Pump vs. Rod – How I Decided

To Pump, Or Not To Pump?… THAT, is the question!…

I’ve been getting this question A LOT, so I just decided to type it once here and just link folk to this posting because it’s not necessarily a one sentence answer. There are quite a few factors that went into my decision making process. And understandably so!

I never thought I would get the semi rigid when I first started my personal research into this process in 2005. Yes, 2005. Actually it wasn’t until only about 4 months ago that I experienced 180° turn in terms of my implant desires. Up until then I didn’t really fully relate to or understand how anyone would think it was the ideal choice to go with the rod if they had the option of choosing the pump. Logically I understood the idea of not wanting to have to replace it every so often with future surgery, but the idea of future surgery seemed well worth it to have a “naturally” soft penis when I wasn’t having sex or aroused. However, I’ve always had a really strong desire to have two symmetrical testicles which, with the pump is not an option. I know some people have questioned whether two testicular implants as well as the pump bulb might all fit into the scrotum. It’s worth noting however, that the UK found that one of the leading causes of pump failure was the scrotum being too tight around the pump bulb – and that’s with only one testicular implant! I also was not all that satisfied with the level of fullness that my penis had when in it’s natural flaccid state which the pump would allow it to be in the vast amount of the time when I wasn’t erect. I’m a very lean guy with thin arms which equates to not much fat in my penis. After trying a fat grafting procedure in June 2016, 4 months post stage 1 and the fat being completely absorbed by my body within a month’s time, I felt like the rod was just going to meet more of my needs. I LOVED how fat/full/thick my penis was right after the fat grafting and that experience made me realize that I would be a whole lot happier with my penis if it always had that level of fullness.

The main reason I went with the rod was because I wanted to have a larger appearing package all the time, first and foremost. And not only just in terms of appearance, but what I would touch and interact with when I reached into my pants. I’ve never been a size queen, but always when imagining my body after finishing all stages of phallo, I absolutely did picture myself having at least a mildly visible bulge in my pants, and I really didn’t have that once the initial stage-one post-op swelling went down. Maybe that would have changed a bit with the introduction of testicular implants but I also wanted the shaft to not only be more visible but thicker and dense. I just all around wanted more to hang on to.

Now that I have the semi rigid rod and balls I am wildly happy with the profile of my package. No, it’s not as floppy as a flaccid penis, and that has certainly been an adjustment. But I was willing to give up a flaccid, floppy penis if it meant that I would have a larger feeling, more noticeable package. I also was not a fan of the way my flaccid penis felt when it fell down completely between my thighs and just seemed to get lost. Sometimes even when wearing thin/light shorts with the way it fell it just didn’t look like there was much of anything there, even to me, and that was a really dysphoria inducing experience. I can’t say that I’ll never get the pump or that I’ll have this specific implant forever, because I don’t think that I will. In the future I would like to have some version of the pump or, even better, an altogether better/new model that is designed specifically for the anatomy of a neo phallus. It’s just that none of the erectile options right now feel like they could completely 100% meet my needs, and for the interim I knew I needed something to hold me over till there was a more suitable option available for us – which will be who knows when.

I thought I would list out my personally experienced pros and cons to the semi rigid rod. Please keep in mind that 1.) these are my opinions – and 2.) I am still in early recovery from having this device implanted (less than 3 weeks post-op). So these pros and cons could still very well shift as swelling and pain decreases and mobility and healing progresses.

 

my PROs:

  • Fuller, more girthy penis 100% of the time to interact with
  • Much more pronounced and visible”profile”
  • Less likely to have complications, infections, and mechanical breakdown than any of the inflatable options, giving it a potentially much longer lifespan
  • Allows for two symmetrical testicular implants

my CONs:

  • At least initial (temporary) audible clicking noise and palpable clicking sensation when changing position of penis
  • At least initially not able to sleep on belly while healing
  • Potentially might be unable to comfortably lay face down on hard or firm surfaces
  • Detaching device at pubic bone connection point is a risk (i.e. sports, falling wrong, a kick in the groin etc.)
  • Never being able to experience a flaccid penile state for as long as I have the device
  • Not being able to experience the full range of the erectile process

 

So there’s clearly more cons than pros, however the numbers in one category versus the other wasn’t what allowed me to make my decision. Not to mention that 2 months into healing the scales might tip in the opposite direction with hopefully making the first 3 cons non-issues. In the end it comes down to what your priorities are. What really REALLY matters most to you when it comes to a device, to your everyday state of being, to complication rates, mobility, comfortability, self confidence, etc. When I had this discussion with Dr Chen in August during my phone consult I asked a ton of questions to find out if one device was really better or safer for the penis in the long run. His reply was that wasn’t really a factor in coming to a decision about an erectile device. He said what it’s really more about is which one you feel more excited about. And truly that’s a damn good way of looking at it. This is your dick, and this is your dick with an erection. Which one feels more exciting??? Maybe that’s a really obvious question, but it worked for me. I was more hesitant about the outcome with the inflatable cylinders than I was about a semi rigid rod.

As I said before, this decision is right for me right now, and that could absolutely change down the road. One of the best things that a close friend reminded me of years ago when I was in the midst of making big decisions (that felt permanent at the time but weren’t) was that you just have to make the best decision that feels right for you NOW. And if at some point down the road things don’t feel right, you make another decision. There’s not too much in life (or anywhere for that matter) that’s truly permanent, and thankfully an erectile device isn’t one of them.

I hope this explanation of how I made my decision was helpful to you. If you haven’t read it already and are looking for more more details about what the rod is like, please first take a look at the exhaustively long:

2 Weeks Post-Op Stage 2 (Semi-Rigid Rod & Testicular Implants)

It goes into detail about everything I ever wondered about the semi rigid and testicular implants, and more… And trust me, I wondered a lot… It felt important for me that I make that available to others… So if you have questions, please read that before asking.

Thanks!

Stage 2 Pre-Op w/ Dr Chen

On October 6th, I had my pre-op appointment with Dr Chen. I thought I would do a rundown on some of the questions that we discussed at my appointment. It’s been a little over two weeks since I met with him about these topics and I didn’t write down too much in the way of notes afterwards, so I’m just doing my best to recall what I can and going off of the list of questions that I had prepared before meeting with him. Here they are:

Me: “Is the semi-rigid rod MRI safe?”

Dr Chen: “Yes, it won’t cause any problems.”

Me: “Will I set off metal detectors?”

Dr Chen: “No”

Me: “Are you familiar with the “no-touch technique”?

(SIDE NOTE: If you’re curious about what this technique is you can check out this link “No-Touch Technique“, in short it’s a draping method used to prevent direct contact with skin (which harbors bacteria) thus reducing the risk of infection during implant surgery).”

Dr Chen: “Yes. What we do is similar and in some ways and actually takes more extensive steps for cleansing the body. The body is cleansed multiple times, even inside the urethra since it’s skin, the body is draped multiple times, we changes gloves and gowns at different points during the surgery. Once we make the incision and create the area for the erectile device a solution is poured into the space and allowed to sit in order to cleanse the area while we change gloves and gowns and prepare the erectile device to be inserted.

(SIDE  NOTE: I wish I had taken notes on exactly what he said in regards to this explanation because it was the most detailed explanation of anything that he’s given me to date. He literally told me step-by-step exactly what they do from the time I was put to sleep up until the last suture is placed and they are finished with surgery. It was at least a 4-minute detailed explanation and really made me feel confident that extensive efforts are taken to prevent the risk of infection – which is a much higher risk with this surgery than any of the others).”

Me: “Do you prescribe antibiotics prophylactically for implant surgeries?”

Dr Chen: “Yes, we prescribe Bactrim which is started 3 days before surgery (technically 2 days, but you take your 3rd day’s dose the morning of surgery). It’s a 10-day course taken twice daily.”

Me: “Do you have any photos or a piece of the Gortex sheath laying around in the office that you use to wrap the semi-rigid in?”

Dr Chen: “Yes, I have some in the other room, one second:”

SIDE NOTE: Unfortunately, I accidentally deleted this photo from my phone, sorry guys. So I’ll have to describe it to you. As soon as I saw this material it reminded me of a Chinese finger trap for some reason, probably because of its tubular nature with an opening at both ends. It was dry and a bit stiff. But inside the body it would be moist and more flexible. It had the texture of a thick woven mesh and was an off-white color as I remember. The semi rigid rod is placed inside the sheath then the ends of the  Gortex material are folded tightly over both ends of the rod and then sutured down securely. It’s my understanding that the sheath is what makes it possible to suture this whole device to the pubic bone, otherwise they would need to puncture the actual device and thread the metal sutures through it which I imagine would eventually cause weakness and breakdown within the device. You have to remember that these rods were designed to be inserted and encapsulated with the corporal cavernosa structures which natal penises have two of. Since neo phalluses don’t have those erectile bodies, suturing this device to the pubic bone is the current work-around for this incompatibility.”

Me: “I’ve heard many guys report that in order to reduce the risk of erosion that very conservative measures are taken, whereas the tip of the erectile device is placed about an inch back from the tip of the penis. I understand that this drastically reduces the risk of erosion but that in addition it causes the head of the penis to kind of droop over the end of the erectile device. This drooping reduces the amount of usable length for penetration (even if only by a little) as well as making it a bit more difficult during insertion since the head of the penis is so squishy. How far back will you be placing the rod?”

Dr Chen: “We should be able to get it quite close to the very tip of the phallus, usually within about 1 cm. Safety is always the top priority though. ”

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Those were the main questions that seemed relevant to share with you guys. Next post will be an update from the actual surgery itself.

Phone Consult w/ Dr Chen Q&A (Stage 2)

The following is my best recollection from my notes following my phone consultation on August 25th, 2016 with Dr Chen regarding my quickly approaching “Stage Two” Semi Rigid Erectile Rod and Testicular implant surgery on October 11th, 2016. This is by no means a word-for-word account. Rather this is the closest I can share with you of the full extent of our conversation that makes sense to present via this type of platform. This also covers some questions that I have that are unrelated to the specifics of implants but I thought some of you might still be curious about regardless.

Dr Chen is a great guy and an extremely talented and innovative surgeon. I always appreciate speaking with him because he shares information with me that I haven’t had the opportunity to hear or learn about elsewhere. I value how receptive he is to the person he’s speaking with and how willing he is to go into greater detail when he senses someone’s desire to know more than just the glossy basics. I hope you come away with that feeling as well after reading this and learn something new today.

Me: I’ve been experiencing a disturbing dripping sensation internally at the place where I imagine the vaginectomy/colpocleisis was performed. I’m worried that this is a sign that a piece of mucosa that was missed during the initial procedure and that fluid is now building up in this space.

Dr Chen: We actually hear about a lot of weird sensations being reported within the first 6-12 months in that area. And that’s because we cut a lot of nerves in order to close up that area. You’re the first person that I’ve heard describe the sensation of wetness, whereas most others are describing the sensation of tingling or discomfort off and on. If you’d like I’m happy to write an order for a CT scan to take a closer look at that area, I’m not sure if insurance would approve it, but I’m happy to write an order for one and see if they’ll approve it because I’d be curious to see what it would show. But in general, odd sensations in this area are quite common up to around the 12 month mark since the nerves are the things that take the longest to heal.

Also, there is a technique that we used to use when creating the urethra that put the patient at a higher risk for having a urethral diverticulum. We used to use this technique because it minimized how many incision lines there are in the urethra. However, it created “outpouchings” (or side pockets) where urine could collect. It also made it necessary for a camera to be used to help guide a catheter because the the tip could caught in one of the outpouchings instead of continuing along the urethra. What we found is that very rarely, urine would pool and collect in this pocket and cause an infection. If this was the case it would require surgical correction. But we’ve only had one case where surgery was needed. However, I spent a lot of time thinking about how we could do this differently but in a safe way. Beginning August 1st, I started using a new technique. Since using this new technique which no longer creates pockets along the urethra – a catheter can now be inserted no problem without a camera! I mention this because I don’t know if these more recent patients might report a different kind of internal sensation in the first 12 months with this technique since it’s still so new.

Me: This is more of an aside question but just so I’m clear, does this mean that anyone that had surgery with the Brownstein Crane team (you or Dr Crane) before August 1st, would need a camera assisted catheterization?

Dr Chen: Yes, it wouldn’t have to be myself or Dr Crane that did the catheterization, but just as long as they used a camera to avoid those little pouches and be guided into the bladder it wouldn’t be an issue.

Me: I’m guess I’m most concerned about a situation where I might have some kind of emergency need for a catheterization but not be awake to let someone know that it must be camera assisted. If someone didn’t use a camera could they potentially damage my urethra if they tried to insert the catheter?

Dr Chen: It’s possible. I’ll say though that most health care providers are very gun-shy when it comes to new things and a neo phallus is a new thing. It’s much more likely that they would probably just automatically call a urologist.

Me: The other sensation I notice sometimes too is an odd buildup of pressure along the perineum. I’ve sort of asked around and I know that there have been some other reports of wetness sensation from other guys that have had the colpocleisis type of vaginectomy which only partially removes the lower part of the canal and then fulgurates (or burns) the remaining mucosa layer that cannot be safely removed with scissors, which would increase the risk for things like bladder, ureter, urethra, or rectal injuries. But I don’t know that I’ve heard of these same odd sensations being reported by those having a full vaginectomy, which is I guess is a more typical procedure in cases of vaginal cancer where it’s much more crucial that the entire structure be removed and thus the higher risks associated with that procedure are more warranted.

Dr Chen: The way we do it now, I’m VERY confident that I get all the mucosa. I check 2 or 3 times before I close up the vaginectomy site. The one CT scan we got for someone post-op where we used this technique I think is the only CT scan we have on record, which I believe was for a differently related reason. But I looked at the vaginectomy site to see if there was anything going on one month post-op in that area and I didn’t see anything, it was completely closed, totally obliterated. But of course, that’s only a sample size of one.

Me: I guess then I will wait out the odd sensations for now and see if that improves on it’s own. So I do have a very small divet where the hole along my perineum took so long to close/heal. Ideally I would like a flat surface rather than a dip at my perineum. I’m wondering how easily this might be revised during my implant surgery?

Dr Chen: We could. The only downside with that is that it lengthens the time of the surgery and it gets into the area behind the scrotum that’s closer to the anus which could put you at higher risk of infection of some sort. I try to do avoid that area is possible when I do these implants because that’s where a lot of bacteria lay. Now I’m not going to do anything silly like have the implant exposed while I’m doing the perineal revision. I do whatever I can to minimize the risk of infection, so the risk I think, overall is low, but it’s slightly higher when we do revisions in that area.

Me: I see what you mean, so there’s a higher risk of infection with regards to the IMPLANTATION area getting infected, not the perineal area?!

Dr Chen: Yeah, exactly.

Me: Ok, I think I’ll give that some thought then and make a final decision when I come out there to see you for pre-op and you have the opportunity to take a look at that area in person. Maybe in the meantime we can still add those tentative insurance codes to the pre-authorization just in case I decide to move forward with that procedure?

Dr Chen: Yeah, sure.

Me: So in terms of implants, I know I want the largest testicular implants that you can fit. And it seemed like you thought that I could probably accommodate the largest one. In terms of the erectile device I’m probably leaning more towards semi rigid rod than the inflatable, I’m not going to have insurance past around the December mark so I’m trying to think about what is going to give me the best shot at not having complications and also having something that’s going to last for a while. I’m not quite sure when I’ll have insurance again that would cover this. Girth is really the biggest thing for me and obviously I want an erectile implant because I want to be able to have penetrative sex but girth and fullness is really a big concern for me. All the fat grafting melted away and at about 4 or 5 weeks out it was totally gone. I was well informed that there was a high likelihood of that happening, but it was something I was willing to try. So really at this point I’m just focussed on coming up with a solution for what the best option is for giving me the most all around girth and fullness. Not even being super thick, but an all around very full appearing penis and I feel like it has kind of more of a deflated look than I want and so I’m wondering is the rod the best option in terms of fullness? I know you mentioned that the rod is about 30cc in size, what would you say the pump is when it’s fully inflated?

Dr Chen: The measurements for the fully inflated pump, the circumference is slightly larger than the semi rigid. That being said, the inflatable, we can’t wrap it in a sheath all the way to the tip, whereas with the semi rigid we are. So when we add the sheath over the semi rigid, they’re about the same size in terms of girth even though on paper it’s higher for the inflatable. I think girth-wise they’re gonna be the same but it’s basically which one are you more excited about. Is it the inflatable one that’s more natural with more moving parts and a high potential for revisions and surgery sometime in the near future? Or would you want something that’s always semi hard but has a lower chance of mechanical breakdown?

Me: I am leaning MUCH more towards the malleable rod, mostly because it’d be 100% the same girth all the time and then also I would be able to have two symmetrical testicles which feels pretty important to me… Is it possible, you said you wrap it in a gortex sheath, is it possible to layer up on that, to add more Gortex to give even a fuller look?

Dr Chen: We potentially could. I haven’t done that before but, we could. I don’t know what the performance characteristics would look like because we’ve never done that. But if it’s safe to do so we can try that.

Me: The other question I had in terms of girth and being creative and trying to find a solution for that problem because I know you have to be careful about how close to the tip you get with the rod with both the pump and the malleable, but have you thought about or has anyone asked you about using some kind of permanent filler like Juvederm as an extra or addition to the IPP to kind of fill out areas that the rod or inflatable might not reach, like the head?

Dr Chen: No we haven’t tried that. I think that’s a reasonable thought. I would think though that adding any foreign body into that area would require sticking a needle to get the Juvederm there and that then introduces a passageway for bacteria to get to that area. So, I’m not super excited about that, but that’s the main reason why. That’s the only hesitation I have for that. Bacteria.

Me: Ok, well then it probably makes the most sense to do just do the rod, layer up on the Gortex sheath if it’s safe and possible to do so, get the testicular implants, heal up, and then see where that leaves me a few months down the road once any remaining edema has subsided… In terms of how the rod is mounted, a couple of questions, 1.) Will the rod change the angle/direction of the base of my shaft, kind of making the penis come out in front of my body a little bit more?

Dr Chen: It could, for some patients it does, for others it stays the same so I can’t tell you for sure but that’s definitely a possibility.

Me: I enjoy doing a lot of yoga and I’m wondering if anyone reports issues with laying on their stomach? In terms of where the rod is mounted I’m worried that I might displace the mounting point even after it’s fully healed months and months down the road, even after I’m cleared for sex. What am I looking at in terms of mobility?

Dr Chen: Yeah, it can limit how active you can be because it’s always there. Certain positions are not good for it. Belly down might not be comfortable. If it’s not comfortable you shouldn’t do it. The biggest complication we’ve had lately is the attachment rips off the pubic bone. And that’s in guys who are unlucky that get kicked in the groin or pulled to hard, something along those lines. We’ve changed our technique a little bit as we’ve seen that. We’re now using stronger metal wire as opposed to the thick silk suture which is what we used before and usually that worked just fine. But we’re starting to use metal wire now to make sure that that risk goes down.

Me: I’m planning to take a full 6-8 weeks off of work and being incredibly sedentary and immobile during that time to ensure I don’t cause any added strain on the connection points, is it true that even going for a long walk is not advised?

Dr Chen: Yes, anything that causes discomfort. If it’s uncomfortable or painful, stop.

Me: I think those are most of my questions. I did want to also ask though about my SP scar. When I touch it and try to move the skin it feels like it’s completely adhered to my bladder? Would that be correct or maybe it’s muscle?

Dr Chen: Muscle.

Me: Is that something that can be released fairly easily? I know you had mentioned that it’s wise to let the scar mature for a year but I’m trying to finish everything up in this October surgery.

Dr Chen: It’s actually really close to the incision that I make to put the implant in, so there is a good chance that it would just be gone as a part of our procedure. But if it’s too high from where I make the incision I can easily just dissect that way and break the adhesion.

Me: In terms of making sure that I get the largest testicular implants that can safely fit, is that something that needs to be ordered ahead of time? I know a decision about erectile device needs to be made a couple weeks in advance so that it can be ordered.

Dr Chen: Nope, we have all the sizes here and I’ll put the biggest and safest ones in as possible. Safety will always take precedent, though.

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Well, that was pretty much the bulk of our conversation. There were a couple other minor things that I left out and will spare you, but nothing major. I will however be in the office next week for pre-op, so if there are any lingering or unique questions that anyone has that they haven’t been able to find answers for elsewhere I’m always especially eager to toss those out.