-8% of men who receive prostheses and can be quite serious. In the event of infection, the entire device must be removed. Replacement of the implant following treatment of the infection is usually feasible, but often more complicated. A penile prosthesis is only recommended when less invasive efforts to manage erectile dysfunction are not successful. In other words, a man would be considered a candidate for a prosthesis only if noninvasive measures were unsuccessful, if he were unable to self-inject, or if an effective dosage level or combination of medications could not be found.
Non-medical/non-surgical interventions
A method for enhancing erections without the use of medicine or surgery involves the vacuum erection device (VED). The VED, which consists of a vacuum tube and constriction band, can be purchased with a prescription from a urologist or other MS physician. With the VED, a plastic tube is fitted over the flaccid penis, and a hand pump or suction tube is operated to create a vacuum.
The vacuum draws blood into the erectile tissues and produces an erection, which is similar to the natural erectile process. Once engorgement of the penis is achieved, a latex band is slipped from the base of the cylinder onto the base of the penis. Air is returned to the cylinder, and the tube is removed, The band maintains engorgement of the penis by restricting venous return of blood to the body, thus allowing for intercourse or other sexual activity.
The use of the band must be limited to 30 minutes or less to avoid any medical complications. Moderate hand sensation and dexterity are required for placing and removing the band in some models. Other models have assister sleeves that permit hands-free placement of the constriction band. For men who can attain erections readily but have difficulty maintaining them, the constriction band alone can be used with satisfactory results. Although minor side effects (e.g,, skin irritation and bruising) are common, patient and partner satisfaction with a VED has been found to be high.
A number of other sexual aids, available by mail-order, do not require a physician's prescription. Strap-on latex penises, some of which are hollow and can hold a flaccid or semierect penis, are preferred by some. Strap-on, battery operated vibrators in the shape of a penis are also available.
Choosing a sexual device to aid with erections is best done with the advice of a urologist or sex therapist familiar with MS. If the man has a long-term sex partner, it is very important to include this person in the discussion. This will decrease anxiety and uncertainty when the devices are used and can enhance intimacy by allowing both sex partners to explore together. If there are struggles in communicating or if the partners feel inhibited about talking through these issues, counseling with a mental health professional who is knowledgeable about MS can facilitate the process.
The efficacy of any treatment depends on the ability of both partners to communicate openly about sexual issues and decide on methods that are comfortable and enjoyable for both. Education about treatment options provides people with MS and their partners with the language and knowledge that enables discussion and informed decision making. To find out more, you can check out Ways To Improve Sexuality For MS Symptoms.