You’re going to stick what into my what?!!

Posted on September 3, 2008. Filed under: Sexual issues |

In this post, I promised to give it to you “straight” about some treatment options for ED, and the inside (a little more ED humor there) info that goes along. Yesterday, we talked about the pills your ol’ pappy wished he’d had when his “best friend, Mr. Happy” died before he did. Today, we’ll feature the self-administration of  intra-penile injections for the purpose of showing “condition wood”. The operative word is “showing”, as this account of the legendary first public demonstration of the ability of injected vasoactive drugs to produce erections recalls: “The introduction of the penile prosthesis paled in comparison to British physiologist Giles Brindley’s dramatic demonstration at the 1983 Annual Meeting of the AUA. Brindley closed his lecture by dropping his pants to reveal a perfectly erect phenoxybenzamine-induced erection.”   Now that’s science! Medical conventions are just not what they used to be (nor is ol’ Giles). As I previously wrote, the pills for ED treatment inactivate the “get it down” chemical. Injectable vasoactive drugs are chemical donors of nitric oxide, the “get it up” chemical: they actually initiate erections. Sometimes, life presents difficult choices; in this case the choice is: do I really want to stick a needle in my dick, or do I not really want to get laid that much? If a man’s penis is physically capable of achieving erection, that is, the blood vessels and the muscles are healthy enough to respond to sexual arousal, an injection of a drug such as alprostadil will get him hard, even if he doesn’t want it to do so. It’s the most powerful thing that can be done to restore erections, save only the penile prosthesis (next post). To most men, it sounds horrible, hence the name of this post. I can’t enumerate the men who have said, “You can test me with the injection if you want (to determine the integrity of the penile vasculature), but there’s no way I’m ever going to do that to myself.” Five minutes later, while staring at the best thing they’ve seen in years, they ask, “is there any way I could get a barrel of this stuff?” 

The phenoxybenzamine chemical that Giles Brindley injected turns out to be carcinogenic, but alprostadil, when dosed properly, has essentially no dangers. A typical dose is ten micrograms (millionths of a gram), while the original intended recipients, four-to-six pound newborns with heart disease, receive 250,000 micrograms IV every six hours. Sounds almost homeopathic, doesn’t it?

I think the idea of being repulsed by needles (these are thirty-gauge, not much different than a mosquito’s proboscis) must go back to all the injections we get as kids, when we have no say in the matter. It certainly doesn’t hurt, but describe it to a man you know, and watch his face. On the other hand, this shot, unlike those we took earlier in life, has an immediate and demonstrable reward. And as a friend observed, noting the diffrences between men and women: “Men will have sex with a headache.”


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4 Responses to “You’re going to stick what into my what?!!”

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Good humor. Pleased I found your site.
Question…, is there a society of retired urologists?

There is, but so far, I’m the only member.

Um, so… um… if one has good health insurance, how does one go about getting alprostadil?

@ Rob:
Info assumes you’re in the USA:

Legally, injectable alprostadil is available by prescription only. Any licensed MD can prescribe it, but usually the doctor is a urologist, or a GP in a sexual medicine clinic, because of the necessity for being able to handle the possible complications. There is no reliable method to determine the proper initial dose, other than a trial injection. If the dose is too weak, the only complications are disappointment and perhaps embarrassment. But if it is too strong, an erection that will not subside spontaneously (priapism) may develop. If not treated appropriately in the first twelve hours or so, permanent damage to the penis may occur (as well as a LOT of pain). Fresh priapism usually can be resolved by an injection of an “alpha adrenergic agonist” drug, such as phenylephrine: same technique as the original alprostadil shot, and painless. For resistant cases, it may be necessary to anesthetize the penile skin and place an IV needle into the muscle, in order to extract the clotted blood. If there were no risks, it wouldn’t be a prescription item. That said, my patients have used over 300,000 alprostadil injections; I have treated priapism about 20-30 times, all successfully.

Some claim that injections lead to palpable scar tissue in the erectile muscles (corpora cavernosa). This certainly is true of some other agents or mixtures of agents, but I know of no controlled studies that confirm it with alprostadil. Scar tissue, in my opinion, develops because of diminished vascularity, the reason the injections are required to begin with.

My method for dosing was (I no longer see new patients): Interview to determine age, general health issues, ability to follow instructions, and the character of erections noticed when awaking (the stronger the awaking erection, the better the vasculature). Make an informed guess about the dose, and administer a trial injection in the office. If the response is too strong, inject phenylephrine and prescribe the minimal dose (or revert to pills). If the response is absolutely too weak, prescribe a stronger dose for home trial, adjusting it as necessary if still too weak. If the response is moderate, try that dose at home before going higher.

By word of mouth from a former patient, a doctor acquaintance, or even the yellow pages, find a urologist who treats erectile dysfunction as a special interest. I saw very few patients whose health insurance paid for alprostadil injections, but that’s an individual issue that you can determine. If not covered, expect each injection to cost $15-30.

NOTE: If you occasionally have completely normal erections, whether sleeping, masturbating, fantasizing, or during sex, injections are not for you. Injections are for people whose penis has a physical disorder. Such disorders do not come and go.

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    The director of the Sexual Medicine Center leaves penile implants behind, and launches a quest for knowledge about Artificial Intelligence, extended life, and the issues inside the health-care industry.


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