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Self-Injection Therapy For Impotence

Introduction

Self-injection therapy is one of several available options for the treatment of impotence. This involves the patient or his partner giving an injection of medication directly into the side of the penis to create an erection. The erection created is a natural one and usually begins 5 to 15 minutes after the injection. Not all patients respond to this type of treatment, but those that do should develop an erection that lasts anywhere from 30 to 120 minutes. The injections are given with a tiny needle and use very small amounts of medicine. The injections are relatively painless and are easily taught to the patients in one or two visits with the doctor.

The drugs used today include: prostaglandin (PGE-1 or Prostin or Alpoprostadil or Caverject), Papaverine hydrochloride and phentolamine (Regitine). All of these drugs have been approved by the FDA for uses other than the treatment of impotence. Only Prostaglandin has been approved by the FDA for the treatment of impotence. Papaverine and phentolamine have not yet been approved by the FDA for this specific purpose, although these two drugs were the initial ones used for self-injection therapy. However, considerable experience has been obtained by urologists over the past decade and all three drugs mentioned above are considered safe for self-injection therapy.

Risks

All medications have some potential risks and side effects and risks do exist with all of these drugs and the injections. These may include the possibility of bleeding or bruising from the injection, and the small chance of infection. One of the more common risks include the development of a prolonged erection or priapism (more than four hours). An episode of priapism might require a trip back to the physician or to the emergency room to receive other medications to counteract the self- injection medications and relieve the prolonged erection. Priapism happens in only a few percent of the patients. The patient does need to be aware that any erection lasting more than four hours needs to be dealt with by a physician. Another complication is the development of permanent scarring within the penis. The medications can be irritating to the penile tissues, and scarring is most often seen in patients who abuse the drug by using it too often. Scarring could create difficulty obtaining erections even with additional medication. If the scarring were severe, placement of a penile prosthesis, if that other option was chosen at a later time, might be difficult. Even rarer is the development of other medical problems. Papaverine has been known to cause changes in liver function tests which go away if the drug is stopped.

Disadvantages Of Self-Injection Treatment

Self-injection treatment does require the patient or his partner to learn to give injections directly into the penis. The patient does need to return to the doctor for follow-up visits, particularly in the early phases of treatment. The patients cannot use the injections too often for fear of developing scarring and the self-injection treatment should be limited to once every four to seven days (range depends on medication type and intitial response).

The injections are relatively costly and average costs depend on what combinations of medications are used. An injection may cost up to $8 to $10 per injection.

Not all patients are candidates for self- injection therapy. A percentage of patients will not develop good erections, and another set of patients might develop erections that do not go away, making them poor candidates for continued use of this drug.

Advantages

The major advantage of self-injection therapy is the fact that the erection created is similar to the body's own spontaneous erections. The erection usually lasts 30 to 120 minutes, which is adequate duration for successful and pleasing intercourse. Self- injection therapy does not impede the development of an orgasm or ejaculation. Self- injection therapy is less costly than surgical implantation. Self-injection therapy can be used by the patient at his own discretion and at anytime with a minimum amount of preparation. Treatment does not involve surgery and is only minimally painful.

Summary

If you decide to start the self-injection program, we will have you back to the office for test doses to see which drug and dosage is most appropriate and effective for you. After we have established the drug dose, we will then teach you how to draw medication from a vial, and also how to inject it safely into the penis. You may want to bring a partner to watch, although a partner is not absolutely necessary if you have good dexterity and eyesight. We will have you read, understand and sign a consent form. The form will mention the various risks of the medications and injections. We will go over all of these risks and conditions for you in detail at the time of the educational program. If you have any questions about self-injection therapy, please don't hesitate to ask us.

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Reprinted with permission from Dialog Medical, dialogmedical.com.

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