Surgical implantation of a penile prosthesis was the more popular option for individuals with SCI before the discovery of penile injections. The surgical procedure involves inserting an implant directly into the erectile tissues. With implants, there is a risk of mechanical breakdown as well as a danger that the implant could push out through the skin. Individuals with SCI usually do not have good sensation in the genital area. They would not experience pain to indicate that the implant has broken through the skin.
All surgical implants carry a high risk of infection.
If an infection develops, the prosthesis may need to be removed. Penile implants are the most expensive option and some health insurance plans do not cover the costs. The vacuum pump is the least invasive aid. It is the recommended alternative when penile injection therapy is not an option. It is a mechanical, non-surgical method of producing penile engorgement and rigidity sufficient for intercourse in most individuals.