Intracavernosal Injections

Despite the introduction of Viagra a few years ago and the recent FDA approvals of Levitra and Cialis, self-injection therapy remains a popular and very effective mode of therapy for erectile dysfunction (ED). Popularized in the early 1980’s, self-administered penile injections had an instant appeal as an alternative to the only available treatment at the time, the penile prosthesis. Although some men hesitate to think about placing a needle into their penis, and some defer their treatment to “think” about it, most men choosing injection therapy quickly realize that the benefit of the injection far outweighs that little pin-prick.

The injectable drug combinations of Papaverine and Regitine (bi-mix) and Papaverine, Regitine and Prostaglandin (tri-mix) have withstood the test of time. Nearly twenty years of patient experience has been gained and much has been learned. Retrospective studies have shown injection therapy to be safe and effective. Liver toxicity, once a concern because of the possible association with papaverine, has become a non-issue. Scar tissue formation as a result of post-injection bleeding can be avoided with proper post-injection compression. Priapism, an unwanted persistent rigid erection lasting for many hours, can be avoided with medically supervised dose-titration office visits. And finally, needle size has been reduced to a user friendly 31 gauge 5/16th length. With proper instruction and medical supervision, adverse effects are practically non-existent. This treatment has evolved at the Center for Sexual Medicine over the past twenty years. Currently, ten different combinations of medications are available for treating all types of vascular and neurologic erectile dysfunctions. For men who have undergone radical prostatectomy and experience discomfort with injections of prostaglandin, we have developed a mixture using lower concentrations of prostaglandin that is effective, yet pain free.

Men finding success with injections and with at least one of the FDA approved oral medications for erectile dysfunction may now have more treatment options. Many men ask about available treatments, including the feasibility of administering an injection simultaneously with the pill. There are no double blind placebo controlled safety studies available for the combined use of a PDE-5 inhibitor and intracavernosal injection therapy as yet. Always check with your physician before changing your medication. While people’s results from the three oral therapies may differ, the use of injections should not interfere with the potential effectiveness of the oral agents. Whereas self-injection therapy was once a first line treatment for erectile dysfunction, it is now a safe and effective treatment should oral therapy fail. There is better than an 80% chance that self-injection therapy utilizing vasoactive drugs is an effective treatment.

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of BU School of Medicine