The Dilemma of Penile Prosthesis Implantation in Sex Offenders

Background Penile prosthesis surgeons face an ethical dilemma when confronted with a sex offender who seeks surgical management of erectile dysfunction. Aim To provide practice guidelines to screen and manage patients with a history of sexual violence prior to surgery. Methods Three urologists with expertise in penile prosthesis surgery and 1 medical bioethicist were asked to contribute their opinions and provide recommendations to address this controversial topic. Outcomes Expert opinion supported by analysis of available literature and institutional experience. RESULTS The authors review current United States legislation, published literature on sex offender registration, and institutional data on the prevalence of sex offenders among men seeking penile prosthesis placement. Within a context established by medical bioethical principles, the authors propose a practice guideline for screening sex offenders prior to penile implantation surgery and referral for trained psychological evaluation prior to surgical management. Strengths & Limitations Strengths: multidisciplinary approach in data acquisition including bioethical and legal review. Limitations: Lack of available evidence regarding recidivism risk in sex offenders who undergo penile prosthesis placement. CONCLUSION Sex offenders exist among the population of patients seeking surgical placement of a penile prosthesis. A standardized practice guideline for management of this population should be employed with the intention to reduce future harm.