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Penile Injections for ED: Effectiveness, Risks & Costs

Mike Bohl, MD, MPH, ALM

Reviewed by Mike Bohl, MD

Written by Sian Ferguson

Published 02/17/2021

Updated 01/18/2024

Although the thought of a needle in the penis is enough to make most guys squirm, penile injections can be an effective and safe way to treat erectile dysfunction (ED). 

If you approach a healthcare professional about treatment for erectile dysfunction, they’ll likely prescribe a medication you can take orally. But if there’s a reason you can’t take the medication, or if the side effects are too intolerable, penile injections are worth considering.

When done correctly, penile injections for erectile dysfunction — also called intracavernosal injections — are highly effective. However, they do carry some risks, plus injecting yourself in the penis can be pretty inconvenient (and off-putting).

Let’s look at the effectiveness, side effects and costs of penile injections for erectile dysfunction.

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Erectile dysfunction affects about 30 million men in the United States. When left untreated, ED can lead to low self-esteem, mental health issues and a lack of relationship satisfaction.

Usually, ED is treated with oral PDE5 inhibitors — short for phosphodiesterase type 5 inhibitors. These oral erectile dysfunction medications are considered a first-line treatment for ED due to their overall effectiveness and general safety.

However, these medications don’t work for everyone. In that case, you might want to try a different treatment like penile injections for erectile dysfunction. 

Penile injections might be a good first option for men who:

  • Experience extreme side effects of PDE5 inhibitors

  • Don’t find that PDE5 inhibitors work well enough

  • Have health conditions that make PDE5 inhibitors too dangerous to try

As the name implies, you insert a needle directly into your penis to inject a medication. Common injectable medications for ED include:

  • Quad mix, which contains phentolamine, papaverine, alprostadil and atropine

  • Trimix, which contains phentolamine, alprostadil and papaverine

  • Bimix, which contains papaverine and phentolamine

  • Alprostadil (such as Caverject® or Edex®), which contains prostaglandin E1

  • Papaverine (a vasodilator often used to treat heart problems)

Generally, these penile injections work by relaxing the smooth muscles and dilating the blood vessels in the penis. This allows more blood to flow into the penile tissue, making it possible to have an erection.

Another option is a platelet-rich plasma injection, also called the P-shot (or Priapus shot). This is a more experimental treatment that involves injecting platelet-rich plasma, extracted from your own blood, directly into your penis.

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Overall, erectile dysfunction injections are quite effective. According to the University of California San Francisco’s Urology Department, when dosed and used correctly, about 80 percent of men will get an adequate erection using penile injections.

A 2019 study looked at 105 men who relied on penile injections for more than eight years. The study found that penile injections were safe and effective.

What is the best injection for erectile dysfunction? At the moment, there aren’t many studies that show that one injectable medication is better than another. Alprostadil is the only FDA-approved erectile dysfunction injection at the moment. It also comes in the form of a pellet. Alprostadil is one of the ingredients in Trimix and Quadmix.

The first injection will typically be given to you in your healthcare provider’s office. They’ll also give you a tutorial on how to administer the injections yourself at home.

If you’re doing some cursory research or need a reminder, let’s cover how to administer a self-injection for ED.

Preparing the Injection

First, get your supplies together. You’ll need:

  • A medication vial

  • A single-use syringe  

  • Two alcohol swabs 

  • A sharps container

Follow these steps to get the injection ready:

  • Wash your hands with soap and water.

  • Wipe the rubber stopper at the top of the medication vial with an alcohol swab. 

  • Take the syringe out of its packaging, ensuring the needle doesn’t touch anything. 

  • Don’t put the needle into the vial yet. Holding the syringe upright with the needle at the top, pull back the plunger of the syringe, just past the relevant dose. 

  • Push the plunger up until it’s at the right dosage. 

  • Turn the syringe downward. Carefully insert the needle into the vial of medication and push down the plunger to let the air into the vial. 

  • Hold both the syringe and the vial and ensure the needle tip is in the medication so you don’t get air bubbles in your syringe. 

  • Draw the solution into the syringe by pulling on the plunger. Read the gradients on the side of the syringe to ensure you’re getting the correct dosage.

If you’re using a Trimix injection, don’t forget to put the medication vial back in the fridge. If you’re using Bimix or papaverine, you don’t need to store your medication in the fridge.

While this may seem like a complicated process, it’s easier the more you practice. Be sure to ask a healthcare professional for medical advice if you need further guidance. 

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Choosing an Injection Site

It’s important to select a proper injection site on your penis to avoid injecting the medication into a nerve or blood vessel. You’ll want to aim for the corpora cavernosa (the spongy erectile tissue on the sides of the penis).

Don’t inject it into the following sites:

  • Any veins you can see or feel (which can create a large bruise)

  • Straight down into the head of the penis

  • The bottom of your penis

  • Into sores or scar tissue

  • Directly on the top side or underside of the penis

Instead, inject the medication near the middle of the shaft. You’ll need to change injection sites frequently to prevent causing any damage to the tissue in your penis.  

You can inject it at:

  • The 10 o’clock position (left side of your penis, looking down)

  • The two o’clock position (right side of your penis, looking down)

Remember to clean the injection site with an alcohol wipe before injecting. 

Injecting the Solution

This part can be scary at first, but it’s relatively straightforward. 

To reduce pain at the injection site, you can use a local anesthetic like lidocaine jelly or cream. If you’re concerned about pain, mention this upfront with your healthcare provider, and ask if they can suggest any topicals or techniques to help. 

Take the following steps: 

  • Use the alcohol wipe to clean the injection site. 

  • Pull your penis straight out in front of you so it’s stretched out. 

  • Insert the needle and slowly push down the plunger until all the solution is in your penis.

  • Carefully pull out the needle.

  • Using your thumb and forefinger, apply pressure at the injection site for two to three minutes. This can reduce bruising. 

Don’t forget to dispose of your needle safely — that is, in a sharps container.

Potential Penile Injection Drug Interactions

A word of warning before you start getting your injection ready: Certain medications, particularly PDE5 ED medications, shouldn’t be mixed with erectile dysfunction injections.

Don’t take these drugs within 18 hours before or 18 hours after a penile injection:

  • 10 to 20 milligrams of vardenafil (Levitra)

  • 20 to 100 milligrams of sildenafil (Viagra) 

  • 50 to 200 milligrams of avanafil (Stendra)

Also, don’t inject within 72 hours of taking 10 or 20 milligrams of tadalafil (Cialis). If you use 5 milligrams of tadalafil daily, ask your healthcare provider how you should use this medication along with your injections.

How Long Does It Take Penile Injections to Work?

Now for the big question: How long do penile injections take to work?

Depending on your health and the injectable medication you use, it should take five to 20 minutes to get an erection — enough time to engage in a little foreplay and connect with your partner (or yourself!) before sex.

While injecting your penis may sound gnarly, it’s quite safe when done correctly. But there are still risks to be aware of.

Possible side effects of ED penile injections include:

  • Bruising or bleeding at the injection site

  • Temporary swelling, irritation or mild pain

  • Rash or discoloration on the penis 

  • Fast heartbeat

  • Dizziness

More serious risks of ED penile injections include Peyronie’s disease, though this only tends to happen if you inject frequently. Peyronie’s disease is a condition where fibrous scar tissue causes painful erections. It can also cause curvature in the penis. 

Penile injections can also cause priapism, a prolonged erection without any sexual stimulation. Priapism is a medical emergency, as it can lead to painful erections and other complications.

If you experience pain with priapism or an erection that lasts more than four hours, it’s a good idea to get to an emergency room as soon as possible.  

Lastly, whenever you use a penile injection, pay attention to how you insert the needle. Be careful not to bend the needle, as there’s a real risk of it breaking off in your penis — yeah, yikes. If this happens, seek immediate medical attention.

Penile injections vary in cost, depending on:

  • What injectable medication you’re using

  • The dosage

  • Whether you opt for a brand-name drug or the generic version

Sometimes, your health insurance plan may cover penile injection therapy. For example, it might be covered if you develop ED after, say, prostate cancer treatment.

However, this depends on your insurance provider and the exact plan you have. It’s a good idea to call your insurance company to find out whether you’re covered.

If you’re paying for your injectable medicine out of pocket with coupons, it can start from around $120 to $200. This means it could cost as little as $5 a dose, depending on your dosage, making it a fairly cheap treatment for erectile dysfunction.

Not keen on the idea of injecting medication into your penis? TBH, we can’t blame you. Fortunately, there are some effective alternatives that don’t involve needles. 

Medications

Oral ED medications will likely be the first treatment your healthcare provider recommends.

As noted, erectile dysfunction is most often treated with PDE5 inhibitors, which work to increase blood flow to your penis.

These medications include:

Our hard mints chewable ED meds contain different active ingredients in safe dosages. They can be easier to take and more discreet than swallowing a pill. 

Testosterone Replacement Therapy

Testosterone replacement therapy (TRT) isn’t primarily a treatment for erectile dysfunction. It’s meant to treat low testosterone levels, which may lead to ED.

If you have low testosterone (also known as low T), TRT might be necessary for your overall health — and it could improve erectile function. However, you might need additional treatments for ED, even if you’re getting testosterone therapy. 

If you don’t have low T and your erectile dysfunction is caused by another issue, TRT won’t necessarily make a difference.

Vacuum Pumps

If oral ED medications aren’t suitable for you, but you can’t — or don’t want to — use an ED injection, you might consider vacuum pumps. 

A vacuum erection device uses suction to improve blood flow to the penis, making it possible to get an erection. There are a number of suction-based erection devices, including the Eddie® by Giddy device.

Though vacuum erection devices have lost popularity since the advent of Viagra, they still have their place — and they can be a great alternative for those who want a drug-free erectile dysfunction treatment.

Other Options

The list of ways to treat ED goes on. There are other options available, such as alprostadil creams and gels, alprostadil urethral suppositories, Eroxon (a non-medicated topical gel that was recently FDA-authorized for ED), and surgery.

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Erectile dysfunction can be frustrating to deal with. But there are quite a few ED treatment options, including penile injections.

While they’re not a first-line treatment for ED, injections can be super helpful for certain people. Here’s what to keep in mind:

  • Penile injections are generally safe and effective. Overall, erectile dysfunction injections have high success rates, working for around 80 percent of men with ED.

  • But they’re not for everyone. Penile injections have their advantages, but some people might be wary of them because of the risks, inconvenience and pain. Also, they might not be effective for everyone.

  • Other treatment options for ED are available. Talk to a healthcare professional about erectile dysfunction medications, testosterone treatment, vacuum pumps and other solutions.

Beyond the treatments mentioned above, various healthy lifestyle changes can support erectile function.

See our blog for natural tips for treating ED, and learn about the psychological causes of ED, which can be addressed through therapy. While you’re at it, check out our guide on how to have sex with ED!

When it comes to treating erectile dysfunction, speaking with a licensed health professional should be your first port of call. They can help you get to the root of your ED and treat it safely. You can use our platform to connect with a healthcare provider today.

15 Sources

  1. Alprostadil Urogenital. (n.d.). Retrieved from https://medlineplus.gov/druginfo/meds/a695022.html
  2. Bearelly, P., Phillips, E. A., Pan, S., OBrien, K., Asher, K., Martinez, D., & Munarriz, R. (2020). Long-term intracavernosal injection therapy: treatment efficacy and patient satisfaction. International journal of impotence research, 32(3), pp. 345–351. Retrieved from https://doi.org/10.1038/s41443-019-0186-z
  3. Bobo W. Elena, Melchiode Zachary, Pavuluri Haritha, Bobo A. Graham & Hellstrom J.G. Wayne (2023). Current status of intracavernosal injection therapy in erectile dysfunction, Expert Opinion on Pharmacotherapy, 24:8, 925-933. Retrieved from: https://www.tandfonline.com/action/showCitFormats?doi=10.1080%2F14656566.2023.2204189
  4. Caverject. (n.d.). https://www.goodrx.com/caverject?dosage=20mcg&form=vial&label_override=Caverject&quantity=1
  5. Definition & Facts for Erectile Dysfunction. (2017). Retrieved from: https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts
  6. Dhaliwal A, Gupta M. PDE5 Inhibitors. (2023). In: StatPearls internet. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549843/
  7. Edex (alprostadil). (n.d.). https://www.goodrx.com/edex/what-is
  8. Krzastek SC, Bopp J, Smith RP, Kovac JR. (2019). Recent advances in the understanding and management of erectile dysfunction. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348436/
  9. McCabe, M. P., Sharlip, I. D., Lewis, R., Atalla, E., Balon, R., Fisher, A. D., Laumann, E., Lee, S. W., & Segraves, R. T. (2016). Incidence and Prevalence of Sexual Dysfunction in Women and Men: A Consensus Statement from the Fourth International Consultation on Sexual Medicine 2015. The journal of sexual medicine, 13(2), pp. 144–152. Retrieved from https://doi.org/10.1016/j.jsxm.2015.12.034
  10. Penile Injection Therapy (2018). Retrieved from https://www.mskcc.org/cancer-care/patient-education/penile-injection-therapy
  11. Penile Injections: A Patient Guide. (2022). Retrieved from https://www.ucsfhealth.org/education/patient-guide-to-penile-injections
  12. Sizar O, Pico J. Androgen Replacement. (2022). In: StatPearls internet. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534853/
  13. Sooriyamoorthy T, Leslie SW. Erectile Dysfunction. (2023). In: StatPearls internet. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562253/
  14. Successful self penile injection hints, questions, and answers. (n.d.). Retrieved from https://urology.ucsf.edu/sites/urology.ucsf.edu/files/uploaded-files/attachments/successful_self_penile_injection_2.pdf
  15. Treatment for Erectile Dysfunction. (2017) Retrieved from: https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Mike Bohl, MD

Dr. Mike Bohl is a licensed physician, a Medical Advisor at Hims & Hers, and the Director of Scientific & Medical Content at a stealth biotech startup, where he is involved in pharmaceutical drug development. Prior to joining Hims & Hers, Dr. Bohl spent several years working in digital health, focusing on patient education. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare. He is a Medical Expert Board Member at Eat This, Not That! and a Board Member at International Veterinary Outreach.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. He is currently pursuing a Master of Business Administration and Master of Science in Healthcare Leadership at Cornell University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

  • Younesi, M., Knapik, D. M., Cumsky, J., Donmez, B. O., He, P., Islam, A., Learn, G., McClellan, P., Bohl, M., Gillespie, R. J., & Akkus, O. (2017). Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. Acta biomaterialia, 63, 200–209. https://www.sciencedirect.com/science/article/abs/pii/S1742706117305652?via%3Dihub

  • Gebhart, J. J., Weinberg, D. S., Bohl, M. S., & Liu, R. W. (2016). Relationship between pelvic incidence and osteoarthritis of the hip. Bone & joint research, 5(2), 66–72. https://boneandjoint.org.uk/Article/10.1302/2046-3758.52.2000552

  • Gebhart, J. J., Bohl, M. S., Weinberg, D. S., Cooperman, D. R., & Liu, R. W. (2015). Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis. Journal of pediatric orthopedics, 35(6), 565–570. https://journals.lww.com/pedorthopaedics/abstract/2015/09000/pelvic_incidence_and_acetabular_version_in_slipped.5.aspx

  • Islam, A., Bohl, M. S., Tsai, A. G., Younesi, M., Gillespie, R., & Akkus, O. (2015). Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair. Clinical biomechanics (Bristol, Avon), 30(7), 669–675. https://www.clinbiomech.com/article/S0268-0033(15)00143-6/fulltext

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