Erectile dysfunction (ED) injections can be an effective alternative treatment for people who cannot use other ED medications. They can also help with severe ED due to underlying health conditions, such as diabetes or high blood pressure.
This article focuses on the different types of injectable ED therapies, how they work, how much they cost, and side effects.
Doctors tend to prescribe three main types of injectable ED medications:
- papaverine
- phentolamine
- alprostadil (prostaglandin E1)
Most people begin their therapy with Trimix, which is a mixture of alprostadil, phentolamine, and papaverine.
Other injectable medications that include the above are also available as part of a single or dual combination treatment.
Injectable ED treatments work by relaxing the smooth muscle of the blood vessel walls, causing them to dilate and fill the penis with blood. ED injections, in most cases, should not be used in combination with oral ED medications, which work in the same way.
Experts state injectable therapies trigger a spontaneous erection without the need for sexual stimulation. In contrast, oral medications, such as Viagra, require sexual stimulation to cause an erection. Injectables also overcome drug absorption issues that may occur with certain oral medications.
Erections typically take 10–15 minutes to develop, lasting for roughly 30–60 minutes.
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Pharmacies will typically send a person an injection kit, which includes needles, medication, and alcohol wipes.
Preparing medication
The first steps are to prepare the medication for injection. To do this, a person should:
- Wash their hands with soap and warm water.
- Wipe the top of the medication bottle with an alcohol wipe.
- Remove the syringe from the container.
- Carefully remove the syringe cap, making sure nothing touches the needle.
- Pull back the syringe to around the 20-unit mark and insert it into the top of the medication cap.
- Inject the air into the medicine to release the vacuum.
- Turn the medication bottle upside down.
- Pull the plunger down beyond the prescribed dose level by about 5 units.
- Slowly expel any air bubbles from the syringe by pushing the plunger towards the correct dose by roughly 1–2 units.
- Remove the syringe and tap the side a few times to release any additional air.
- Push the plunger to the correct number of units, which will cause the medication to expel from the needle.
- Carefully put the cap back on the needle.
Injecting the medication
Once a person prepares the syringe, they should take the following steps to administer a dose:
- Hold the penis firmly at the head and pull it taut over the left or right thigh.
- Avoid the urethra on the underside of the penis, visible veins, and the neurovascular bundle on the underside of the penis during the injection.
- Clean the penis base with an alcohol wipe.
- Pick up the syringe and remove the cap.
- Pull the penis tight without twisting it.
- Hold the syringe similar to a dart, placing it at a 90-degree angle to the penis.
- Slide the syringe into the penis quickly.
- Use the thumb to push the plunger into the syringe.
- Remove the syringe rapidly and apply an alcohol wipe to the injection site, putting pressure on both sides of the penis for about 5 minutes.
- Place the syringe in a sharps container for disposal.
Medication and dosage
A doctor will prescribe the lowest effective dose of a medication. It is important to only inject as much as a doctor recommends.
While medications usually come from a compounding pharmacy, with the pharmacist mixing medications according to the specific instructions from the prescribing doctor, there are two commercially available and premade drugs availble.
A person administers ED injections at home following two visits to the doctor’s office, where they learn how to administer the injections.
To inject, a person inserts the needle directly into their penis on the left or right side of the shaft, avoiding the base and head of the penis.
It is important not to inject the top of the penis shaft where the nerves are, as well as the bottom, which contains the urethra.
A person may feel a pinch or sting when they insert the needle. However, the medication should not cause pain in the penis.
Pain as a side effect is most common when using a medication that only contains alprostadil. People should let their doctor know if they feel pain after an injection.
Prices vary based on the type of medication and pharmacy location. Note that insurance companies often do not cover the cost of ED injections.
Medicare programs also typically do not cover the injections since they are not considered medically necessary. People should talk to their doctor about pharmacy options that may be within their budget.
Learn more about ED treatments that are covered by Medicare here.
People should store all medication out of the sight and reach of children.
If a person is using medication that contains alprostadil, they should keep the medication in a refrigerator and away from light. Medications that do not contain alprostadil are suitable for storage in cool places away from direct sunlight.
It is important to check the medication before each use. People should not take any medication that is missing its rubber stopper or if the liquid looks cloudy or has particles.
Memorial Sloan Kettering Cancer Center suggests people should not inject themselves with ED medicine 18 hours before or after taking some oral ED medications.
These ED medications include:
- 10 milligrams (mg) to 20 mg dose of vardenafil (Levitra)
- 50 mg to 200 mg dose of avanafil (Stendra)
- 20 mg to 100 mg dose of sildenafil (Viagra)
A person should not take a 10–20 mg dose of tadalafil (Cialis) within 72 hours or 3 days of using injectables.
Some side effects of ED injections include:
- bleeding at the injection site
- pain in the penis
- temporary swelling under the skin
- a prolonged erection, known as priapism
- hematoma on or near the injection site
- penile scarring
- penis curvature
A person should take no more than 3 ED injections per week. In addition, they should wait 24 hours between doses.
ED injections are generally safe and effective for treating more severe cases of ED, or where a person cannot take oral ED medications. People should talk to their doctor if they notice any changes in the quality of their erection.
A person should track their erection quality using a numbered scale, with ‘6’ indicating an erection adequate for penetration, while ’10’ indicates an optimal erection. Anything less than ‘6’ may mean a person needs a larger dose of medication or a different treatment.
People should never change their dose without speaking to their doctor first.
Pain in the penis shortly after an injection is uncommon. People who feel discomfort after they inject should speak with their doctor.
In addition, people who experience priapism, a prolonged and painful erection, should consult with their doctor.
If an erection lasts for 4 hours or more, they should seek emergency medical attention, as possible nerve damage could occur.
ED injections are a generally safe method to achieve an erection. A person or their partner needs to administer the injections on either side of the shaft while avoiding the top and bottom.
People should work with their doctor to find the medication and dosage that works best for them. If pain occurs, they can talk to a medical professional about switching doses.
If an erection lasts longer than 4 hours, seek emergency medical attention.