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Nonsurgical Treatment of Erectile Dysfunction (cont.)

How Does Penile Injection Therapy Treat Erectile Dysfunction?

Penile injection therapy, intracavernous injection, involves the injection of a vasodilator (a chemical that relaxes arteries to increase blood flow) into the penis. Penile injected therapy is recognized as the most effective nonsurgical treatment for erectile dysfunction. However, due to the invasive nature, it is often used in men who have failed or have contraindications to other treatments such as oral therapies.

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 an erectile dysfunction treatment.

  • Alprostadil (prostaglandin E1) is currently the most commonly used drug for injections into the penis. Alprostadil works well in most men who try it, however it may be associated with penile pain.
  • Bimix and Trimix (combinations of alprostadil, phentolamine, and papaverine) are generally more effective than alprostadil alone and have less risk of penile pain. However, combination therapy is not readily available and often requires a compounding pharmacy and may not be covered by insurance plans.

The use of injection therapy requires being taught how to properly inject the medication, determination of the best dose, and monitoring for side effects. It is recommended that one inject on the side of the penis at the base and to alternate sides. Injection therapy should be used no more frequently than once every 24 hours. Individuals on blood thinners must be careful with use of injection therapy.

Side effects include the following:

  • Pain from the medication (not from the injection), which is more common when alprostadil is used
  • Priapism
    • Priapism is a persistent or abnormally prolonged erection that lasts four hours or more.
    • Priapism is a urologic emergency if an erection lasts six hours or more. Prolonged erection is an erection lasting four hours or longer.
    • Priapism/prolonged erection is a urologic emergency. If an erection lasts for four 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: Gentle compression at the site of injection after removal of the needle may help prevent bleeding/bruising.
  • Penile curvature related to the development of scar tissue at the injection site
Medically Reviewed by a Doctor on 9/11/2017
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