Needles and the penis: not exactly a combination anyone dreams about. But if tablets have not delivered or the side effects were not worth it, an erectile dysfunction injectable is the option your doctor may bring up next and it is an erectile dysfunction injectable is an option your doctor may discuss with you.
Penile injection therapy has existed for many years, as it acts directly on the blood vessels of the penis, thus being effective in men who do not respond well to oral medicine. However, it does not come without difficulties in learning how to use it and some degree of risk which is not always mentioned in the advertising materials.
Here, you can find information about how erection injections function, which medicines are included in this treatment, what studies say about the effectiveness of the method, what side effects may occur, and when to seek medical help.
What Is an Erectile Dysfunction Injectable?
Erectile dysfunction injections refer to prescription drugs injected into the penis, medically termed intracavernosal injection therapy. This drug relaxes the smooth muscle of blood vessels, resulting in the widening of blood vessels and erection. Most men can achieve an erection within 5-20 minutes.
In contrast to erectile dysfunction pills, which depend on the body’s natural response to sexual stimulation, injections act directly on the penile blood vessels and do not rely on nerve signals in the same way. This is one reason they are considered for men who do not respond to oral medication. Sexual stimulation is not required for injection therapy to produce an erection, although it may enhance the response.
What Medications Are Used in ED Injections?
Alprostadil works by relaxing smooth muscle and widening blood vessels in the penis. Your doctor will advise which medicine, if any, is suitable for you.
Alprostadil (prostaglandin E1): A medicine identical to a naturally occurring substance that helps keep blood vessels open. Note – Used in Caverject Impulse, the product the safety information below is based on.
Some prescribers may use other medicines or combinations. Whether these are suitable for you, and how they are supplied in Australia, is a decision for your prescriber.
Your clinician prescribes the medicine and sets an individual starting dose, then adjusts it step by step under supervision until it produces a firm erection that is not overly prolonged. This can take several visits.
How Do ED Injections Work in Practice?
The initial injection has to be done at a medical center, supervised by the staff. Medical centers with injection programs ensure their patients are well-trained in the process. For example, Men's Health Melbourne provides patients with training in two 30-minute sessions: in the first session, they observe the process and are given a test dose under supervision; in the second session, they carry out the whole process themselves under supervision.
- Where injections are given: Into the shaft, at the middle of the shaft while steering clear of the top where there are major blood vessels, and the bottom where the urethra is.
- Switching sides during injections: Changing sides regularly keeps scar tissue accumulation at bay.
- Erection time: This happens within 5 to 20 minutes.
- Duration: Typically 30 minutes to an hour, depending on the medicine and dose. Your clinician will tell you what to expect. If an erection lasts longer than they advised, follow their instructions.
- Discomfort: Pain or aching in the penis is common. Tell your doctor if it is troublesome or new, as a dose adjustment may help.
How Effective Are ED Injections?
The numbers are strong with one important caveat about whether men stick with it.
- Roughly 70% to 80% of men achieve a firm erection while on injection therapy, according to the statistics provided by Cleveland Clinic (around 80%) and the University of Wisconsin Health (70% to 80%).
- Satisfaction of 89% but high dropout rates. According to a 2012 review of an injection program, it was estimated that 89% of participants were satisfied, but the high dropout rate made it possible to report about many men who obtained satisfaction but preferred to stop doing the therapy.
- Long-term satisfaction is satisfactory for the men who continue the treatment. According to a 2019 study on 105 individuals, around 70% of men using injection therapy for longer than eight years were satisfied with the treatment.
- Nerve-related ED: Because injections act directly on the penile blood vessels rather than relying entirely on nerve signals, they are often effective for men with nerve-related ED, including after prostate surgery. Results differ between men, so ask your specialist what to expect
ED Injections vs. Other ED Treatments
Treatment | How It's Used | Typical Onset and Duration |
ED injections | Self-injected into the side of the penis shortly before sex, after clinic training | Onset about 5 to 20 minutes; erection usually 30 to 60 minutes |
PDE5 inhibitor tablets (sildenafil, tadalafil, etc.) | Taken as a tablet; requires sexual stimulation to work | Onset about 30 minutes to 2 hours depending on the medicine; duration from about 4 hours up to 36 hours |
A drug-free medical device that draws blood into the penis, with a tension ring to help hold the erection | Used at the time of sex; no medication involved |
All options suit different men. The right choice depends on your health condition, additional medical treatment, willingness to use needles, and previous experiences related to the treatment that could be assessed by a specialist.
What Are the Side Effects and Risks of Penile Injections
Injections are not risk-free. Here is what you should know:
Side Effect | What to Know |
Bruising or bleeding at the injection site | Apply pressure to the site for about five minutes or until bleeding stops, and follow the instructions for your prescribed product |
Pain or aching in the penis | Tell your doctor; a dose adjustment can help |
Swelling or skin rash on the penis | Report it to your doctor |
Dizziness, headache or blood pressure changes | Fainting is possible. Tell your doctor |
Scar tissue or a painful curve when erect | Contact your doctor if you notice hard areas or a new curve |
Prolonged erection (priapism) | An emergency if it reaches four hours; see below |
Infection | Seek medical advice if you notice fever, chills or worsening pain |
When a Prolonged Erection Becomes an Emergency
Your clinician will explain at your training session what to do if an erection lasts longer than expected. Follow those instructions.
An erection lasting four hours needs urgent medical attention. Go to the nearest emergency department or call 000. Do not wait to see whether it settles, and do not treat four hours as a point you can safely reach before acting.
Left untreated, a prolonged erection (priapism) can cause permanent damage to penile tissue and lasting problems with erections.
Who May Not Be Suitable for ED Injections?
A doctor reviews your medical history before prescribing. This section reflects the Australian product information for Caverject Impulse (alprostadil). Other products may carry different restrictions, so follow your prescriber’s advice.
Caverject Impulse should not be used if you:
- are allergic to alprostadil or any other ingredient in the product
- have a penile implant
- have penile fibrosis, a scarred or curved penis, or Peyronie’s disease (including angulation, cavernosal fibrosis or fibrotic nodules)
- have a condition that predisposes you to prolonged erections (priapism), such as sickle cell anaemia or trait, multiple myeloma or leukaemia
It is also not for use in women, children or newborns.
Other things your doctor will weigh up:
- Blood thinners and anticoagulants: These are a bleeding precaution, not an automatic exclusion. Tell your doctor about every medicine you take, including blood thinners, so they can assess the bleeding risk at the injection site and advise you.
- Dexterity and comfort with needles: Limited finger dexterity or discomfort with injecting does not necessarily rule treatment out, but discuss it with your clinician, because you must be able to inject safely.
- Combining with ED tablets: Do not combine injections with ED tablets such as sildenafil or tadalafil unless specifically instructed by your prescribing clinician. Combining them can raise the risk of priapism and other significant side effects.
Using ED Injections Safely
- Use the dose your doctor prescribed. Do not adjust it yourself. Departing from your clinician’s instructions can cause serious harm, including lasting penile damage.
- Respect the frequency limit. For Caverject Impulse, use it no more than once in a 24-hour period and no more than three times a week. Other products may have different limits, so follow your prescriber’s instructions.
- Make follow-up appointments. Consult your physician regarding possible changes in your dose and technique.
- The price may vary. Consult your doctor regarding what cost you should prepare for and what financial issues may arise.
- Know your emergency plan. An erection lasting four hours needs urgent medical attention. Follow your clinician’s earlier instructions for a prolonged erection.
Frequently Asked Questions
How do ED injections work?
ED injections work by relaxing the smooth muscles in the lining of the blood vessels of the penis, allowing the blood vessels to widen. This enables blood to flow to the penis to give an erection usually in 5 to 20 minutes. Sexual stimulation is not required for injection therapy to produce an erection, although it may enhance the response.
How long do ED injections last?
An erection lasts from 30 to 60 minutes, but it can last up to two hours. If it regularly lasts much shorter or longer than your clinician expected, tell them so the dose can be reviewed. An erection lasting four hours needs urgent medical attention.
Are ED injections safe?
ED injections can be used safely when the dose and technique follow your clinician’s instructions. The most common effects are penile pain and bruising at the injection site. With frequent use, scarring or curvature of the penis can develop. A prolonged erection can occur and is a medical emergency once it reaches four hours.
Do penile injections hurt?
Some men experience penile aching or burning after the injection. Tell your clinician if pain is troublesome or new.
Can you use ED injections with Viagra or Cialis?
Do not combine injections with ED tablets unless specifically instructed by your prescribing clinician
Who are ED injections recommended for?
They're generally considered when oral ED medication has not worked well enough causes troublesome side effects or is not suitable. A doctor will assess whether they are appropriate for you.