When a man has erectile dysfunction (ED), he cannot achieve or maintain a firm erection. ED also is called "impotence." About one in every ten men has erectile dysfunction or some degree of impotence.

Most ED has a physical cause. Diabetes and the side effects of prostate cancer treatment can reduce or prevent blood flow and nerve impulses to the penis. So can pelvic injury and the side effects of some drugs.

Penile injection therapy is one of several proven treatments for impotence. Injection therapy originated in the 1980s. It was more commonly used before the introduction of newer treatments. Generally, it is less effective than Viagra and urethral suppositories.

How injection therapy causes an erection

Injection therapy typically uses a combination of drugs prescribed by a doctor, usually a urologist. The man directly injects the drugs into the side of his penis. The drugs relax muscles and increase blood flow to create an erection.

The most common drugs are Papavarine, Phentolamine and alprostadil. The doctor may combine two of these drugs (called a "bi-mix") or all three of the drugs (called a "tri-mix.")

The drugs are injected directly into the penis through a fine-gauge "insulin-style" needle. A firm erection develops in 10-15 minutes and lasts up to 60 minutes. If a prolonged erection occurs, the man should contact his prescribing physician immediately or seek medical treatment.

Who should use injection therapy?

Injection therapy can be an alternative for the 30-40% of men who commonly fail with Viagra. The best treatment for erectile dysfunction, however, depends on many things. These include a man's health and personal and physical tolerance for the treatment. A man with ED should involve his spouse or partner and his doctor in the treatment decision.

Who should NOT use injection therapy?

Some conditions rule out the use of injection therapy.

• Allergy to alprostadil.
• Abnormally formed penis.
• Peyronie's disease or penis angulation.
• Carvernosal fibrosis.
• Diseases that might result in prolonged erection, such as sickle cell anemia.
  

Injection therapy results

Injection therapy can be very effective. About 75-85% of those who choose this option have success. Failure often is due to extremely poor blood flow or venous leakage in the penis.

Some men must combine the injection with an external vacuum device to get satisfactory results. This procedure, however, can be cumbersome and expensive. The additional time it takes tends to reduce romantic spontaneity.

Injection therapy advantages

• Fast-onset, high-quality erection.
• Erection may last longer than a natural erection.
• Partners have no reported side effects.
  

Injection therapy disadvantages

• Side effects may occur.
• Limits sexual spontaneity.
• Some men feel a sting from the needle.
• Some men feel penile pain after injection.
• Some men develop nodules in their penis, although this may disappear after a short break from injections. In a small number of cases, permanent nodules may occur with long-term use.
• Some scarring can occur with multiple use. This can further complicate the process of achieving an erection.
• Although rare, prolonged erection can occur. Such an erection can turn into "priapism." This is a painful erection lasting more than four hours. If priapism occurs, immediately seek medical help.
• Depending on the drugs used, injections cost about $15-25 each. Medicare does not pay for the treatment, but some insurance plans will cover the cost of the prescription.
• The treatment may fail, causing additional stress and anxiety.

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