ICI (injectibles)

Intracavernousal injection therapy (ICI) is the most effective nonsurgical treatment for ED. Intracavernosal injection therapy has been an effective and reliable ED therapy since 1983. Alprostadil, bi-mix (papaverine and phentolamine), and tri-mix (papaverine, phentolamine, and alprostadil) are all injectable vasodilators used to treat ED. These are injected into the cavernosal tissue of the penis with a very fine needle just before intercourse. The medication works by relaxing the corporal smooth musculature and/or building the adrenergic tone of the corporal smooth muscle (102). As with intraurethral gels, the first dose of injection therapy should be administered under healthcare supervision. A specialized practitioner will be able to instruct patients on proper application in addition to monitoring the efficacy and side effects of the dosing.


The medication works by relaxing the cavernosal smooth muscle cells. Injections are one of the most effective forms of ED treatment: up to 92% of patients find it effective. In a study conducted by the British Medical Journal, 88% of patients who failed to respond to PDE5-Inhibitors (Viagra, Cialis, Levitra) were successful with injection therapy. Additionally 48% of men who failed to respond to PDE5-inhibitors responded when used in conjunction with injection therapy.  According to a Continuing Medical Education (CME) Article, of the men who stop using injection therapy, 82% of them would still recommend it to a friend.

Injection therapy treatments should not be used more than once in a 24-hour period. The most common adverse effect is priapism. Priapism is defined as a prolonged erection which lasts for more than four hours. Patients must be cautioned to call their physician if an erection persists for 4 hours or longer. Other reported side effects include hematomas, burning pain after injection, urethral damage, local infections, curvature, and prolonged erections.

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