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Erectile dysfunction (ED) is a condition in which it’s difficult to get or keep an erection firm enough.

There are many ways to treat ED, including lifestyle measures, psychotherapy, oral medications, surgical procedures, and penile injection therapy, also known as intracavernosal injection therapy.

Penile injections can generally be self-administered at home. They help treat ED by improving blood flow to the penis, which leads to firmer erections.

While the thought of injecting a needle into your penis may make you cringe, a 2019 review found that penile injection therapy is generally an effective and well-tolerated treatment for ED.

Erectile dysfunction injections come in a standard vial and the medication is extracted through a needle syringe. The syringe is then injected around the midpoint of the penis, which will maximize the medication’s effect and prevent interference with nerves or blood vessels.

This medication helps increase blood flow to the penis and an erection is achieved approximately 5 to 15 minutes after the injection.

Overall, this is one of the fastest-acting ED medications. Even popular alternative treatments, like Viagra, could take you 30 to 60 minutes to achieve an erection.

Your first injection should take place at your doctor’s office under supervision. During the visit, your doctor will show you how to correctly administer the injection and how to do the injections at home.

The first step is to wash your hands and assemble your supplies on a clean surface. You’ll need:

  • 1 medication vial
  • 1 sterile syringe
  • 2 alcohol wipes
  • 1 sharps container for used syringes. It’s best to use a container that’s been approved by the Food and Drug Administration (FDA). If you don’t have access to one, you can use a sturdy plastic container, such as an empty detergent bottle with a cap.

Once the medication is in the syringe, gently grasp the head of your penis between your thumb and forefinger and pull it straight out in front of you. If you’re not circumcised, pull the foreskin back before grasping the head.

Locate an area on the right or left side of the penis, midshaft, to perform the injection. It’s important to remember that the injection must only be given on the sides of the shaft. This avoids interference with the top of the shaft, where the blood vessels are, and the bottom of the shaft, where the urethra is located.

Alternating sides each time you inject can also help you avoid developing scar tissue. Be sure to avoid an area with a visible blood vessel.

Once you’ve selected an area, clean it with an alcohol wipe. Let go of the head of your penis and pick up the syringe with both hands.

Remove the cap on the syringe and make sure the dose is correct and there are no bubbles in the syringe. With one hand, hold the syringe between your thumb and your index and middle fingers, as though you were about to throw a dart.

Using the other hand, pull the head of the penis out in front of you again. Be careful to hold only the head, so you’re not pulling any skin along the shaft.

Place the needle against the skin in the chosen area and slide the needle into the shaft. The needle should be at a slight angle, with the plunger facing up at the 10 or 2 o’clock positions. Adjust your hand so your thumb or index finger can push the plunger.

Push the plunger quickly to release all the medication. Once the syringe is empty, quickly pull the needle straight out. Apply gentle but firm pressure on the injection site with your thumb and your index finger on the opposite side of the shaft. Do this for 2 or 3 minutes to avoid any bleeding or bruising.

Put the syringe in the sharps container for disposal.

In general, an erection should follow an injection within 5 to 15 minutes. However, some people may need sexual foreplay to achieve an erection. The erection should last about 30 to 60 minutes, though this will vary depending on your overall health and other factors.

Some people report that injections affect the sensation in their penis and their ability to ejaculate. However, these effects may be due to the cause of ED rather than the injections themselves.

Penile injections are intended for any person who has issues with becoming erect, achieving enough stiffness for penetrative sex, or keeping an erection for the desired length of time. People with erectile dysfunction may find that penile injections are a very effective treatment that can work much faster than some other alternatives.

However, penile injections aren’t recommended for people with mild erectile dysfunction as the medication may be too strong for their needs. They are also not recommended for people who will have difficulty accurately performing the injection.

Examples of people who should avoid penile injections include:

  • anyone with limited finger dexterity, as this might cause issues holding the needle or physically holding the penis for the injection
  • people using certain blood thinners
  • someone with significant penile scarring, which might complicate locating a proper injection site
  • anyone uncomfortable using or being around needles

Penile injections are also worth exploring if you have seen limited results from other ED medications. Since these injections require a prescription, it’s important to discuss your ED symptoms with your doctor so that you both can decide if penile injections are right for you.

The three main types of medications used in penile injection therapy include:

  • papaverine
  • phentolamine
  • prostaglandin E1 (PGE1) or alprostadil (Caverject, Edex, MUSE)

Sometimes, only one medication is administered. But combinations of these medications are also widely used. Combination medications include BiMix, which is papaverine and phentolamine, and TriMix, which contains all three medications. Anyone who finds that TriMix is ineffective may be prescribed QuadMix, which combines Trimix and atropine.

All these medications work by relaxing the smooth muscles and widening the blood vessels in your penis. This increases circulation and leads to an erection.

Penile injection therapy is considered an established and effective second-line therapy for ED. That means it’s generally prescribed only if first-line therapy — oral ED medications — are ineffective or not well tolerated.

Some people don’t like the side effects of oral ED drugs, which can include:

  • congestion
  • headache
  • upset stomach
  • flushing
  • back pain

Some people may also prefer injection therapy over other ED treatments, such as having penile implant surgery and the risks and potential side effects with that approach.

Overall, studies have shown that penile injections are very effective. In fact, a 2012 review showed that an estimated 89 percent of participants reported satisfying results from the injections. However, the review also noted a significant drop-off or cancellation rate among participants. This seems to indicate that while the injections were widely successful, a large number of participants didn’t choose to continue with the medication.

Additional studies also support the effectiveness of penile injections. A 2019 study of 105 males found that about 70 percent of males who relied on penile injection therapy for more than 8 years were satisfied with the results.

While there is strong evidence for their effectiveness, this medication isn’t guaranteed to work for everyone. If you are not seeing the desired results, talk with your doctor to see if there are other options worth exploring.

ED injections are not totally risk-free. As with any type of injection, there’s a slight risk of bleeding or bruising at the injection site. If you’re careful and follow your doctor’s instructions, these problems can be avoided.

Proper placement of the needle can help avoid temporary irritation and swelling.

Some users also report mild pain after injecting.

In rare cases, priapism — a prolonged erection that occurs without, or long after, sexual stimulation — may occur. To treat priapism, try applying an ice pack to your penis. Taking a decongestant containing phenylephrine may help, too. However, if the erection lasts longer than 4 hours, seek immediate medical attention.

Likewise, if you’re experiencing pain or any bleeding that lasts more than a couple of minutes after the injection, see a doctor immediately.

When to seek immediate care

  • you have an erection that lasts longer than 4 hours
  • pain or prolonged bleeding occurs
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Medications for penile injection therapy are available with a prescription, and sometimes they’re covered by insurance. For example, people who develop ED after prostate cancer treatment may be eligible for coverage. Check with your insurance carrier to find out if you’re covered.

Though some oral ED medications are now available in generic form, they can still cost $10 to $20 or more per dose, according to estimates on GoodRx. The cost of medications can certainly change from pharmacy to pharmacy and choosing a generic form over a brand name can also help bring down your overall cost.

You may save money in the long run by comparing a few different pharmacies, considering generic medications, and exploring websites like GoodRx that focus on discounting prescriptions.

Depending on the dosage your doctor recommends, injectable medication may be as little as $5 per dose, according to GoodRx. This means that injection therapy may be cheaper, if not somewhat riskier, than oral medications.

If you have been experiencing issues becoming erect or losing an erection prematurely, it’s important to keep in mind that this can occur from time to time, even in young people.

However, if you are experiencing these difficulties several times a week and over several weeks, it may be time to see a doctor. Erectile dysfunction is very common, but it is also a condition that can be treated.

If you are currently using penile injections and aren’t seeing satisfying results, are experiencing an erection that lasts long past intercourse (known as priapism), or experiencing an erection lasting more than 4 hours, you should contact your doctor immediately as it may lead to large medical complications if left untreated.

Finally, you should contact your doctor if you are considering changing your dosage. Increasing your dosage without your doctor’s approval may cause unexpected side effects that will require medical attention.

Your doctor can write you a prescription for an injectable medication after you receive an ED diagnosis. Depending on your situation, your doctor may have you try oral medications before trying injectable medications.

Once you have a prescription, you should be able to have it filled at your local retail pharmacy or at a compounding pharmacy. In some cases, you may also be able to fill it online. However, it’s important to know that buying any kind of medication over the internet carries some risks.

To be safe with this approach, check with your state board of pharmacy to see if the pharmacy you’re buying from is licensed. You should also make sure that you’re ordering FDA-approved drugs and that a licensed pharmacist is available to answer your questions.

Keep in mind that a valid pharmacy will require a prescription to purchase medications.

How long does Trimix last after an injection?

Trimix is one of the most popular brands of penile injections and is generally expected to give you an erection for about an hour following the injection. In some cases, this length of time can be anywhere from about 30 minutes up to 2 hours. It is important to note that an erection lasting over 4 hours may require medication attention after that length of time.

How long do erectile dysfunction injections last?

The length of time that you can maintain an erection after injection will vary from brand to brand and from person to person. In general, erections can last within a range of about 30 minutes to 2 hours. If you are experiencing an erection that lasts fewer than 30 minutes or longer than 2 hours, discuss this with your doctor as they may want to change your dosage amount to maximize each injection.

Which erectile dysfunction injection is best?

The truth is, most erectile dysfunction injections have a very high success rate, so it can be tough to pick the best. Overall, most research tended to focus on the overall effectiveness of injections across several brands instead of focusing on just one brand. However, when specific brands were mentioned, Trimix appeared often with an approximate 70 percent success rate.

Are erection injections safe?

Yes, when performed correctly, these injections are safe. However, it is important to talk with your doctor and to read the instructions thoroughly before your first use. Injections in the wrong place or at the wrong angle can reduce the medication’s effectiveness or cause a negative reaction. If you experience excessive bleeding at the injection site or an erection that lasts over 4 hours, you should seek medical attention.

Penile injection therapy is used by people of all ages to treat ED with a variety of causes. It can be used long-term, though you’ll want to vary injection sites each time you inject. This helps avoid creating any scar tissue.

To achieve the best results, learn as much as you can about the process from your doctor, and don’t hesitate to ask them questions about side effects, dose, or any other topic.

Getting the right dose may take a little trial and error, but if you’re willing to put in the time and effort, good results are possible.