ED Injections: What Are the Risks?

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 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 muscle and opening the blood vessels in the penis, 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 the following medications within 18 hours of injecting (before or after):

  • Sildenafil (Viagra®): 20 mg to 100 mg
  • Vardenafil (Levitra®): 10 mg to 20 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.

Preparing the injection

Gather your supplies:

  • 1 medication vial
  • 1 syringe (single-use only)
  • 2 alcohol wipes
  • Sharps container

Then, wash your hands well with soap and water. Insert the needle into the vial and draw up the medication. Pull the plunger down past your prescribed dose. This will help remove any air bubbles. Slowly push the plunger back up to your prescribed dose. Check the amount of medication in the syringe to make sure it’s the correct dose.

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 a refrigerator.

Choosing an injection site

You must inject the medication into a specific area of your penis. This is so you don’t inject into a nerve or blood vessel.

To prevent trauma to your penile tissue, always change sides of your penis each time you inject the medication (right side, then left side). 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? 

As with any type of injection, there’s a slight risk of bleeding or bruising at the injection site. But if you’re careful and follow your healthcare provider’s instructions, these problems may be avoidable.

Proper placement of the needle can help avoid temporary irritation and swelling. 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.

In rare cases, priapism (a prolonged erection that occurs without, or long after, sexual stimulation) may occur. To treat priapism, try applying an ice pack to your penis. 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.


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

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 pulls 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.

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.

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.