Penile Injection Therapy for ED, with Tim Stewart.

“That was awesome! I really liked your relaxed, interview style. Makes a difficult conversation easy”
- Jo Milios, Men’s Health Physiotherapist, Perth


Just want the video instruction for injecting Trimix? Click here.

Edited transcript for what Trimix is, how to inject it, the side effects and how often you can/should use it for rehabilitation:

Trimix has three ingredients as the name might suggest. So the first one is alprostadil, which is the same as what's in Caverject itself. The other two are phentolamine and papaverine. Now these kinds of things can be used to dilate blood vessels, blood pressure and all sorts. But obviously in this formulation it's used to dilate blood vessels in the penis to allow lots of blood to flow through the cavernous tissue and cause an erection.

The typical dose of Trimix - it's very hard to say, it's so variable. We use insulin needles generally to draw up the amount that we're going to dose with. So we speak in terms of units rather than mils, but typical dose would be anywhere from about 15 to say 30 units, which would be kind of like 0.15 to 0.3 mils.

Now, a real quick run through of how an injection is performed. Again it would take me probably 15, 20 minutes to go through this completely. And if you'd like to do that, then please get in contact. This is the typical type of syringe that you would use, an insulin syringe. The actual dose comes in a vial. And that's the needle itself. So to start dosing, you would draw down to the amount that you're going to dose with. Now this isn't going to be a guessing game. You would talk to your doctor or your injection therapist, to start with anyway.

You'll draw it down to the amount that you're going to dose with. You'll pop that into the vial. So the needle goes through a bright rubber banger in the top of the vial. You'll insert that air just to equalize it a little bit. And then you'll draw down the amount of liquid that you're going to inject.

Now that amount of liquid obviously equates to the dose that you're going to be giving yourself. It's important to hold the vial upright and kind of upside down because otherwise you may end up injecting air. This isn't going to cause any problems, but it's obviously not going to work.

So to start with, you would pull the full skin down, if you've got one of course. You would stretch the penis out away from your body and you want to inject it in kind of an area, if you imagine the penis as a clock, you would inject it into either 10 o'clock or two o'clock, so it’s on the top side of the penis, not the side, not the bottom.

You would swap the area with an alcohol swab first. You would hold the needle like a dart, or the syringe like a dart, and then just straight in. So you want to avoid any visible veins or arteries. If there are any, just inject a different spot. Once it's in, you'll push the plunger all the way in and then you'll remove that and put it straight in a sharps container.

Then you put a good amount of pressure onto the site that you've just injected into and then you'll start massaging quite firmly. You want to do that to help the blood start to flow and also to spread the medication throughout the penis.

Some of the side effects ... Well the main thing with any kind of injection could be a small prick or a sting. Typically there are not systemic side effects because the drug is literally just being injected into the spot where we want it to work. So most of the side effects are in the penis itself and generally it's a bit of pain. If the pain is more than just a bit, there are methods that you can use to get rid of it. And if it's obviously lasting longer than what you might want it to.

A typical erection after one of these injections should last about an hour. That's an ideal time frame. That might sound like a bit long, or a bit short depending, but an hour is about what we're aiming towards, to have that really good oxygenated blood flowing through the penis, getting that tissue stretched as well. So an hour is ideal.

If it's going up to say two hours, you want to start thinking about getting rid of the erection. And the way to do that is essentially by doing anything that's going to constrict those blood vessels to get the blood out again. One way is to try pseudoephedrine tablets. Now all of this advice, of course you should run through your doctor or pharmacist first because these aren't suitable for everyone. But as an example, you could use pseudoephed tablets. The guidelines say 120 milligrams on this particular one here so you would take two tablets of that one. You would also use an ice pack or a bag of peas or frozen peas to try and constrict those blood vessels as well. You could also jump in the shower, a cold shower, make sure those blood vessels are being constricted to get rid of the blood out of the penis.

That will typically do the trick and you won't need to do any anything further, but if it gets to a point where the erection is lasting, it's going on say four hours now, that's considered a medical emergency and you need to seek medical help, namely the hospital. Very, very rare but possible and you need to know what to do if it happens (this is called a ‘priapism’).

For prostatectomy rehabilitation purposes, we generally recommend using injections once to twice a fortnight. If you want to do it more often, we wouldn't recommend any more than say twice a week.

This is because if you're injecting into the same area quite often you can cause a bit of scarring in that area. And it can get to the point that it can cause a bit of a bend in the penis. You might know it as Peyronie's Disease, and that can be induced by multiple injections in the same area. So for that reason as well, we recommend alternating the injection site each time you do it. So even if you're doing it once to twice a fortnight you would do it on one side one time, and then the next time you do it you do it on the other side.


Tim Stewart is a pharmacist and injection therapist in Canberra, Australia. Learn more about his work and get in touch at Men’s Health Downunder here.

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