What Is Penile Injection Therapy?

Penile injection therapy involves using a very small needle to inject medicine into the side of your penis. The medication relaxes blood vessels and muscles in the area, allowing more blood to flow in, and this gives you an erection.

Common medicines used in injection therapy include:

• Alprostadil
• Combinations of drugs (often called “bimix” or “trimix”) that may include alprostadil, papaverine, and/or phentolamine

These medications act directly where they are needed, so they can work even when ED pills are not effective.

Who Might Be a Candidate for Injection Therapy?

Injection therapy may be recommended for:

• Men who do not get sufficient benefit from oral ED meds.
• Men who cannot take PDE5 inhibitor pills for safety reasons.
• Certain men with nerve damage or other conditions that limit their response to pills.

Because injection therapy requires careful dosing and using the correct technique, it is usually started with training in the medical office, and your progress is carefully followed by a clinician experienced in sexual medicine and urology.

How Injection Therapy Works

If you decide to try injection therapy, the process typically involves these four steps:

1. Initial evaluation: Your doctor reviews your health history, current meds, and any causes of your ED.
2. In-office teaching and test dose: You are shown how to prepare the medication, how to handle the syringe, and where to inject. A test dose may be given in the clinic to see how you respond.
3. Dosing micro-adjustments: The dose may be increased or decreased over a few tries to find the lowest amount that gives a reliable erection.
4. Home use: Once you are comfortable with the technique and your dose amount is set, you can use the medication at home according to your clinician’s instructions.

Each injection is meant for a single use, and there are limits on how often you should inject, which your clinician will explain.

What to Expect During and After an Injection

Many people are surprised that the needle used for injection therapy is quite small. With proper technique, discomfort is often mild and brief, though different men's experiences vary.

After injecting:

• An erection usually begins within several minutes.
• The goal is for the erection to last long enough for sexual activity, but not too long.
• You and your partner should be familiar with when to seek help if an erection does not go down as expected.

Your clinician will provide specific guidance on timing and what you can expect to be "normal" for your situation.

Benefits vs. Risks and Side Effects

Here is a comparison of the benefits and the risks, to help you decide.

Penile injection therapy benefits include:

• Injection therapy can work even when ED pills fail.
• The medication acts locally, which may reduce some systemic side effects.
• In some circumstances, it allows more control over timing.

For many men, injection therapy provides a reliable way to achieve an erection. This can significantly improve your quality of life and intimacy.

Risks and Side Effects

Like any medical treatment, injection therapy has potential risks and unwanted side effects, such as:

• Pain or discomfort at the injection site.
• Bruising or mild bleeding.
• In some cases, the development of scar tissue or penis curvature occurs over time.
• Infection can occur if needles and injection sites are not handled properly.
• If your erection lasts too long, it creates a medical emergency.

Your clinician will explain how to reduce these risks, including rotating injection sites, using sterile techniques properly, and knowing when to seek care if things go wrong.

When Injection Therapy Is Not the Best Choice

Just the idea of injecting your penis makes some men feel queasy.

Injection therapy may not be suitable if:

• You are terrified of needles or unable to perform the injections safely, even with training and support.
• You have certain blood disorders or conditions that increase bleeding risk.
• You are at particularly high risk for priapism (erections that do not go down).

In these situations, other options such as vacuum devices, different medications, or penile implants might be better choices.

Questions to Ask Your Doctor

If you are considering injection therapy, helpful questions include:

• Why do you think injections are a good option for me?
• Which medication would you use, and how does it work?
• How often can I safely use injections?
• What side effects should I watch for, and when should I see a doctor for help?
• What other options are available if I later decide injections are not for me?

While the idea of injecting medication into the penis can feel daunting at first, many people adapt quickly after receiving proper training and support. For the right person, injection therapy can be a safe and effective way to manage erectile dysfunction.