A Rare Presentation of Suicidality Following Penile Implant Surgery

Dear Editor,

We wish to bring attention to a rare and clinically significant case of suicidality following penile implant surgery, which highlights the importance of comprehensive mental health support and patient education in the management of erectile dysfunction (ED).

ED is a common condition affecting men worldwide, with prevalence ranging from 35% to 50%. It is often associated with significant psychological distress, interpersonal relationship issues, and affects the overall quality of life. Aging, coronary artery disease, obesity, smoking, hypertension, previous pelvic surgeries, spinal cord injuries, depression, and various other psychological factors are risk factors for the development of ED. ¹ The treatment of ED ranges from lifestyle modifications, oral phosphodiesterase type 5 (PDE5) inhibitors, vacuum erection devices, and intraurethral suppositories to intracavernosal injections or surgically implanted penile prostheses.^2–4

We present the case of a heterosexual male patient aged 28 years, unmarried, sexually active in a romantic relationship, presented to a general practitioner with a complaint of ED for the past six months. Following initial consultation, he was referred to a sexologist, where he underwent penile Doppler on advice. He was not given adequate information about the procedure results leading to confusion and distress. Subsequently, getting influenced by an advertisement, he underwent single-piece silicone penile implant surgery. Once he returned home, he was distressed as his genitals were always erect, and he did not know how to detumescent the same. This also led to marked embarrassment and fear of public humiliation. Subsequently, patient developed pervasive sadness, feelings of guilt, worthlessness, and suicidal thoughts for the past two months. He came to us for psychiatry consultation. After thorough evaluation, he was given psychoeducation regarding his condition. Simultaneously urologist’s opinion was sought and necessary education on how to use single-piece penile implant and how to manage in public settings was given. His mood symptoms improved with a few sessions of cognitive behavioral therapy. After one month, there was improvement in patient’s symptoms as witnessed in follow-up.

It is important to recognize that penile implants, while effective, come with inherent risks, including infection, mechanical failure, and complications such as the one experienced by the patient in the case. ⁵

This case serves as a reminder of the importance of comprehensive care in the treatment of ED. While penile implants are a valuable treatment option for some patients, they are not a first-line solution and require careful consideration and counselling. Patients should be fully informed of all treatment options, the risks and benefits of each, and the psychological implications of the chosen treatment. Psychosocial support, including counselling and therapy, should be an integral part of the management of ED, particularly for younger individuals who may be more vulnerable to the emotional impact of the condition and its treatments.

We believe that this case will serve as a reminder to the medical professionals of the importance of preoperative counselling, postoperative care, and psychological support as essential components in the management of ED.