Injections for Erectile Dysfunction

When I was diagnosed with prostate cancer, my scans were clear and I opted for surgery after a discussion with my urologist. An inguinal hernia was found in the scans, and both that repair and the prostatectomy would be handled at the same surgery.

My urologist was wonderful in addressing all my questions and offering a large amount of information. This included the fact that my surgery would not be nerve-sparing. This meant that my ability to achieve an erection after surgery would require assistance.

Why I turned to injections for erectile dysfunction

Without the nerves, Viagra/Cialis would not be effective. We discussed alternatives, and I felt that the use of TriMix injections would be my preferred method.

The prescription would be handled with a specialty pharmacy who ships it chilled. I scheduled an appointment for about 3 weeks post-surgery to discuss proper use. The medication requires refrigeration to maintain potency, and we would do a test at my appointment so that I could see how to properly inject. Once established, the pharmacy needs a prescription from your doctor and you deal with the pharmacy directly.

How to properly inject into the penis

At my appointment I was a bit nervous. The thought of putting a needle into your penis is not top of mind. Luckily, I have medical education and training that helped.

I found it is important to wash your hands first and then get the needle and fill with the proper dose, making sure there are no air bubbles. My injection goes into the side of the penis, avoiding any veins or the urethra. I think it is best to choose a sight closer to the base and clean it with an alcohol wipe. The needle is very small and thin, similar to an allergy syringe. I usually insert it at a 90-degree angle. You may feel a slight “pinch.”

I inject the medication slowly, then withdraw the needle and apply light pressure to the injection spot to prevent any bleeding. Afterward I dispose of the needle safely. My urologist administered my first injection, so you need to be comfortable with your doctor. I've found that an erection using injection occurs within a few minutes.

What else to know about penile injections

That initial injection wasn’t so bad, and my doctor talked with me about the need to adjust the dosage up with each injection until a satisfactory erection is achieved.

I was told it is important not to go too high, as this can bring complications and a trip to the emergency room. You may also need to rotate or move the injection sight around to prevent scarring or fibrosis. If you experience any issues such as rash, skin irritation, or pain, talk to your doctor.

How much do they cost?

It is important to know that the cost is not cheap. I’ve seen prices anywhere from $80 to $250 per vial. A vial provides somewhere between 6-12 doses depending on the amount used per injection. Since it is a compounded medication (a combination of 3 medications), it is not specifically covered by insurance usually.

It is recommended to only use it 2-3 times per week.¹

Do the injections get any easier?

Once you get past that initial fear of injecting yourself, I think it actually gets easier.

Practical use can become quite easy, albeit with a bit of planning. As mentioned, the medication requires refrigeration, otherwise it loses effectiveness.

How do they affect sexual function and erections?

Spontaneity for sexual activity is limited, but I can say that my partner and I have become much more creative and it has increased our intimacy. He has been very supportive and at times we joke about my having to inject myself. In my case a condom also helps, because when I ejaculate, I can produce a small amount of urine. This is a case-by-case issue depending on the extent of the surgery.

Of course, there are certain toys or aids that can assist with all of this. One that can assist with firming and maintaining an erection is a cock ring. An adjustable type may make placement and removal easier. I think vacuum pumps can also be useful in “exercising” the penis and drawing more blood into the penis.

As for medications, it is important to discuss this with your doctor. All of us have different surgeries depending on our circumstances. I think the most important consideration is whether the nerves were spared, as nerves working well are important for achieving and maintaining an erection.