Penile Injections: Erectile Dysfunction Treatment Without Surgery


Erectile dysfunction is the male's inability to have or maintain a satisfactory erection for the sexual act. There are medical and surgical treatments to heal or reverse the dysfunction, aiming to help the patient to keep a healthy sexual life.
Among the non-surgical methods created to solve erectile dysfunction is the intracavernous injection.

It consists of the application of medication inside the corpora cavernosa to produce an erection. It is composed of prostaglandin, phentolamine, papaverine and/or atropine. There can also be a combination between two, three or four medications, resulting in bimix, trimix and quadmix compounds.

It is important to emphasize that if the medication contains prostaglandin, it must be kept in the refrigerator to keep it suitable for use.

Intracavernous injection is indicated for patients who previously used oral medications to solve the dysfunction, but did not obtain the expected results.


How to give the Intracavernous Injection


* The patient who does the treatment through intracavernous injection must follow the instructions given by the urologist who prescribed the medication.

The injection must be taken from 05 to 20 minutes before the sexual act so that at the right time its effect is satisfactory for the couple.


It is indicated that the patient injects the medicine on the lateral of the base of the penis, avoiding the veins, as well as the upper part where nerves and vessels are and the lower part where the urethra is located.


After injecting the medicine, the patient has to press the spot where the injection was given from 30 seconds to 01 minute.


It is necessary to be careful with the frequency of the use of the injections, the patient needs to wait 48 hours before he uses the injection again, using it 03 times a week at most.


To avoid problems such as fibrosis in the body of the penis, it is also indicated that the patient changes the sides where the drug is applied. That is, one day he should apply on the right side and the next application within 48 hours on the left side.

If the couple has a very active sex life and intercourse is frequent, intracavernous injection treatment may not fulfill the expectations.


How to buy the intracavernous injections

Only an urologist can prescribe the use of intracavernous injections as a treatment for erectile dysfunction, after exams confirm its necessity. Prostaglandin can be found in common drugstores. Fentolamine, papaverine and atropine or the combinations mentioned above can only be acquired in compounding pharmacies and require prescription.


What are the complications of using Intracavernous Injections?

Studies show that 70% of patients who use penile injections as a method to solve erectile dysfunction stop using it because it is not practical. This is because the compounds containing prostaglandin need to be stored in the refrigerator, which requires more attention from the patient in the handling with the medicine. 


Moreover, the multiple punctions made in the penis to inject the medication can result, in addition to priapism, in  fibrosis which can cause the decrease in size, thinning and/or tortuosity.


There are situations in which the dose previously prescribed by the doctor will not have the expected effect. In this case, the patient should see the doctor again to reconsider the dosage and increase it if necessary. 


The reckless decision of increasing the indicated dosage by the patient, without consulting the urologist, may cause an unwanted prolonged erection, known as priapism

Priapism is an erection which, unlike a sexual stimulated erection, causes pain and can last for more than 3 hours. In this case, the prolonged erection is caused by the low blood flow inside the corpora cavernosa, which can lead to a lack of oxygen inside the tunic and may cause severe penile deformities. 


To reverse the priapism caused by the excess of medication, needle aspirations are necessary to remove the stored blood. If this procedure is not performed, cells may die due to the lack of oxygen and can result in sexual impotence.


What to do if increasing the dose does not solve the problem?

If increasing the dose does not solve the dysfunction, it means that it is not the ideal treatment for the patient, and then other methods should be considered. 
The treatment with penile prosthesis aims to solve definitively the erectile dysfunction and makes the use of medicines unnecessary. 
The penile prosthesis aims to give rigidity to the penis so that the patient obtains the desired firmness for the sexual act. However, before placing the prosthesis it is extremely important to reconstruct the penis. 
Penile reconstruction is a procedure that comes before the placement of the prosthesis because it aims to recover the size, caliber and correct the curvature of the penis. 
If the prosthesis is placed without the penile reconstruction, the patient may lose penile size, its caliber and not have the necessary rigidity to have a healthy erection. 
It is essential that the urologist, who will treat the erectile dysfunction, have a honest conversation with the patient, exposing him all possible treatments for the recovery of penile health. 
You will find below a video, in which I talk about penile injection and the pros and cons of that
Dr. Paulo Egydio

MD, PhD, Dedicado no Tratamento da Doença de Peyronie, Pênis Curvo e Implante de Próteses Penianas. Doutor em Urologia pela USP, CRM 67482, RQE 19514. - Vencedor do Debate do Sobrevivente da AUA em 2019.

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