main menu   -   articles   -   prostate   -   stories   -   sexuality   -   resources   -   glossary   -   search     from the injections menu Some Questions and Answers About Injections IMPORTANT NOTE: The following is taken from Rockwell Physician Supplies (RPS) which sells injectable solutions and thus has a financial interest in this topic. Phoenix5 has no connection to RPS and receives nothing for providing this material. This is not an endorsement or recommendation. It is posted here purely as an example of advice and supplies to be found on the Net.  How was it discovered?  What are the medications that are used?  Are there any side effects?  How safe is it?  How long have these medications been used for this purpose?  Is it painful?  How often can I use it?  Does it work?  How long must I wait for the medication to work?  How long will the erection be maintained?  Do "Pharmacological erections" cure the arterial blockage?  Can I still have an orgasm?  What happens if I inject myself in the wrong place?  Who uses this type of treatment? How was it discovered? In 1977, while performing a bypass procedure, a surgeon accidentally injected Papaverine in the area near the penis. This produced a prolonged, fully rigid erection of 2 hours' duration. Other medications such as Phenotolamine (Regitine) were noted to induce an erection in cats when administered intravenously. It wasn't until 1982 the Dr. Virag, a surgeon in France, noted that the pressure inside the penis increased with an injection of papaverine. In 1983, Dr. Brindley, professor of Physiology at the Institute of Psychiatry in London, first reported that 11 impotent men were able to have intercourse following an injection. Since then, the injection of medication into the penis for evaluation of erectile dysfunction has been one of the most popular as well as controversial topics in Urology. Although there has been a very rapid, widespread acceptance of medically induced erections over the last 7 years, there are still several questions to be answered. What are the medications that are used? After having experimented with over forty different types of medications, we presently use three. Papaverine hydrochloride is the most often used medication. Papaverine dilates arteries by working on the muscle cells present in the arterial walls. With the relaxation of the muscle wall, dilation of the artery occurs, resulting in increased blood flow into the penis. Several researchers have also noted that blood flow out of the penis carried by the veins is reduced after papaverine injection. Phentolamine (Regitine) is another substance used for pharmacological erections. Phentolamine blocks the nerves signaling arterial muscle wall contraction. Thus, when these nerves are blocked, the muscle cells in the arterial wall relax and the artery dilates. This action compliments the action of papaverine. It is for this reason that papaverine and Phenotolamine are mixed together prior to injection. Finally, the third medication used is Prostaglandin E1. Prostaglandin E1 is a chemical that occurs naturally in the human body. It was discovered approximately 30 years ago. Prostaglandin E1 is a very potent vasodilator. It will also relax the muscle cells of the arteries of the penis resulting in an erection. Are there any side effects? We can divide the side effects into two categories. First, there are the side effects which are produced whenever a needle is struck into part of one's body. A small bruise or hematoma may develop at the site of the injection. A small nodule or lump may develop if the exact same site is injected over the long run. Rarely, scarring or fibrosis in the inner body of the penis may occur. Also, a hardened area called plaque can develop at the site of the injection. The second category of side effects are those produced by the medications. Papaverine and Phentolamine may produce a painful, sustained, prolonged erection. This is know as priapism, which occurs mostly in the beginning while the doctor is attempting to adjust the dosage of medication. Once the dosage of medication is established, priapism is rare. Very often with injections, a man may develop erections lasting 2-3 hours. We consider priapism to be an erection lasting longer than 4 hours and we request that you seek medical attention immediately if this should occur. Priapism is easy to reverse when treated early. Other side effects have been described. These are very rare and include dizziness or headache. Even less frequently is an increase in the liver enzymes usually associated with papaverine injection. Prostaglandin E1 is safer as it rarely produces priapism or liver enzyme abnormalities. It is a natural product of the body and is broken down by the enzymes locally present in the penis. One of the possible side effects of Prostaglandin E1, however, is the development of a slight dull ache in the penis. The pain will usually subside when lying down. How safe is it? These medications are safe for use in men. However, like any other medication, they do have their side effects. Papaverine has been used for over 20 years. It is a very safe medication and has been used by doctors for the dilation of arteries in the heart as well as for Alzheimer's disease and Multiple Sclerosis. Vascular surgeons have also used Papaverine for a long period of time. Radiologists use Papaverine during radiological procedures involving the arteries. Although Papaverine is approved by the Food and Drug Administration for use in the human body, its manufacturer states that "Papverine Hydrochloride is not indicated for the treatment of impotence by intracorporeal injections" One of the toxic effects reported with Papaverine is a skipped heartbeat or abnormal conduction in the heart. This usually occurs in large doses. Cardiologists and surgeons have used up to 120 mg of Papaverine intravenously every 3 hours without any toxic effects. The usual dosage used in the penis is 30 mg. This dose is only used twice a weekly. Therefore, with the amount of Papverine we use, we are well under toxic dose levels. Phentolamine has also existed for a long period of time. It has the ability to lower the blood pressure of the body when used in higher doses. Phentolamine can produce heartbeat irregularities, diarrhea, and abdominal discomfort. This medication was used in the past to uncover tumors of the adrenal glands. This test was described "pheochromocytoma test," and involved the intravenous injection of 5 mg of Phentolamine. The dose used in the penis is 0.5 mg to 1 mg, again well away from the toxic dose levels. Prostaglandin E1 is by far the safest of all the drugs we use. It is an excellent medication for dilation of the arteries, and it is used in premature babies with cardiac malformations. Prostaglandin E1 is rapidly metabolized in the lungs should it leak from the penis. Prostaglandin E1 is used in high doses in the newborn. The dose used for erections is minute, anywhere from 5 to 40 micrograms. How long have these medications been used for this purpose? Papaverine and Phenotolamine have been used for the purpose of stimulating an erection as of 1983. However, Prostaglandin E1 has only been used for the last 2-3 years. Is it painful? The needle utilized for this injection is a 30 gauge needle (ultrafine). Over ninety percent of the patients claim they have felt the needle and were surprised at how painless it was. Also, since the needle hole is very tiny, very little bruising or bleeding occurs. It is safe for patients on Aspirin, Persantine, and Coumadin. Papaverine and Phentolamine, when injected, do not produce any pain. Prostaglandin E1, on the other hand, may result in a transient dull ache at the base of the penis. This is well tolerated and does not interfere with intercourse. The pain, if present, usually subsides in 15 minutes. How often can I use it? The number of injections is not to exceed ten per month and we recommend that injections be spaced evenly. Also, the site of injection should alternate between the right and left side of the penis. Does it work? The pharmacological treatment has been successful in producing an erection in over 80% of the patients seen in the Erectile Dysfunction Unit. This erection is more than adequate to perform intercourse. The rest of the patients in whom the injection has no effect are candidates for other forms of treatment. How long must I wait for the medication to work? An erection will occur anywhere from 10 to 20 minutes following the injection. In general, Prostaglandin E1 works slightly faster than Papaverine and Phentolamine. We recommend that the site of injection be held 3 to 5 minutes after the injection. A better erection is usually obtained with the addition of foreplay. Some men may require a 30 minute wait before a fully rigid erection is obtained. In general, the amount of time that it takes to obtain an erection is a correlate of the extent of arterial blockage. How long will the erection be maintained? Anywhere from 20 minutes to an hour and a half is considered a successful result. Do "Pharmacological erections" cure the arterial blockage? Erection by the injection method is not a treatment. It does not cure or reverse the blockage of the arteries. It simply allows one to obtain an erection without the need of surgery or a penile prosthesis. Furthermore, the injections may not continue to work, especially if the condition (high cholesterol, high blood pressure, etc.) continues to affect the penile arteries. Tobacco smoking will also affect the erectile function an may worsen the atherosclerosis of the penile arteries to the point where injections will not work. Can I still have an orgasm? Erections produced by the injection method will not interfere with the capacity to obtain an orgasm. Generally, men who are able to achieve orgasm without an erection will continue to do so when having an erection by the injection method. What happens if I inject myself in the wrong place? A 30 gauge ultrafine needle is utilized for the injection. There are only four possible locations for the injection. The first one is into the body of the penis which will produce an erection. If the injection occurs in one of the penile veins, a bruise may result. If the tube that drains the bladder and the urethra is injected, the medication may leak out of the tip of the penis. Injections into the urethra will not result in an erection. It is very unlikely that injection in the wrong place or into the urethra will cause a problem. Finally, the last possible mishap that may occur is injection underneath the skin and this will result in a temporary swelling of the skin. Also, an erection will not occur. Who uses this type of treatment? A wide range of men use the injection method to obtain erections. In general, these men are active and would like to remain sexually active. Men who are reluctant to have surgery find the injection method to be a good alternative to a penile prosthesis. It is for this reason that pharmacological erections are gaining in popularity. To see diagrams of how to do the injections, click here. Go to INJECTIONS MENU     main menu   -   articles   -   prostate   -   stories   -   sexuality   -   resources   -   glossary   -   search This information is provided for educational purposes only and does not replace or amend professional medical advice. Unless otherwise stated and credited, the content of Phoenix5 (P5) is by and the opinion of and copyright © 2000 Robert Vaughn Young. All Rights Reserved. P5 is at <http://www.phoenix5.org>. P5's policy regarding privacy and right to reprint are at <www.phoenix5.org/infopolicy>.