Before you begin pursuing self-injection therapy for erectile dysfunction, know that ED can be symptomatic of many underlying problems more serious than erectile dysfunction. Please read “What is low testosterone?”
“How did I end up here?”
Who ever thought that sex, which used to be so easy, would require an intervention? You’ve tried pills and have rejected the idea of a penile implant. The pills either didn’t work quite well enough, or just stopped working a while ago. You’ve tried a vacuum device with no luck, and the intraurethral suppository – well that just didn’t work either. So it’s either grab a tiny needle and inject your most precious possession, or give it up completely. Obviously, now you’re considering “self-injection.”
In self-injection, you or your partner inject your penis with medication that creates a natural erection within 5 to 15 minutes. It lasts from 30-40 minutes. If your erection lasts longer than an hour, have your dosage changed.
Although this therapy sounds excruciating, the needle is very small, 29 gauge, the same size as needles used to administer insulin by diabetics. Some men describe the feeling as about the same as pulling a hair out of the back of your hand. The amount of medication is also small.
Injection therapy is not new; it has been around since the 1980s and is safe and reliable.
A short and happy story
Let us consider a story. A small study of erectile dysfunction among young men from extremely conservative backgrounds was undertaken when they came to a clinic seeking help. They had been married for an average of 18 months yet their marriages were unconsummated. They had tried Viagra®, etc, but with no success. They were expected to start families, yet because of no sexual experience or knowledge–but plenty of anxiety–their efforts were stymied.
The cause of their ED was not physical. They were all young and healthy. The cause was psychogenic, or caused by a psychological barrier in their backgrounds that rendered sexual discussion and education non-existent.
They began self-injection therapy and after 1-2 self-injections, they began having normal sexual relations with their wives. This simple, inexpensive treatment decreased their sexual anxiety to such a degree that they stopped self-injections.
The value of this story is that this therapy helps men who want to have sex and are physically capable of it, except for a touch of erectile dysfunction.
At the doctor’s office
When you go to a urologist to ask about treatment options, be prepared to answer many questions. The answers help the doc prescribe the best option for you. Bring a list of allergies, prior illnesses, history of priapism, surgeries, especially urological surgeries, your meds, and other ED treatments you have tried. Tell the doctor about all existing conditions you have including leukemia, multiple myeloma, polycythemia, sickle cell disease, or thrombocythemia.
Training at the doc’s office
You (and your partner, if you choose) will learn about how to self-inject in a short doctor’s office visit. Unless your partner attends training in the doctor’s office, your partner cannot inject you later.
You will also go home with detailed instructions for giving yourself a shot in the penis. (Don’t cringe. Think of the payoff.) It is important to follow instructions closely and to disinfect every surface the instructions say.
In order to regulate your dose, you will probably record a couple of pieces of information after you self-inject and after you have sex. You will rate your erection and report how many units of medication you used. Record these statistics each time you self-inject and have sex. Don’t self-inject again until you have reported to your doctor.
If the medication doesn’t work for you, don’t give yourself another injection until after speaking to your doctor.
Drugs
You may get a prescription with one, two, or all three of these drugs.
- Prostaglandin (PGE-1) has been approved by the FDA for the treatment of erectile dysfunction.Caverject, is a synthetic version of Prostaglandin. They are vasodilators.
- Alprostadil (brand name Edex®) increases blood flow by expanding blood vessels.
- Phentolamine is a drug which blocks the alpha adrenergic system and allows patients to maintain their erection.
If you get a prescription for a compounded drug, your doctor has prescribed a two-drug or three-drug mix. The mixtures are usually composed of papaverine, phentolamine, and/or alprostadil. The compounded mixture is not manufactured by a drug company and consequently has not gone through FDA testing, and probably never will. But they have been used for a decade longer than Caverject® and Edex®. Some doctors think the mixture is more effective than a single drug.
It is important to use the drug accurately, otherwise, you could damage your penis permanently. Be constantly aware of which product you are preparing to inject.
There is a limit to how many times you can use it per week—usually about three. Always wait 24 hours between injections. Do not use it in larger amounts than instructed, or you could cause priapism, which could cause permanent ED.
Use clean hands when preparing and administering the injection and a clean surface on which to place the bottle. Use a cotton swab and alcohol to wipe the tops of the injection bottles. But do not wipe the needle with the alcohol swab.
Drugs containing alprostadil should be refrigerated.
Warning
Do not use Viagra, Levitra, or Stendra within 18 hours, before or after, self-injecting.
Do not take Cialis, 10 or 20 mg, within three days of self-injecting.
If you use Cialis, 5 mg, ask your doctor how to coordinate it with your self-injection.
Do not use your medication at all if it contains particles or is cloudy, or if the rubber stopper comes off the vial.
Side effects
The most serious side effect is priapism, an erection that lasts over four hours. It is painful and if not treated immediately, can permanently damage your penis. To avoid this side effect, take correct doses of your medication.
A few notes on Priapism. First – it sucks and should be avoided. It’s embarrassing and it hurts. Second – the longer it lasts the harder it is to make it go away. For patients using penile injection, this advice is important. If you have an erection lasting longer than 1 hr, this is not good. You can use over the counter pseudophed and take 1-2 pills. If your erection lasts longer than 2 hours you should take a different medication (terbutaline) and consider going to the emergency room. If the erection has lasted for 3 hours you should head to the emergency room. Call your doctor and let him know you are planning to go. Finally, if your doctor has given you phenylephrine, it can be used to reverse the erection. Use it only as directed by your urologist.
Other side effects include:
- Bleeding or pain at the injection site
- Bruising or clotting in the area of the injection
- Scarring
Do not use Alprostadil to achieve an erection unless you have ED. If not used correctly, it could permanently damage your penis.
Contact your doctor immediately if after the injection, you have any of the following:
- Curved penis and painful erection
- An erection lasting longer than two hours with continuing pain
- Painful or swollen testicles
- Swelling at the injection site (usually caused by poor technique)
- Dizziness, faintness
- Pelvic pain
- Flu-like symptoms
Effectiveness
Satisfaction is reported in about 80% of men. Once you get used to handling the syringes, the vials of medication, and the used needles, self-injection is simple and reliable. It is a long-term option.
Just think. After self-injection you will not only have learned a new skill—how to give yourself a shot—but you will also have enjoyed an old and familiar skill—sex!