The Total Guide to Penile Implants For Transsexual Men

Penile implants for erectile dysfunction have been been continually improved and refined over the last 40 years. More than 300,000 cis gender and trans gender men have had penile implant surgery, with approximately 20,000 penile implant surgeries a year. 1

Expert Reviewed by Dr. Curtis CranePenile implants provide an erection by serving as a replacement for the spongy tissue (corpora cavernosum) inside the penis that normally fills with blood during an erection. They come in a variety of diameters and lengths.

Penile implant surgery is typically performed at stage 2 or 3 of a multi-stage phalloplasty (a minimum of nine months following stage 1.) Recovery time is typically 6 to 8 weeks. Patients can resume sexual activity after physician consultation.

Note On Terminology: Penile implants are also known as penile prosthetics. However a penis “prosthetic” or “prosthesis” commonly refers to a non-surgical “packer” — a polymer or silicone penis that’s worn in a harness or affixed with medical adhesive. Similarly, “erectile device,” which is also sometimes used interchangeably with “penile implant,” can refer to external devices that assist with erections via vacuum pressure, vascular constriction, nerve stimulation, stretching, etc. This article will use the term “penile implant” exclusively to describe those penile prosthetic devices that are surgically implanted.

Types of Penile Implants

There are three basic kinds of penile implants used in FTM Phalloplasty: the non inflatable or semi-rigid implant (malleable and non-malleable), the 2-piece inflatable implant, and the 3-piece inflatable implant.

Non Inflatable Penis Implants

Non Inflatable Penis Implant

(Includes semi-rigid malleable and non-malleable rods.)

One or two bendable and “positionable” rods are inserted into the penis. The rods have an outer coating of silicone and inner stainless steel core or interlocking plastic joints. Non inflatable (or semi-rigid) implants are always firm. They can be bent into different positions for erect and flaccid states. These implants are used the least of all types, in approximately 10% of cases.2

Deflating Non Inflatable Penis ImplantHow it works: For an erection, simply bend the penis in the erect position. To end the erection, bend the penis down. Erections can be of various degrees depending on how the penis is bent.


  • Easy to use: bend it up for an erection and bend it down when not in use.
  • Totally concealed in body
  • Simplest penile implant procedure
  • Least expensive
  • With fewer mechanical parts, these implants can last more than 20 years.


  • Having a permanent semi-erection can feel and look awkward

Popular Brands of Semi-Rigid Penile Implants:

2-Piece Inflatable Penile Implants

2-Piece Inflatable Penile Implants - AMS AmbicorInflatable penile implants have two cylinders in the shaft of the penis, a reservoir that holds salt water, and a hydraulic pump to move the salt water from the reservoir to the cylinders, providing an erection.

The release valve on the pump drains the salt water out of the cylinders and back into the reservoir.

A 2-piece inflatable implant has the reservoir at the beginning of the cylinders (at the base of the penis) and the pump and release valve in the scrotum. These are used in about 15% of cases.3

Deflating 2-Piece Inflatable Penile ImplantHow it works: Gently squeeze the concealed pump in the scrotum several times. This moves the saline solution from the reservoir into the cylinders. As the cylinders fill, the penis becomes erect and firm. To end the erection, gently bend the penis down for 6-12 seconds. This transfers fluid back into the reservoir.


  • Easy to use: pump it up for an erection, bend to deflate.
  • Totally concealed in body
  • Simplest inflatable penile implant procedure, least expensive surgery and implant.
  • More easily concealed under clothing than semi-rigid/non inflatable implant


  • Requires some manual dexterity to inflate
  • Because only a small amount of fluid is transferred into the cylinders to obtain an erection, the penis is not as rigid as with a multi-component 3-piece inflatable penile implant.
  • The pump can be felt more in the scrotum to sex partners compared to the softer pump of the 3-piece inflatable implant

Popular Brands of 2-Piece Inflatable Penile Implants:

3-Piece Inflatable Penile Implants

3-Piece Inflatable Penile ImplantA 3-piece inflatable implant has the cylinders in the penis, the reservoir in the belly, and the pump and release valve in the scrotum. Compared to 2-piece inflatable implants, the reservoir in this type of implant is larger and separate from the cylinders. These are the most common of the penile implants, used in approximately 75% of cases.4

Inflating 3-Piece Inflatable Penile ImplantHow it works: Gently squeeze the concealed pump in the scrotum several times. This moves the saline solution from the reservoir into the cylinders. As the cylinders fill, the penis becomes erect and firm. To end the erection, simply press a “deflation site” on the pump. Deflating the cylinders transfers the fluid back to the reservoir and the penis becomes flaccid.


  • Most closely resembles the process and “feel” of a non-assisted erection
  • Easy to use: pump it up for an erection, press the release valve to deflate
  • Easier to inflate than a 2-piece device due to larger, softer pump
  • Provides better rigidity of the two inflatable devices
  • Provides the best flaccidity of all implants when not in use
  • Creates the least amount of pressure on penile flesh when not in use, lessening risk of deterioration and thinning
  • Often more reliable than 2-piece penile implants
  • Totally concealed in body
  • More easily concealed under clothing than semi-rigid/non inflatable implant


  • Requires some manual dexterity to inflate
  • Most involved implant surgery, most expensive surgery and implant.
  • More mechanical parts translates into a higher chance of mechanical failure compared to other implants. Can last as little as 3 years before needing replacement, though research has indicated that they can last 10-15 years.
  • Patients do not typically see any increase in length or girth due to the thickness of the flaps used to create the phallus
  • Highest complication rate. Most centers in Europe have stopped using this implant because, in some series, 50% of implants needed to be removed.

Popular Brands of 3-Piece Inflatable Penile Implants:

Factors In Choosing a Penile Implant

Choosing a type and brand of penile implant can be difficult as several factors need to be considered:

  • Age
  • Penis size: Overall size (including intra-operative measurement), ratio between the length to girth of penile shaft, ratio between penile length and size of scrotum, overall size of scrotum, size of glans penis.
  • History of previous implant, abdominal surgery, kidney transplant or other major pelvic surgery
  • Body type, incl. presence of a very prominent supra-pubic fat
  • Overall patient health and life expectancy
  • Costs

Dr. Curtis CraneWhile the 3-piece inflatable penile implants are the most commonly used implants today, there are compelling reasons for trans men to consider the semi-rigid non-inflatable devices.

Dr. Curtis Crane is a reconstructive urologist and plastic surgeon who performs gender-affirming surgeries in Austin, Texas. Dr. Crane prefers the semi-rigid implants for a number of reasons:

  • Over the long term, semi-rigid implants provide better rigidity compared to inflatable implants, which can lose rigidity over time.
  • Semi-rigid implants have a longer lifespan than inflatable implants (20+ years vs. 5-10 years.)
  • The semi-rigid implant and implant surgery are less expensive compared to inflatable implants.
  • Simpler implant surgery = reduced complication rates.
  • Unlike cisgender men, transsexual men do not generally get an increase of girth with inflatable implants.

Potential Complications

While improvements over the years have made the penile implant more reliable, no mechanical device is 100% free of malfunction, and that includes penile implants.

As with any surgical procedure, there always is the chance of post-operative infection. If the infection is severe, the implant must be removed.

Chronic pain may occasionally require removal of the implant.

Leakage from the cylinders can also require removal or replacement of the implant.

Less common complications include tissue erosion (particularly in the glans), implant malfunction (such as pump or reservoir failure) or defectiveness, and incorrect positioning or migration or the implant.

Recent Studies

Surgical Outcomes at a Single Institution of Infrapubic Insertion of Malleable Penile Prosthesis in Transmen
Helen H. Sun, Ilaha Isali, Kirtishri Mishra, Michael Callegari, Nicholas C. Sellke, Kimberly S. Tay, Shubham Gupta, Mang L. Chen. Urology, Volume 173, March 2023.
Description of the surgical technique for the infrapubic approach for malleable penile prosthesis (MPP) insertion after phalloplasty in transgender men, and a review of surgical outcomes.

Penile Prosthesis in Transgender Men after Phalloplasty [FULL TEXT]
Rajveer S. Purohit, Marissa Kent, and Miroslav L. Djordjevic. Indian J Plast Surg. 2022 Apr; 55(2): 168–173.
A penile prosthesis can be successfully implanted after phalloplasty in transgender men to permit sexual intercourse. There are a variety of techniques and devices available and the choice depends both on the surgeon and patient preferences as well as the type of phalloplasty that was utilized initially. While successful implantation can improve patients’ quality of life, surgeons should counsel patients about the relatively high risk of the need for revision surgery.

Penile Prosthesis Placement by a Dedicated Transgender Surgery Unit: A Retrospective Analysis of Complications
Brenna L Briles, Ravyn Y Middleton, Kenan E Celtik, Curtis N Crane, Michael Safir, Richard A Santucci. J Sex Med. 2022 Mar 1;S1743-6095(22)00552-5.
We demonstrate that preoperative conditions of the neophallus, such as prior stricture correction, and perioperative factors, such as simultaneous clean and clean-contaminated procedures, seem to pose no additional increase in complication rates, but we did notice a markedly lower rate for semirigid prostheses compared to inflatable. Our data suggest that surgical experience may further decrease complications over time.

1. Source: Erectile Dysfunction Institute (EDI)
2. Source: EDI
3. Source: EDI
4. Source: EDI

Last updated: 09/14/23

14 thoughts on “The Total Guide to Penile Implants For Transsexual Men”

  1. How about spread the word about Patent US8126558 B2?

    It’s a genius device, and it’s possible during our generation.

    Basically, a controlled penile prosthesis able to remotely control erections. Either by an external device or chemical sensor signals. Check it out! & GOOD LUCK!

  2. Wow… in terms of exact costs for this procedures. , how much do they cost and how long does the prosedure take? What age is it most favorable for one to go for it and is it available in south africa?

    • Costs will vary greatly depending on where the surgery is done and what your needs are. Age may impact the type of implant used. Trans men from SA typically travel to Thailand or Serbia for the surgery (while cis gender men can have it done in SA.)

  3. What is the percentage of infections from using these things? Seems like it would be problematic, having gears and machinery around sensitive skin involved in sexual activity. And what happens if the skin breaks during intercourse?

    • Good question! In a 2010 study of 129 trans men… 41% needed either a revision or had to have the penile implant removed due to infection 11.9%, erosion 8.1%, leakage 9.2%, dysfunction 13%, or malposition 14.6%.

  4. Penile implant surgery in transgender men is challenging because of the lack of corporal bodies in a neophallus to accommodate the implant cylinders. This new method of anchoring the device to the pubic bone is one strategy to achieve stabilization adequate enough for intercourse.


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