Penile Injection Therapy 

Viagra and other oral medications (PDE-5 inhibitors) aren’t always effective in treating erectile dysfunction (ED). These medications may also be ruled out because other medical factors make it impossible for you to take the necessary dosage. So, your physician may suggest penile injections as a treatment option. These are prescription medicines that are injected directly into the penis. It may sound unpleasant, but penile injection therapy (also known as introcavernosal injection therapy), using a single drug or combination of drugs, may be the best treatment option for you to once again enjoy a normal sex life. 

Reported success rates for injection therapy are high and could be a good option if you are also taking oral nitrates at the same time, since many oral medications for ED can’t be used in conjunction with these drugs. 

Types of Drugs Used in the Injections 

Alprostadil, one type of prostaglandinE1 (PGE-1), is used in single-drug injections. (It may also be given as a suppository.) Alprostadil is sold under the brand names Caverject, Muse, and Edex.  

Much like alprostadil, papaverine and phentolamine are used to smooth muscle tissue so the blood can flow into the penis and create and erection. Drugs that perform this function are known as vasodilators. 

Administering the Injections 

Any use of penile injections should be coordinated by your urologist to avoid any potential penile injury. The medicine is injected at the base of the penis, furthest from the head where the shaft connects to the rest of the body, around five to 10 minutes before sexual intercourse. 

A very fine, short needle (an insulin-type syringe) is used. The feeling of the injection has been compared to pulling the hair on the back of the hand. Once injected, the medicine increases blood flow and causes an erection as the blood vessels inside the penis widen and dilate. Erection can last up to 60 minutes. If your erection lasts much longer, consult your physician immediately. 

Patients should never perform more than three injections per week or use more than the recommended dosage. They should be fully trained on self-injection technique by their physician. 

Never be afraid to speak with your doctor about any issue that comes up or to be retrained on administering penile injections to treat ED. 

Possible Side Effects of Using Injections to Treat ED 

Priapism, a prolonged erection lasting up to four or six hours, is the most concerning possible side effect of self-injection therapy. To prevent priapism, only use the amount of medication recommended by your urologist. 

Aside from priapism, other possible side effects include:

  • Slight bruising -- This often occurs at the site where the medicine is injected and can be prevented by pressing over the injection site for two to three minutes.
  • Swelling -- Another common side effect at the site of injection, swelling might occur when medicine is discharged under the skin due to poor self-injection technique.
  • Penile pain -- This is one of the least common side effects and usually occurs when alprostadil is administered. Men who have had radical prostatectomy surgery or diabetes are likely to experience this. 

The Cost of Self-Injection Therapy to Treat ED

Alprostadil injections can get expensive. Combination therapies (mixing phentolamine and/or papvarine with alprostadil) are usually the less expensive option. Check with your insurance provider before deciding on one or the other to see if either ED treatment will be covered.


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