Penile Implant vs Injections
When tablets such as sildenafil or tadalafil do not work well enough, penile injections and penile implant surgery are two other treatment options.
Both treatments can create an erection firm enough for sex, but they work in different ways.
Penile injections are used before each sexual encounter and do not require surgery. A penile implant is placed during an operation and provides a long-term way to create an erection.[1–3]
The best option depends on your health, previous treatments, feelings about needles or surgery, and how important spontaneity is to you.
What are penile injections?
Penile injections are also called intracavernosal injections. A very small needle is used to inject medicine into one side of the penis.
The medicine relaxes the blood vessels and tissue inside the penis. This allows more blood to enter and creates an erection.[1–3]
Common injection medicines include:
Alprostadil
Bimix
Trimix
Bimix and Trimix contain a mixture of different medicines. Their availability varies between countries.[1,3]
An erection usually develops within about 5–15 minutes. The dose needs to be adjusted carefully so the erection is firm enough for sex but does not last too long.[1–3]
How well do injections work?
Alprostadil injections produce an erection firm enough for sex in more than 70% of carefully selected patients. Combination injections may help when alprostadil alone does not work well enough.[1,3]
Injections can work for men with severe erectile dysfunction, including men with:
Diabetes
Blood vessel disease
Nerve problems
Erectile dysfunction after prostate cancer treatment
Erectile dysfunction that has not improved with tablets
Some men continue using injections for many years. Others stop because of pain, dislike of needles, loss of spontaneity or concern about side effects.[4,5]
Advantages of penile injections
No surgery is needed
Treatment can be stopped at any time
The dose can be adjusted
Injections may work when tablets fail
They may suit men who only need treatment occasionally
Risks and disadvantages of injections
A new injection is needed before each sexual encounter.
Possible side effects include:
Pain or burning in the penis
Bruising or bleeding
Scar tissue
New penile curvature
A prolonged erection
Priapism
Priapism is an erection lasting four hours or longer. It needs urgent medical treatment because it can permanently damage the penis.[1–3]
What is a penile implant?
A penile implant, also called a penile prosthesis, is a device placed inside the penis during surgery.
The device creates firmness mechanically. It does not depend on tablets, injections or natural blood flow.
There are two main types.
Inflatable penile implant
An inflatable implant usually contains:
Two cylinders inside the penis
A pump inside the scrotum
A fluid reservoir inside the lower abdomen or pelvis
Squeezing the pump moves fluid into the cylinders and creates an erection. Pressing the release button returns the penis to a softer state.[1,2]
Malleable penile implant
A malleable implant contains bendable rods.
The penis is moved upwards for sex and downwards for concealment. This type may be easier to use for men with reduced hand strength, but the penis remains partly firm all the time.[1]
How well does a penile implant work?
A working implant usually creates a firm erection whenever it is activated.
It does not depend on tablets, injections, sexual stimulation or blood flow.[1,2]
A recent review reported overall patient satisfaction of about 83%. Other reviews found improvements in sexual function, confidence, relationships and quality of life.[8,9]
Satisfaction is usually highest when patients understand what the implant can and cannot do.
A penile implant restores firmness. It is not designed to make the penis larger.
Advantages of a penile implant
A highly reliable erection
Greater spontaneity after recovery
No injections before sex
No need to wait for medicine to work
Control over when the erection starts and ends
A long-term treatment for severe erectile dysfunction
Treatment for erectile dysfunction linked with some cases of Peyronie’s disease
A penile implant does not directly increase sex drive. It also does not usually change skin sensation.
A penile implant does not interfere with a person’s ability to reach orgasm or ejaculate.
Risks and disadvantages of an implant
A penile implant requires surgery, an anaesthetic and several weeks of recovery.
Possible problems include:
Infection
Bleeding, swelling or pain
Wound problems
Movement or erosion of the device
Mechanical failure
Difficulty using the pump
Dissatisfaction with penile length or appearance
The need for another operation
Increased mobility of the glans penis
Implant infection is uncommon after a straightforward first operation, but it is serious. An infected implant often needs to be removed or replaced.[6]
Implant surgery permanently changes the erectile tissue inside the penis.
How long does an implant last?
A penile implant should not be expected to last forever.
A large review estimated that inflatable implants were still working without replacement in:
87.2% of patients after five years
76.8% after ten years
63.7% after 15 years[7]
Some implants last much longer. Others need earlier repair or replacement.
Who may prefer injections?
Injections may suit someone who:
Wants to avoid surgery
Only needs treatment occasionally
Is comfortable using a small needle
Gets a reliable erection from injections
Wants to try a non-surgical treatment first
Who may prefer an implant?
An implant may suit someone who:
Has not had a reliable result from tablets or injections
Finds injections painful or inconvenient
Wants a more predictable erection
Wants greater spontaneity
Has severe erectile dysfunction that is unlikely to improve
Has erectile dysfunction together with Peyronie’s disease
Understands the risks of surgery and future replacement
Guidelines recommend considering penile implant surgery when other treatments have failed, are unsuitable or are not acceptable to the patient.[1,2]
Which option is better?
Neither treatment is best for everyone.
Injections may be a good choice for someone who gets a good result and wants to avoid surgery.
An implant may be better suited to someone who wants a reliable, long-term treatment and is comfortable having surgery.
There are no recent high-quality trials directly comparing the two treatments in identical groups of patients. The decision should be based on your goals, health and personal preferences.
A specialist can help you decide which option best suits your health, lifestyle and treatment goals.
This article provides general information and does not replace medical advice. Seek urgent medical care for an erection lasting four hours or longer.
References
European Association of Urology. EAU guidelines on sexual and reproductive health. Arnhem: EAU Guidelines Office; 2026.
Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633-641. doi:10.1016/j.juro.2018.05.004.
Duncan C, Omran GJ, Teh J, Davis NF, Bolton DM, Lawrentschuk N. Erectile dysfunction: a global review of intracavernosal injectables. World J Urol. 2019;37(6):1007-1014. doi:10.1007/s00345-019-02727-5.
Bearelly P, Phillips EA, Pan S, et al. Long-term intracavernosal injection therapy: treatment efficacy and patient satisfaction. Int J Impot Res. 2020;32(3):345-351. doi:10.1038/s41443-019-0186-z.
Ledesma BR, Codrington J, Velasquez D, et al. Factors influencing continued usage of intracavernosal injections for erectile dysfunction: a retrospective analysis. World J Mens Health. 2025;43(2):407-414. doi:10.5534/wjmh.230329.
Gon LM, Campos CCC, Voris BRI, Passeri LA, Fregonesi A, Riccetto CLZ. A systematic review of penile prosthesis infection and meta-analysis of diabetes mellitus role. BMC Urol. 2021;21(1):35. doi:10.1186/s12894-020-00730-2.
Miller LE, Khera M, Bhattacharyya S, Patel M, Nitschelm K, Burnett AL. Long-term survival rates of inflatable penile prostheses: systematic review and meta-analysis. Urology. 2022;166:6-10. doi:10.1016/j.urology.2022.03.026.
Corona G, Santi D, Cocci A, et al. Long-term penile prosthesis couple’s satisfaction: a systematic review and meta-analysis. Andrology. 2025;13(3):610-623. doi:10.1111/andr.13696.
Manfredi C, Russo GI, Capogrosso P, et al. Quality of life and sexuality with penile prosthesis: a systematic review and pooled analysis. Minerva Urol Nephrol. 2024;76(2):166-175. doi:10.23736/S2724-6051.23.05466-6.
