Abstaining from sexual activity, pornography, and masturbation is NOT recommended as a treatment for delayed ejaculation after penile prosthesis implantation
The evidence-based approach for delayed ejaculation (DE) after AMS 700 implantation focuses on increasing arousal through behavioral modifications, not abstinence. The AUA/SMSNA guidelines explicitly recommend modifying sexual positions or practices to increase arousal, which is the opposite of abstinence 1.
Why Abstinence Is Not the Answer
The pathophysiology of DE involves difficulty achieving adequate psychosexual arousal to trigger ejaculation. The 2022 AUA/SMSNA guidelines emphasize that behavioral interventions should enhance arousal and trigger orgasmic response through incorporation of alternative sexual practices, scripts, and/or sexual enhancement devices 1. Abstaining from sexual activity would theoretically reduce sexual conditioning and familiarity, potentially worsening the problem rather than improving it.
Evidence-Based Management Algorithm
First-Line Approach:
- Modify sexual positions and practices to maximize arousal 1
- Incorporate alternative sexual practices and scripts
- Consider sexual enhancement devices
- Open communication with partner about sexual needs and desires
Second-Line Approach:
- Referral to mental health professional with sexual health expertise 1
- Psycho-behavioral strategies to enhance psychosexual arousal and remove psychological barriers
- These approaches avoid pharmacotherapy risks while addressing the core issue
Third-Line Approach:
- Check morning testosterone levels - DE prevalence increases with lower testosterone 1
- Consider pharmacotherapy if other approaches fail:
- Pseudoephedrine 60-120 mg (120-150 minutes prior to sex)
- Oxytocin 24 IU intranasal during sex
- Other options per AUA/SMSNA table 1
Specific Context: Post-Penile Prosthesis
Research shows that penile prosthesis implantation does not inherently interfere with ejaculatory or orgasmic function 2. In fact, most patients maintain their pre-surgical ejaculatory capability 3, 2. The key finding is that 41% of IPP patients resume sexual intercourse within 1-4 weeks post-operatively, and over 60% use their prosthesis at least weekly 4. This frequent use pattern contradicts any rationale for abstinence.
One study even demonstrated that in cases of psychogenic orgasmic dysfunction, the penile prosthesis helped overcome psychological barriers when patients engaged in sexual activity 2.
Critical Pitfall to Avoid
Do not confuse delayed ejaculation management with premature ejaculation management. While some PE treatments involve reducing hypersensitivity, DE requires the opposite approach - increasing stimulation and arousal. Abstinence would be counterproductive as it reduces sexual conditioning and partner intimacy, both of which are protective factors for ejaculatory function.
Timeline Consideration
Note that ejaculatory function may naturally decrease over time post-implantation (>5 years), independent of sexual activity patterns 3. This is likely related to aging and progressive disease rather than frequency of use, further supporting that abstinence offers no benefit.