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ED Injections: What Are the Risks?

Katelyn Hagerty FNP

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 7/29/2021

Needles and penises aren’t two things that typically go together. However, suppose you are one of the millions of men experiencing erectile dysfunction

In that case, ED injections might be a good option to help get your mojo back.

What are ED Injections? 

Some estimations indicate that over 18 million adult men in the U.S. have erectile dysfunction. 

While there are ED medications like Cialis®, Viagra® and Levitra® that treat this condition, these medications don’t work for every man. 

The thought of inserting a needle into your penis might not sound like a good time. Still, ED injections are a viable option for about 70 percent of men experiencing erectile dysfunction.

The three most commonly used medications for injection therapy are Trimix®, Bimix® and Papaverine®. 

Most men begin injection therapy with Trimix, a mixture of three ingredients: alprostadil, phentolamine and papaverine. 

These ingredients work by relaxing the smooth muscles and dilating the blood vessels in the penis, which in turn allows more blood to flow into it, thereby causing an erection.

What Does the Process Look Like? 

As you prep for the injection, there are a few things you should know before you begin:

Do not take these medications within 18 hours either before or after an injection:

  • Vardenafil (Levitra®): 10 mg to 20 mg

  • Sildenafil (Viagra®): 20 mg to 100 mg

  • Avanafil (Stendra®): 50 mg to 200 mg

If you take tadalafil (Cialis®) 10 mg or 20 mg, do not inject within 72 hours of taking the medication.

If you are using tadalafil (Cialis) 5 mg daily, ask your healthcare provider how you should use this medication along with your injections.

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Preparing the Injection

Gather your supplies:

  • 1 medication vial

  • 1 syringe (single-use only)

  • 2 alcohol wipes

  • Sharps container

Following this, wash your hands with soap and water. Insert the needle into the vial of medication and draw the solution into the syringe by pulling on the plunger. 

Make sure you pull enough of the solution into the needed to go past your prescribed dose. Then, push the plunger down until you’re at the correct level (this helps get rid of air bubbles).

Note: If you’re using Trimix, put the medication vial back into the fridge. If you’re using Bimix or Papaverine, you don’t need to store your medication in the fridge.

Choosing an Injection Site

It’s important to select a proper injection site on your penis so as to avoid injecting the medication into a nerve or blood vessel.

It’s also important to change sides of your penis and injection sites frequently in order to prevent causing any damage to the tissue in your penis.  

Make sure to keep a record each time, so you don’t forget. Other important tips to note:

  • Don’t inject the needle into any vein you can see or feel because it could cause a large bruise on your penis.

  • Don’t inject the needle straight down on the top or the bottom of your penis.

A helpful method may be mentally dividing your penis into three groups. The first is the middle — you always want to inject to place the injection in the middle of the shaft. 

The second is the 10 o’clock position (left side, looking down), and the two o’clock position (right side, looking down). 

What Are the Risks of ED Injections? 

Like other types of injections, there’s a small but normal risk of bruising or bleeding at the injection site. 

But if you’re careful and follow your healthcare provider’s instructions, these problems may be avoidable.

Knowing the right place to inject the needle helps avoid temporary swelling and irritation. 

It is also important to note that frequently injecting into the penis may cause scarring, known as Peyronie’s disease.

Some men also report mild pain after injecting. If you’re experiencing pain or any bleeding that lasts more than a couple of minutes after the injection, see a healthcare provider immediately.

Additionally, in some cases, priapism, which is a prolonged erection that can be painful, doesn’t involve sex and may even be painful, may occur. 

If you experience priapism while using the ED injection, an ice pack on the penis may help. Taking a decongestant containing phenylephrine may help, too. 

However, if the erection lasts longer than four hours, seek immediate medical attention.

What Are Alternatives to ED Injections?

If ED injections aren’t your thing, there are other alternative treatment options.

Medication

Oral medications that stimulate blood flow to the penis and help with ED include:

  • Sildenafil (Viagra®) 

  • Avanafil (Stendra®)

  • Tadalafil (Cialis®)

  • Vardenafil (Levitra®, Staxyn®)

Alprostadil (Caverject®, Edex® and Muse®) is another medication administered as both a penile suppository or a self-injection. 

Side effects can include headache, facial flushing, upset stomach, sensitivity to light or blurry vision.

Testosterone Replacement Therapy (TRT)

Before Viagra and other medications were around, testosterone therapy was used for the treatment of ED. 

However, TRT is not a miracle cure for ED. Many men suffering from ED do not have low levels of testosterone. 

Nowadays, a healthcare provider won’t consider prescribing TRT as a treatment for ED unless other symptoms are present, such as decreased libido and fatigue.

Vacuum Pumps

A vacuum erection device (VED) is an external device placed on the penis to stimulate an erection. 

When pumped, it creates enough vacuum to physically pull blood into the penis Then, a special ring is placed around the base of the penis to hold the erection firm.

Side effects can include bruising or burst blood vessels, penile pain or pain with ejaculation, numbness, unstable erection or penis feeling “cold” to partner.

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The Bottom Line on ED Injections

If oral ED medications don’t work for you and vacuum pumps aren’t your jam, ED injections might be your golden ticket to getting your erection back. 

Talk to your healthcare provider about Penile Injection Therapy to see if it’s right for you.

7 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. McCabe, M. P., Sharlip, I. D., Lewis, R., Atalla, E., Balon, R., Fisher, A. D., Laumann, E., Lee, S. W., & Segraves, R. T. (2016). Incidence and Prevalence of Sexual Dysfunction in Women and Men: A Consensus Statement from the Fourth International Consultation on Sexual Medicine 2015. The journal of sexual medicine, 13(2), pp. 144–152. Retrieved from https://doi.org/10.1016/j.jsxm.2015.12.034
  2. Bearelly, P., Phillips, E. A., Pan, S., OBrien, K., Asher, K., Martinez, D., & Munarriz, R. (2020). Long-term intracavernosal injection therapy: treatment efficacy and patient satisfaction. International journal of impotence research, 32(3), pp. 345–351. Retrieved from https://doi.org/10.1038/s41443-019-0186-z
  3. Penile Injection Therapy (2018). Retrieved from https://www.mskcc.org/cancer-care/patient-education/penile-injection-therapy
  4. Successful self penile injection hints, questions, and answers. (n.d.). Retrieved from https://urology.ucsf.edu/sites/urology.ucsf.edu/files/uploaded-files/attachments/successful_self_penile_injection_2.pdf
  5. Erectile dysfunction (ED) in men (n.d.). Retrieved from https://healthcare.utah.edu/menshealth/conditions/erectile-dysfunction/
  6. Pendick, D. (2012). A logical approach to treating erectile dysfunction. Retrieved from https://www.health.harvard.edu/blog/a-logical-approach-to-treating-erectile-dysfunction-201211275583
  7. Erectile dysfunction (ED) in men (n.d.). Retrieved from https://healthcare.utah.edu/menshealth/conditions/erectile-dysfunction/

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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