Group of questions from someone weighing implant decision

[Markc2008]

Hey guys, I’m 38 years old and have posted here a couple of times. I have PSSD from stopping an antidepressant too suddenly and have had it for two years with no improvement. This means my sensation is not normal, and I have severe ED because it is hard for me to translate arousal to an erection. With that being said you can imagine that pde5s don’t work well for me. They seemed to work the first year although unreliably, and now they don’t hardly work at all unless I take well over the maximum dose. I also have flaccid shrinkage like where my blood doesn’t flow there like it should? All these problems arose at the same time. Anyways, I’m about to start trying injections but I’ve already been told it can cause scarring and larger issues so I’m not far off getting the ball rolling on an implant. I’m hoping some of you guys can weigh in on these topics and put my mind at ease:

What is the deal about no glands engorgement? I’m not even sure I understand what people are referring to. The head doesn’t get hard? In pics I’ve seen on here people look completely hard? Wouldn’t it just flop around otherwise? Is this common?

I know it’s been worn out but how likely am I to lose significant size(more than 1/2”)? I’m only between 5 3/4” - 6” Depending on how you measure so don’t want to lose a lot.

I’ve read a lot of people mentioning almost a “third ball” with the pump in there. Is it that big and noticeable? I always envisioned something pretty tucked away and smaller. I get you could feel it in there but how visually noticeable is it?

How are people traveling? Are many people having issues with airport security?

Does insurance generally cover the majority of the cost if you have tried other options first and doctor gives a referral?

[Fran4524]

Sorry for ask, but coul you explain me what is PSSD?

[Markc2008]

No problem. It’s Post SSRI Sexual Dysfunction. Sometimes it’s just long standing and sometimes it’s permanent. After two years I’m starting to think for me it’s permanent. I have a large loss of sensation in my penis although sex is still pleasurable although some of that may be other senses and stimuli helping. I have a hard time getting aroused even though I like what I see etc. it’s like emotions and arousal become dull.

[Markc2008]

It’s believed to be due to dopamine and seretonin interactions that don’t return to normal. I have no idea but I’ve tried other antidote meds such as wellebutrin and buspirone etc and nothing fixes it. So my options are keep struggling with my sex life and my Marriage or move on and accept it and find a work around.

[frwmw1]

Sorry for ask, but coul you explain me what is PSSD?

PSSD is recognised as medical condition by the European Medicines Agency.

https://www.psychologytoday.com/us/blog ... -condition

[Markc2008]

Sorry for ask, but coul you explain me what is PSSD?

PSSD is recognised as medical condition by the European Medicines Agency.

https://www.psychologytoday.com/us/blog ... -condition

Thanks for adding that. Yeah it’s very real. So at this rate my last attempt to fix this is to reinstate the ssri I quit to see if it helps restore something which I’m terrified to do but that will be my last attempt before I look to an implant.

[frwmw1]

So at this rate my last attempt to fix this is to reinstate the ssri I quit to see if it helps restore something which I’m terrified to do but that will be my last attempt before I look to an implant.

Note that there are cases of PFS causing a venous leak, and so I wonder if PSSD can do the same, and if you should try getting a penile doppler scan done to see if there's a venous leak. I found getting medical support to be easier after getting the diagnosis of a venous leak.

[Quincy]

I'll give you my opinions on your answers. I've had my implant for over 2 years. It's a big step to take, so it's good that you're doing research. This site is great for getting answers, so don't hesitate to ask.

1. Glans engorgement. Engorgement of the glans penis (that's the official term, often shortened to just "glans") is natural during erection. Some men with implants have indicated that their glans no longer gets larger and harder during arousal. Others indicate that they have lost some sensation in the head of their penis. We all want full sensation and arousal, but it's clear that not everyone with an implant gets that. Many implantees, however, are happy with the level of engorgement of the glans. YMMV. Lack of sufficient engorgement can make penetration more difficult. If you decide to go forward with an implant, you should talk this over with your surgeon. Most good implant surgeons will discuss this in whatever level of detail you want. FWIW, in my own case I don't feel I have as much glans engorgement as I did in my youth, but I'd had some level of ED for over 15 years when I got my implant. What I have now is far better than what I had during those years. In my case there is some engorgement with arousal, increasing as things move forward. and full engorgement of the glans happens just before climax.

The discussion of glans engorgement is separate from but related to another term used here - "floppy head". In some cases, an implant can be shorter than it should be, with the tips of the implant not reaching far enough into the head of the penis. This can allow the head to be under-supported and it can "flop" around making penetration very difficult. This should never happen with a good surgeon. As with many things pertaining to implants, getting the right surgeon can be very important.

2. Loss of size. IMO, no man should ever lose length from a penile implant if they have a competent surgeon and no complications. I'm sure some other men here will disagree with me, but this is how I feel and I'll give you my reasons.

Understanding and techniques have improved so much over the years that an implant should always get most or all of your length back. This is another, and critical, reason for picking the right surgeon. There have been many studies conducted that give "best practices" for ensuring maximum length restoration for IPPs. The best surgeons know and use these techniques and will talk with you about how they ensure maximum length. At the same time, these surgeons will NOT promise you more than you're likely to get. My own doctor, during a pre-op exam pulled hard on my dick, told me to look at the length, and said essentially, "that is how big you'll be, if you think you should be bigger please go to another doctor." Many of us fondly remember how big we were before ED and remember it incorrectly. My surgeon wanted to make sure my expectations were reasonable and rational.

That said, there are some complications that can result in loss of size. Many of them include issues that happened before the implant but get blamed on the implant. Typical things like this include Peyronies Disease, prostate removal due to cancer, and atrophy/shrinkage from years of ED. Some can not be rectified by an implant but are blamed on the implant, not the original cause of the loss of length.

My personal experience includes many years of atrophy. I had lost some of the tissues in my penis (use it or lose it) and what was left was shortened significantly. Some of this type of loss can be rectified with stretching the tissues before the implant surgery. Under my doctor's guidance, I did 3 months of daily VED use and penile traction to stretch my dick and allow a longer implant to be inserted. Another technique in restoring lost length can be early and frequent cycling of the implant after surgery. I chose a surgeon that supported early "activation" of the implant, allowing me to start inflating/deflating just one week after surgery. He instructed me to pump the implant up to maximum for at least 30 minutes four times every day. He even gave me ideas about how to make sure I was at the maximum the implant could take. This early, full and frequent inflation helps make sure the penis does not heal in a smaller size or cause scar tissue to make it harder to stretch through later. I have regained all of the size I lost to atrophy and feel like I'm even a little bigger than I was before. I always felt like I was smaller than average. I was just shy of 5 inches in length immediately after surgery, about 5.5 a year later, and now over 5 and 3/4.

3. The 3rd nut. There is no question that the extra equipment in the scrotum is noticeable to touch. The pump is actually a little bigger than a regular testicle once you include the block at the top of the bulb, and someone feeling around in there will be able to notice that there are 3 items, not 2. However, depending on how your balls rest in the scrotum, the size of your sack, how tight things are, etc., it may or may not be noticed visibly. When things are really relaxed and warm down there I can look in a mirror and see 3 rounded areas, but I'm looking for it. I don't believe it is noticeable with a casual glance. I certainly have no trouble being naked in a locker room and no one that may have noticed has stared or said anything, not that most would. In my case, my right nut rides higher than my left and is often resting above the pump far enough that it looks like the pump is my right nut and my left nut is the other. It's certainly not enough of an issue to cause me concern. Your partner will know, of course, and the question about what to say to new partners is something talked about in other posts here.

4. Traveling. I've traveled a lot since the surgery and been through the very detailed scans used in many airports. Never a problem. I assume by now there are enough men with implants that security knows what the implant is. But perhaps the scans don't reveal anything. At any rate, it's never been a problem.

5. Insurance. This is one where you'll need to get information from your specific insurance. Medicare covered my implant, though they wouldn't pay for the cost of injections. Go figure. I don't believe my insurance before I retired would have covered an implant.

I hope this extremely verbose reply helps. Sorry it's so long. I come back to FrankTalk mainly because I got so much help and good advice here when I was researching implants that I want to help others and "pay it forward". If you have further questions or just want to talk, drop me a PM.

Best wishes on your decision. I personally am very happy with my implant and wish I'd done it sooner. But it's permanent and irreversible. You should be very sure before you take the step.

Q.

[Markc2008]

So at this rate my last attempt to fix this is to reinstate the ssri I quit to see if it helps restore something which I’m terrified to do but that will be my last attempt before I look to an implant.

Note that there are cases of PFS causing a venous leak, and so I wonder if PSSD can do the same, and if you should try getting a penile doppler scan done to see if there's a venous leak. I found getting medical support to be easier after getting the diagnosis of a venous leak.

Yeah the last urologist I went to said no need to do a scan since there is no fix for it. I think I need to find another urologist.

[wolfpacker]

Note that there are cases of PFS causing a venous leak, and so I wonder if PSSD can do the same, and if you should try getting a penile doppler scan done to see if there's a venous leak. I found getting medical support to be easier after getting the diagnosis of a venous leak.

Yeah the last urologist I went to said no need to do a scan since there is no fix for it. I think I need to find another urologist.

My urologist said the same, and I agree with him. Whether they detect a veinous leak or not, the treatment is the same, so why even bother? Assuming you don't have any obvious correctable hormone or lifestyle issues, the treatment path is the same; pills, then injections, then implant.