Intercavernosal Injection Therapy
Watch Dr. Karen Boyle teach a man about self-injection therapy for ED.
Self-injection therapy provides excellent results for those men who have a positive and response and are willing to take the time to learn how to perform this technique properly. The main risks of this treatment include prolonged erections, infection at the site of injection, and build up of scar tissue within the penis. Using the proper technique of self-injection can minimize all of these risks. This is why it is so important to spend the time to learn how to do the technique properly. The instructions that follow are designed specifically for those men using generic medicine or Trimix. The brand name medicine, Caverjet, comes with its own instructions, which are slightly different from those described below.
Please keep your medicine vial refrigerated at all times. When traveling, place it within a thermos with ice. Write down the date on the side of the bottle when you first open it. This bottle should be discarded within one to three months after you have opened it despite the expiration date typed on the label. Never inject more than the prescribed amount of the drug and never inject anyone else. The syringes are for one time use only, please discard them after a single use. Limit the use of this medication to no more than once every three days. Instructions for use are as follows:
1.Carefully wipe the top of the medicine vial with an alcohol soaked pad and set down.
Carefully wipe the top of the medicine vial with an alcohol soaked pad and set down.2.Pull the plunger of the syringe (29 or 30 gauge needle 1cc syringe) with a back to fill the syringe with the amount of air equal to the amount of medicine that you will want to get out of the vial.
Pull the plunger of the syringe (29 or 30 gauge needle 1cc syringe) with a back to fill the syringe with the amount of air equal to the amount of medicine that you will want to get out of the vial.3.Place the needle of the syringe through the center part of the rubber area on top of the medicine vial. Do not bend the needle.
Place the needle of the syringe through the center part of the rubber area on top of the medicine vial. Do not bend the needle.4.Inject all of the air from the syringe into the medicine vial while holding the bottle upside down in your hand.
Inject all of the air from the syringe into the medicine vial while holding the bottle upside down in your hand.5.Draw back on the plunger of the syringe to an amount slightly greater than your desired volume and wait until the barrel of the syringe fills with the medicine.
Draw back on the plunger of the syringe to an amount slightly greater than your desired volume and wait until the barrel of the syringe fills with the medicine.6.Take the syringe and the needle out of the medicine vial.
Take the syringe and the needle out of the medicine vial. 7.Flick the syringe barrel several times until all the air bubbles have risen to the top. Make sure that you are holding the syringe vertically; push the plunger up so that all of the air is expelled as well as the excess medicine within the syringe. Stop when you have reached the desired volume. If you have less medicine than you are supposed to, go back to step #1.
Flick the syringe barrel several times until all the air bubbles have risen to the top. Make sure that you are holding the syringe vertically; push the plunger up so that all of the air is expelled as well as the excess medicine within the syringe. Stop when you have reached the desired volume. If you have less medicine than you are supposed to, go back to step #1.8.Stretch the penis out directly aware from your body by grasping the head of the penis with the thumb and index fingers of one hand being certain that the slit is oriented vertically. Then pull the penis slightly over to one thigh.
Stretch the penis out directly aware from your body by grasping the head of the penis with the thumb and index fingers of one hand being certain that the slit is oriented vertically. Then pull the penis slightly over to one thigh. 9.Take an alcohol-soaked pad and wipe off the area of the penis where you will perform the injection.
Take an alcohol-soaked pad and wipe off the area of the penis where you will perform the injection.10.The injection is given at a 90 degree angle at the 10 or 2 o’clock position on the penis (away from the ventrally located urethra), away from visible veins, and never in the midline. To minimize the chance of scar formation, the sight is changed with each dose.
The injection is given at a 90 degree angle at the 10 or 2 o’clock position on the penis (away from the ventrally located urethra), away from visible veins, and never in the midline. To minimize the chance of scar formation, the sight is changed with each dose. 11.Take the syringe and push the needle directly into the penis as shown on the attached diagram until it goes all the way up to the hub.
Take the syringe and push the needle directly into the penis as shown on the attached diagram until it goes all the way up to the hub.12.Inject all of the medicine into the penis. If you meet any resistance, pull back slightly on the syringe.
Inject all of the medicine into the penis. If you meet any resistance, pull back slightly on the syringe.13.While stabilizing the syringe and needle with one hand, get ready to press over the injection site with an alcohol soaked pad using the other hand.
While stabilizing the syringe and needle with one hand, get ready to press over the injection site with an alcohol soaked pad using the other hand.14.Remove the needle from within the penis and hold tight pressure over the injection site for 2 full minutes. Patients taking blood thinners (aspirin, coumadin) are advised to continue pressure for 6 minutes.
Remove the needle from within the penis and hold tight pressure over the injection site for 2 full minutes. Patients taking blood thinners (aspirin, coumadin) are advised to continue pressure for 6 minutes.15.Pinching the penis between 2 fingers does this.
Pinching the penis between 2 fingers does this.16.Stand for 5 minutes.
Stand for 5 minutes.17.If you do not get a satisfactory erection, DO NOT give yourself another injection.
If you do not get a satisfactory erection, DO NOT give yourself another injection.Good judgment and careful technique are the keys to having satisfactory sexual function using the self-injection technique. Spending time to learn how to properly perform this technique is an investment in the future. If you experience bruising of the penis at the injection site, this probably means that you are not pinching the penis at the site of injection. If an erection lasts for longer 1.5 hours take Sudafed 60 mg (available without a prescription), lie down and apply an ice pack and wait another hour. If the erection is still persistent, call immediately Dr. Boyle.
Worksheet for Injection Therapy
These are general guidelines
1. Wait 3 days between injections.
2. Do not inject more than 10 times a month.
3. Keep mixture refrigerated, as effectiveness will decrease if left at higher temperatures.
4. Your medication is ____________________. Your initial dose is ___cc (_____units). Wait 3 days before increasing dosage. Increase by 0.05 cc (5 units) until a satisfactory dose is reached. The maximum dose is 0.50 cc (50 units). Do not be discouraged by a poor result with the first few injections, as the initial dose has been kept low to avoid a prolonged and painful erection (priapism).
5. Return to the office in 1 month for an interval evaluation and bring this worksheet. This is to be sure that you are not experiencing any difficulty and to check for scarring at the injection sites.
6. If you have any questions regarding the above instructions, please do not hesitate to call.
7. If your erection lasts longer than 1½ hours, you may take Sudafed, 60 mg orally (available without a prescription), apply an ice pack, and wait another hour. If the erection is still persistent, call IMMEDIATELY. You will be instructed to go to an Emergency Room (if after hours), or to my clinic.
8. Instructions to attending doctor for treating a prolonged erection (if not local):
Dilute 1 amp (10 mg) of Neo-Synephrine (phenylephrine) in 9 cc of normal saline (this is now 1 mg/cc). Inject 0.3-0.5 mg (cc) of Neo-Synephrine intracavernosally every 10 minutes until detumescence occurs, up to a maximum dose of 2 cc. If this is unsuccessful in decreasing the erection, irrigate the corporeal bodies with a 19 gauge butterfly needle, one in each corporeal body, with a mixture of Neo-Synephrine in normal saline as follows: 1 amp (10 mg) of Neo-Synephrine injected into 250 cc of normal saline. Use this solution to irrigate in-and-out of the corpus cavernosum. Please call Dr. Boyle with questions.
Karen Elizabeth Boyle, M.D.
Reproductive Medicine & Surgery, Sexuality and Aesthetics
Contact Us
Karen E. Boyle, M.D.
Phone: 877-290-5055
Fax: 410-825-5811
Chesapeake Urology Associates at Greater Baltimore Medical Center (GBMC)
Physicians Pavilion North
6535 North Charles Street, Suite 625
Baltimore, MD 21204
