Why are men being denied surgery to revive their love lives?

  • rowland rees

After a decade of worsening impotence problems, David Lawrence finally decided to seek medical help.

‘I’d tried herbal products and then Viagra, but nothing was really working,’ he says.

‘Sexual intercourse with my wife was difficult, and I was also having trouble going to the loo.’

The 47-year-old engineer said he first went to his GP about the problem two years ago, but it was only when he was referred to a third doctor that he finally got a diagnosis.

David (not his real name) has Peyronie’s disease — an abnormal curvature during an erection caused by fibrous scar tissue under the skin.

Although the condition affects around 150,000 men in the UK, most of whom are over 40, doctors are still unclear what makes it develop.

One theory is that it’s caused by some type of injury; other experts believe it may run in families. 

Peyronie’s can be treated by surgically removing the scar tissue, or removing tissue from the side of the penis opposite the scar tissue. 

As he already suffered with erectile dysfunction, David’s only option was a penile implant — an inflatable device consisting of two fluid-filled cylinders which are surgically inserted into the penis and connected to a separate reservoir of fluid, and a pump which lies under the skin of the scrotum. 

The mechanical pump is squeezed to push fluid up the cylinders and, once full, the penis becomes rigid — a process that takes between five and ten seconds. The erection remains until the deflate button is pressed.

Despite the devastating impact that the erectile dysfunction problems were having on his life, David was told the NHS would not pay the £4,500 cost of the implant.

‘It was my only real option, so I was very angry when I was told they would not pay,’ he says.

‘This is not a cosmetic procedure. The only other time I have ever used the NHS was when I had my tonsils out when I was a child, and I’ve been paying my taxes for 30 years.

‘In the end, I decided to take out a loan to have the operation done privately, but it shouldn’t be that way.’

David is one of thousands of men who could benefit from a penile implant.

Yet the NHS funds only around 400 such implants a year — and the chance of receiving one varies widely depending on where you live.

Doctors say the situation is unfair and is a clear case of ‘medical sexism’ by the NHS. 

Rowland Rees, a consultant urological surgeon in Hampshire, explains: ‘Many men with erectile dysfunction are in their 50s and 60s and want to have a sex life.

‘Restoring sexual function is an issue that’s often brushed under the carpet. This doesn’t have to be the case, and is not the experience of men in other parts of the world.’

A penile implant is a long-term solution for men with severe erectile dysfunction problems caused by a wide range of conditions including diabetes, prostate cancer surgery, Peyronie’s disease and age-related vascular disease.

But experts are particularly concerned about the lack of availability of the device for men with prostate cancer.

Almost half of the 16,000 men having a radical prostectomy each year, where they undergo surgery to remove the prostate gland, will be left with impotence problems. 

This is because the nerves and blood vessels which supply the penis are situated right next to the prostate and often get torn, stretched or cut during surgery. 

A recent survey by the Department of Health revealed that two in three prostate cancer survivors say they are unable to have and maintain an erection.

Medication such as Viagra, which increases blood flow to the penis, is generally the first treatment offered.

However while, overall, Viagra helps 80 per cent of men to get an erection, among prostate cancer patients the success rate is less than 50 per cent because of the extensive nerve damage.

Penile injections are another good option, helping 80 per cent of men achieve an erection. But the nature of the treatment puts many men off.

Here, a pre-loaded syringe — containing medication which relaxes the muscles in the penis and allows blood to flow in — has to be injected into it just before sexual intercourse.

‘Injecting the penis just before sex can be a bit of a passion-killer,’ admits Mr Rees.

For some, a penile implant may be the only solution. However, as the NHS does not routinely fund these devices, many men have no choice but to abandon their sex lives.

Mr Rees explains: ‘Because the nerves to the penis run alongside the prostate gland, it is almost inevitable there will be some damage to them during surgery.

‘It seems very unfair that men do not have automatic access to treatments to rectify problems caused by cancer therapies when women with breast cancer who have a mastectomy are routinely offered reconstructive surgery on the NHS.

‘We need a fairer approach which allows patients who have cancer treatments to have access to this very successful device if they meet certain criteria, such as if they are young, have a partner or want to be sexually active.’

Dr Gordon Muir, a consultant urologist at King’s College Hospital and the Lister Hospital, London, agrees: ‘It seems perverse that women having breast cancer treatment can — rightly — have complex reconstructions on the NHS when a fundamental part of a male cancer patient’s identity can be ignored. 

‘Penile prostheses have a very high success rate, and treatment of erectile dysfunction shows fantastic quality of life benefits for men and their partners. This is a clear case of medical sexism.’

There are two types of implants: an inflatable device, as David had, and a malleable device.

The malleable one involves a pair of small wire-filled rods being inserted into the erectile chamber of the penis. The penis is then always semi-rigid.

The more popular option is the inflatable device. The implant itself costs around £4,500, while the total cost (including the two-hour surgery and hospital stay) is between £8,000 and £10,000. 

Afterwards, patients have to wait six weeks to allow the body to heal and the pain to subside before use.

Complications with both devices include infection, the device pushing out through the skin and mechanical issues which mean revision surgery is required in around seven per cent of cases.

However, such risks have dropped significantly (infection rates from 5 per cent to less than 1 per cent) since antibiotic-coated devices were introduced ten years ago and surgeons’ training improved.

‘I have not had any infections or cause to remove any device over the past three years,’ says Mr Rees.

He says analysis of Health Episode Statistics data reveals a 33-fold difference in the odds of receiving the implant on the NHS depending on where you live, with men in Greater London having a much higher chance of receiving treatment.

He adds: ‘It is very difficult as a doctor when a man turns up to your clinic and asks: “Why can’t I have this done?”

‘We should be saying to men:  “You have cancer in the prostate, you may experience these problems as a result of treatment and we can fix them.” 

‘The same is true for men with erectile dysfunction problems caused by other conditions.’

For David, having the implant surgery last year has been a ‘lifesaver’. 

He says: ‘It does what it says on the tin — and I am absolutely delighted.

‘My life is now back to normal.’

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