Penile injection therapy is one of the several approaches that we can use to help patients who have erectile dysfunction. There are several treatments available, which include medication, such as Viagra, Levitra, Cialis, penile injection therapy as well as vacuum devices and there may be a role for injection therapy. It can be used in situations where medications may not be effective or where patients may have significant side effects from some of the medications that they've tried. In these cases then, patients are often offered alternative forms of therapy, which may include the use of vacuum device or penile injection therapy.
Let's talk about how we do penile injection therapy. Basically, a formulation of medications, usually a mixture of several compounds that have properties that create vasodilation, or dilation of blood vessels in the penis, is formulated and this formulation is then directly injected into the side of the penis. We use a very small syringe and a small voluminous solution is injected directly into the penis, usually along the side. You never want to inject on top or on the bottom because there are critical structures in those areas. But we instruct patients on how to do these injections.
The injection is done to the side of the penis and the medication is directly delivered into the penile tissues where the medication then has direct effect on those tissues to stimulate an erection. The advantage of doing this is that there is much less medication that then gets absorbed systemically throughout the body. So we tend not to see certain side effects that you can see with medications, things such as headaches, dizziness, diarrhea, upset stomach, stuffiness or flushing. These are all common systemic side effects that occur with medications. However, with injection therapy, we tend not to see these types of side effects. There can be other side effects that occur, these are due to the injection process. There can be bruising along the side of the penis.
As with medication therapy, with injection therapy, if you have an erection that lasts longer than four hours, that is a medical emergency and you need to bring that to the attention of your physicians. There can be bleeding or something called a hematoma, which is a clot formation under the skin. There may be certain warnings.
Some patients may not be candidates to undergo injection therapy. These include patients who are on blood thinners for various other medical conditions. Because those blood thinners can increase the risk of bleeding from injection therapy. So, it is an effective treatment for erectile dysfunction when done properly.
A lot of people are concerned about the actual act of doing the injection. What I tell my patients is that it's similar to a diabetic using insulin. Those patients inject with insulin syringes everyday. We have various levels or doses of medications we can try. And we have multiple formulations or combinations of medications so that if one is not effective, we may be able to try other formulations that may work slightly better.
In cases where there has been surgery and there has been damage to the nerves going to the penis, in those cases, medications are not likely to have a significant effect. However, penile injection therapy, because it does not work through the use of intact nerves, may actually still work even in the absence of solid intact nerves that go to the penile tissues.
So, it is one approach that can be used for patients who have undergone prior surgery and have erectile dysfunction as a result of injury to the nerves. As I mentioned, it can be used in patients for whom medications are no longer effective or not working or where patients have significant side effects from them.