Why Many Men Avoid the Most Effective Erection Drugs

Quick: What’s the most effective treatment for erectile dysfunction (ED)? No, not Viagra (sildenafil) or its sister medications Cialis (tadalafil), Levitra (vardenafil), or Stendra (avanafil). Among ED treatments, they’re the most popular.

The most effective drugs are papaverine, phentolamine, prostaglandin E1, or a mixture of all three (Trimix). However, these medications repel the vast majority of men because they must be self-injected into the shaft of the penis shortly before lovemaking. Few men can imagine sticking needles into themselves anywhere, let alone there.

One-quarter of adult American men have ED, around 40 million. The best evidence suggests that 1% of them self-inject, in the neighborhood of 400,000 men, most of whom have type 1 diabetes and also self-inject insulin.

Few men who have erections by injection discuss it, but when they do, most say: The first time was difficult, but it quickly became no big deal—and I like the results.

Erection by injection debuted more than 40 years ago (1982). Urologists are familiar with it. But it’s received only scant media attention, so many men who might consider it have never heard of it.

Trypanophobia?

The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) recognizes many irrational, exaggerated fears (phobias). One is trypanophobia, an intense fear of needles in medical settings—vaccinations, blood draws, or any treatment delivered intravenously. Some men recoil from injected ED treatment because of trypanophobia.

Risk factors for trypanophobia include a family history of needle fear, a personal history of trauma around injections, having other phobias, and age—it’s most common in children, but also afflicts adults. The treatment psychologists recommend involves deep breathing, which is relaxing, imagining a place where you feel safe and happy, also relaxing, and closing your eyes or looking away from needles.

Evolutionary psychologists suggest that natural selection may explain a good deal of trypanophobia. For our primeval ancestors, getting stabbed or cut was often life-threatening. It’s possible that individuals who were wary of sharp objects including needles gained a survival advantage that eventually became wired into our genetics and psyches.

But for most men, needle-sticks, per se, are not the problem. What they fear is self-injection into a very special place.

Erection by Injection

The needle is tiny. It’s only a few inches long, and has a very small diameter (30 gauge). Injections often feel like mosquito bites, which most men hardly notice.

As mentioned, the first few self-injections are hardest. Once men get the hang of it, self-injecting into the penis quickly becomes routine. Many men say the most difficult part of this treatment is not plunging the needle, but loading it with the right dose.

Erections produced by injection typically rise after 10 to 20 minutes of erotic fondling. They last around an hour, and subside after ejaculation.

How do men accomplish those first few scary injections? They get trained by urologists, who teach them one-on-one how to attach the needle to the syringe, how to load the drug, stretch the flaccid penis, and where to inject—not on the top or bottom of the shaft, but along either side. The drugs open (dilate) blood vessels in the shaft, allowing extra blood to flow into the penis’ erectile tissues. Training takes around 30 minutes, and involves practicing self-injection in the urologist’s presence.

After initial training, some men can’t bring themselves to actually stick themselves. Most urologists are familiar with this. Inability to self-inject means that men should either use another ED treatment or adjust to life—and sex—without erections.

After men get used to self-injecting, they must determine the dose that works best—sufficient to produce firm erections, but not so large that men develop side effects. The main one is priapism, painful erections that may persist for hours. Priapism is most common among men younger than 50, but it may develop in older men.

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To minimize priapism risk, men should start with a low dose and increase it incrementally until they enjoy the desired result.

Mild priapism can be treated with a drug that constricts the blood vessels (pseudoephedrine, Sudafed). Urologists prescribe it to men who opt for this treatment. If pseudoephedrine doesn’t deflate the erection, men should visit an emergency room for stronger medication.

The other possible side effect is injection-site infection. Along with the other paraphernalia, urologists also provide alcohol wipes to disinfect the penis skin before and after injections.

The Joy of Outercourse

What can men do if they dislike oral ED drugs, but don’t want to inject? They can enjoy fabulous sex and great orgasms without intercourse.

For many older couples who remain sexual, vaginal intercourse eventually becomes problematic. Older men may develop erection difficulties, and many postmenopausal women experience vaginal dryness and atrophy (tissue thinning) that often makes intercourse uncomfortable or impossible, even with lubricant. Many adults who remain sexual past 60 decide that intercourse is no longer worth it.

Fortunately, after kissing intercourse goodbye, older lovers—actually, couples of any age—can enjoy marvelous sex by embracing what sex therapists call “outercourse”: kissing, hugging, cuddling, mutual whole-body massage, genital hand massage, etc. Many older adults, especially men, have a hard time transitioning from sex based on intercourse to sex without it. But sex therapists almost universally recommend this shift, and with a little practice, most older lovers come to enjoy it. Note: For male orgasm, erection is not necessary.

In Conclusion

In addition to oral ED medication, there’s also erection by injection. Only a small proportion of men opt for it, but those who do usually say they’re happy with the results.