Why Penile Injections Can Restore Your Sex Life
Why are we doing this?
Ok, we have come to the point where pills aren’t working. Your urologist has prescribed Viagra or Cialis or both and it isn’t quite cutting it. If you wanna learn the ins and outs of erectile dysfunction then click over here. A good, albeit kinda nerve-wracking, to start option for this is to do penile injections.
Medically, the term we use here is intra-cavernosal, or penile, injections. This means that we are directly injecting medication into the part of the penis that allows for erections.
So let’s go back to how the pills work. The pills don’t cause or create an erection, what they do is delay the processes that make an erection go way.
The penile injection medication actually creates an erection. There are several ways that the medications cause changes in the penis to create a hard on even if you aren’t aroused or stimulated. Now, getting aroused helps and is important to get the full effect but even without this, the injection will start the process of getting the penis hard.
Which penile injection is best?
For most patients, the cheapest and most common way is to get the penile injection medication through a special pharmacy called a compounding pharmacy. These are pharmacies that actually compound or mix the penile injection.
For most of my patients, I will start them on a medication called Trimix. As the name implies, this medication is actually a cocktail of three medicines in one—papaverine, phentolamine and PGE1. For reasons that I will discuss below, sometimes I will prescribe a cocktail that is called Bimix which has papaverine and phentolamine. Lastly, there is an option called Quadmix which is the same as Trimix plus the addition of a medication called atropine.
So how do I take this medication?
The first time, the urologist will teach you how to do the injection in the office.
In the beginning there is a getting to know you process. You will bring the medication (cold with an ice pack) and the syringes to the office. We don’t know what is the right dose for you. So we start low. Usually I will start patients at “10 units” or 0.1 mL. So we draw this amount of the medication into the syringe.
Next, we will perform the injection. This is a two hand process. Your non-dominant hand will pull the penis on stretch. This is actually the most important part. You want to pull the penis on stretch because then you will be less likely to inject the medication just into the skin. You will then insert the needle all the way in the penile shaft.
There are three areas to avoid—the head of the penis, 6 o’clock, and 12 o’clock. The head of the penis is a different area and not our focus to create an erection. 6 o’clock, or the underside of the penis, is the location of the urethra and where you pee out of so you want to avoid there. 12 o’clock has the nerve bundle and some extra blood vessels so you want to avoid that as well.
After you inject the medication, pull the needle out and squeeze the penis at the site of the injection to minimize any bruising. This seems like a long drawn out process but in reality, once you get the hang of it, it takes only seconds. After this we wait and see.
Complete list of steps for penile injection
- Wipe the medication bottle with alcohol wipe
- Take syringe and draw up the medication. Usually I will draw 5 units past where I want and then push the plunger to the location that I want
- Pull out the syringe from the medicine bottle and place to the side.
- Pull the penis on stretch with you non-dominant hand
- Wipe the side of the penis with the alcohol wipe. Now you can inject anywhere on the side of the penis, all the blood connects from the base to the tip and from the left to the right
- Insert the needle all the way and push the plunger down to inject the medication
- Pull the needle out and squeeze the penis for 5-10 seconds at the injection site
- Click here for a picture image of where to inject.
Phew, that wasn’t as painful as I thought, now what?
No we see what the response was. Typically, I will come back into the room and assess the response we got.
The medication works fast and we will see a result in 5 minutes or less. Depending on the response, I will tell you to try the next time with 10 units or go up in terms of the amount.
Now, we don’t like to re-inject for 24 hours.
Also, the office is not the most romantic place and your brain still has a factor into how hard the penis will get so I will factor that into my recommendation. Again, depending on the response in the office, you will go up by 5-10 units until you get the response you want. This is the getting to know you phase. This is where we play with how much to inject to figure out what strength you need. On average, we can get this to work for ~70-80% of patients.
How do I know what dose to use?
There are three reasons to not go higher with the dose:
- It works. If 15 units works, there no reason to go to 20 units or higher.
- The penis hurts. Now, there’s no way to avoid feeling the poke of the needle but remember it is a really tiny needle and the poke is actually way easier than people imagine. However, if the penis stays sore for the next couple hours, we will need to switch to Bimix and take out the part of the cocktail that can lead to penile soreness.
- Your penis stays hard for 4 hours. This is called priapism and needs to be addressed right away. Most guys when they hear this they laugh and say that’s great, who wouldn’t want to last that long. The reality is that if we leave the erection up for that long it can be damaging to the penis. If this happens, you will need to go to the emergency department for an antidote to get the erection to go away. Thankfully this only happens ~1% of the time.
So again, we will start out at a lower dose. If that dose works, then we are good to go. If not, you can in 24 hour intervals retry the injection until we get a good response. I will typically tell people to go up by 5-10 units at a time until we are satisfied with the result. The max dose is 100 units. So if you aren’t getting a good result, you can keep going, or titrating, up the dose until we are satisfied as long as the penis doesn’t get too sore while doing that.
Dr. Jafri Wrapup
For many men, penile injections can be a true game changer.
You gotta just stay patient in the beginning. It does take a little time to learn the process but once you get it down, it can work really really well.
It works fast, is reliable, and can really help restore your sex life. So if the pills aren’t working and you aren’t quite ready to have a penile implant, then injections can be a great solution that you should ask your urologist about.
If your penis is firm at all should you go-ahead with the injection? Or should it be completely soft? I have problems with keeping an erection or losing it or not being hard enough to make penetration. I have but 2 fingers on my left hand (non-dominant). So I don’t know if I can stretch my penis with my left hand and then inject it with my right (dominant) hand.
But I plan on trying. If my wife helps me or does the injection I probably will get a little firm. That is why I ask about penis
firmness.
It doesn’t have to be “completely” flaccid. In theory, the injection could be done one handed. The important aspect is making sure the needle reaches all the way into the erectile body (part of the penis that gets hard) rather than just under the skin.
The videos I have observed, the flaccid penis model seemed semi erect before the injection, also appeared to be longer and had more girth. I assume the process is the same for smaller in length and girth. My question is the needle length adjusted for penises which are smaller in girth?
Thank you
The needle length doesn’t typically need to vary. I have found the key is to place the penis on stretch such that when the needle is inserted, it reaches the actual erectile body (area of the penis that gets enlarged with erection) rather than just underneath the skin surface.