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P
enile
prosthesis
implantation
: A
solution
or
a
dilemma
for
the
couple
R
ev
A
ssoc
M
ed
B
ras
2017; 63(6):475-476
475
EDITORIAL
Penile prosthesis implantation: A solution or a dilemma for the couple
I
mplante
de
prótese
peniana
:
uma
solução
ou
um
dilema
para
o
casal
T
héo
L
erner
1
, J
osé
M
aria
S
oares
J
únior
1
, A
na
L
úcia
C
avalcanti
1
, E
lsa
P
ereyra
G
ay
1
, A
na
R
egina
dos
S
antos
2
, J
osé
C
ury
2
,
M
iguel
S
rougi
2
, E
dmund
C. B
aracat
1
1
Division of Gynecology, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
2
Division of Urology, HC-FMUSP, São Paulo, SP, Brazil
http://dx.doi.org/10.1590/1806-9282.63.06.475The physical, social and psychological changes resulting
from aging have a significant impact on the sexuality of
both men and women.
1-5
Among men, erectile dysfunction (ED) is a common
cause of impaired quality of life. In the last decades, an
arsenal of alternatives has been developed to deal with this
problem. Local drugs such as injectable or intraurethral
prostaglandins, systemic agents such as phosphodiester-
ase inhibitors, and mechanical methods including vacuum
constriction devices are among the possibilities of non-sur-
gical intervention. For cases in which vascularization or
penile innervation is compromised, surgical treatment of
ED is indicated involving placement of a penile implant.
5
The two types of implants available are semi-rigid and
inflatable, differing in cost and functional outcome.
As for women, climacteric corresponds to a period of
transition marked by estrogen decline (hypoestrogenism).
It is characterized by physical, metabolic and psycholog-
ical changes with negative repercussions in the psycho-
social domain and in sexuality.
1-4
Culturally, society has
stigmatized menopausal women in relation to their sex
life. However, with the advent of hormone therapy and
career advancement of many women, this perception has
changed and sexual interest at this stage of life has once
again been accepted.
1-4
In addition to the urological as-
sessment of the male partner, evaluating the physical
changes that occur during perimenopause and which
affect the sexuality of women is justified.
The influence of cultural and social factors related to
the aging process and the expression of sexuality increas-
es the complexity of treating couples with indication for
a penile implant. Assessing the female partner’s expecta-
tions and degree of satisfaction is critical.
The literature of the 1980s and 1990s dealt with fe-
male sexual satisfaction in a generic way and reported
satisfaction experienced by most women in relation with
their partner’s prostheses.
6,7
Some authors began to ques-
tion the influence of cultural and social factors that pre-
vented this satisfaction from being generalized.
8
Beliefs
related to erection, as an expression of desire (and there-
fore of love) and fear of infidelity, have generated prejudice
against artificially induced erections by a significant pro-
portion of women.
9
Ultimately, another category of prob-
lems began to be observed: women with sexual dysfunc-
tions prior to the treatment of erectile dysfunction, who
had become accustomed to the problem of their husbands,
began to experience high levels of stress as a result of the
new demands and expectations associated with penile
implant placement.
10,11
Often, the couple’s sexual interest disappears com-
pletely, being replaced by feelings of friendship and com-
panionship after long years of marital life. The female
partner is not always ready to resume sexual activities,
which can pose a dilemma for the couple and even break
the marital bond.
The prior sexual history of both partners needs to be
investigated, including beliefs, fantasies, fears, and expec-
tations related to the procedure. Doubts should be clar-
ified, while conflicts in the relationship can be identified
and properly managed.
12
Couples therapy can be a useful tool for dealing with
psychological and behavioral factors that hinder the mar-
ital bond and consequently sexual satisfaction.
1-4
Thorough
evaluation and sexuality counseling are fundamental for
the prevention of negative impacts of a penile implant on
the couple’s relationship.
R
eferences
1. Galhardo CL, Soares JM Jr, Simões RS, Haidar MA, Rodrigues de Lima G,
Baracat EC. Estrogen effects on the vaginal pH, flora and cytology in late
postmenopause after a long period without hormone therapy. Clin Exp
Obstet Gynecol. 2006; 33(2):85-9.
2.
Favarato MECS, Aldrighi JM. A mulher coronariopata no climatério após
a menopausa: implicações na qualidade de vida. Rev Assoc Med Bras. 2001;
47(4):339-45.