Penile injections for impotence

What is this?

Self-injection of alprostadil (Caverject®) to produce a penile erection sufficient for intercourse

What alternatives are there?

Tablet treatment, vacuum erection assistance devices, penile prostheses, MUSE, psychosexual counselling, no treatment

What to expect before procedure

Penile injections do not require any form of anaesthetic and are usually performed in outpatients under the supervision of a Consultant Urologist or a Specialist Nurse. The technique of penile injection produces the most natural form of erection for a man with impotence. This technique can allow the return of normal sexual activity although, If you have problems with ejaculation, these are unlikely to be helped by this method. For your first injection, prepare 10?g of Alprostadil using the dual chamber device. This ingenious device allows the dose to be selected, the drug to be mixed with fluid and the injection to be given using the same syringe & needle. Your Specialist Nurse will show you how to use the device on the first occasion.

What happens during the procedure?

Insert the needle into the side of the penis with a sharp thrust, pushing it in to its full depth. The injection should be given about 1 inch (2.5 cm) behind the circular ridge (corona) which forms the head (glans) of the penis. Try to avoid piercing veins running directly under the skin. Do not give injections into the under-surface (where the urethra is at risk) or on to the top of the penis (where large veins are at risk). Initial insertion of the needle is, of course, slightly painful but a firm and rapid thrust improves or minimises the pain of needle insertion. You may experience a slight pricking sensation on injection which is not unusual. If there is severe pain, stop the injection immediately and seek medical advice If the pain does not settle within 30 minutes.

After the procedure

When the contents of the syringe have been injected, remove the needle and use your finger or thumb to put gentle pressure on the injection site for a few minutes. Gently massaging the penis a few times between thumb and finger will help distribute the drug throughout the penis. A satisfactory erection should be achieved within 10 minutes. The Nurse Practitioner will adjust the dose as necessary.

Potential side effects