How To Give a Penile Injection

In this video, we’ll show how to give a penile injection. A penile injection is a shot of medication in your penis. It’s also called an intracavernosal injection or ICI.

If you take a medication for erectile dysfunction, also called ED, follow your care team’s instructions for taking it during your penile injection therapy. It may not be safe to take it for a few hours or days before and after each injection.

First, set up your supplies on a clean surface. You’ll need your penile injection medication vial, a single-use syringe, and 2 alcohol wipes. You’ll also need a home sharps container to hold your used syringes. You can use an empty, hard plastic container with a screw-top lid, such as a laundry detergent bottle. Label it “Home sharps – not for recycling.”

If you’re using the vial for the first time, take off the cap and throw it away. Be sure to check the medication in the vial. Don’t use it if there’s anything floating in it, if it’s cloudy, or if the rubber stopper comes off the vial.

Once you have your supplies, wash your hands well with soap and water.

Open an alcohol wipe and scrub the rubber stopper on the top of the vial for 15 seconds. This will kill any germs on the stopper.

Next, get the syringe ready. If there’s a cap covering the plunger, take it off. Then, take off the orange cap covering the needle. Be very careful not to let anything touch the needle. If anything does touch it, put the syringe in your sharps container and use a new one.

Holding the syringe with the needle pointed up, pull the plunger back past the dose your care team told you to inject, then push it back up until the top of the plunger—the part closest to the needle—is at the dose you need to inject.

Turn the syringe so the needle points down. Hold it between your thumb, index, and middle fingers, like you’d hold a pen or a dart, close to the needle. Hold the medication vial with your other hand. Put the needle through the center of the rubber stopper on the vial. The vial is pressurized, so you need to put air into it before drawing out the medication. Push the plunger down to inject air into the vial.

Next, turn the vial and syringe upside down. Don’t let go of the vial, or the needle will bend. Make sure the tip of the needle is in the medication. Turn the syringe so you’re looking at the numbers and lines. Pull the plunger down past your prescribed dose, then slowly push it back up to your dose. This helps remove any air bubbles.

Without taking the needle out of the vial, look for air bubbles in the syringe. If you see any, pull more medication into the syringe, then slowly push the air bubbles and extra medication back into the vial. Check the amount of medication in the syringe to make sure it’s the right dose.

When you have the right dose, pull the needle out of the vial. Put the cap back on the syringe without pushing the plunger or touching or bending the needle. Set the capped syringe down. If you push the plunger, you may need to draw up more medication to make sure you’re getting the right dose. If you touch or bend the needle, you’ll need to put the syringe in your sharps container and start over with a new one.

If you’re using Trimix, put the vial back into the refrigerator. If you’re using Bimix or papaverine, you don’t need to keep the vial in the refrigerator.

Once the syringe is ready, choose the injection site—the place on your penis where you’ll inject the medication. You must inject the medication into a specific area of your penis so you don’t inject into a nerve or a blood vessel. Imagine the shaft of your penis is divided in 3 parts. You’ll give the injection in the middle part at the 10 o’clock position on the left side or the 2 o’clock position on the right side. Switch sides each time you give yourself an injection. This helps protect the tissue. Never inject straight into the top or bottom of your penis, and avoid any veins you can see or feel. Injecting into a vein could cause a large bruise.

Once you’ve chosen the injection site, open an alcohol wipe. Gently pull the head of your penis straight out in front of you. Wipe the injection site with an alcohol wipe, then set the wipe down nearby.

Next, you’ll inject the medication. Let go of your penis, pick up the syringe, and take off the cap covering the needle. Check to make sure the medication dose is right. If you pushed out any medication by accident, draw up more from the vial following the same steps as before.

Hold the syringe between your thumb, index, and middle fingers, like you’d hold a pen or a dart, with the needle facing the floor. Don’t touch the plunger yet.

If you have foreskin, pull it back. Once again, grasp the head of your penis and pull it straight out in front of you so it’s fully stretched. This helps make sure the medication goes into the erectile tissue. Keep pulling on your penis from the time the needle goes into the shaft until it comes out. Don’t twist it, or you could inject into the wrong area.

Quickly slide the needle into the shaft of your penis, move your index finger or thumb to the plunger, and push down to inject the medication. Be careful not to pull out the needle as you’re doing this.

Once you’ve injected all the medication, quickly pull the needle straight out of your penis. Don’t twist it, or it may cause bruising. Let go of your penis. Drop the syringe into your sharps container. You don’t need to recap it.

Pick up the alcohol pad and place it over the injection site. Hold it in place with your thumb and place your index finger on the opposite side of your penis. Apply pressure for 2 to 3 minutes. If you’re taking a blood thinner or aspirin, apply pressure for 5 minutes. This will help decrease any bleeding or bruising. Then, stimulate yourself so you get an erection.

After about 10 minutes, grade your erection. The erection grading scale goes from 0 to 10 with 0 being completely soft, 6 being just hard enough not to buckle, and 10 being rock hard. The goal during penile injection therapy is to get to at least a 6 on the grading scale for about 30 minutes.

Send your healthcare provider a message through MyMSK. Tell them your erection grade and whether you’re getting the results you want. They’ll tell you which dose to try next based on your response. It usually takes a few injections to find the right dose for an erection firm enough to have sex. It’s important to follow the treatment plan your care team gave you. Never change your dose on your own.

Sometimes, penile injections can cause priapism, an erection that doesn’t go away. When you have a full erection, no fresh blood flows into your penis. If you have a full erection for too long, it can damage the tissue and lead to permanent ED. This is more likely to happen if you don’t follow your care team’s instructions for your injection doses or schedule.

Your care team will give you written instructions for managing priapism. You can also find them by going to www.mskcc.org/pe and searching “priapism.”

If you have any questions, talk with a member of your care team. For more information about penile injections, you can also visit www.mskcc.org/pe and search “penile injection.”