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Nonsurgical Treatment of Erectile Dysfunction (cont.)

Penile Injection Therapy

Although many substances are touted as male sexual boosters, the modern age of such drug therapies began in 1993.

At that time, papaverine, a drug that produces vasodilatation (widening of the blood vessels), was shown to produce erections when injected directly into the penis. Soon afterward, other vasodilators were demonstrated to be effective as a treatment of erectile dysfunction.

  • Alprostadil is currently the most commonly used drug for injections into the penis. Alprostadil works well in most men who try it. In one study of 683 men with erectile dysfunction, 94% reported having erections suitable for penetration after alprostadil injections.

  • TriMix (a combination of alprostadil, phentolamine, and papaverine) has roughly twice the effectiveness of alprostadil alone. However, it is relatively expensive and usually not covered by insurance, whereas alprostadil is often covered by most insurance plans.

Self-injection of these drugs has been very beneficial. Penile injection therapy represents the most effective way to achieve erections in a wide variety of men who would otherwise be unable to obtain adequate rigid erections. In fact, if the vascular structure of the penis is healthy, the use of injectable drugs is almost always effective. Note that men on anticoagulant medications (blood thinners) cannot use this therapy.

Your doctor will determine an appropriate dose. The dose is adjusted to achieve an erection with adequate rigidity for no more than 90 minutes. The injection cannot be done more often than 3 times a week.

Side effects include:

  • Pain from the medication (not from the injection)

  • Priapism

    • Priapism is a persistent or abnormally prolonged erection that lasts 4 hours or more.

    • Priapism is a urologic emergency. If an erection lasts for 4 hours or more, you must either contact your urologist or go to an emergency department for immediate treatment.

  • Scarring or bleeding at the site of the injection

If you choose this therapy, your doctor will teach you how to perform the injections. Even though the injection itself is painless, many men are still uncomfortable with penile injection therapy.

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