After 40 years the penile prostheses is now a well accepted treatment for erectile dysfunction (ED) in the Netherlands. The most important treatment outcome is patient satisfaction. Penile length is an important aspect of satisfaction. Fibrosis of the corpora due to the cause of ED, former treatments and the duration of ED shortens the penis. Also the penis doesn’t increase in length when using the prosthesis. An involved partner has a positive effect on patient satisfaction. The challenge is to counsel the patient and partner on all medical, psychosexual and relational factors. Therefore it is a necessity to work together with sexologists. It is important when conservative therapy fails to refer a patient with ED to a centre for penile implant surgery.