What about penile injections?

This is a topic that every man approaches with a degree of fear. You mean someone is going to stick a needle into my penis? For the record, they are called intracavernous injections and your physician will give you an auto-injector that works with a simple push-button mechanism. You hold the head of your penis and stretch it along your thigh while sitting upright. You have to make the injection at the base of the penis (or you can ask your partner to do it for you). Although it is an area that is sensitive to pleasure, it does not register too much pain. The sensation is no worse that being flicked with an elastic band. After the injection, you have to apply pressure to the injection site with an alcohol swab for about five minutes (or until the bleeding stops). You should aim for a slightly different point for each injection, rotating the penis a little if necessary. This will reduce the risk of bruising or scarring. The erection usually lasts for about an hour.

Hmmm. This needs thought! Why can I not simply pop a Viagra, Cialis or Levitra?

Well, no matter how successful they are for most men regardless of age and regardless of the underlying cause of erectile dysfunction (ED), there are limits to the PDE-5 inhibitors. These limits may be physical — the underlying cause of the ED is sufficiently far advanced that Viagra, Cialis or Levitra simply will not work. Or you may already be taking medications for those underlying causes which, for now, make it impossible for you to take one of the PDE-5 inhibitors at an effective dosage.

This forces us to discuss a range of alternative treatments. The first for these purposes, is a penile injection.

These injections have been available for almost twenty years so we doctors are not experimenting on you. The technology and the medications are well tested and routinely used. The first and the only one with Food and Drug Administration (FDA) approval for use in the treatment of erectile dysfunction is prostaglandin E1, sold as Alprostadil and Prostin VR. It is a naturally occurring chemical released by the smooth muscle cells of the penis when you are sexually stimulated. As such, it has the best success records with the fewest side effects and, if you are resident in the United States, the cost is covered by most prescription plans.

It is also available as a small pellet sold under the brand name, Muse, which you insert into the tube through which urine passes from the bladder out of your body. Now this is slightly more complicated than it sounds. You have to use a device which opens up the canal sufficiently to allow the tablet to be inserted inside your penis. This may not be a completely comfortable process either in the insertion or when the penis closes around the pellet. As you will realise, the tablet slowly dissolves and so the pressure on the penis diminishes fairly rapidly. Some men report a slight burning sensation as the medication is absorbed into the penis. There can also be a drop in your blood pressure so you should not be taking any other medication which may have an additive effect. It is also not advisable to consume alcohol before using Muse.

Papaverine is a vasodilator used to relax blood vessels and it was adapted for this purpose almost twenty years ago. It rarely causes any pain although it has a slightly higher risk of causing priapism (an unnaturally long and painful erection which should be treated as an emergency to avoid damage to the penis) because it remains active in the body for a longer period of time than Alprostadil. It may also be slightly more likely to cause scarring if you hit the same injection point too often. You should not use this medication if you are drinking too much caffeine, alcohol or taking any other recreational drugs. Heavy smokers should also take care. You also cannot mix this medication with:

1.the barbiturates used for inducing sleep or treating seizures;

2.medicines such as temazepam or diazepam for sleeping or anxiety problems;

3.medicines to control Parkinson’s disease; or

4.some narcotic pain killers such as morphine or tramadol.

The third drug is also a vasodilator: phentolamine sold as Regitine or Rogitine. It is rarely used on its own but usually in combination with one of the other two medications mentioned above.

Neither of the latter two medications have been approved by the FDA for this purpose — all this means is that the manufacturers have not gone through the expensive process of getting approval. But off-label use under medical supervision is quite common. So if either you or your partner are prepared to learn how to give the injections, this is a good system, available to use whenever you want with no real preparations required. Once given, they produce erections that are close to the body’s own spontaneous erections and allow you to have an orgasm and an ejaculation. The erections last for between thirty minutes and two hours which is normally long enough for sexual intercourse to be satisfying. This is a cost-effective alternative to the more expensive and invasive surgical option. The only drawback is that the use of the injections is usually limited to three or four times per week to reduce the risk of scarring to your penis.