Penile Injections for ED: Effectiveness, Risks & Costs

The thought of injecting a needle into your penis might be enough to make you squirm. But penile injections can be an effective and safe way to treat erectile dysfunction (ED).

If you see a healthcare professional about treatment for erectile dysfunction, they’ll likely first prescribe medications you can take orally. If these drugs are ineffective or if the side effects are too intolerable, your provider may recommend penile injections.

When done correctly, penile injections for erectile dysfunction can be a worthwhile solution. However, they do carry some risks — plus, you might not be overly excited by the idea of injecting yourself in the penis.

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

Penile injections for ED (also called intracavernosal injections) are a treatment option that involves inserting a needle directly into the shaft of the penis to administer medication.

The first-line treatment for ED is usually phosphodiesterase type 5 inhibitors (PDE5 inhibitors). These oral erectile dysfunction medications are effective for many men and have good safety profiles, but they don’t work for everyone.

Penile injections of a medication like prostaglandin E1 (PGE1) might be a secondary treatment option healthcare providers recommend for erectile dysfunction. 

Medicative shots for ED could be a good first option for men who:

• Experience too many or serious 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

Common injectable medications for ED include:

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

• Papaverine, a vasodilator often used to treat heart problems

• Phentolamine, which causes blood vessels to expand and is often used to treat hypertension (high blood pressure)

• Aviptadil, a synthetic form of the hormone human vasoactive intestinal peptide (VIP)

• Bimix, which contains two of these medications

• Trimix, which contains phentolamine, alprostadil, and papaverine and is only available from compounding pharmacies

• Quad mix, which contains phentolamine, papaverine, alprostadil, and another drug called atropine

Penile injections work by relaxing the blood vessels in the smooth muscles of the penis. This effect allows more blood to flow into penile tissue, making it easier to achieve and keep an erection long enough to have sex.

Alprostadil is the only penile ejection currently FDA-approved for erectile dysfunction.

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 (PRP) — extracted from your own blood — directly into your penis.

Overall, erectile dysfunction injections seem to be quite effective. According to a 2019 review of studies published in the World Journal of Urology, the clinical efficiency rate is between 54 and 100 percent.

But evidence of P-shots effectively treating erectile dysfunction is still somewhat weak. For instance, in a 2023 study, researchers found no difference between the effectiveness of P-shots and a placebo among 61 men.

Your first injection will typically be administered for you in your healthcare provider’s office. Your provider will also give you a tutorial on how to do the injections yourself at home.

Here’s a general overview of 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 dosage marker you’re using.

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

• 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, ensuring 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.

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 medication:

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

• Straight into the head of the penis or urethra

• Into the bottom of your penis

• Into sores or scar tissue

• Directly on the top side or underside of your 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.

Take the following steps to administer penile injections:

• Use an 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 gentle 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.

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

Potential drug interactions between alprostadil and other drugs haven’t formally been studied.

Some researchers have raised concerns that mixing penile injections with other erection medications, particularly PDE5 inhibitors, may raise the risk of complications like priapism. Priapism is a prolonged erection lasting more than four hours — it’s considered a medical emergency.

In a 2023 study, researchers didn’t see an increased risk of priapism when combined with tadalafil or sildenafil (the active ingredients in Cialis^® and Viagra^® respectively), but ongoing research is looking at the possible link.

It’s always best to talk to your medical provider before combining penile injections or PDE5 inhibitors with other ED treatments — or any other medications.

The amount of time that it takes for penile injections to work depends on factors such as the type and strength of injectable medication you use.

Some men can achieve an erection within minutes of the injection. Your penis might swell within five to 15 minutes of a Trimix injection. It might be erect at that time, but you may not actually get an erection until you’re sexually stimulated.

While injecting your penis may sound dangerous, it’s often 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 forms and may lead to painful erections or a curvature in the penis. 

Penile injections can also cause priapism, a prolonged erection without any sexual stimulation. Priapism has been reported in about four percent of people who receive Caverject.

If you experience pain with priapism or an erection that lasts more than four hours, visit 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 risk of it breaking off in your penis. If this happens, seek immediate medical attention.

Penile injections vary in cost, depending on factors like:

• 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 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, the price can start from around $113 to $213. This means it could cost as little as $5 a dose, depending on your dosage, making it a fairly cheap treatment for erectile dysfunction.

If you’re not keen on the idea of injecting medication into your penis, there are effective alternatives that don’t involve needles. 

ED Medication

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 by increasing blood flow to the penis.

These medications include:

• Sildenafil (the generic version of Viagra) 

• Tadalafil (generic for Cialis) 

• Stendra^® (avanafil)

Our hard mints chewable ED meds contain different active ingredients in personalized 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 are sometimes linked 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. But you might still 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.

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

Other Options for ED

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 to stimulate penis nerve ending that was FDA-authorized for ED in 2023

• Surgery

Talk to your healthcare provider about your symptoms and what’s worked or hasn’t worked for your sexual dysfunction issues. They can help you figure out the right treatment.

Erectile dysfunction is estimated to affect roughly half of men between ages 40 and 70 in the United States. Although not life-threatening, ED can be a sign of an underlying health problem or cause problems such as:

• Low self-esteem

• Mental health issues

• Lack of relationship satisfaction

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

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

• Penile injections are generally safe and effective. Overall, erectile dysfunction injections seem to have high success rates and a relatively low risk of side effects.

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

• Side effects are possible. Most side effects are mild and include bruising or swelling, but they can be serious in rare cases. 

• Other treatment options for ED are available. You can talk to a healthcare professional, such as a urologist, about erectile dysfunction medications, testosterone treatment, vacuum pumps, and other ED solutions.

Beyond the treatments mentioned above, various healthy lifestyle changes can support erectile function — think healthy eating, exercise, and getting enough sleep.

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.

You can also use our men’s health platform to connect with a healthcare provider and start exploring ED treatment today.