When oral medication fails, penile injections to induce erection are another possible ED treatment. While the idea of injecting the penis may be unappealing, the needle typically used for these injections is thin and short; most patients are not bothered by it.
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Penile rehabilitation is a strategy for helping patients regain erectile function following surgery or radiation for prostate or bladder cancer. The theory behind the treatment is that poor blood flow after cancer treatment leads to scarring and shrinkage of the penis. In this context, even if the nerves recover over time, changes to the penis itself may make erections difficult. Theoretically, if blood flow to the penis can be maintained, the tissue may be less prone to scarring and shrinkage. This is typically accomplished by administering regular doses of Viagra, Levitra, Stendra or Cialis without the patient necessarily planning to have sex.
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In some cases, physical exercises or a vacuum erection device (sometimes called a penis pump) may also be used. You should know, however, that after reviewing the available data, the American Urological Association's guideline panel on erectile dysfunction recommended informing all patients that there is not convincing evidence that penile rehabilitation works for recovery of spontaneous, unassisted erections. Be sure to consider the costs and potential short-term side effects as you decide whether to take medications as part of penile rehabilitation. Regardless of their use in rehabilitation, ED medications can help patients achieve erection for sexual activity after prostate cancer treatment. We also encourage patients to maintain intimacy with sexual partners during the recovery process; the emotional connection is as important as the physical recovery. The most commonly used drugs are prostaglandin E1 alone or a combination of drugs that increase blood flow, such as papaverine and phentolamine. Drug combinations, sometimes called bimix or trimix, may be more effective than single drugs alone and less likely to cause side effects.
| Product | Dosage | Quantity + Bonus | Price | |
|---|---|---|---|---|
| Kamagra Polo | 100 mg | 120 + 6 Pills | 327.15€ 311.57€ | |
| Viagra Professional | 100mg | 30 Pills | 88.92€ 84.69€ | |
| Levitra Professional | 20mg | 180 + 4 Pills | 502.31€ 478.39€ | |
| Viagra Generic | 150mg | 90 + 6 Pills | 147.18€ 140.17€ | |
| Apcalis SX Oral Jelly | 20mg | 70 + 7 Sachets | 184.98€ 176.17€ | |
| Kamagra Oral Jelly | 100 mg | 110 + 9 Sachets | 334.87€ 318.92€ | |
| Kamagra Soft Tabs | 100 mg | 20 Pills | 79.79€ 75.99€ | |
| Viagra Super Active | 100mg | 60 + 8 Pills | 116.84€ 111.28€ | |
| Viagra Original | 100mg | 4 Pills | 40.94€ 38.99€ | |
| Cialis Soft Tabs | 20mg | 10 Pills | 39.03€ 37.17€ |
Patients must have appropriate training and education before beginning penile injection therapy. The injections must be given in proper amounts with the appropriate technique in order to minimize the risk of penile scarring or priapism, a prolonged and painful erection that can cause permanent damage. The medication is injected on one side of the penis into the corpora cavernosa, spongy tissue on either side of the shaft that contains the blood vessels involved in producing erections. Patients can administer the injection themselves, enlist a partner to help, or use an auto-injector (a spring-loaded device that inserts the needle quickly, minimizing psychological hesitancy). If possible, patients should receive in-office training; if not, remote counseling and viewing of vetted video training materials may suffice. Generally performed with an insulin syringe which has a super p force 200mg small needle.
Can Supplements Help Erectile Dysfunction?
Take 5-20 mg at least 2 hours before you wish to engage in sexual activity. Take 50-200 mg 30 minutes before you wish to engage in sexual activity. Stendra works best on an empty stomach. Stendra works best 30 minutes to four hours you take it. For all of these medications, if you don't achieve an erection after six attempts that include stimulation, speak with your provider about adjusting the dose or trying a different treatment.
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Most common side effects include headache, facial flushing and upset stomach. A small number of patients taking Viagra or Levitra complain of a "blue cast" to their vision, sensitivity to light or blurred vision. Back pain and joint aches may occur with Cialis. Talk to your provider about using Viagra, Cialis, Levitra or Stendra if you take Flomax, Hytrin, Cardura, Rapaflo or Uroxatral. Though rare, using these medications in combination may lead to significant drops in blood pressure. Skin and injection site are prepared with alcohol swab.
Counseling for Erectile Dysfunction
Consider beginning injections two or three times per week or using vacuum erection device two or three times per week. Continue Viagra 50 mg or Levitra 10 mg four or five days per week on days when not using injections. If you have had no spontaneous erections after one year and are unsatisfied with penile injections or using a vacuum erection device, consider alternative ED treatments. For patients with acquired penile curvature (Peyronie's disease) or complex sexual concerns, earlier intervention may be warranted. To administer Muse, an acronym for medicated urethral system for erection, a small pellet of medication (prostaglandin E1) is placed inside the penile urethra.
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The medication is then absorbed and helps to produce an erection. Muse may be used when oral pills are not an option or have failed. Large studies in both Europe and the United States have shown Muse to be effective – after dose adjustment – in 43% of patients with ED from various causes. The major advantage of this therapy is that it's applied locally and has few systemic side effects. However, Muse may cause significant penile pain and may be transferred to a partner during sex, leading to pain or discomfort for them. Medication is drawn up in a sterile manner. Medication is injected on one side of the penis. Pressure is held on the injection site for several minutes.
Should I Get Surgery for Erectile Dysfunction?
There are numerous protocols for penile rehabilitation. Please understand that this protocol hasn't been shown to be superior to any other, and there are no data suggesting it will reliably help with recovery. This protocol therefore should be taken as a suggested but not necessary part of ED recovery. Viagra 100 mg or Levitra 20 mg two times per week and Viagra 50 mg or Levitra 10 mg on days you're not taking the bigger dose. Viagra 50 mg or Levitra 10 bayer vardenafil mg daily or Cialis 10 mg three times per week.
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Take in evening to enhance nocturnal erections. Take Viagra 100 mg, Levitra 20 mg or Cialis 20 mg at least weekly with sexual stimulation. If you have a response to oral medications (penile fullness or erection), continue Viagra 50 mg or Levitra 10 mg daily four or five days per week and Viagra 100 mg or Levitra 20 mg two or three times per week. Alternatively, use Cialis 20 mg three times per week. If you have no or minimal response to oral medications, begin penile injections or vacuum erection instruction (or both). For more details on exactly where and how to inject the penis and other information on this therapy, see the Penile Injections: A Patient Guide or Dr. Stacy Elliott's instructional video "Understanding Penile Injection" on YouTube. Occasionally associated with fainting, dizziness and low blood pressure.
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Priapism, or a prolonged erection (lasting more than four hours), may occur. Can cause pain, infection, bruising and scarring if patients are not trained properly.
| Age Range | Typical User Profile | Usage Frequency | Notes |
|---|---|---|---|
| 20-30 years | Young men seeking performance boost | Occasional or as needed | Usually healthy, minimal side effects |
| 30-50 years | Middle-aged men experiencing mild ED | Regular use with doctor guidance | Often combined with lifestyle changes |
| 50+ years | Older men with chronic ED | Under medical supervision | Monitor blood pressure and health |
May require self-stimulation to increase blood flow to the penis. If erection lasts more than four hours, seek medical care at your local emergency room or contact your urologist. May be ineffective if patients have vascular disease or blood flow problems. A vacuum erection device, or penis pump, may be helpful for patients who have only partial erections or who don't respond to or want to use other treatments. The device consists of a plastic cylinder connected to a pump and a constriction ring.
What Are Alternative Treatments for Erectile Dysfunction?
Doses of an ED drug and an alpha-blocker should ideally be separated by at least four hours. The following shows how we prescribe these medications at UCSF. Please consult doctor about the right dosage for you. Take 25-100 mg one hour before you wish to engage in sexual activity. Viagra works best 30 minutes to four hours after you take it.
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Viagra works best on an empty stomach. Don't take it after a high-fat meal, as it will take longer to work. Take 5-20 mg one hour before you wish to engage in sexual activity. Levitra works best on an empty stomach. Levitra works best 30 minutes to four hours after you take it. Either manual or battery power is used to create suction around the penis and draw blood into it; the constriction ring is then released around the base of the penis to keep blood in the penis and maintain the erection.
| Risk | Description | Precautionary Measures |
|---|---|---|
| Blood Pressure Fluctuations | Sudden changes in blood pressure | Consult doctor if hypertensive |
| Allergic Reactions | Hives, swelling, difficulty breathing | Discontinue use, seek medical attention |
| Drug Interactions | Interactions with nitrates or certain medications | Always check with healthcare provider |
| Dependence Risk | Psychological reliance on pills | Use as directed, avoid overuse |
The device may be used safely for up to 30 minutes, at which point the constriction ring should be removed.
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The advantages of such a device are that it's relatively inexpensive and easy to use and there's no concerns about drug side effects or interactions.
| Brand Name | Active Ingredient | Price Range | User Ratings | Notes |
|---|---|---|---|---|
| Viagra | Sildenafil | High | 4.5/5 | Prescribed medication |
| Cialis | Tadalafil | Moderate | 4.4/5 | Long-lasting effects |
| Kamagra | Sildenafil, Dapoxetine | Low | 4.0/5 | Often sold online, reliability varies |
| VigRX Plus | Natural ingredients | Moderate | 4.2/5 | Natural alternative |
Possible side effects of the device include temporary penile numbness, bruising, and semen trapped by the ring.
How do health care professionals treat ED?
It should not be used by patients whose partners are pregnant because the main ingredient may induce uterine contractions. In rare cases, Muse may also lead to bleeding, dizziness or decreased blood pressure. For patients who find Muse effective but painful, applying a small dose of lidocaine jelly to the urethra before placing the pellet may increase tolerance. Patients interested in trying Muse should receive instruction on proper technique in their provider's office; a test dose may be applied in this setting, so that side effects can be assessed. Patients should be instructed in the office.
Cancer treatments
The medication is inserted after urination; after insertion, it helps to massage the penis between two hands to dissolve the pellet. The absorbed medication helps lead to an erection. Rarely causes priapism – a prolonged erection (lasting more than four hours). After placement, stimulation is required to increase blood flow to the penis. Maximum use is one suppository per day. Some patients also report that the erection they obtain with the device feels somewhat artificial. For men with ED who don't tolerate or respond to other treatments, a penile prosthesis offers an effective yet more invasive alternative, requiring surgery. Prostheses come in either a semirigid form or as an inflatable device.
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Most men prefer the inflatable prosthesis because it permits a more natural appearance when the penis is flaccid. Patients are under general anesthesia (completely asleep) for surgical placement of the prosthesis.