Making the decision to have a penile implant is easy for many men, but for others it may take months or years to undergo this operation. On one hand, men look forward to recovering reliable sexual functioning and intimacy, but on the other, men are commonly afraid that they will regret their decision. I understand this is not always an easy decision, and I want men to feel they are making the best decision for themselves and their partner.
Having surgery on your penis is intimidating for most men. Understanding what to expect in the days, weeks, months and years that follow penile implant is helpful and can relieve some pre-surgery uncertainties. What I do know (and the literature supports it) is that once recovered, more than 90% of men (and their partners) would do it again. Recently, I learned that the satisfaction rate for knee and hip replacement surgery isn’t even that high!
I have attached the handout I give to all men undergoing this operation. I have broken the recovery down into the stages of recovery, so men can be reassured that what they’re experiencing is usually expected and will almost always resolve.
Click here to download/view our free penile implant resource.
I have also written about Preparing for Prosthetic Surgery
In the course of treatment for erectile dysfunction, some men may be treated with penile injections. This method involves men injecting medications directly into the penis,instead of taking a pill like Viagra. This is the most direct route, and a very effective treatment for ED. In general, obtaining medication to do this type of injection is different than obtaining other prescriptions.
Penile injections for ED
Commercially available injectables include Edex and Caverject, and some insurances may cover them. However, most plans do not cover them, and they can be very expensive, from $50-$100 per dose! Obtaining the same medications from a compound pharmacy reduces the cost significantly, bringing it to $8-$20 per dose, depending on the type of medication, dose used, and compound pharmacy.
When I mention ‘compound pharmacy’ most men have never heard of it. Typical pharmacies sell only medications that are ‘pre-packaged’ and sold ‘as-is.’ Compound pharmacies are different. From the FDA website, “a licensed pharmacist, combines, mixes, or alters ingredients of a drug to create a medication tailored to the needs of an individual patient.” This allows us to tailor the strength and even combine 2, 3 or 4 medications, increasing the efficacy or potency of the compound solution.
In the Seattle area, a online search for compound pharmacy yields a few different results. We have worked with most of the pharmacies listed, and all of them have at least a couple of commonly used compounds readily available. Prescribing injections that are not part of that pharmacies ‘usual compounding’ results in a higher price, because each unique solution requires quality testing. Each pharmacy will also have a different price often for similar compounds. It pays to do some research, and some men find using an online compounder is the most convenient.
It is important to note that the medications that go ‘into’ a compound are FDA approved, but once compounded into a solution, it is NOT FDA approved. This type of prescribing is called ‘off-label’ and in general is safe, however quality can vary. I encourage everyone to read this information from the FDA about compound pharmacies.
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Testicular self-examination is a quick and easy way for men to catch issues quickly if/when they arise. Typically recommended for men over 18 years of age, self-examination takes just a few minutes and can be performed in the comfort of your own home. The process can help men identify lumps on the testes. Personally, I found a lump of my own, which turned out to be cancerous. Fortunately, it was small, and I received the treatment I needed at the earliest possible stage.
How to perform a self-exam
- Perform a self-examination once a month after a warm shower, when the scrotum is relaxed and changes can be more readily identified.
- Grasp the testicle with your thumb on top, and pointer and middle finger on the bottom and roll gently, yet firmly.
- Feel for swelling, hardness, lumps, or changes to the texture of the scrotum.
- Familiarize yourself with the epididymis, the tube at the back of your testicles that stores and carries sperm to the vas deferens. This tube can often be mistaken for a lump. Its equally important to become familiar with how it normally feels. If it is sore to touch, this could be a sign of a common infection called epididymitis.
Causes of testicular lumps
Testicular lumps are not always a cause for alarm. While they can indicate cancer, there are many other benign conditions that can present themselves as lumps. Varicoceles can cause swelling due to enlarged veins in the cord above the testicle, while hydroceles causes swelling as a result of fluid build-up around the testicle. Epididymal cysts may cause one testicle to feel heavier than the other, are generally painless and will usually feel like they are above or behind the testicle. Swelling caused by infection may often be painful and accompanied by fever or unusual testicular placement or redness and thickening of the skin.
If you’re experiencing pain, collection of fluid in your scrotum, an ache in your groin or abdomen, or swelling in your chest, it’s important to schedule a doctor’s appointment as soon as possible.
When to contact your doctor
If you found a lump, you might panic or be scared, but don’t minimize or think it ‘will go away’. Contact your doctor any time you detect a change in your testicles. Identifying the cause of a lump in its early stages is critical for treatment–whether it’s cancerous, or caused by other medical conditions. Your doctor will use a variety of methods and tests to determine the cause of any testicular abnormalities, and work with you to find the best treatment solution. Often a simple examination in the office is all that is needed to rule out serious causes. When indicated, an ultrasound is a very good test to evaluate the testicles.
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