from the injections menu
Some Questions and Answers About Injections
This is not medical advice or an endorsement of any product or method. It is from the FAQ on impotence, from the alt.support.impotence newsgroup Web site which covers more issues than those created by prostate cancer but is still a resource. Do not abide by or rely upon any single lay opinion. Takes these issues to and consult your physician.)
I've heard about penile
injections for ED. What's this all about?
There are several drugs which can be injected directly into the erectile
tissues of the penis to cause an erection.
Before you run screaming at the
idea of sticking a needle in your dick, be assured that the injections are
made with a very fine needle (the type normally used for insulin) and are less
painful than a flu shot. The following questions discuss the various
drugs and how they're used.
What is Caverject?
Caverject is the trade name for an injectable solution of prostaglandin E1
(PGE1) or alprostadil, which is manufactured by Pharmacia-Upjohn. There are
other variants of this including Edex, a similar product from Schwarz-Pharma.
Caverject makes the shot kit. (Do a Internet search for 'Caverject') It is
portable and does not require refrigeration until you mix the
ingredients. It's expensive, compared to the PGE1 or PPP (Prostaglandin, Papaverine and Phentolamine). A popular
complaint is that the needle is very large. Many here will tell you to
purchase the small needles that diabetics use for insulin injections. Mix your
powder and liquid using the large needle supplied with the kit, then change to
the small needle for the injection. The reason the company supplies large
needles may be the worry you might break off the needle in your dick and sue
What are Bimix and Trimix
Bimix and Trimix are injectables for intracavernosal administration. They
refer to any combination of either two or three chemicals. Bimix is often a
mixture of papaverine and phentolamine, while Trimix (PPP) would add PGE1. Other
cocktails are used, mainly in Europe.
These mixtures are not commercially available but must be mixed by a
compounding pharmacy. They are generally much cheaper than Caverject or
Edex, and tend to minimize aching in the penis or testicles which is a problem
in some men with Prostaglandin (PGE-1) alone. A compounding pharmacy is
one which will create custom medications on a doctor's prescription; it
usually doesn't include the corner drugstore or large chain pharmacies.
If you need to find a compounding pharmacy close to where you live, you can
go to the International Academy of Compounding Pharmacists at http://www.iacprx.org/
. You can fill in a form on the site and they'll mail you a list of
pharmacies in your area.
My urologist says he's going to try me on
injections my next visit. What should I expect?
Either the doctor or a nurse will inject your penis with a test dose of the
chosen medication and observe the reaction. Since different men react in
varying degrees to the same dose, this is to establish what's the correct
dosage for you. The doctor or nurse will also show you how to administer
the shots yourself. Depending on your penis's reaction to the test
dosage the doctor will write you a prescription showing a higher, a lower or
the same dosage for home use.
When you inject at home you may get a different reaction than you did in
the doctor's office. That's because the environment is different;
you may be more or less relaxed or apprehensive. You can adjust the
dosage upwards or downwards in small increments until you find the
right dosage for you. The danger of too large a dose is that you may get
an erection that refuses to go down. This is called Priapism and if it
goes on for more than three hours you should contact your doctor
immediately. Priapism can be serious.
[P5 Webmaster note: The danger is that if blood is not allowed to circulate in any tissue oro portino of the body within a certain period of time, that blood and the tissue can "die." See question further down.]
Do the shots hurt?
Less than in your arm. The small needles, combined with the soft tissue,
makes it go in easy. It's just a little unnerving the first time. And the
first time is usually done by a Dr. in their office.
How do I give myself an injection?
A diagram usually comes with the medicine. One says to lay your dick to one
side, against your body, and shoot into it. Another has you hold it out. The
idea is to inject into the corpora cavernosa; the tubes on each side of your
dick. Going into the side at about the 9 o'clock to 11 o'clock, or, 1 o'clock
to 3 o'clock position. This way you miss the urethra. Anywhere from the base
of your dick (next to your body) to about ¾ of the length. Don't shoot in the
What about the possibility
The understanding is that there's a possibility that Prostaglandin (PGE1)
can cause scarring, (fibrosis) with long-term use. Several men in the
newsgroup, however, have used injections for years with no adverse effects.
There seems to be less risk with Trimix. Penile fibrosis can lead to
Peyronie's disease or "bent penis".
Will the shots give me a 100% erection
They can, but in practice the shot alone should give you about an 80%
erection. Stimulation should bring it the rest of the way up. If the shot
alone gives you a 100% erection, you may have an erection for a longer time
than you want. Many have received a shot in the doctor's office and had little
to nothing happen. Yet when they inject at home, in a situation where they
began having sex, it worked.
What is the medicine in the
Most doctors start you out with PGE1 . This is Prostaglandin E1 (AKA
Alprostadil) and is the ingredient in Caverject and Edex. If this
doesn't work the doctor may prescribe Tri-mix, which is a mixture of
Prostaglandin, Papaverine and Phentolamine. A typical mix, in one
bottle, is: Prostaglandin, .05ml; phentolamine, .55ml; Papaverine, 2.5ml;
Can I use my injectables intravenously to
get better effect?
In a word, NO. It would be inadvisable to do this and may be
positively dangerous. Certainly with Trimix, side-effects are minimized by the
fact that you are applying the drug intracavernously and are, in fact,
localizing the effects of the drug to the corporal tissue. To give the drug
intravenously would be likely to cause serious systemic side-effects.
What about Priapism (an erection
that won't go down)? I've heard it can be a problem with injections.
This can be a problem, especially of you take too large a
dose. It's unlikely to happen if you follow the injection guidelines
your doctor gave you and increase or decrease dosage in small steps until you
find the right dosage for you. Your doctor should definitely have given
you specific instructions about what to do in case this happens. If not, then
be sure to ask about it! This will normally involve a prescription which
you should have filled and on hand, and instructions about either calling the
doctor or going to the emergency room if the prescription doesn't work.
In general, you should be concerned about any erection that
lasts for more than about 3 hours (but follow your doctor's advice about
this). We're talking about a hard, steady erection here; not one that
comes and goes. The problem is that with a very hard erection, there is
virtually no blood flow through the penis, since the veins that carry blood
away are shut off tight. Blood flows in but can't leave. All the
oxygen in the blood captured in the penis is used up and the blood stagnates
and thickens, making it even harder for it to be removed by any veins that are
still open. If this goes on too long it can cause permanent damage to the
In extreme cases you might have to go to a hospital or
doctor's office for treatment. The treatment may involve injection of
antihistamines, caffeine or adrenaline directly into your penis, or
"bleeding" your penis to remove stagnant blood.
|This information is provided for educational purposes only and does not replace or amend professional medical advice. Unless otherwise stated and credited, the content of Phoenix5 (P5) is by and the opinion of and copyright © 2000 Robert Vaughn Young. All Rights Reserved. P5 is at <http://www.phoenix5.org>. P5's policy regarding privacy and right to reprint are at <www.phoenix5.org/infopolicy>.