Introduction: Inflatable penile prosthesis (IPP) remains the gold standard for surgical management of erectile dysfunction. Device buckling and malfunction represent a problem leading to patient dissatisfaction and high cost of care. While prior data suggests that the force needed for vaginal penetration (6.0 – 14.1 N) is typically below that at which prostheses begin to buckle (8.2 – 10.5 N), no data exists detailing the force needed for penetrative anal intercourse. To evaluate the safety of IPP use with penetrative anal intercourse, we aim to determine the maximal axial loading force associated with anal penetration. Methods: A hand-held force sensor device attached to a silicone rod with a length and girth representative of the average male phallus in the U.S. was inserted into the anal canal of six participants. The maximal axial loading force during penetration to a depth of six inches was recorded for a total of five measurements per participant. Participants then completed a survey eliciting past experience with receptive anal intercourse. Results: The average maximal force recorded across all participants was 30.3 N (16.1 – 51.7 N). By participant, average maximal forces ranged between 21.1 N – 49.4 N. All participants identified as homosexual men and had engaged in anal receptive intercourse within the past year. Participants who engaged in receptive anal intercourse more than once per month were with lesser average maximal forces (25.7 N) than those who less frequently engaged in receptive anal intercourse (42.0 N). Conclusions: The average maximal force recorded during anal penetration exceeded the historically reported force required for vaginal penetration by a factor of 3.2 times, and that at which IPP buckling has been noted by a factor of 2.9 to 3.7 times [Table 1]. While the axial force required for anal penetration was lesser in those who more frequently engaged in receptive anal intercourse, this force still exceeded that at which IPP buckling can be seen. This study, while limited by sample size, highlights the necessity for further research investigating the efficacy and satisfaction associated with IPP implantation in those who engage in penetrative anal intercourse. SOURCE OF Funding: None.
