What Are the Pros and Cons of Penile Injection Therapy for ED?

Penile injection therapy is a minimally invasive treatment option for men with erectile dysfunction (ED). This treatment is usually recommended for men who are unable to tolerate or achieve an erection with oral ED medications such as sildenafil (Viagra) or tadalafil (Cialis).

Learn more about the pros and cons of penile injection therapy for ED and how to determine whether this treatment is right for you.

What is penile injection therapy for ED?

Penile injection therapy is a self-administered erectile dysfunction shot you can give yourself at home to achieve an erection. These injections should be given about five to 15 minutes before you want to have an erection, and they produce results that last between 30 and 60 minutes.

Your first couple of penile injections are administered by a doctor, who will then teach you how to administer the shots so you can do them safely at home. A 2019 study published in the World Journal of Urology found that penile injections for ED are generally effective and a feasible alternative for men who cannot tolerate or benefit from oral ED medications.

How does penile injection therapy work?

The three medications most commonly used in penile injection therapy are papaverine, phentolamine and alprostadil. These medications may be used separately or combined with one another to treat ED.

Papaverine is an antispasmodic, which relaxes the muscles in blood vessel walls to promote faster-flowing blood. Phentolamine and alprostadil are vasodilators, which expand blood vessels to promote easier blood flow. All of these drugs work similarly to treat ED in how they can improve and increase blood flow to your penis to trigger an erection.

What happens during penile injection treatment?

Your doctor will train you how to perform penile injections on yourself during your first two appointments, which usually last about an hour each.

First, your doctor will show you how to draw your medication from the bottle using a syringe and how to safely handle these medical supplies to avoid contamination and air bubbles in the vial. Then, your doctor will show you where to inject the medication into your penis so it does not affect nerves or blood vessels.

Next, your doctor will show you exactly how to administer the medication, including how to hold both your penis and the syringe, how to push the plunger and how to remove the needle. If you do not achieve an erection within several minutes, your doctor may have you come back for additional appointments until you both find a medication and dosage that work best for you.

What are the pros and cons of penile injection therapy?

Penile injection therapy is ideal for men who do not respond to other treatments for erectile dysfunction or who want to avoid the side effects and risks associated with more invasive treatments, such as surgery. Injections can be given in the privacy of your own home and often produce a relatively painless sensation comparable to that of a quick pinprick.

Disadvantages to erectile dysfunction shots include potential bruising, pain, scarring, bleeding and infection at the injection site when administered improperly. Injections can be given only once during a 24-hour period up to three times per week, which may limit your sexual activity to no more than three times a week.

Some men may need to self-stimulate themselves to achieve an erection even after injecting their medication. Additionally, men are advised not to fall asleep until their erections have worn off and to avoid taking any oral ED medications within 18 hours of a penile injection.

What are the potential side effects of erectile dysfunction shots?

Side effects of penile injection therapy are usually only temporary and typically caused by improper placement of the needle. Potential short-term side effects include dizziness, fainting, low blood pressure, pain, bruising, swelling and scarring.

The most serious side effect that can occur with penile injection therapy is priapism—a condition in which blood gets stuck in the erection chamber of the penis to cause a persistent, long-lasting erection for up to four hours. Contact your doctor immediately if your erection lasts longer than four hours because this condition requires emergency medical care.

Talk to your doctor to learn more about penile injection therapy for erectile dysfunction if you have tried other treatments without success. Your doctor can answer any questions you may have and determine whether you're a candidate for this procedure.