What is erectile dysfunction (ED)?

ED is the persistent inability to achieve or maintain an erection that is firm enough for sexual intercourse. It happens when blood flow to the penis is limited or the nerves that trigger an erection are damaged. It is common: more than half of men over 40 in the U.S. have some degree of ED, and one projection estimates around 322 million men worldwide will have it by 2025.

There is no single cause. Risk factors include age, smoking, diabetes, high blood pressure, high cholesterol, depression, obesity and a sedentary lifestyle — and ED is often a side effect of prostate cancer treatment.

Treatment options for ED

Treatment usually moves from least to most invasive, starting with lifestyle changes and treating the underlying cause. If those are not enough, Dr. Uhr offers every established option:

Oral medicines. Prescription pills that improve blood flow to the penis and, combined with sexual stimulation, produce an erection. They need working nerves and healthy blood vessels, so they can be less effective after prostate surgery or with long-standing diabetes.
Vacuum erection devices (VEDs). A hollow tube and hand- or battery-powered pump pull blood into the penis; an elastic tension ring at the base maintains the erection.
Penile injections (intracavernosal injection therapy). Medication injected directly into the penis increases blood flow and creates an erection.
Penile implants. A device placed entirely inside the body that lets a man have an erection whenever he chooses and keep it as long as he wants. Nothing is visible, it is controlled by the user, and it typically does not interfere with ejaculation or orgasm. It offers spontaneity without medication side effects or ongoing costs. In a survey of 80 men who received an AMS 700™ inflatable penile implant, 97% would recommend a penile implant to a friend.

Types of penile implant

Inflatable, three-piece (AMS 700™ with Tenacio™ pump). Fluid-filled cylinders in the penis, a small pump in the scrotum and a reservoir in the lower abdomen. Squeezing the pump inflates the cylinders for a natural-looking erection; a release returns the penis to a flaccid state.
Inflatable, two-piece (AMS Ambicor™). Cylinders and pump only, for men who prefer a simpler device.
Malleable (Tactra™). Bendable rods that are positioned by hand — the simplest to use when dexterity is limited.

ED after prostate cancer treatment

The nerves and blood vessels that supply the penis lie very close to the prostate and may be injured during a radical prostatectomy or radiation. Even after a nerve-sparing operation, recovery of erections can take more than a year, and for some men ED is permanent.

Penile rehabilitation is a structured program that Dr. Uhr starts soon after surgery to help the erectile nerves recover by improving oxygen flow, blood flow and the structure of the erectile tissue — usually with low-dose medication, a vacuum device, or injections. If ED persists, a penile implant restores reliable erections regardless of nerve recovery.

ED and diabetes

Half of men with diabetes have sexual problems caused by the condition, and for some men ED is the first sign of diabetes. High blood sugar damages both the nerves and the small blood vessels of the penis, which is why pills may work less well. Managing blood sugar and blood pressure comes first; when ED continues, devices, injections and implants remain fully effective.

ED and heart disease

ED shares the same risk factors as cardiovascular disease and can be an early warning sign: the arteries to the penis are smaller than those to the heart, so plaque build-up shows up there first. On average, ED appears about three years before coronary artery disease, peripheral artery disease or stroke, and precedes silent coronary disease in almost 70% of cases. If you have new ED, Dr. Uhr will make sure your heart risk is evaluated — and once your doctor confirms your heart is healthy enough for sex, every treatment option is open to you.

Hear from patients: the HARD series

HARD: The Fight to Solve Erectile Dysfunction is a documentary series in which real men — and their partners — talk candidly about living with ED and choosing a penile implant. All episodes, including three in Spanish, are in the Videos section below under HARD series.

Frequently asked questions about penile implants

Is it an outpatient procedure? Usually, yes — a decision you and Dr. Uhr make together. The operation typically takes 30 minutes to 2 hours.
Will anyone be able to tell I have an implant? No. Once in place it is completely concealed inside the body — no one will know unless you tell them, even in the locker room.
How much pain will I have? Discomfort at the surgical site is expected in the early weeks and when you first use the device; in most cases it resolves within a few weeks, although chronic pain has been reported.
When can I use it? Most surgeons recommend waiting four to six weeks before intercourse.
How do I use an inflatable implant? You squeeze the pump in the scrotum, which moves fluid into the cylinders. This takes some manual dexterity; Dr. Uhr will teach you at your follow-up visit.

Patient resources

EDCure.org — treatment options, FAQs and the HARD patient docuseries (sponsored by Boston Scientific)
AMS 700™ inflatable penile implant — patient information
Find Your ED Cure — patient education brochure (PDF)
AMS 700™ with Tenacio™ pump — patient guide (PDF)
Speak with a real patient who has a penile implant: call +1 (844) 433-2873 or email MHPatientEducation@bsci.com and a Boston Scientific patient educator will connect you.

Important safety information — AMS 700™ Inflatable Penile Prosthesis. Your doctor is your best source for information on the risks and benefits of the AMS 700™ Inflatable Penile Prosthesis. The AMS 700™ is intended for use in the treatment of male erectile dysfunction (impotence). Implanting a penile prosthesis will damage or destroy any remaining ability to have a natural erection, as well as make other treatment options (oral medications, vacuum devices or injections) impossible. Men with diabetes, spinal cord injuries or skin infections may have an increased risk of infection. Implantation may result in penile curvature or scarring. Some AMS 700 devices contain an antibiotic (InhibiZone™ Antibiotic Surface Treatment) and are not suitable for patients allergic to rifampin, minocycline or other tetracyclines, or who have systemic lupus. Potential risks may include: device malfunction/failure leading to additional surgery, device migration potentially leading to exposure through the tissue, wearing away/loss of tissue (device/tissue erosion), infection, unintended inflation of the device and pain/soreness. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician. (MH-545411-AB)

Tactra™ Malleable Penile Prosthesis. Intended for the treatment of erectile dysfunction in adult males. Implanting a penile prosthesis will damage or destroy any remaining natural ability to have a spontaneous erection, as well as make other treatment options impossible. Men with diabetes, spinal cord injuries, or skin infections may have an increased risk of infection. Implantation may result in penile shortening, curvature or scarring. (MH-611821-AA)

Sources: NIDDK; Feldman HA et al., J Urol 1994; Ayta IA et al., BJU Int 1999; Burnett AL et al., AUA guideline, J Urol 2018; Bettocchi C et al., J Sex Med 2010; Mulhall JP et al., J Sex Med 2013; Vlachopoulos C et al., Eur Heart J 2013; Gandaglia G et al., Eur Urol 2014; Phé V & Rouprêt M, Diabetes Metab 2012. Patient-education content adapted from Boston Scientific web-ready materials (2024–2025).