How does intracavernosal injection therapy treat erectile dysfunction?
To understand the treatment, you must first comprehend the biology involved.
The penis consists of two corpora cavernosa, one corpus spongiosum, nerves, blood vessels and the urethra.
The two corpora cavernosa are chambers of spongy tissue that run along the sides of the penis. They’re interconnected and they fill with blood to produce an erection. When stimulated, the cavernous nerves send signals to the brain to relax the muscles around the corpora cavernosa. This allows arterial blood to flow through the blood vessels of the penis and flood the corpora cavernosa. The increase in pressure compresses the veins in the penis and prevents blood from draining out. This is what creates an erection.
The urethra is simply a tube that runs through the penis. It allows urine and semen to exit the body.
An ICI is an artificial way to obtain an erection, by injecting a drug into one of the corpus cavernosum, which is helpful if there’s a neurological or vascular defect. An erection rigid enough to allow penetration gradually appears after about 15 to 20 minutes, and it can last for about an hour.
What are the side effects of treating erectile dysfunction with intracavernosal injections?
Bruising around the injection site is common.
Priapism, which is a painful erection that persists for more than four hours, is rare if the recommendations and dosages are followed. However, priapism is considered a medical emergency that must be treated within three hours of the injection. Otherwise, it can cause permanent damage to the penis.
If an erection lasts for longer than two hours after an injection, stop all sexual stimulation and immediately begin to apply ice (in a bag wrapped in a damp cloth) intermittently to the penis.
Which pharmacies carry the medication for intracavernosal injections used to treat erectile dysfunction?
The medications used for ICIs are only available with a prescription in a few specialized pharmacies in Montreal and elsewhere in Quebec.
Alternatively, they can be obtained from a large compounding pharmacy in Toronto, with rapid home-delivery through a special order from Dr. Marois.
The pharmacy will provide all the necessary medical equipment for an intracavernosal injection in accordance with the prescription.
What equipment is needed to administer an intracavernosal injection?
● 1 vial of medication (about 4 to 5 millilitres)
● Alcohol swabs (for disinfection)
● 1 millilitre graduated syringes
● Small gauge 1/2-inch needles
It’s best to pick up a specialized container to dispose of used needles from a pharmacy. Once full, this container must be returned to the pharmacy.
How is medication for intracavernosal injections stored?
Vials of medication for intracavernosal injections must be refrigerated. However, the medication won’t be as effective if it freezes.
In the proper conditions, a vial of medication can be stored for three to four months.
A syringe can be prepared in advance with the correct dosage and stored in the fridge.
How is an intracavernosal injection to treat erectile dysfunction prepared?
Always begin by washing your hands with soap and water before you handle any of the equipment.
Start by checking the expiration date marked on the vial. The medication comes as a clear liquid. Confirm the prescribed dosage, which should be about 0.5 cc (or 0.50 on a 1 cc or 1 millilitre syringe).
Next, remove the cap from the vial and wipe the rubber stopper with an alcohol swab.
Remove the needle from its sterile packaging and insert it in the tip of the syringe. This should only be done immediately before administering each injection.
Make sure the needle and the tip of the syringe don’t touch anything besides the interior of the vial. Otherwise, you’ll need to use a fresh needle or syringe.
Remove the needle cap, and insert the needle into the rubber stopper. Hold the syringe and vial securely in both hands, and turn the vial upside down.
Pull back on the plunger of the syringe until it reaches 0.1 millilitre above your prescribed dose. Slowly push the plunger until the medication reaches the prescribed dose.
Gently tap the syringe to remove any air bubbles.
Remove the needle from the vial, and put the cap back on the needle. The syringe is now ready to inject the next time an erection is desired.
How do you administer an ICI to treat erectile dysfunction?
Start by stretching out the penis toward the right or left thigh.
To successfully obtain an erection, the medication must be injected into the middle third of the penis on the side. Alternate sides between injections to prevent a buildup of scar tissue.
Thoroughly wipe the selected side of the penis using an alcohol swab.
Remove the needle cap. Holding the syringe like you would a pen, insert the entire needle in the penis at a 90 degree angle.
Slowly press down on the plunger with your thumb until all the medication has been injected. Carefully remove the needle. Dispose of the needle and syringe in a specialized container.
Hold an alcohol swab on the injection site for about seven minutes to prevent bruising. You can then begin sexual stimulation, and an erection will gradually appear.
If you’re both comfortable with it, an ICI can also be administered by your partner.
What precautions should be taken when administering an intracavernosal injection to treat erectile dysfunction?
Remember to alternate sides of the penis between injections to prevent scarring.
Avoid injecting the medication into a visible vein, as this can cause bruising.
Avoid injecting medication into the urethra, as this can cause pain or a burning sensation. You may also notice a few drops of blood in your urine.
Avoid injecting medication into an erect or semi-erect penis, and don’t administer two injections on the same day.
Where can you learn how to administer an intracavernosal injection?
A nurse at Les Cliniques Marois can teach you how to administer the medication during an injection test or Doppler ultrasound (link to this page), which is used to assess moderate to severe erectile dysfunction.
You can also contact a nurse by phone or email if you have any questions or concerns about administering injections at home.
Can an ICI dose be adjusted if it doesn’t produce a satisfactory erection?
After an injection test is performed at the clinic to ensure you don’t experience pain or priapism, you’ll be prescribed an initial dose. It’s common that this amount will need to be modified.
If you don’t experience a satisfactory erection, you can gradually increase it by 0.1 cc or one unit. However, you should follow the initial dose at least twice before determining if it needs to be adjusted.
Once you reach a sufficient dose without a prolonged erection, you may be able to decrease the dose by half a unit.
The maximum recommended dose is usually equivalent to one full syringe.
A follow-up appointment should be scheduled after four weeks of using the medication to ensure it’s safe and effective. This is also an opportunity to ask further questions.
If ICI therapy doesn’t achieve satisfactory results, you can discuss alternative treatments with Dr. Marois.