Auto Injector Trimix

[Marion Georgi]

Althoughyou probably find the idea of injecting something into your penis unappealing, many men are highly satisfied with this therapy and will testify to the ease and effectiveness of the injections. Before using the therapy on your own at home, your doctor will show you how to inject the medication. Improper injection and any subsequent scarring can lead to penile curvature and nodules in the penis, so it is important to get proper training before beginning injection therapy.

The medication is injected along either lateral side of the penis. First, the medication is drawn into a syringe, usually an insulin-type syringe with a short, very fine needle. The medication is given into the spongy tissue of the penis, called the corpora cavernosa.

After choosing the proper site to inject on your penis, clean it with an alcohol wipe, "poke" the needle through the skin of the penis, and then inject the medication into the penis. Immediately afterwards, press firmly on the injection site with either an alcohol pad or gauze with your thumb and first finger to compress the area for at least five minutes or up to 10 minutes for patients taking blood thinning medication, such as coumadin.

The medication tends to work better if you stand, as it allows more blood to go to your penis. Also, external stimulation to the penis increases blood flow to the penis and allows the medication to take effect faster.

Some people prefer the auto-injector, which is a spring-loaded device that inserts the needle into the penis very quickly, minimizing discomfort and psychological "hesitancy." It comes in two forms: a simple, non-prescription device designed to insert the needle for you, and a prescription device that also depresses the plunger for you.

Check with your local drug store for the non-prescription simple auto-injector. Many men prefer the auto-injector that does not inject the medications for them, because they maintain the necessary feel to know that they have injected in the right place and to the right depth.

Occasionally, penile injections can cause fainting, dizziness and low blood pressure. In rare instances, priapism or prolonged erections can occur. Patients who are not trained properly may experience pain, infection, bruising and scarring.

If the medication is dosed and injected properly, most men will experience an erection response to injections. Finding a dose that works typically requires making adjustments early on. Some men, however, don't respond even to high doses.

Yes. While blood thinners increase the risk of bleeding and bruising, the needles used for penile injections are small. The risk is minimal so long as you apply pressure on the site immediately after giving yourself an injection.

Injections are a powerful treatment but don't work for everyone. Men who have severe or long-standing diabetes have less chance of success with injections. The only way to find out, however, is to try them.

The risk of scar tissue rises with each injection. We don't fully understand this process, but hypothetically, frequent injections increase the risk of scar tissue buildup. Some experts therefore recommend avoiding "overly frequent" dosing. What that means is subject to interpretation, so you should discuss this safety concern with your doctor.

There are several medications that can work to help you achieve erections. You and your doctor should discuss which is likely to be best for you. The drugs and drug combinations currently in use include the following:

The drugs lead to an erection by relaxing the smooth muscles and widening the blood vessels in the penis, enhancing blood flow. They don't depend on nerve stimulation. A more complete description of how the penis functions can be found in our discussion of erectile dysfunction.

Dosage involves the medication's strength and the amount used. With the appropriate strength and amount (usually less than 1 cc), as determined by a doctor, erections usually occur in five to 10 minutes and last approximately 30 minutes to an hour. The erection becomes more rigid if sexual stimulation occurs. It may take some time and experimentation to determine your optimal medication and dose.

You won't develop a tolerance, but since ED is progressive, dose adjustments over time are sometimes necessary, particularly for men who use injections for many years. You may be able to reduce the need for this by compressing the site after injecting, switching up your injection placement and spacing out your injections.

The issue isn't that the medication will spoil and become dangerous, as with food left out of the refrigerator. But these drugs gradually lose potency, a process that accelerates if they're not kept cold. So try to put your medication back in the fridge promptly.

Some medications are available in powdered form to be mixed at the time of use. Examples include alprostadil (CaverJect or Edex) and some formulations of Tri-Mix. Mixed compounded medications can be transported but ideally should be kept in checked bags or a cooler, so they stay as cold as possible and retain potency.

Yes, over several months they become less effective. Compounding pharmacies are required to note expiration dates for their products. The medication won't become dangerous to use after expiration but may be less effective.

There is a small risk that injections or medications used can cause or reveal scarring in the penis. This can lead to Peyronie's disease, a painful deformity of the penis caused by a build-up of plaque or scar tissue in the erectile tissue (the corpus cavernosa). However, Peyronie's Disease is relatively rare and can be treated. You can minimize the risk of developing Peyronie's disease by using correct injection technique.

No medical therapies are shown to reduce the risk of developing Peyronie's disease. Some experts recommend using certain drugs (such as pentoxifylline, which improves blood circulation), but we don't have robust evidence that these drugs work for this purpose.

Before piercing the rubber top of the vial, pull back on the syringe plunger to draw in a volume of air roughly equivalent to the amount of fluid you plan to inject. Keeping this air in the syringe, push the needle through the rubber stopper on the medication vial. Holding the vial upside-down, press the plunger to push the air into the vial before withdrawing the medication dose.

You need to inject into the corpora cavernosa (columns of spongy erectile tissue running the length of the penis). Alternate between injecting at 3 o'clock and 9 o'clock positions at the middle of the shaft. Avoid any area where a blood vessel is visible, and don't inject the same spot every time.

The key is to ensure that the needle gets into the corpora cavernosa. This is best accomplished by inserting the needle perpendicular to the penis shaft. You may note a small amount of resistance as the needle penetrates your skin and again when it penetrates the tunica albuginea (the tough sheath covering the erectile tissue). If the needle is properly placed, it shouldn't be difficult to push down on the plunger. If you meet resistance, the needle tip may be in a tough layer of fascia; in this case, back up the needle slightly and try again.

Approximately 90 degrees. As long as the injection is perpendicular to the shaft of the penis, the risk of urethral injury is low. If the injection is too shallow, the medication may not get into the corpora cavernosa and may not work.

In general, it's easier to inject into the right spot if the head (glans) of the penis is grasped and pulled away from the body to full extension. This technique thins the skin and makes the corpora cavernosa easier to target.

Yes, any local anesthetic, such as a lidocaine jelly or cream, will help. Emla, a combination of 2.5% lidocaine and 2.5% prilocaine, is available with a prescription. ELA-Max, which is 4% or 5% lidocaine, is available without a prescription.

An auto-injector is a spring-loaded device that inserts the needle very quickly, minimizing that moment of hesitation that people commonly have when injecting a sensitive area. It comes in two forms: a nonprescription device that simply inserts the needle and a prescription device that also depresses the plunger. Check your local drugstore to get the simple auto-injector without a prescription.

Using an auto-injector makes sense for men who balk at inserting a needle into their penis or worry about not hitting the right spot. Whether the device results in less pain is unclear; some men report that using the spring-loaded device hurts more than a regular self-injection.

Fill the syringe as usual, then load it into the auto-injector. Clean one side of your penis with an alcohol swab, place the injector against the site where you want to inject, and press the button that activates the injector. The needle will be automatically inserted.

Stimulation is not required after penile injections but may enhance erectile response. You may be able to use less medication if you combine it with stimulation. Bear in mind too, that you don't need to have an erection to achieve an orgasm. Using a vibrator or modifying your sexual practices can help in having satisfying sexual encounters even without an erection.

The most likely explanation is either that the injection failed to reach the corpora cavernosa or that the medication has expired and lost effectiveness. It's also possible that your ED has worsened and you need a higher dose or different formulation.

Repeat dosing is risky, as it may increase the risk of priapism. Sometimes you just need to wait a bit longer for the medication to take effect. If there's definitely no response, your safest bet is to accept that the injection didn't work this time and wait at least 24 hours before trying again.

Bleeding from the opening of your penis likely indicates puncture of the urethra. This will most likely stop if you apply pressure to the entire penis for five to seven minutes. In the very rare case that the bleeding doesn't stop, you should go to the ER.

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