Comment on “Dilemmas of penile prosthesis implantation in healthy homosexual males in heterosexual relationships”

Abstract

Placement of a penile prosthesis in healthy homosexual men in heterosexual relationships is an interesting dilemma [1]. It would definitely be classified as situational erectile dysfunction (ED), a form of psychologic impotence. In my practice I had two patients with definite psychologic ED referred for penile implant placement by a very good psychologist (sex therapist) when all known medical and relationship therapies had failed. Both men had good erections with masturbation but failed with a female partner. The implant was successful surgically and cemented the relationship with the partner in both cases. I would consider the current dilemma an analogous situation: the patient can achieve a good erection in one circumstance but not in another. Performance with a female spouse is essential to procreation and maintaining the marriage, and I would not hesitate to place a penile implant in this situation. There are other issues to consider. The main one is informed consent. All the ramifications of placing an implant should be explained to the patient: infection and other complications, device malfunction, expected implant longevity, future loss of spontaneous natural erections, and possible effects on sensation and ejaculation. I would naturally want to include the patient’s male partners and female spouse(s) in the discussion. However, the male partners may be transient relationships, and I’m unaware of Sharia Law and customs and how they apply in the case of the wife. In most Western cultures, if the wife were involved in the discussion, the marriage would likely not last long. In my opinion such a penile implant placement would be considered a necessary procedure to cure a medical problem. The patient cannot perform when he is expected to perform in the marriage. As such it should be covered by the health system financially. Although there may be some religious objections to placing a penile implant in homosexual patients, my feeling is that I can restore a man’s erection with an implant; what he does with his erections is his concern.