083 Partner Prosthesis Panic

Abstract

Introduction: Approximately 300,000 penile implants are placed annually in the US. Female partners in relationships with men with ED considering implant surgery have expressed concern over re-introduction of an erect penis into their sexual lives. We define “Partner Prosthesis Panic” as the concerns of the female sexual partner who during pre- or post-operative interview openly described issues such as: her low sexual desire, reduced arousal, muted orgasm, and bothersome pain during penetration. These conditions may negatively influence the post-operative outcome and frequency of implant use. We examined prevalence of “Partner Prosthesis Panic” and management strategies of the distressed female partners of men undergoing IPP insertion. In the last fifty consecutive penile implant surgeries in men in monogamous heterosexual relationships, 11 (22%) female sexual partners were identified (mean age 57±11 years) who expressed “Partner Prosthesis Panic” and underwent management in our facility. Contemporary management of women with sexual dysfunction is biopsychosocial including judicious use of FDA-approved and non-approved treatments. 82% were menopausal and 18% were peri-menopausal. All had FSD >5 years prior to implant procedure. FSFI (mean 18±4) and SDS (21±6) scores were abnormal in all. Psychologic interviews revealed findings consistent with a history of sexual trauma/abuse (27%) and mood issues: anxiety, depression, panic, use of mood-related medications (45%). Pelvic floor physical exams were abnormal in 73%. Vulvoscopic assessments revealed abnormalities such as clitoral atrophy, resorption of labia minora, erythema and tenderness of minor vestibular glands, limited robust peri-urethral tissue, urethral prolapse, limited gavial rugae, abnormal vaginal pH in all patients. Hormonal assessments of sex steroids were abnormal in all patients. Following sex therapy, physical therapy and biologic management, 8 of 11 experienced markedly improved sexual function that significantly facilitated couple satisfaction post-penile implantation.