* Penile injection therapy has been in use for about 30 years.  The injections consist of various combinations of Prostaglandin, Papaverine and Phentolamine.  These drugs were initially discovered to be an effective treatment when one of them was accidentally injected into a patient's penis during heart surgery.  The patient developed a solid erection for over an hour and this field of medicine began.

The medicine, also known as ICP is applied with an auto-applicator.  It is user friendly and just about anyone can do it.  * The injection is with a 30 gauge ultra-fine needle that goes about 1/2 inches into the side of the penis.  The injection can be performed on either side of the penis and the medication will spread throughout the penis.  Because the spring loaded applicator inserts the needle quickly, the injection itself is relatively painless.  Most men are aware of getting the injection but describe it as not bothersome.  Many patients do not feel the injection at all and others relate that it feels like a mosquito bite.

The amount and strength of the medicine that needs to be injected varies from person to person.  We will determine the smallest amount of medicine that is necessary to get an adequate erection.

* The goal of penile injection therapy is to get a strong erection that is suitable for sexual intercourse and lasts about 30 - 45 minutes.  * The medicine starts to work about 5 - 15 minutes after the injection is given. * It may be used once a day and as often as 3 times each week.

The erections that a patient gets from penile injection therapy are similar to his natural erections, as both are caused by the penis being filled with blood.

Patients choosing to use penile injection therapy or ICP are tested in the office to determine the dose for them to use at home.  Patients are instructed in great detail on exactly how to use and apply penile injection therapy, how often they may use it and how to vary the site of the injection.

Penile injection therapy is a relatively safe and effective treatment to help a man's sexual function.  Because the needle is penetrating the skin on the side of the penis, possible side effects include bruising or the formation of a small hematoma at the injection site.  Occasionally and rarely a small nodule or lump of fibrotic scar tissue may form at the injection site, particularly if the same injection site is used.  * Patients who follow our instructions and who do not use the medicine more than 3 times each week and who vary the injection site and apply pressure for at least 2 minutes after the injection is given usually do not have any of these problems. 

While men with diabetes and/or who are obese may usually use penile injection therapy with relative safety, they tend to have a higher incidence of developing scar tissue in the penis.

While these medications are safe for men to use, all medications have certain side effects.  This medication may cause a prolonged erection. * While our goal is an erection for 30 - 45 minutes an erection lasting 1-2 hours will cause no harm.  However, an erection lasting more than 4 hours requires immediate medical attention.  While the medication is relatively painless for most patients, the medications may cause some achyness or dull pain in the penis.  This discomfort usually dissipates after using the medicine a few times; the patient's formula can often be changed to decrease the pain if necessary.  Rarely a patient may feel dizzy from the medicine.  Even rarer are heart rhythm abnormalities and effects on liver enzymes.

Only Prostaglandin is specifically FDA approved for erectile dysfunction and comes in the brand names of Caverject and Edex.  Prostaglandin is the shortest acting of the various vasodilators used to induce an erection, but is also the most likely to cause discomfort and less likely to induce an erection than when used in combination with the other vasodilators.  For these reasons, most clinicians treating erectile dysfunction use combinations of the various vasodilators.  While the individual vasodilators are all FDA approved for something, only Prostaglandin is FDA approved for erectile dysfunction.  So when these vasodilators are used in combination, this compounded or combined injectable medication is called an off-label, but legal use of individually FDA approved drugs.  While Caverject® and Edex® are available in regular pharmacies, the compounded medications are available only through a compounding pharmacy.  All of the compounding pharmacies that we use are accredited by PCAB - the Pharmacy Compounding Accreditation Board and/or FDA approved outsourcing facilities.

Most men can safely use penile injection therapy.  Men who are taking aspirin or other blood thinners may bruise more easily, but may still use the medication.  Moderate alcohol consumption or eating prior to usage will have little effect on the medication.

Men who have poor manual dexterity or who are legally blind may need to have their partner apply the medication.  Men who have sickle cell disease, who have a penile implant or who have abnormal liver enzymes may not use this medication.  Men who have dizziness from penile injection therapy, which probably results from a condition called venous leakage, should not use this medication.

Patients who are already using penile injection therapy from another physician can usually have their medicine renewed from us after a video chat tele-medicine visit (virtual visit) with Dr. Smiley. Our long-term relationship with the compounding pharmacies allows us to have MUCH better prices on ICP medicines than most large national ED practices.

*  While we will certainly try to help all of our patients, as with any medical treatment, there is no guarantee of specific results, as results can and usually do vary from patient to patient.  All numbers and time frames are approximate.








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