What are the indications for penile injection therapy?
Penile intracavernosal injection therapy is used to treat troublesome erectile dysfunction. It is generally recommended in the following situations:
- Oral tablets have not worked well enough, or are unsuitable for you.
- Erectile dysfunction has occurred after prostate or pelvic surgery, with associated cavernosal (penile) nerve damage.
- You prefer an on-demand treatment that reliably produces an erection.
Most men respond well to self-injection once they have been taught the technique.
What are the alternatives?
- Psychosexual counselling — Where emotional or relationship factors play a part.
- Oral tablets — Including sildenafil, tadalafil, vardenafil or avanafil.
- Vacuum erection device — An external pump used with a constriction ring.
- Urethral pellet (MUSE) or topical cream — Medication placed in, or applied to, the urethra or glans penis.
- Penile implant — A surgical device for men who do not respond to other treatments.
What happens before surgery?
This is not an operation — it is a treatment you learn to do yourself. At your appointment the team will review your history and medications and explain the technique. The first injection is usually given by a member of the team so you can see exactly how it is done. Injection therapy is used with extra caution if you take blood-thinning medication, so please let the team know beforehand.
What does the procedure involve?
- The skin of the penis is cleaned with a sterile wipe.
- A very fine needle is used to inject a small dose of medication (usually a drug called alprostadil) into the penis.
- The injection is placed into the side of the penis — never the top, underside, head or into a visible vein.
- A quick, accurate injection keeps any discomfort to a minimum.
- For your safety, your first injection will be a low dose. Based on how you respond, you will be given clear instructions on how to adjust the dose over time to achieve an erection that is both safe and suitable for sexual activity.
What are the side-effects?
- Discomfort at the time of the injection (almost all patients).
- Bruising under the skin of the penis (almost all patients).
- An ache in the penis as the erection develops (20 to 30%).
- Scarring or bending with repeated injections into the same spot (10-20%).
- The injection failing to produce an erection (5-10%).
- A prolonged, painful erection (priapism) lasting over 4 hours, needing hospital treatment (less than 2%).
What happens after surgery?
The full effect takes up to 15 minutes, and your first erection usually lasts around 45 minutes. A mild ache for a few hours is common and not a cause for concern. If the erection stays rigid, try simple measures such as a cold shower or gentle exercise. Any erection lasting longer than four hours is considered a medical emergency, requiring prompt treatment. Go straight to your nearest Emergency Department and tell them the type and dose of injection you have received.
Patient information leaflet
Read the British Association of Urological Surgeons (BAUS) leaflet: Penile injection for erection.
View the BAUS leaflet