Basic overview of Penile Injection Process

Here's a post I made sometime back, sorta an overview of the whole injection process. Maybe some of it will pertain to some of the current threads dealing with the subject .

Injection drugs are obtained by a doctors prescription and must be filled by a specialized pharmacy- an compounding pharmacy- which mixes the drugs to be used. There are 3 types of drugs- Caverject (alprostadil), Bimix and Trimix. Alprostadil is a a single drug, bimix is a mixture of papaverine and phentolamine, usually in the strengths of 30mg papaverine/1mg phentolamine when written on the prescription. Trimix is the same as bimix, with the addition of alprostadil to it, and usually written as 30mg/1mg/20mcg, the 20mcg being the alprostadil. In listing strengths, the alprostadil is the strongest and seems to obtain the most effective result. It is also the most expensive and lots of guys have problems with both aching, pains and piraprisms (SP)- erections of longer than 4 hours. Trimix is the next strongest and results in very good erections, with much less chance of the aching/pain and the 4 hour hour erections. Bimix is the llowest strength of the 3 , but seldom gives the aching/pain or the 4 hour erections. Dosing sizes of Trimix is usually much less than Bimix, so it takes much less to get the same result, however it does seem to have a chance of giving more troubles with aching/pain and the problem erections.

Most doctors will begin the injection treatment with Caverject (alprostadil) injected in the office to get a baseline of what is needed and to teach the man how to inject. Some men have a bad experience with this, as the alprostadil is usually injected at a much higher dose than needed, which creates the aching/pain and the over 4 hours erections which we hear about once in a while. It seems doctors have a set formula of what they are taught to inject and that isn't always the best. If it works in the office, he will usually send the patient home with a prescription for alprostadil and further instruction on how to use it. It seems that most doctors don't begin with Trimix or Bimix, unless they are dealing with an educated patient who can ask for, explain why, and can advocate for themselves trying something different. I am fortunate to have a doc who will deal with me on an equal basis and is willing to try what I suggest with different ratios of strengths to dial it in for me. I feel that a man who is starting injection therapy should begin with either Trimix or Bimix, rather than alprostadil, as the chances of a ache/pain free experience will have him much more willing to continue. The physical act of injecting is simply pain free for me now, but it took quite a bit of repetition and experimenting to reach this state. Once a guy begins injecting, he needs to keep at it, experimenting and dialing in what he needs to get the best results with the least amount of drug or trouble.

As far as technique, its simple, actually. Use the least diameter needle, usually a 5/16" 31 ga. insulin syringe, and inject into the penis midway between the head of the penis and the body, at the 9 or 3 o'clock position. A little milking motion of the penis will help open the cavernous cavities a little, so the drug cane be deposited into the space. A little massage and the erection should begin, usually within 5 to 10 minutes, and if enough drug is injected and adsorbed, results in a penis erect for an hour or so. That's the idea goal. It can vary. Done right, with practice, the injection can and will be painless for most guys. There's no reason to think you would be any different. I don't combine by injections with other items such as pills or pump, but some here do. I, and several other guys, use what I call a pre-plump method to ensure successful injections. It begins with a penis pump, if you have one, and a penis ring. Using the pump, obtain a partial- maybe 30%- erection and apply the ring. This engorges the penis with blood, opening the cavernous cavities and filling them with blood. Then inject into this expanded cavity. Imagine injecting into an uninflated balloon, and putting the drug into the inside, versus injecting into a partially inflated one. That's what is being accomplished with this method. When injecting, you can easily tell when the needle point enters the cavity, as the resistance will drop and the needle will feel like it has 'fallen' into it. Inject and very lightly massage the penis, the purpose is to spread the drug around and ensure optimium adsorption of the drug. Keeping the ring on for 3 or 4 minutes holds the blood (and drug) inside and lets it have the best chance of being adsorbed. Continue to gently massage the penis and the drug around for 3 to 4 minutes, then remove the ring- the blood will most likely run back out of the penis, until the erection begins. You should get the drug induced erection in 5 minutes or so. Most of us who use this method find we can use much less drug, we can control results more consistently from one time to the next and reduce the chance of priaprisms.

Yes, once in a while we will have guys here have a bad experience, resulting in a 4 hour erection and a trip to the hospital or doctors office. It's traumatic, of course, but frankly still part of the risk of using injections. The draining of the penis blood was sorta overkill, IMO, usually the penis is injected with epenephrine(SP) or such, which counteracts the penile injection drug. I have only had one over 4 hour erection, I relieved it with Sufafed, rathert than a hospital visit. That was the first time I self-injected, it was alprostadil and it was the doctors recommended dose, which was 3 times more than I found I needed.

There's several excellent websites with great instructions on the process, and we can look at them later, when you are ready to start the injections.

This is a general overview of the process, stressing they general or average, or normal process and results by the majority of the guys here, to give you a general look at the normal experience and answers to your questions.

Here's a few links to a posts that will contain some research info for you to continue your study:
www.ustoo.org/PDFs/Injection.pdf
www.healingwell.com/community/default.aspx?f=35&m=1347869&p=1
www.healingwell.com/community/default.aspx?f=35&m=897291
www.healingwell.com/community/default.aspx?f=35&m=1062508
www.healingwell.com/community/default.aspx?f=35&m=1115024
www.healingwell.com/community/default.aspx?f=35&m=1022627&p=1&ord=d
www.healingwell.com/community/default.aspx?f=35&m=1069182
www.healingwell.com/community/default.aspx?f=35&m=1110785
www.healingwell.com/community/default.aspx?f=35&m=992063
www.healingwell.com/community/default.aspx?f=35&m=1285932
www.healingwell.com/community/default.aspx?f=35&m=1072323
www.healingwell.com/community/default.aspx?f=35&m=1274734&p=1&ord=a
www.healingwell.com/community/default.aspx?f=35&m=106647
www.healingwell.com/community/default.aspx?f=35&m=767571
www.healingwell.com/community/default.aspx?f=35&m=1012934&p=1&ord=d

Post Edited (James C.) : 11/18/2011 8:18:07 AM (GMT-7)

Very helpful to resurrect this post James.  Thanks.

Since I've recently posted questions on this subject, my current status is that an appt is set with an 'expert' here in NYC that my surgeon recommended.  The only downside is that the appt isn't until the last day of august.

Hey Fifties.
I know what you are talking about when you use a pump. So does James C. He had a name for it. Something like a hinged purple eggplant. I'll let him tell it.
Anyway, with the injections that does not happen You are perfectly normal. It inflates from the base and moves forward. No hinge effect.
I use an auto injector. There is a lot of info on that when you are ready.
Good luck to you.
Jeff
(Pumps and pills did not work for me.)

James, I think you deep knowledge of injections is great, and even though I haven't had the need, I find your posts on the subject filled with great information, technique, and even compassion. I think you do a great service here at HW, particularly in this area of your expertise. Also a good moderator, btw, lol.

David in SC

PS If I ever have the need, I will gladly come back and re-read all your injection related postings.

Thank you ALL, for the information. I have an appointment with my Urologist to check it out. They probably will do their own version of a test, which is OK with me. But with the details from all the posts, especially James' posts, i should be able to narrow in on a preferred path forward. I am excited. I will post more, when things are underway.

bump

Monthly bump for new friends

James you sound like the injection expert.  What I need to know is what exactly is fibrosis?  I have injected 15-20 times with great results but seem to be developing some cysts or lumps, like a hardening of the veins all along the bottom of "Jr".  I have posted this question but not gotten any good responses.

Is this just scar tissue or is this what penile fibrosis feels like?

Thank you for the help.  I enjoy your posts.

Help me out here, guys. I don't have any experience with penile fibrosis. Anyone here experienced it and wants to share?

There were a couple of questions about injections floating around. I thought I would give this a bump for the new guys that are just starting injections are thinkgs about it.

Cajun Jeff

There is a suggestion that injections can lead to scarring -- by no means proven. Also it doubles the slight chance of infection. For these reasons I never did it, and wouldn't do it.

Mike? and????? details, man, details.... unless you're in the middle of 'right now' ??

Yes, it is important to alternate sides, so as not to risk fiberous buildup, etc. this also allows for both sides to receive the benefit, if any, of being the first to get the drug, hence a little better reaction there.