ROLE OF PENILE PROSTHESIS IMPLANTATION IN MEN WITH EGODYSTONIC HOMOSEXUAL ORIENTATION

ICD-10 defines egodystonic sexual orientation as sexual preference that the individual wishes was different because of associated psychological and behavioural disorders, and may seek treatment in order to change it. This work describes penile prosthesis implantation (PPI) as a possible aid to pursue a heterosexual relationship in males with egodystonic homosexual orientation (EHO) that is refractory to psychiatric and sexual counseling.

This is a retrospective cohort of men with EHO who requested PPI in order to pursue a heterosexual relationship. Men with EHO were advised to engage in psychosexual counseling, and to attempt heterosexual activity or masturbation while fantasizing as per their current orientation, along with phosphodiesterase inhibitors (PDEi’s). Men who failed this protocol for a minimum of six months were approved for PPI as per their documented request and fully informed consent.

From the year 2010 to 2023, a total of 162 men with EHO requested PPI in two centers. Eighty-eight men completed the fore mentioned protocol. Thirty-eight (43.2%) were able to initiate and maintain heterosexual activity with homosexual fantasies and were not operated. Fifty (56.8%) opted for PPI. Forty-eight PPI cases (96%) were able to commence and maintain heterosexual activity throughout the follow up period. Thirty-six (75%) reported a change in sexual orientation towards bisexuality or heterosexuality, while 12 still fantasized for sexual pleasure.

Men with egodystonic homosexual orientation may be able to pursue heterosexual activity while fantasizing, possibly aided with PDEi’s and psychosexual counseling. Men who fail such a protocol may benefit from PPI.

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