ED Treatment: Penile Injection Therapy

+ - What happens if I inject myself in the wrong place?

No tissue is removed. Accessibility links, for example, you may not get an erection so easily if you are tired, stressed, distracted, or have drunk too much alcohol. In placebo-controlled studies, penile pain was reported by 31% of patients after edex® (alprostadil for injection) and by 9% of patients after placebo injection. This is not a serious side effect.

  • This can make it easier for your sexual partner to be exposed to your blood.
  • We ask you to have an open mind and only reject this therapy if after a few instructional sessions you are unable to tolerate or perform the procedure.
  • 20 mg of vardenafil (Levitra) taken on an empty stomach.

Don’t use a twisting or jerking motion, because this may cause bruising. APP if you aren’t getting the effects you want. Despite common sense and clinical experience that indicates men become very anxious about penile injection therapy, anxiety has rarely been assessed in studies of penile injection therapy. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. Do not touch the exposed needle or allow the needle to touch anything. Do not touch the plunger at this time. Going long periods of time without an erection is unhealthy for erectile tissue and may damage it. Aarp® staying sharp, debusk R et al. We’ve had many patients who really, the idea just totally was so unappealing to them, or they’d actually failed in other offices.

There is also an alprostadil-based suppository called Muse on the market, which a man inserts directly into his penile urethra through the opening of the penis. Postmarketing studies are continuing. Start with a low dose of alprostadil and titrate the dose based on the erectile response and the duration of erection.

Less commonly, the problem is psychogenic. Use these drugs as directed. After that, the patient learns to inject under Dr. Insert the cartridge into the injection device with the tip facing toward the attached needle (Figure F). Moxisylyte is an alpha‐adrenergic receptor blocker with a preference for alpha‐1 adrenoreceptors 56. Pressure is then placed over the site for 5 minutes until the bleeding has stopped. An additional dose of the vasoactive agent may be administered intra‐arterially following cannulation of the internal pudendal arteries to further improve peripheral perfusion. Despite major advances in surgical techniques, patients still frequently experience temporary or permanent ED after RP, with 60% of previously potent patients experiencing ED 2 years post‐prostatectomy 77, 78.

  • Additionally, the pain was mild in the majority of these instances, and only 6% of participants (43 of 683) withdrew from the study due to pain.
  • It’s very frustrating.
  • Adjust the dose of alprostadil to achieve an erection that is sufficient for sexual intercourse but that does not last more than 30 minutes.

Lifestyle And Home Remedies

To learn if you’re a candidate for penile injection therapy and to discover more options for treating erectile dysfunction, visit the Men’s Health Center or call 1-877-641-4636(4MEN) to make an appointment. Between late March and July 1998, 3. The amount of each drug used can be changed based on the severity of your ED, by an experienced health professional. These drugs increase blood flow by expanding blood vessels. When you have a full erection, no fresh blood flows into your penis. The reusable edex® (alprostadil for injection) injection device is for use only with the single-dose, dual-chamber cartridges and needles included in the edex® (alprostadil for injection) Cartridge 2 Pack or 6 Pack. Footer, then switch it up from a place of love and exploration, rather than trying to fix or repair something. If an erection lasts for over four hours, it will need medical attention to make it go down. Sometimes, switching to another medication in the injection can help.

Please call your APP when your supplies run low. If this medicine is not used properly, permanent damage to the penis and loss of the ability to have erections could result. Referral to a psychologist or psychiatrist with expertise in sexual dysfunction may be beneficial for patients with psychogenic erectile dysfunction.

Potential Side Effects And Complications

If your partner experiences insufficient vaginal lubrication or painful vaginal sensations during intercourse, the use of a lubricant may be helpful. If you have priapism, taking pseudoephedrine HCl can help. A tiny needle is used to inject a small amount of the medication into the shaft of the penis.

With use of up to 24 months, penile pain was reported at least once by 29% of patients during injection, 35% of patients during erection, and by 30% of patients after erection.

What are the risks of Penile Injection Therapy?

Don’t let go of the vial, or the needle will bend. Another 2020 review found that there was extremely limited evidence that PRP had a positive impact on ED. In penile injection therapy, the medication is injected directly into the inner part of the penis through a very small "insulin-style" needle. The erection may also be associated with a painful sensation.

With proper training, 75 out of 100 men can get a working erection using a vacuum erection device.

Wipe off with an alcohol swab. Impaired vascular endothelial function causes decreased production of nitric oxide and insufficient relaxation of smooth muscle within the cavernosal bodies 7, 8. You will only be supplied with the necessary drugs, syringes and needles for home use when you have demonstrated satisfactorily that you are competent to draw up and inject the correct dose of drug safely. On a per injection basis, 15% of injections were associated with penile pain.

You should not use Vitaros® if you have Peyronie’s disease (see our factsheet ‘ Peyronie’s disease ’), or if you have sickle cell anaemia, leukaemia, or multiple myeloma, as these may cause a prolonged erection. Eighty percent of patients were able to reach full erection with ICI of papaverine, compared with 60% with sildenafil and 56% with tadalafil 31. Take 60mg of Sudafed. If present, the pain usually subsides in 15 minutes. Alprostadil is injected into the side of penis with a very fine needle.

Some people prefer the auto-injector, which is a spring-loaded device that inserts the needle into the penis very quickly, minimizing discomfort and psychological "hesitancy.

Featured Slideshows

Priapism occurred in only 1. Recalled eggs should not be eaten. In these such cases, and in cases where a doctor has failed to inform a patient of potential priapism or what to do if priapism occurs, the patient may be a victim of medical malpractice. Do not use in larger or smaller amounts or for longer than recommended. And finally, needle size has been reduced to a user friendly 31 gauge 5/16th length. Conclusion ICI of vasoactive agents remains an important tool in treating and diagnosing ED, with high patient satisfaction and efficacy rates.

As with all prescription medicines, do not allow anyone else to use your medication. Although there has been a rapid and widespread acceptance of medically induced erections over the last seven years, many questions remain to be answered. For example, your doctor might ask you not to eat before having a blood test.

Helpline: 0207 486 7262

It could be something as simple as a run away script or learning how to better use E-utilities, http: Penile pain was judged by patients to be mild in intensity for 80% of painful injections, moderate in intensity for 16% of painful injections, and severe in intensity for 4% of painful injections. Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office. However, it wasn’t until 1982 that Dr. Penile vascular surgery is not recommended for older men with hardened arteries. Alprostadil has been used as an injection for the treatment of erection problems in the UK since 1994.

3% of the patients in the study conducted by Porst et al.

Continue reading from September 15, 1999

If you wear sunscreen whenever you are outside, your skin may not be making vitamin D. For further information or advice, ask your doctor or pharmacist. Talk to your doctor if you experience pain. Your doctor will give you the first dose to teach you how to do it properly. Contraindications to ICI treatment include a history of hemoglobinopathy, bleeding diathesis, or idiopathic priapism.

The most popular form is called the Priapus Shot. 5 mg) No significant difference between alprostadil and bimix in the mean total percentage of rigidity (60% with alprostadil vs. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies.


Men who are overweight with ED often improve with weight loss. Montorsi et al. 16 mg + papaverine 5 mg in 0.

Products & Services

This creates a vacuum that pulls blood into your penis. Who should NOT use edex® (alprostadil for injection) ? Remove the cartridge from the injection device by turning the blue portion of the plunger counterclockwise. Late responders see good results in three to four months. Avoid having unprotected sex. If an erection is painful or persists for more than 3 hours the following treatment should be commenced.

Support Us

Record your response. Subsequently, additional DSA images taken after bilateral selective catheterization of the internal iliac arteries provide a detailed evaluation of the penile vasculature after ICI of the vasoactive agent(s). Read the instructions in the “Treating Priapism (An Erection That Lasts Too Long)” section for more information. Get a quote for intracavernosal penile injections from The Compounding Center. Differentiating between the different causes of vasculogenic ED is particularly important in patients considering surgical interventions. Remove the seal from the base of the needle. The medication is placed directly into the side of the penis with a tiny needle, which is virtually painless. Both these drugs have their effect by causing dilatation (widening) of the blood vessels to the penis.

Do not use the solution if it remains cloudy, is colored, or contains particles.

Search Harvard Health Publishing

ICI of a low dose vasoactive agent (usually 2–15 mg of alprostadil or bi/trimix) in a physician's office setting is still commonly used to help determine if vascular abnormalities are present and further hemodynamic testing is indicated. The most common side effects are: An elastic ring is then slipped onto the base of the penis. It may take from 2-6 visits before you reach this stage. Push the medication in slowly - over 8 to 10 seconds. With each use of edex® (alprostadil for injection) , alternate the side of the penis and vary the site of the injection (Figure L). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.

Urine tests (urinalysis). But she says that as long as she washes her hands and her eggs, she doesn’t care about the recall. Involve your sexual partner. These medications amplify that signal, allowing some men to function normally. Lots of different things can cause ED, including depression and neurological disorders, so counseling and therapy can also be effective treatments. Push the needle in, gently but firmly, all the way to the brown hub. As reviews and ratings are subjective and self-reported, this information should not be used as the basis for any statistical analysis or scientific studies. Get treatment for alcohol or drug problems.

How To Find A Provider

All that sunshine should keep us from needing a vitamin D supplement. Moxisylyte therapy had low rates of priapism (<1%) and penile fibrosis (<2%) but caused orthostatic symptoms and dizziness in 5–8% of patients during clinical trials 57. What are some natural ways to regain clarity and focus? These are not ‘allergic reactions'. Call your doctor, nurse, or pharmacist if you have any questions. The number of injections is not to exceed 12 each month, and should be spaced as evenly as possible.

Treatment can include medications, such as Viagra or Cialis. Following just a single injection, results are seen approximately 5-15 minutes later. So the first thing to notice about this injection technique is the syringe that we’re using. Turn the vial and syringe upside down (see Figure 2). The erection should last up an hour; although very occasionally, it will last longer if the dose of alprostadil is too large (see the section below ‘What if my erection lasts too long? )

This is not harmful. 6 mL of a 30 mg/mL solution) Alprostadil resulted in a significantly higher proportion of erections judged adequate for penetration 10 to 20 minutes after the injection compared with papaverine (AR for full erection: This can easily be achieved by pushing in your wheelchair for approximately 20 minutes. Alprostadil is a medicine that men take for ED (erectile dysfunction).

What To Expect During Your Appointment

When used in conjunction with color penile Doppler ultrasound for ED evaluation and diagnosis, ICI helps to detect penile vascular abnormalities and allows for differentiation between the multiple vasculogenic causes of impotence, thus helping clinicians to select the optimal treatment modality for each patient. 20 mg of tadalafil (Cialis) taken with or without food. How can I best manage other health conditions with my erectile dysfunction? Hold the injection device as shown in Figure M. In addition to your prepared questions, don't hesitate to ask additional questions during your appointment. Others may not experience results for several months or until they’ve received multiple treatments.

These silicone rods give the man's penis the firmness needed for sexual penetration.

Risks And Alternatives

The 2 Pack contains the following items: 0 years, various causes of erectile dysfunction Alprostadil 20 μg vs. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). What are other possible causes? Currently, the most commonly used ICI vasoactive agents are alprostadil alone and the bimix and trimix formulations.

Seek emergency medical attention if you have a painful or prolonged erection lasting 4 hours or longer.

This will limit delays in delivery. Write down questions to ask your doctor. Gaines added, “[With] very severe ED, which means several years it’s been an issue, there’s a lot of variables. How do you prepare for the procedure? However, this treatment is effective and it another option for patients who suffer from erectile dysfunction.

Patients also reported ICI therapy was useful in the maintenance of PDE5 inhibitor effectiveness, and 36% of patients were able to decrease to intermittent from regular ICI use after 7 months of treatment because the quality of their erections had improved 89.

15 Things That Make Men Infertile

Increasing your level of activity might also further reduce your risk. 25 mL of sterile water) has been suggested in confirming arterial insufficiency; however, the necessity of using low doses of each single agent in order to prevent prolonged erection and priapism, which occurs in up to 10% of cases with trimix (vs. If a penile prosthesis is removed, other non-surgical treatments may no longer work.

2% of patients treated within the first 3 months had PSVs of <30 cm/s, compared with 51. We represent clients in Nashville, Knoxville and Hendersonville whose injuries were the result of another person’s negligence, and we want to hear your story. Although some men hesitate to think about placing a needle into their penis, and some defer their treatment to “think” about it, most men choosing injection therapy quickly realize that the benefit of the injection far outweighs that little pin-prick. Clean the injection site with an alcohol pad, allow it to dry. Ed: lowering your risk, another study found that castrated rats had erections if given testosterone alone or dihydrotestosterone (DHT) and 5-alpha reductase inhibitors but not if given testosterone and 5-alpha reductase inhibitors. However, the needle itself is quite small and you should feel only minimal discomfort. 58 mg/mL) Trimix significantly increased the proportion of men who gained an erection sufficient to allow penetration compared with alprostadil alone (AR:

The effect of more burdensome regulatory requirements recently enacted by many states for compounding pharmacies on patient access to the bimix and trimix formulations remains to be seen. Battery-powered penis pump for erectile dysfunction Open pop-up dialog box Close Battery-powered penis pump for erectile dysfunction Battery-powered penis pump for erectile dysfunction A penis pump is used to draw blood into the penis to create an erection. Multiple studies indicate that re‐dosing of a combination of bimix (frequently a combination of prostaglandin‐E1 [PGE1] 10 μg + phentolamine 2 mg or chlorpromazine 2. Pregnancy (week by week, trimesters), there is a close relationship between the muscles and nerves that control bladder functions and those that control bowel movements. )He is the Director of Prosthetic Urology and Men’s Sexual Health and the Director of the UCA Fellowship in Men’s Sexual Health. We can divide the side effects into two categories:

Side Effects and Risks of Penile Injection Therapy

You may be asked to do this yourself daily for 10 minutes over a few weeks. Use of ICI Therapy in the Treatment of ED Zorgniotti and Lefleur first suggested auto‐injection of a vasoactive substance for the treatment of ED in 1985 34. Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity. This can keep the medication good for a few additional months. 12 Patients usually start at 2.

Wash your hands with soap and water.

Call your APP and tell them your responses and whether you’re getting the results you want. When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff. Additionally, elevated liver enzymes have been reported in papaverine containing combination agents, including bimix and trimix 45. My erection was a _________ on a scale of 0 to 10.

How should I use alprostadil?

Here's some information to help you get ready and know what to expect from your doctor. Side effects can include pain, minor bleeding in the urethra and formation of fibrous tissue inside your penis. Request username, however, there is a limited amount of research into marijuana’s effects on sexual enjoyment:. Although these devices are generally safe, bruising can occur and the erect penis may lack some support.

Very often with injections, a man may develop erections lasting two to three hours.

Mulhall et al. The most common adverse effects reported with intravenous administration of phentolamine are hypotension and tachycardia 37. 5%), high cost of maintenance (5. These products are especially dangerous for men who take nitrates. There are numerous other ways to treat ED, including testosterone injections, vacuum penis pumps, and surgical rods implanted in the penis.

The first target is the body of the penis, which will produce an erection.

Injection Therapy Highlights

The patient (or his partner) is taught by a nurse or doctor how to inject the drug directly into the shaft of the penis when he wants an erection (up to a maximum of 3 times per week and not more than once daily). This will help to decrease any bleeding or bruising. Most men who find oral medicines to be ineffective respond to penile injection therapy. 17 A small percentage of patients report an alteration in color perception. After the needle is in past the thick fascial layer and it enters the spongy tissue, one should be able to draw blood back into the syringe. In addition to dilating the arteries in the heart, Papaverine has also been used to treat Alzheimer’s disease and Multiple Sclerosis. Alprostadil (brand names Caverject®, Edex®, Prostin VR®) belongs to a group of medicines called vasodilators. Various bimix and trimix formulations have been used in clinical practice and research.

Given the relatively high rate of prolonged erection or priapism with this form of alprostadil, prescribing physicians should be aware of appropriate management of these conditions. You should not use alprostadil injections if you have Peyronie’s disease (see our factsheet ‘ Peyronie’s disease ’), or if you have sickle cell anaemia, leukaemia, or multiple myeloma, as these may cause a prolonged erection. Be sure you know which product you are using and that you fully understand the correct way to mix the injection. The vagus nerve can slow down the heart and dilate blood vessels inappropriately due to neurological signals, causing blood pressure to go down, in response to many conditions, such as emotional stress, pain, fear, prolonged standing and heat exposure. What is alprostadil? For men who have undergone radical prostatectomy and experience discomfort with injections of prostaglandin, we have developed a mixture using lower concentrations of prostaglandin that is effective, yet pain free.