Penile injections for impotence


Alprostadil (Caverject) is the same as a naturally occurring hormone called prostaglandin E1, which causes blood vessels in the penis to expand.The injections have been widely used by men since the 1980s and produce erections firm enough for sex in 80 to 90 per cent of men.


What does the procedure involve?


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

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What are the alternatives to this treatment?


Tablet treatments, vacuum devices, penile prostheses, MUSE, psychosexual counselling (sex therapy), choice of no treatment.

4/8/2010 | 4Urology Administrator

Who is the procedure not suitable for?


If you have underlying conditions that make sexual intercourse dangerous such as sever heart disease.

Also please be sure to inform your Urologist or nurse specialist in advance of your first injection if you have any of the following:

  • an artificial heart valve
  • a coronary artery stent
  • a heart pacemaker or defibrillator
  • an artificial joint
  • an artificial blood vessel graft
  • a neurosurgical shunt
  • any other implanted foreign body
  • a prescription for Warfarin, Aspirin or Clopidogrel (Plavix®)
  • a previous or current MRSA infection
  • high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human-derived growth hormone)
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What happens before the 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 a 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 the 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 Urology Nurse will show you how to use the device on the first occasion.

Caverject injection system
Caverject penile injection
4/8/2010 | 4Urology Administrator

How do I do the injection?


Step 1

Fill the needle with medication, extracting the Caverject from the prescription vile. Secure the amount of medication as prescribed by your doctor in the needle's applicator.

Step 2

Swab an area near the base of the penis with rubbing alcohol to sterilize the injection site. If this is not the first time using Caverject, make sure the injection site is not on the same side of the penis as the previous injection.

Step 3

Carefully insert the needle into the area sterilized in step two. 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. Inject the Caverject into the sterile area. 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.

injecting caverject Where to inject caverject
Inject on the side Avoid vessels and the urethra

Step 4

Ensure the entire dose of Caverject is injected into the penis before removing the needle and pressing a cotton ball at the site of the injection. Continue pressing the cotton ball for up to five minutes, to prevent bruising at the injection site.

Step 5

Wait at least one day before administering Caverject again.

4/8/2010 | 4Urology Administrator

What happens after the procedure?


When the contents of the syringe have been injected you can remove the needle and remember to use your finger or thumb to put gentle pressure on the injection site for a few minutes. This will help prevent bruising. 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 on the first occassion.

4/8/2010 | 4Urology Administrator

What should I look out for after the procedure?


Your erection may last anything from 5 minutes to 2 hours. If your erection lasts more than 4 hours or becomes very painful, you must contact your local accident and emergency department or your urologist immediately; they will arrange for an antidote to be administered to bring your erection down but this must be given in hospital. Please also contact your doctor if you develop severe pain or bleeding.

You may develop a small bruise (haematoma) under the skin of the penis at the site of injection. This is nothing to worry about and it will disappear by itself over the next couple of days. However, if it becomes very large, please see your GP.

4/8/2010 | 4Urology Administrator

Other important points


You are advised not to use this technique for obtaining erections more than 3 times in any one week and injections should not be used more than once in any one day. More frequent injections run the risk of damaging the erectile tissue of the penis (which can make you impotent again) and of producing long-lasting painful erections (priapism).

If the dose of drug produces no erection, you should contact the Erectile Dysfunction Specialist Nurse who will arrange for you to be re-assessed in the Outpatient Department.

4/8/2010 | 4Urology Administrator

What are the side effects?


Common Side-effects (greater than 1 in 10)

  • Pain/discomfort at the time of injection
  • Bruising under the skin of the penis after injection
  • A persistent painful erection lasting longer than 4 hours (10%)

Occasional Side-effects (between 1 in 10 and 1 in 50)

  • Scarring or bending of the penis on erection following repeated injections given at the same site
  • Failure to achieve an erection following injection
  • Bleeding from the water pipe (urethra) due to a misplaced injection
  • Progressive lack of response to injections due to scarring within the penis

Rare Side-effects (less than 1 in 50)

  • Infection at the injection site (more likely If you are diabetic)
4/8/2010 | 4Urology Administrator