Penile injections are an underutilized but very effective treatment for erectile dysfunction. It’s understandable that men will get squeamish when you talk about putting needles in their penis but bear with me, and we think you’ll come to understand that this is a safe, effective, and a quite inexpensive method to help with erections.
What happens if you decide to use these shots is after you get trained how to use them properly when it comes time to have sex, drop your own medicine using the tiny insulin needle, and inject yourself into the side of the penis. After you’ve injected the medicine, you hold pressure for 30 seconds, and five minutes later, you should have a good erection. Again, you never inject yourself in the tip of the penis because that would be painful and unnecessary. You want to go on the shaft.
There are different formulations available of injections that you can try:
Alprostadil is the most commonly used injection, and there are actually two FDA-approved versions of this medication – Caverject, and Edex. They come in a prepackaged kit, and as soon as you’re ready to have the sex, you assemble the syringe together. It activates the medicine, then you inject it, and away you go.
This approach using these FDA-approved medications tends to be a little more expensive, and your insurance may not cover it. So most people who use penile injections will actually use off-label applications of injectables in the form of Trimix, Bimix, and Quadmix.
Alprostadil you can get from a compounding pharmacy and also can get it relatively cheaply, but although it’s very effective and has very few side effects, it can cause more pain than these other formulations. If you try Alprostadil and don’t tolerate it because of pain or it’s not strong enough, then you graduate to the next level of medications.
The next medication that’s commonly used is Trimix. It is about 8 times stronger than Alprostadil, and you can get it from a compound pharmacy. Trimix tends to decrease the pain from the medication itself because there’s less Alprostadil in the mixture, but there are two other chemicals: papaverine and phentolamine, which all three work together to have a very strong response.
With these stronger medications come slightly higher risks of scarring the penis, feeling a lump in the area where you injected over time, or priapism – that’s an unwanted erection lasting greater than 4 hours.
Bimix is a different formulation of papaverine and phentolamine, and this may be a good choice for men who really have a lot of pain with Alprostadil as a single agent. So this one works pretty well, and it’s not as strong as Trimix.
Quadmix is the most powerful of all, which is rarely written for, but sometimes, if you fail the highest dose of Trimix, Quadmix can help a certain percentage of men still get good erections with this type of injection.
What are the advantages of penile injections?
Well, they work. In 60 to 90% of men who fail pills, the shots will be effective in getting good erections. That’s pretty impressive. Why does it not work? Well, if people have a severe venous leak, that’s where the blood can’t be trapped in the penis. It doesn’t matter how much medication you give to pull blood in, it just leaks out as fast as it comes in. So those are the guys that actually fail the shots in general.
You’d think these medications would be very expensive, but the truth is they averaged around $5 to $10 per erection or about $100 per vial of medication. Typically there’s going to be anywhere from 10 to 30 doses in there, so it can be as cheap as $3 per erection.
It is relatively easy to use. Most people say give it five tries, and you’ll get the hang of it. If you don’t want to use shots or you’re very afraid of needles, you don’t have to try this. You can go to other treatment approaches, but it’s probably worth giving it a shot to see if this would be a good treatment for you.
What about the disadvantages?
Well, sticking a needle in your penis. For some people, that’s a non-starter, so but you can try it and decide whether or not it hurts or not. There is actually a good study where they took 65 men who got their first penile injection, and they had them rate the pain on a scale of one to ten. The average pain score with 10 being horrific pain and one being hardly any pain as little as possible.
The average score from the needle was 0.8. So most guys didn’t think the needle hurt that much. The medication itself had a higher pain score with a total of 1 out of 10 because of the burning it sometimes caused, so the medicine itself causing a little discomfort in the penis. If you look at the range of scores of the 65 men, the worst score that the needle got was 3 out of 10, and the worst scored that the medication got was 5 out of 10. So, give it a try – it may not be as painful as you think.
Priapism is a medical emergency, where you’re getting an unwanted erection in the last greater than 4 hours. The number one cause of priapism is these types of medications mentioned above. So use these medications after proper advice from a physician because you may end up in the emergency room, and you can end up with permanent erectile dysfunction or surgery to reverse this unwanted erection.
Another thing that can happen as a result of the erection is a curvature or lumpiness in the penis where the needle goes in. Most guys will alternate sides of where the shot goes in and locations in the penis, so this typically is not a problem.
Getting a new curve as a result – it’s so much from the medicine, but it’s a result of trying to have intercourse with a penis that isn’t as strong as possible – not a 10 out of 10 erection. So when you have sex with a weaker erection, you can sometimes cause trauma or damage the penis, which that can lead to curvature.
Now, 25 to 80% of men who get a prescription will quit within a year to two years.
What are some of the risk factors for discontinuing?
Well, if you’re older or your partner is older, you tend to not like injections as much. Maybe it’s because it’s a little bit harder to drop the medicine or inject yourself properly. You have to be able to see your penis to inject yourself safely, so if you have a big belly and you can’t see the area, this may not be the greatest treatment.
Interestingly, people with diabetes will tend to discontinue medications, and this is because they tend to get a venous leak, and the medication tends to become less effective. Then if you have a history of prostate removal for cancer, that was also a risk factor. Often the ED is so severe that men will progress to needing surgery, and so that’s one of the reasons why people stop.
In medical practice, it’s not like they give you needles and just ship you out the door. You’ll have several intensive training sessions with nurses or physicians, or they have you watch videos to help as well. Also, the partner can learn how to give these shots so that they can participate as well.
After you start using penal injections, it’s very important that you follow up with a physician to make sure that things are still working well and that you don’t develop new-onset curvature or scar. So again, this is a process that you need to be trained on to make sure you’re very comfortable and confident.