How to Do Penile Injections Step by Step
A patient-friendly guide to intracavernosal injection therapy, designed to help you master the technique with confidence and safety.
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Download PDF GuideWhat Penile Injections Are
Penile injections, also called intracavernosal injection therapy or ICI injections, are a treatment for erectile dysfunction that places medication directly into the erectile tissue of the penis. If oral medications like Viagra or Cialis are no longer providing sufficient results, injections are often the recommended next step. Learn about ED treatment options →
Common medications include alprostadil or compounded combinations such as Trimix. When used properly, penile injections can be highly effective and can provide a more predictable response than pills alone. Read our complete Trimix for ED guide →
The Step-by-Step Process
Follow these instructions carefully. We recommend practicing the "drawing up" steps with plain saline first if your doctor suggests it. Always ensure you are in a clean, relaxed, and private environment.
Preparation
Hold the medication bottle so that your fingers do not touch the rubber stopper through which the needle is inserted. Always check the expiration date before you begin.
Sterilization
Using a circular motion, wipe off the top of the vial with a fresh alcohol swab to ensure a sterile entry point.
Prepare Needle
Remove the needle cover. Crucial: Do not allow the needle to touch anything prior to drawing the medication or before injecting.
Equalize Pressure
Draw an amount of air into the syringe equal to the amount of medication to be injected. Push the needle through the center of the stopper and push the air into the bottle.
Draw Medication
Turn the bottle and syringe upside down. Slowly draw the medication into the syringe until you reach your prescribed dose.
Remove Bubbles
Tap the syringe gently and move the plunger in and out several times to ensure all air bubbles are removed from the medication.
Site Selection
Locate the injection site as illustrated by your doctor (usually the side of the shaft, avoiding veins). Wipe the area with an alcohol swab. Grasp the head of the penis, not the skin, and maintain traction.
The Injection
Hold the syringe like a pen. Insert the needle at a 90-degree angle into the injection site. Push the medication in slowly—over a period of 8 to 10 seconds.
Post-Injection
Remove the needle. Apply firm pressure with your index finger on the injection site and your thumb on the opposite side of the penis for two minutes to prevent bruising.
Key Safety Rules
- Do not inject into visible veins.
- Use only the dose prescribed by your doctor.
- Rotate sides with each injection.
- Apply pressure after the injection to reduce bruising and bleeding.
- Seek help if an erection lasts too long.
How Often to Use ICI
Do not use injections more often than prescribed. Many men are instructed to limit use to no more than three times per week, with at least 24 hours between injections, but your personal instructions may differ.
Using more medication than prescribed does not make the treatment safer or better. In fact, it raises the risk of side effects and prolonged erections.
While side effects are generally manageable, Dr. Kashani monitors patients closely to ensure the dosage is optimized for hemodynamic stability, preventing the risk of prolonged ischemia (priapism).
If you have questions about your specific dosage or medication type, please book a consultation with Dr. Kashani →
Possible Side Effects
The most common side effects include mild pain, bruising, or a small amount of bleeding at the injection site. Some men also notice a burning sensation depending on the medication used.
The most important complication to know about is priapism, which means an erection that lasts too long. This can become a medical emergency if it is not treated quickly.
When to Call for Help
Contact your doctor right away if you have severe pain, significant bleeding, signs of infection, or an erection that lasts longer than expected. If your erection lasts more than four hours, you should seek urgent medical care.
You should also call if you are unsure about your dose, if you miss the target area often, or if the medicine is not working as expected. Fine-tuning the dose is often part of the normal process.
Frequently Asked Questions
Does a penile injection hurt?
Most men describe only brief discomfort. The needle is very small, and many patients find the process easier after proper instruction and a few tries.
How long does it take to work?
The erection often begins within minutes, although timing can vary based on the medication and dose.
What if I get the dose wrong?
Do not take an extra dose on your own. Call your prescribing clinician for guidance.
Can I use penile injections after Viagra or Cialis did not work?
Yes, injection therapy is commonly used when oral medications are not effective enough.
Why a Specialist Visit Matters
Penile injection therapy is highly effective, but the best results come from proper teaching and careful follow-up. A urologist can help determine the right medication, the right dose, and the right technique for your anatomy and your goals.
At Men's Health Long Island, we make this process private, clear, and comfortable so you can use the treatment with confidence.
Dr. Mahyar Kashani, MD
Fellowship-trained urologist and Director of Male Sexual Health at Men's Health Long Island. Specializing in erectile dysfunction, penile injection therapy, Low Testosterone, Peyronie's Disease, and advanced men's sexual health care.
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