How to Self-Inject: Penile Injections with Prostaglandin (PGE1, Caverject, and Edex), Bimix, Trimix, and Quad-Mix.

by Alex Shteynshlyuger MD


If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call 1-(646) 663-5211.


Logistics of Intracorporeal Injection Therapy for Erectile Dysfunction

This discussion applies to the following medications Bimix, Trimix, Quad-Mix, and prostaglandin preparations including Caverject and Edex.

shutterstock_183978314-vasectomyUsually, a small needle used by diabetic patients for injecting insulin is used for injection of these medications in the penis.  It is important to inject the medication on the side of the penis at 90-degree angle to the penis (perpendicular). The preferred site of injection is about one third from where the penis originates.

I usually advise patients to stretch the penis, especially if you are uncircumcised, and then inject the medication while the penis is on a stretch.  Usually, right-handed men hold the syringe in the right hand and pull the penis to the left to make injections easier.  It is better to inject towards the top than towards the bottom of the penis as urethra runs on the “bottom” of the penis which you want to avoid.

How the Dose of Injections is Determined:

There is no single dose that is used for everyone. Each man is individually evaluated and an appropriate dose of medication is chosen to provide adequate erection while minimizing the risk of priapism (an erection that lasts for > 4 hours). With combination medications such as Trimix, various Trimix preparations are available with various strength, in addition to the dose of medication (mL or microliters), the preparation strength is chosen.  Multiple visits may be required to choose the correct dose.

The goal when choosing an appropriate dose is to provide adequate erection hardness and adequate duration.  The duration of erection should be close to or just under 1 hour.

We have also noticed that some men with ED can benefit sufficiently from 1 injection to be able to skip additional injections for one to two weeks at a time. They are able to achieve adequate erections spontaneously for some period of time after an injection before they need another injection.

Storage of Medications

Prostaglandin injections come as refrigerated (less expensive) and those that do not require refrigeration (EDEX, Caverject).  We usually order prostaglandin (alprostadil) that requires refrigeration in small vials of 5 ml each.  We advise that you store them in the freezer; keep one in the refrigerator until you use it up; then thaw out a fresh vial at room temperature and store it in the refrigerator.

Trimix injections are also available as refrigerated (less expensive) and those that do not require refrigeration.  We usually order Trimix that requires refrigeration in small vials of 5 ml each.  We advise that keep one vial in the refrigerator until you use it up;  store other vials of Trimix in the freezer until you need them.  When you need a fresh vial of Trimix, remove it from the freezer and put it in the refrigerator; if you need it fast, you can thaw it in your palm for 10 minutes; store it in the refrigerator.

If properly stored, medications should work well for 3-6 months.  If you are not getting good erections there are two possibilities: the medication lost its potency; you can try a new vial from the same batch.  It is also possible that something happened in your body such as your diabetes worsened or your cholesterol is higher, or testosterone levels lower and as a result, the prior dose of medications does not work well.  Please schedule an appointment for re-evaluation.

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Scheduling Appointments with ED Specialists


If you have any questions about ED treatment, schedule a consultation, contact us or call 1-(646) 663-5211.  We have excellent reviews from patients and their partners. 

We offer affordable, highest-quality urology care with or without insurance.   Find out our office hours or directions to our office. We offer weekday, weekend and evening office hours.

Dr. Alex Shteynshlyuger is a board-certified urologist, who specializes in all aspects of care for sexual problems in men including ED, premature ejaculation and other sexual concerns.  He has successfully treated hundreds of men with sexual problems including ED and poor libido.


 

ED is Treatable in Nearly Every Man

Excellence-Urology_Care-banner2At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of erectile dysfunction.  We understand the challenges that ED creates for our patients, their relationships and their self-esteem.  We help you find a treatment for erectile dysfunction that fits your needs, your lifestyle and your preferences.

Urologists are doctors specializing in the treatment of men with erectile dysfunction. By the virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for ED.  We offer medical and surgical treatment for erectile dysfunction.

We treat some of the most complex ED problems including:

Schedule an Appointment with Dr. Shteynshlyuger:

Call today: (646) 663-5211 or make an appointment online

Dr. Alex Shteynshlyuger is a fellowship trained board-certified urologist with expertise in evaluation and treatment of urological problems in men and women using modern effective and proven treatment methods.  He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.

 

 

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