Porn Publisher Larry Flynt Uses Penile Implant at Age 70

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Erik, one of Kramer's patients who did not want to share his last name, became impotent in 1997 just before he turned 40 because of hypogonadism, a condition where the body does not produce enough testosterone. "It was awful," he said. "I was way too young."

First he tried Viagra, then injections. "I would take an insulin needle and stick it in my penis," said Erik, now 55. "It was marvelous at the time, but after 10 years, it wore off."

In 2008, he had surgery for a penile implant. "It works fabulously," he said. Erik's wife is especially pleased and doesn't seem to mind the "funny, squeaky noise" it makes as he squeezes the pump about 30 times to achieve firmness.

"It's like being 25 all over again," said Erik. "The implant allows me to do it anytime, anywhere."

Surgery takes less than one hour and most times the man is under anesthesia. Recovery is usually about six to eight weeks before the patient can have sexual intercourse.

"It's relatively noninvasive," said Dr. David Gentile, associate professor of urology at University of Rochester Medical Center, who on average does at least one penile implant surgery a week.

"It sounds very intimidating, but it's not nearly as bad as one would think, especially because when you look at the apparatus, it spooks people."

The cost is daunting, about $18,000, although most insurance plans cover the surgery. The lifespan of the implant, made by several manufacturers, is about 10 to 12 years, but doctors say that with advances in materials, the mechanical failure rate is low and only rarely must parts be replaced.

"By the time I see them, they are begging for the implant," said Gentile. "They have an exponentially high partner satisfaction rate."

Some spouses have told Gentile that their husband is "better than any teenager." A man can have an erection as long as he wants, as he controls the device.

More spontaneous, the penile implant allows the couple to engage in uninterrupted foreplay. "She can inflate the device and it's much more natural," he said.

Don Martin, a North Carolina psychologist, had a retropubic prostatectomy in 1996 at the age of 48, before laparoscopic and nerve-sparing surgery techniques were perfected.

"It sort of went from being everything was wonderful to hardly anything worked," said Martin, who is now 64.

Injections had the opposite effect, giving him an uncomfortable erection lasting for five or six hours. Drugs like Viagra and Cialis caused flushing of his skin that continued hours after intercourse.

The vacuum device was painful. "You slip a rubber ring at the base, so it's like your penis is not attached to your body," he said. "There's not much feeling or sensation."

Martin and his wife, who had been married only seven years, settled for sex without penetration."It caught us both by surprise," he said. "We had been expecting an active and enjoyable sex life."

Just last summer, Martin had surgery for a penile implant. "In some ways it's better than before -- something you can count on," he said.

Both Erik and Martin say their wives are happy customers, but their doctor Kramer said that is not always the case for middle-aged women who have become accustomed to not being sexually active.

"I have done thousands of these surgeries and seen every possible story," said Kramer. "One guy was doing great, but when we asked him about his wife, he said they were divorced. But I've seen men who come in and say my wife is going to leave me if I do not provide her with sex.

"It saves marriages and it ruins them, too."

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