Penile Injections for Erectile dysfunction (ED) affects many men at some point in their lives, and while oral medications are commonly used, penile injections can be a viable alternative if other treatments are ineffective or not suitable. In this guide, Dr. Peter Bajic, Director of the Center for Men’s Health at Cleveland Clinic, provides a step-by-step tutorial on performing penile injections safely and effectively.
Introduction
Erectile dysfunction, or ED, can significantly impact quality of life and sexual satisfaction. While pills are often the first line of treatment, penile injections are another option for those who do not respond to or cannot take oral medications. These injections, commonly referred to as Trimix or Bimix, are compounded by pharmacies for optimal efficacy but are generally not covered by insurance.
Preparing for the Injection
- Gather Your Supplies:
- Medication vial (stored in the refrigerator)
- Syringe
- Alcohol wipes
- Sharps container (for disposing of used needles)
- Sanitize:
- Wash your hands thoroughly with soap and water.
- Remove the seal from the medication vial and clean the rubber stopper with an alcohol pad.
- Do not use the vial if the fluid is cloudy, has particles, or if the stopper is damaged.
- Prepare the Syringe:
- Remove the cap from the syringe, ensuring the needle does not touch any surface.
- Pull back the plunger to draw air into the syringe. Inject the air into the vial to prevent a vacuum.
- With the vial upside down, pull back the plunger to draw the prescribed dose of medication. Ensure the tip of the needle remains submerged in the liquid.
- Remove air bubbles by drawing up a bit more medication, then pushing the air bubbles out.
- Prepare for Injection:
- Make sure you have the correct dose and minimal air bubbles.
- Place the syringe on a clean surface.
Administering the Injection
- Position Yourself:
- Stand if possible. The injection is more effective when administered while standing.
- Choose an injection site in the middle-third of the penis shaft, avoiding the head, top, bottom, and large veins.
- Alternate injection sites between the left (10 o’clock position) and right (2 o’clock position) sides of the shaft.
- Clean and Inject:
- Clean the chosen injection site with an alcohol wipe and let it dry.
- Remove the cap from the syringe and check the dose.
- Hold the syringe like a pencil and grasp the penis. Stretch it out either in front or to the side.
- Insert the needle quickly and firmly into the penis shaft at a 90-degree angle.
- Push the plunger to inject the medication while keeping the needle in place.
- Remove the needle and apply pressure with an alcohol pad for 2-3 minutes. Apply pressure for 5 minutes if on blood thinners.
- Post-Injection:
- Avoid lying on your back after injection. Sitting, standing, or walking around helps blood flow.
- Expect the medication to take effect within 10 minutes, aiming for an erection suitable for sex lasting no longer than one hour.
Dosage and Frequency
- Injection Frequency: You can inject up to three times a week, but not more than once in a 24-hour period.
- Record Keeping: Maintain a journal of doses, erection hardness, duration, and any side effects to assist your provider in adjusting your treatment.
Warnings and Precautions
- Avoid: Sildenafil (Viagra), Vardenafil (Levitra), Avanafil (Stendra), or Tadalafil (Cialis) within 24 hours before or after injection.
- In Case of Problems:
- If the medication doesn’t work, do not inject again within 24 hours.
- If an erection lasts longer than one hour, consider reducing your dose.
- For erections lasting more than two hours, take two 30 mg tablets of pseudoephedrine (Sudafed) and seek medical help if needed.
- If on Chemotherapy: Consult your oncologist before using penile injections.
Alternative Options
If penile injections are not satisfactory due to pain, ineffectiveness, or needle aversion, other treatments such as penile implants are available and covered by most insurance plans. Consult with a specialist to explore and find the best option for your needs.
Conclusion
Penile injections can be a highly effective treatment for ED when used correctly. Following these steps will help ensure safe and successful administration. If you have concerns or need guidance on other treatment options, contact the Cleveland Clinic Men’s Health team for personalized support and solutions.