Some men with erectile dysfunction elect to use penile injection therapy, which is also known as intracavernosal injection therapy. This treatment approach involves injecting medications directly into the penis. The technique is easy to learn, but it should be taught and demonstrated by a healthcare professional, such as doctor, nurse, or sexual medicine clinician, before men try it alone at home. Monitoring of the dose by a healthcare professional is also necessary in the beginning until the optimal dose can be determined, based on a man’s response to the medication.
Injections can be made into the base or side of the penis, but the least sensitive spot on the penis is the middle of the shaft on either side. Many men express anxiety over the prospect of injecting their penis with a needle. However, because the needle is very fine and only about one-half inch in length, the pain is minimal, similar to injecting yourself with insulin. Some medications are available in pre-filled syringes, while others require that you draw them up into the syringe yourself from a vial.
A new drug called Vitaros is new available as a cream that is rubbed on the penis. It is the same drug as Caverject. Many men are finding that is works just as well as the injected form.
Medications for Penile Injections
The most commonly used medication for penile injection therapy is alprostadil (Caverject), a synthetic version of a hormone called prostaglandin E. This hormone has the ability to relax the muscles in the penis, which improves the blood flow necessary for an erection. Alprostadil can produce an erection in 5 to 20 minutes, and it can last for about 60 minutes or longer, although the average is about 30 minutes. About 60 percent of men with erectile dysfunction respond to alprostadil injections, including men who have undergone prostatectomy and radiation therapy. A possible side effect associated with alprostadil in men who have damage to their cavernous nerve (which includes men who have had a prostatectomy or who have diabetes) is pain. This can occur because the penis in such men is overly sensitive to prostaglandin. The pain is mild in some men but severe in others. Alprostadil comes as a powder to be mixed with the liquid provided in the package and injected into the penis and as a urethral suppository (pellet to be placed into the urinary opening of the penis). Alprostadil is used as needed before sexual activity. An erection may occur within 5 to 20 minutes after using the injection and within 5 to 10 minutes after using the pellet. The erection should last approximately 30 to 60 minutes. Alprostadil injection should not be used more than three times per week, with at least 24 hours between uses. Alprostadil pellets should not be used more than twice in a 24-hour period. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use alprostadil exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Another medication used in penile injections is Trimix. Response to this drug is better than with alprostadil—greater than 90 percent—although a drawback is that unlike alprostadil, which is available in pre-filled syringes, men have to draw up their own syringes for Trimix. Trimix is a combination of three ingredients: papaverine, phentolamine, and prostaglandin E. Because the amount of prostaglandin E is much less than in Caverject, the possibility of pain associated with the prostaglandin is nearly eliminated. For men who are very sensitive and still experience some pain or burning in the penis with Trimix, another drug called Bimix, which contains only papaverine and phentolamine, can be used.
One side effect from drugs to treat ED can be a prolonged erection, those lasting more than 4 hours are known as priapism. A prolonged erection may also be caused by other treatments such as injections and MUSE suppositories.
Priapism is a serious medical condition, because the penis is deprived of oxygen, which damages and destroys erectile tissue. These warnings should be taken seriously and medical attention sought immediately. [CONTINUE READING]
How much do the injections cost?
The cost per injection for alprostadil (Caverject or Edex) alone can be expensive if insurance carriers do not cover it. The injection mixtures of alprostadil, phentolamine and/or papavarine, are generally less expensive option. Treatment and medication coverage by healthcare insurance varies from one insurance provider to the next, as well as from one plan to the next. Therefore, it is best to contact the individual provider in order to determine which treatments for ED are covered by insurance.
Caverject is typically covered by insurance, while Trimix and Bimix usually are not. For men who must pay for their drugs out of pocket, Caverject can prove to be expensive, because each injection is about $20. Comparatively, a vial of Trimix can cost about $85 and last several months. The bottom line, however, is finding the drug that works best for you, and then shopping around for the best price from a reliable source.