The purpose of this document is to instruct you on how to give yourself intrapenile injections of medication in order to treat erectile dysfunction. These injections have been used successfully for the past few years by numerous patients and are considered fairly safe. Nevertheless, injections are not a cure for your erectile dysfunction. As such, treatment with this method will continue for as long as the following three conditions are met: the injections suit your lifestyle, you have no ill effects from the injections, and the medication helps you achieve an adequate erection.
HOW DOES IT WORK?
The injections work by putting medicine into the areas of your penis called the corpora cavernosa. The corpora cavernosa are two cylinder-shaped structures that straddle the urethra and lie side-by-side in the shaft of your penis. These two bodies make up the greater portion of the shaft of your penis. Any medicine put into one of these cylinders will automatically go into the other because of the connection between the two.
The medicines used to treat erectile dysfunction work by causing increased blood flow into the corpora cavernosa and decreased blood drainage away from them. These effects together increase the amount of blood in the penis and cause an erection to occur.
HOW TO GET STARTED
In order to successfully use penile injections to get an erection, you will need to know the following:
- How to get the medicine into the syringe
- How to inject it into your penis
- When to do the above
- A 1 ml insulin-type syringe with a 1/2 inch, 27, 28 or 29 gauge needle
- Rubbing alcohol and cotton balls, or alcohol wipes
- Vial of the medicine to be used (Note: Store medicine in your refrigerator only.)
Filling the syringe
This step is probably the most technically difficult part of the whole process. The important points to remember in filling the syringe are:
a) Wash your hands.
b) Clean the top of the medicine vial with alcohol and let dry.
c) Pull back the plunger so the amount of air in the syringe equals the dose of the medicine you plan to take.
d) Remove the cap of the needle and set it down carefully.
e) Inject the air from the syringe into the medicine vial.
f) Fill the syringe by pulling back on the plunger with the amount of medicine required.
g) Check for air bubbles and remove them by pushing in the plunger and withdrawing again.
Small air bubbles are in no way dangerous to you if you follow all other self-injection instructions carefully. You will, however, reduce the amount of the medicine you are using by the size of any air bubbles present. This reduction may make the medication less effective for you. It is therefore important to try to remove them.
Air will tend to collect at the highest end of the syringe. First check the syringe for air bubbles with the needle inside the bottle and the bottle flipped upside-down. If you see any bubbles, push the medicine back into the vial and slowly fill the syringe again. If necessary, you can remove bubbles from the bottom of the syringe by tapping it with your finger. You can also check for air bubbles by laying the syringe on its side across the top of a cup. After you refill, check again.
If you have difficulty seeing air bubbles, seeing the numbers on the syringe, or handling the syringe itself, ask us what to do.
Removing fluid from vial
Tapping syringe to release air bubbles
It is quite normal for you to feel a bit nervous about giving yourself an injection. Only by doing it once or twice will you truly be able to tell if this feeling will pass or if this method is simply not for you. If you follow the directions below, you should be able to give yourself an injection into your penis with relative safety.
The injection is given into the corpora cavernosa. Since these bodies make up the majority of the penile shaft, it is relatively easy to locate and self-inject into them. In order to properly identify these areas, you need to start with a proper grip on your penis.
The grip you will use is similar to the three-fingered grip you use to throw a baseball. Put the thumb on the top part of the head of the penis, the second and third fingers together on the bottom of your penis, and grip firmly. Gently pull your penis to either the left or the right while keeping the thumb on the top. This exposes the area where you should inject into your penis: on the sides, from the base to below the head. Keeping your thumb on top while you grip and pull will help you from twisting your penis and exposing the top or bottom.
Injection sites are shaded (top of penis)
Areas not to inject circled (cross section).
Areas OK to inject are shown by the syringe.
Get the medicine-filled syringe, uncap it, and put it down on a clean surface in close reach so you can use it in a minute. Right-handers will probably want to use their right hands to inject, and left-handers will want to use their left.
Grip your penis as described above, and pull it over to one side and choose a spot on either side of your penis to inject. Clean the spot with some alcohol while gripping your penis with your other hand. Pick up the syringe and hold it the same way you would pick up a dart or a pencil. Now, use your wrist to "poke" the needle straight through the skin and into the penis. You will feel some resistance when you do this; that is OK. Remember to keep the needle at a right angle to the surface of the skin of the penis.
Remove either your thumb or first finger from the syringe while still holding it with the rest of your hand. Use that finger to slowly but firmly inject the medication into your penis. INJECTION SHOULD BE PAINLESS AND SHOULD MEET LITTLE RESISTANCE. If you meet resistance, gently pull the syringe out 1/4-inch and try again. If you still meet resistance, remove the needle and try again.
Immediately after giving yourself the injection, press firmly on the injection site for three minutes with your thumb and first finger, using a cotton ball or alcohol swab. Keeping pressure on this area for a full three minutes by the clock after injecting will help prevent a bump or bruise from occurring at the site. Minor bruising of the penis, however, is not at all serious and may be treated with warm compresses as needed. Please contact us before your next injection if you experience uncomfortable and/or extensive bruising of your penis.
Inserting the needle into the penis
Injecting the contents of the syringe
The medication tends to work better if you are standing up, as this helps pool blood in your penis. External stimulation to the penis will also greatly enhance the effects of the medication. You should notice results in 10 to 15 minutes after your injection. If the results are not optimal for you, do not use more medication. You will be in danger of using too much at once if you do. You may want to try some extra physical stimulation to your penis. If this does not help, call the clinic when convenient and we will help you solve the problem.
Your erection should last on average from one-half hour to two hours. Please fill out the log supplied to you in the clinic at your earliest convenience so we may better evaluate how this medication is working for you.
IF YOUR ERECTION LASTS FOR MORE THAN FOUR TO SIX HOURS, PLEASE CALL.
You may need medical intervention to avoid injury to your penis. If you are unable to reach anyone by phone, go directly to an emergency room for help.
In the beginning, we recommend using the medicine only once a week for the first four to six uses; then you should return to see us. We will ascertain whether any scar tissue is forming in the injection site. Once things are going well, we will suggest that you try to limit your use of the medication to less than eight to10 times a month (or approximately twice a week). If you find you desire to use it more frequently than that, please call and discuss the matter with us.
WHEN AND HOW TO USE IT
Your first decision is whether you want your partner to be involved with any part of the actual injection process. What you (or you and your partner) decide about this will determine a lot about the injection process as a whole. If possible, you should discuss your use of intrapenile injections with your partner long before you actually attempt to use them during sexual activity. You may or may not want your partner to be involved in the actual injection process -- the choice is yours. Keep in mind that in general, all treatments for erectile dysfunction work best when both partners are cooperative and interested.
Partners who want to take an active role in the actual injection process should be encouraged to do so. You should not, however, assume that your partner is uncaring or indifferent if your partner chooses not to be involved with the actual injections. The most common reasons for partner refusal is the partner's fear of inflicting pain on a loved one. Regardless of thoughts about the process, however, this will probably have no effect on what your partner thinks of the results. How you time your use of the penile shot is a very individual decision. It will depend upon how fast and how well the medicine works for you, and on your and your partner's personality.
Some men prefer to become partially erect through physical stimulation prior to getting an injection. If you do, think about whether you want to have a syringe filled and ready to use when the time comes.
Some individuals like to have a syringe made up and ready for use prior to initiating any sexual foreplay. If you choose to do this, be sure the syringe does not sit out of the refrigerator for longer than two to four hours (less time in warm weather). Also, be sure that the medication does not leak out of the syringe or get accidentally pushed out. You can do this by handling the syringe carefully and by quickly checking its contents just before you inject it.
WHAT DO I DO IF I AM AFRAID OF NEEDLES?
Automatic injecting devices (such as Injectaid) can make the injecting process easier for some men. These devices will place the needle into the penis with a spring loaded mechanism. The medicine will still need to injected after the needle is in place. Newer devices, although more complicated, will even inject the medicine.
Penile self-injection is a safe and effective treatment for erectile dysfunction. Your success or failure with this method will depend both on how the medicine works for you and how you "work with" the medicine. Keep in mind that not every method is suited to every person. Do not hesitate to call if you have a problem.
After starting on a self-injection program, you will be asked to return in six weeks (or after four to six injections) for a recheck. Please bring your injection record with you to this visit, as well as any questions you have. If you decide to continue with this method of treatment, you should plan to return every six months. In between visits, you can obtain refills by calling us to arrange a time to pick up more medicine.
When you return for your six month checks, we will first review your use of this treatment. A genital exam will then be done to check for penile scarring due to the injections. Depending on your age and/or other health problems you might have, we may also do a prostate exam and possibly some laboratory blood tests. Don't hesitate to call if you have any questions.