How I Feel After Two Years

[fucked0ne]

I can’t understand why people think a malleable is going to fix problems that you’re having with a 3 piece? It’s a constant hard on that can not get flaccid. It is what it is at all times. Save some engorgement. Good luck with your decisions. For me I’m very satisfied with my implant and the day it fails be it next week or ten years from now I will immediately be getting another.

The problem is the more surgeries you have the higher the risk of an infection or a traumatic complication.

My plan is to switch to malleable on the first revision and just adapt to it, because I don't want to take too many risks with my penis

This.

[phliptrip]

I joined this community in January 2023. After receiving my Coloplast Titan Implant in 2022, one thing has consistently troubled me: the questions I get about my satisfaction with the implant. Each time I visit my urologist, I am given simplistic questionnaires that ask if I am satisfied with my ability to have an erection sufficient for intercourse. And each time, I mark up the forms, commenting that the question is far too narrow to capture my real feelings.

You would think after repeatedly crossing out these questions, my doctor might stop and ask why. But no. He never does. If these types of surveys are the primary tools for measuring patient satisfaction, it is no wonder satisfaction rates are high. I answer "yes" to the basic question because it is the only one, I am given and, technically, it is true. I can pump it up and have an erection whenever I need one. But that is just scratching the surface.

I do not blame my doctor personally for this, but it speaks of a larger issue in how society and the healthcare system view men's sexual health. In my experience, urologists often approach men with a simplistic mindset: "Get him hard again, and he’ll be happy." They cannot restore natural erections, but they can offer a prosthesis that mimics one.

However, this level of satisfaction would not be expected for any other kind of prosthesis—whether it is for a nose, an ear, a hand, or a foot. Research bears this out. There is nowhere near the same satisfaction rates for those prostheses as there are for penile implants. This raises concerns about the design of these satisfaction surveys. Men are human beings with complex feelings, and it seems perfectly natural to feel conflicted about needing a prosthesis for such an intimate function. But when it comes to penile implants, there seems to be an unrealistic expectation that we will all be thrilled with the result.

What really struck me recently was an article in the Oxford Academic Journal titled Managing the Difficult Penile Prosthesis Patient. It explained that the small percentage of patients who are dissatisfied despite “acceptable surgical results” are often labeled with the acronym CURSED—standing for Compulsive/obsessive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric. When I read this, I thought, "Wow, talk about shaming patients into silence." Who would feel comfortable being honest about their dissatisfaction if doing so risks being dismissed as "CURSED"?

This reminds me of something Nietzsche said about group criticism—he called it a manifestation of the "herd mentality." In this view, people conform to common values and suppress those who deviate from the norm, not to promote individual growth but to maintain mediocrity and safety. Some men may have a perfectly reasonable psychological and emotional reaction to a prosthesis, but their concerns are often sidelined.

I have been reading posts here for a while now, and I am constantly impressed by the courage many of you show in sharing your stories, both of success and vulnerability. However, I have also noticed (though not always—there are many empathetic members here) that when someone expresses dissatisfaction, they are sometimes told, “Be happy you can still have an erection,” as if that alone should soothe us. We know we are much more complicated than that.

In my own experience, I went through what I believe is the typical path for a 48-year-old prostate cancer patient at the time: normal sexual function, followed by a radical prostatectomy, which led to erectile dysfunction. I tried ED pills and injections, but eventually, neither worked. After a period of complete impotence, I chose to get a penile implant. Alongside this physical journey were significant challenges in my personal life—relationship struggles and breakups linked to erectile dysfunction, as well as battles with depression, anxiety, therapy, and sexual counseling. I'm still standing, but not without physical and emotional scars, along with lingering reservations.

It's a mixed experience for me. Some days, I’m thrilled that I can enjoy penetrative sex again. I work out 3 to 5 days a week, my endurance is great, and I can engage in long sessions without getting winded. On those days, I feel good about the functionality. But other days, I really dislike the way my penis looks. It has an odd, flat, oval shape, with an indentation running down the middle of the shaft that makes the tubing on both sides more noticeable. There's little to no blood flow, no natural tumescence, and the head of my penis remains small and doesn’t engorge. I use gels, vacuum erection pumps, and rings to trap blood, but honestly, it often ends up being painful. Many times, I have sex while dealing with discomfort or pain, which only adds to the frustration. After seeing multiple doctors, all of them have basically told me, “It is what it is,” and there’s not much more they can do.

Then there's the issue of anorgasmia. My sensitivity has decreased to the point where achieving orgasm has become incredibly rare. I’ve tried medications without success. I don’t take anything that would interfere with my ability to orgasm, but no matter how much I pump or attempt manual stimulation, I’m lucky if I can orgasm 1 out of 10-15 times. Whether it’s through intercourse or other forms of stimulation, it’s just not happening. I’ve seen excellent sex therapists and tried all kinds of approaches, but this is where I am now.

So, to put it plainly: Yes, I’m glad I got the implant. Yes, I love that I can have intercourse again and no longer have to worry about impotence. But at the same time, I struggle with accepting the prosthesis. I have issues with my body image, with how my penis looks, with depression and anxiety, and with the frustration of not being able to release my sexual energy through orgasm. I understand that sex is about more than just orgasms—it’s also about intimacy—and I show up for that. I don’t shy away from life, relationships, or sex.

I’m sharing this to emphasize that it’s complicated. We all know that. It doesn’t have to be all sunshine and rainbows, nor does it have to be darkness and gloom. For me, sometimes it’s both, and sometimes it’s neither. There are days when I don’t even think about it. And there are some days it's all I can think about. But I’ll admit, since prostate cancer, I think about my penis way more than I used to.

I want to encourage other men to be open, honest, and vulnerable about their low points, if they have them, without feeling labeled or CURSED. I’ve found that the high moments can balance out the lows, and making space for both feels like the most human thing to do.

Men's experiences with penile implants are multifaceted, and it's time the healthcare system acknowledges the emotional and psychological complexities that come with this journey. It is not just about functionality; it is about feeling heard and understood.

Thanks for Reading
Peace

I think there are a few different groups and likely the different groups have different opinions about the surgery and satisfaction.

The first would be "long term normal function, decline in function, and eventual (or impending) inability to function" group. They likely can naturally still orgasm.

The second group would be the "significant event caused immediate impaired function." They may or may not be able to orgasm.

The third group would be "lifelong ED." They may or may not be able to orgasm.

I fall in the first group-- there is a seriously damaging psychological effect to the decline... and after a decade of struggles and eventual barely able to be used 1 in 10 times... I can't even tell you how traumatic it was for me to orgasm with a limp dick (or fail to because I couldn't stimulate it enough) because I couldn't stay hard long enough to penetrate no matter how horny i was, no matter how badly i wanted it, no matter the dosage of pills or meds taken (like at the end I took *multiple* ed meds concurrently at doses I wouldn't recommend to anyone ever for safety reasons, but I was *that* desperate.) I am beyond thrilled with my implant. In fact above and beyond that, it eliminated all my original sexual anxiety, I don't lose my erection until *I'm* ready to. Even given the choice between this and the penis I had at my prime (which functioned very well), I would 100/100 times choose the implant knowing what I know now. I imagine a LOT of people in this group are really happy with the implant, at least at the level of "wish I'd have done it earlier even if its not entirely my natural penis." and if the only problem you had was getting erect, and you can still orgasm, absolute control over your erection, what's not to love (other than surgical risks)?

The third group has no real baseline to what it *should* function like or it's been so long it's memory is dim, so I imagine satisfaction is fairly high, they can function and they have no solid baseline to compare to... at a minimum its a psychological relief, and If they can orgasm, they're probably thrilled, if they can't at least it's closer to normal and enough to keep them from being self-conscious when with other people.

The second group in my opinion likely makes up most of the dissatisfied/CURSED (which is really an unfair term) people. In some cases there is a loss of ability to orgasm... this alone is devastating if you could prior. They have a solid base line to compare to, maybe recently, so every failing is glaringly obvious where it's dimmed for those losing function for years or never existed for lifelong ed sufferers... and it's so easy to compare yesterday to today. They don't have the *years* of disappointment, anxiety, and societal judgement that someone in the first and second group is relieved from. They may or may not have come to terms with everything involved in whatever resulted in their ED in the first place... and that makes it all the harder to accept the implant and loss of function.

I guess there would be a fourth group as well, those with complications... and those could happen to any of the prior groups and I think it's highly likely they're not real thrilled in many cases.

YMMV, I'm sorry you're struggling with body image issues and you're not happy with how the implant has panned out for you and especially the lack of orgasms, that's a raw deal, frustrating. There is a lot of psychology questionnaires that don't offer enough granularity and this is a good example of one, another is the depression/anxiety surveys... options are (weekly) "never", "several days", "most days", "everyday"... I have went from a 3-4 day average frequency on the one to a 1 day a week frequency... but that is still more than never. So my survey value there is always 1 and my psych doctor says "oh no improvement" and it's like "no, pretty significant improvement, about reduction of 75%... but ok :/"

Hopefully the day comes when you can get your natural function (use and orgasm) back through new therapies... for me, long as this thing keeps working, I'm happy having it... if it fails, I'll replace it. I would take it over my natural 100% of the time.

[equusAz]

I know this is an older thread, but as I'm perusing the forum looking for information this thread really struck me.

Like the OP, I too was blinsided with a cancer diagnosis at age 47. Not really what I was expecting in life. I had to make decisions quickly as the worry was it was agressive and would spread fast, so I took the 'best' option and went for surgery. One of the issues was there was worry that it had spread to one of my penile nerves so they removed it. Enter severe ED and Peyrones.

My journey after my RP has been one of depression and trying to be optimistic and making the best of the situation. I keep the depression at bay by reminding myself I'm alive and after a year and a half, cancer free, however, that doesn't remove the issue of severe ED I've struggled with. Pills had zero effect, and injections made fibrosis worse leading the disfigurement and shrinkage / narrowing. So...I'm now two weeks in post implant.

The medical community in the US is an absolute joke. I also agree that there is too much focus on fixing the 'problem' without examining the entire person. Not once was I asked how I was feeling about my ED from my doctor. Not once was there a refereal to a therapist. Not one of them asked how my husband was doing or how we were doing as a couple. We communicate and work things through as healthily as we can - and we are doing well - but it would have been NICE for someone to ask. Fix the dick was the way it was approached. No way to run a railroad IMO.

In the end I did get the implant - and my road to recovery will take a long time - but hey - I'm here and possibly will have a working dick at the end of this. I hope so. I'm a strong individual and can seek out my own care and own my treatments - but our system needs to improve because no everyone is me.

[Donkeykong]

I also agree that there is too much focus on fixing the 'problem' without examining the entire person. Not once was I asked how I was feeling about my ED from my doctor. Not once was there a refereal to a therapist. Not one of them asked how my husband was doing or how we were doing as a couple. We communicate and work things through as healthily as we can - and we are doing well - but it would have been NICE for someone to ask. Fix the dick was the way it was approached. No way to run a railroad IMO.

I think people have different preferences in this regard. I like my doctors to be no-nonsense professionals. Like, if you just fix my problem my head will fix itself.

At least where I usually go for men's health issues there is a lot of emphasis on the couple, as well as therapy to talk about your ED... To me it just feels like patronizing witch-doctoring and makes me cringe. I'm not in your office to talk about my feelings. To be fair, I'm a committed bachelor uninterested in couplehood, and also gay, and nobody knows what to do with that. Also, therapy for organic ED won't fix anything.

Yes it is true we have a lot of trauma related to impotence. Not to trivialize the diagnosis, but I think at this point I have a level of PTSD regarding my dick. But if it gets fixed in the right way, time will take care of the psychological part.

[GoodWood]

It is miraculous that urological surgeons have developed ways to rid men of prostate cancer and there are options to regain erectile function.

The complaints about feelings not being addressed seems to miss the mark. The vast majority of surgeons are happy to discuss their patients feelings and concerns. The doctors and nurses I’ve met have chosen that profession because they want to heal people. Not because they are trying to make a buck.

No satisfaction survey can ask the perfect question for every patient. But they aren’t the only tool for raising concerns. Before the doctor leaves the room say, “I’m concerned about, I’m unhappy with, I need help with, I’m struggling with, can you recommend…. Ask for help. Don’t expect them to read your mind.

A number of the unaddressed concerns in this thread fall more in the psychology, psychoanalyst, therapist,social worker, relationship, sexual health therapy realm. We don’t blame those folks for not being better at treating prostate cancer. Why do we expect urology surgeons to be advanced therapists?

Seems to me that this is like going to the hardware store and complaining that they don’t sell oranges.

All of these folks are specialists. Are they to blame because they didn’t meet our need? Or are we to blame because we didn’t ask for the specific help we need or are looking for the wrong help from that specialist?

[easymoney]

I have found with my surgeon in my opinion he is removed from the penis being connected to a person. Kind of looks at his patients like a mechanic looks at a car as something to repair, if it runs down the road and the problem it came in for is repaired then it's fixed. I have others tell me and have seen it expressed on here how others have felt the same way about their surgeons.

[Hope84]

Very interesting discussion. Although I also wish doctors could be more empathetic sometimes, I tend to agree with Donkeykong and GoodWood that what I primarily expect from my urologist is to fix my ED from a mechanical perspective. I know for a fact that:

a) my ED was rooted in a physical condition (damages to my corpora cavernosa following several priapism episodes), such that no amount of therapy/counseling would have helped, and

b) ED is the main issue I have in my life: I am young, good looking, doing very well professionally and financially, have lots of kind and awesome friends and family. As a consequence, in the spirit of what Donkeykong said, my reasoning is that once my ED has been fixed, this crippling depression and anxiety that I have suffered from for years, which I unequivocally attribute to my ED, will be gone or at the very least, be largely alleviated. Now I may be wrong, after a few months of using this implant, I may realize that it was something else all along, that I should have been an airline pilot, a poet, or lived in the Andes Mountains to raise alpacas, or that I should focus less on material things and rather spend my time helping those in need. Only time will tell, but I have strong opinions already about where this is headed.

In an ideal world, urologists would also be good psychologists and should pay great attention to their patients' overall wellbeing and satisfaction with their sexual health, rather than just focusing on whether their patients can clinically obtain and maintain an erection. The shortcoming of the latter is in my opinion perfectly illustrated by some doctors' perspective on injections. Many members of Franktalk have reported that their urologist stubbornly emphasized that, as long as shots "work", they should not go for an implant. But what does working mean for a penis and a treatment for ED? Can men's sexual function and health be reduced to a mere mechanical process? Should sexual function be ring-fenced to the bedroom such that, provided a man manages to do an injection right before sex and succeeds in having intercourse every time, we can safely say that he has no ED and functions perfectly? What about the 97% rest of the time where he does not have Alprostadil circulating through his veins and would therefore be unable to perform if the opportunity materialized, can we really expect men to overlook this aspect? Will he not be reminded of his ED when he sees a gorgeous girl smiling at him in the metro, or another girl flirting with him in a bar and making barely disguised sexual advances, while he knows his pills and injection material is at home?

To me, this is one of the main benefit of an implant compared to pills or injections. It provides a sense of normalcy, as it allows its owner to obtain and maintain an erection on-demand, with minimal effort and preparation. But I disagree that all urologists ignore this aspect. My urologist has tons of videos on Youtube where he not only explains the science behind implants, but also the psychological implications involved. But in the end, if one wants counseling, one should look for a sex therapist, psychologist or psychiatrist. A urologist's main business, as far as ED is concerned, is to diagnose the bodily functions that are responsible for ED and offer a range of solutions, by clearly explaining the upsides and downsides of each solution.

One last thing is that, having several doctors among my close friends and family, I have noticed that they tend to disconnect bodies from their owners and appear to forget that the latter have feelings and emotions. Exactly like easymoney put it, they tend to look at patients like a mechanic looks at a car to repair. But in my humble opinion, I think this is a natural coping mechanism allowing them to do their job without being constantly traumatized by what they see and do. One of my friend works in ER in a big hospital in France and you simply cannot fathom the horror he sees on a daily basis. I think one needs to detach himself from his normal emotional and sentimental reactions to navigate such environment, and rather adopt a scientific approach.

[Donkeykong]

I have found with my surgeon in my opinion he is removed from the penis being connected to a person. Kind of looks at his patients like a mechanic looks at a car as something to repair, if it runs down the road and the problem it came in for is repaired then it's fixed. I have others tell me and have seen it expressed on here how others have felt the same way about their surgeons.

In my case that's all I want: for the physical problem to be repaired. If the outcome is excellent, I will automatically be happy.

If I'm going to need therapy to deal with the outcome, maybe that's a sign I'm with the wrong doctor.

Some of the best surgeons are what they lately call "on the spectrum", and not people persons. The skill set is different.

I don't take my car to a therapist to be fixed either

[Totitoti]

“Get them hard he will be happy”

It really is that simple guys, is it perfect “NO” was your original penis perfect….. well mine was LOL I enjoyed it for 30+ years but it was not working well anymore, that’s life, in the end of it nothing will work and we die, better get the most of it while we are still living.

No need to complicate things, enjoy your device and stop thinking it’s not perfect, the women you are sticking into is not perfect either , they stick other stranger objects in it besides your penis , have you all seen the huge selection of dildos available and yes they do buy them and use them, so get out of your heads and have fun.

Good luck

[android912]

Hey Brothers. I just wanted to throw in my story to the database for those compiling information. I had my prostate removed robotically in 2021 due to a cancer diagnosis. Never got another erection with pills. Went to vacuum device with constriction ring…(no fun) but could orgasm with significant stimulation. Did injections for a while which worked well. Received a Titan IPP 9/2023. It was obvious that my “nerve sparing” RP didn’t spare the nerves I needed for erection or orgasm. I think I only have about 20-30% of my original sensitivity. The male orgasm involves “emission” (that part when your tubes get filled with ejaculates and you have that crazy good feeling that you’re gonna bust) and expulsion (the part when you’re pelvic floor muscles spasm wildly to expel the fluid). With the loss of my prostate and seminal vesicles I don’t have anything close to the emission phase. This is just my new normal, unfortunately. However my new orgasm is only the second phase of a “dry” pelvic floor spasm. From my experience the expulsion trigger is indeed brought about from this emission sensation. With that being gone the pelvic floor takes its time and is “confused” as to why it’s being recruited in the orgasm chain. But this only occurs about half the time with my partner. I can masturbate to success nearly every time. PIV gets me there, but rarely. I’ve had the most success with oral stimulation. The biggest organ in the orgasm chain is the brain. But my partner has to tap out in a heap of sweat and love endorphins. I’ll take that.

I’m very happy with my Titan. Good luck to everyone.