I want to talk about one of the most effective treatments for erectile dysfunction that almost nobody wants to bring up — penile injection therapy.
I get it. The words “penile” and “injection” in the same sentence is enough to make most men cross their legs and change the subject. But hear me out, because this treatment genuinely changes lives, and the fear around it is almost always worse than the reality.
First — What Even Is It?
Penile injection therapy (also called intracavernosal injection therapy, or ICI) involves injecting a small amount of medication directly into the side of the penis. This medication relaxes the smooth muscle and opens up the blood vessels, allowing blood to flow in and produce a firm erection — usually within 5 to 20 minutes.
It sounds confronting. In practice, for the vast majority of men, it’s far more manageable than they expected.
Who Is It For?
This treatment is particularly well-suited to men for whom oral medications like sildenafil (Viagra) or tadalafil (Cialis) haven’t worked well enough — or can’t be used at all.
That includes men whose erectile dysfunction is related to:
- Diabetes
- Cardiovascular conditions
- Nerve damage (including after prostate surgery or radiation)
- Psychological causes where other treatments haven’t taken effect
- Peyronie’s disease
It’s also used as part of penile rehabilitation after prostate cancer surgery — helping to maintain blood flow and tissue health while natural function recovers.
“But… a Needle? In My Penis?”
Yes. And I want to be honest with you about what that’s actually like, because the anticipation is almost always the worst part.
The needle used is very fine — typically a 29 or 30 gauge needle, which is similar in size to what’s used for insulin injections. It doesn’t need to go deep. The injection is into the side of the penile shaft, not the tip, and takes only a second.
Most men describe the sensation as a mild pinch or pressure — not painful in the way they imagined. Many are genuinely surprised by how straightforward it feels once they’ve done it the first time.
The first injection is always done here in the clinic, where I can guide you through the technique, find the right dose, and make sure you feel confident before ever doing it at home. That first visit takes all the mystery out of it.
What Medications Are Used?
There are a few different formulations used in injection therapy, and the right one depends on your individual situation. The dose is tailored to you individually.
We start low and adjust from there — there’s no one-size-fits-all approach, and getting the dose right is part of the process.
How Effective Is It?
Very. Injection therapy is one of the most reliable treatment options available for erectile dysfunction, with high success rates even in men who haven’t responded to oral medications. Studies consistently show satisfaction rates of around 70–90% in men who continue with the treatment.
The key phrase there is “who continue” — some men do find the idea takes adjustment, and that’s completely normal. With proper guidance and support, most find a good rhythm that works for them.
What About Side Effects?
It’s important to be upfront about this, because the treatment works best when you know what to watch for.
- Mild bruising or temporary skin swelling at the injection site is fairly common, especially early on, and usually settles quickly.
- Some aching or discomfort — particularly with alprostadil — can occur in around 10–30% of men. If this happens, switching to a different formulation typically resolves it.
- Priapism — an erection lasting more than 3–4 hours — is the one side effect that requires prompt attention. It’s uncommon when the dose is correctly calibrated, but it is an emergency if it occurs. You’ll be given clear instructions on what to do (and we make sure you always have a plan before you leave the clinic).
Using the treatment no more than 2–3 times per week, and allowing time between injections, helps protect the tissue and reduce risk over the long term.
What Does a Typical Appointment Look Like?
Your first visit is a teaching appointment. We’ll go through your history, talk through what to expect, and I’ll perform the first injection in the clinic so we can assess your response and find the right starting dose.
You’ll leave knowing exactly how to do it yourself — the technique, the dose, what to watch for, and who to call if you need support. Most men feel quite at ease by the end of that visit. Click here to watch my YouTube video on it.
Follow-up appointments allow us to adjust the dose as needed and check in on how things are going.
A Word on Asking for Help
Erectile dysfunction is incredibly common — affecting roughly 1 in 5 men — and yet it remains one of the most underreported and undertreated health issues there is. Most men wait years before bringing it up with a health professional.
If you’ve been struggling in silence, or if you’ve tried oral medications without much success, injection therapy might be the option that makes the real difference. It deserves to be on the table even if the idea of it initially made you wince.
You don’t have to have this conversation alone, and you don’t have to figure it out without support. That’s exactly what we’re here for.
Kendall Gow is a Urology Nurse Practitioner & Sexologist, specialising in men’s health, sexual function, and penile rehabilitation. Clinics in Joondalup, Subiaco, and Mandurah, with Telehealth available.