Your clinical pathway
Intracavernosal injection therapy is recommended by major international guidelines (EAU and AUA) as a highly effective second-line treatment for erectile dysfunction when oral PDE5 inhibitors are inadequate or not tolerated.
A small amount of medication – most commonly alprostadil (Caverject® or Viridal®) – is injected directly into the corpus cavernosum. This bypasses the digestive system and acts locally within the penis.
- During your consultation I will assess whether ICI is appropriate for you, considering your medical history, cardiovascular risk and any urological conditions.
- If we proceed, I will perform your first injection in clinic to demonstrate the technique, observe your response and establish the correct dose.
- You will receive written instructions on how to prepare the medication, inject safely and store equipment correctly at home.
How to self-inject
Once you are confident with the technique, injections can be performed discreetly at home. The following steps help keep the process safe and comfortable.
1. Prepare
- Wash your hands thoroughly with soap and water.
- If the medication is kept in the fridge, allow it to reach room temperature before drawing it up – this can reduce discomfort.
2. Clean the skin
- Choose a site on the side of the shaft of the penis (3 o’clock or 9 o’clock position).
- Clean the area with an alcohol wipe and let it dry completely.
- Do not inject into the top, underside or the glans (tip) of the penis.
3. Position and inject
- Gently stretch the penis outwards to one side, away from your body.
- Insert the needle at 90° (straight in) into the selected site.
- Inject the medication slowly and steadily, then withdraw the needle in one smooth movement.
- Alternate between the left and right sides with each injection to protect the tissue.
4. After the injection
- Apply gentle pressure with a clean cotton pad or tissue for 2–3 minutes to minimise bruising.
- An erection should start to develop within 5–15 minutes.
- Do not inject more than once in 24 hours or three times per week, unless I have specifically advised otherwise.
Medications used
The most commonly used drug for injection therapy is alprostadil (Caverject®, Viridal®). In some cases, combination therapies (sometimes called “trimix” or “bimix”) may be used if appropriate and available.
We will decide together which preparation, dose and schedule are best suited to you, taking into account other medical conditions and treatments.
Possible side effects
Most men tolerate ICI therapy very well. Common or expected effects include:
- Mild discomfort at the injection site – often settles quickly.
- Small bruise or localised redness at the injection site.
- Aching during erection – affects approximately 20–30% of men.
- Scarring or curvature (Peyronie-type changes) – uncommon, around 1 in 10 to 1 in 50.
- Priapism (prolonged erection > 4 hours) – rare, affecting fewer than 2% of men, but requires urgent attention.
Prolonged erection (priapism)
A prolonged, rigid erection can damage the erectile tissue if not treated quickly. Recognising this early is crucial.
- If your erection remains fully rigid for more than 4 hours, attend A&E immediately.
- Take your medication details (name and dose) with you and tell staff that you are using intracavernosal injections.
Safety information
Please tell me if any of the following apply to you, as they may influence whether ICI therapy is suitable or how we prescribe it:
- You take blood thinners such as warfarin, aspirin, rivaroxaban or apixaban.
- You have a bleeding disorder or sickle cell disease.
- You have a penile implant, a history of priapism, or established Peyronie’s disease.
- You have significant cardiovascular disease or you are under the care of a cardiologist.
Alternative and complementary treatments
ICI therapy sits within a wider toolkit for managing erectile dysfunction. Depending on your needs and preferences, we may also consider:
- Oral PDE5 inhibitors (for example sildenafil, tadalafil).
- Vacuum erection devices (penis pumps) used with or without constriction rings.
- Intra-urethral pellets of alprostadil (MUSE).
- Low-intensity shockwave therapy for selected men with vasculogenic ED.
- Penile prosthesis surgery where other treatments are ineffective or unsuitable.
- Psychosexual therapy or couples work when psychological or relational factors are part of the picture.
Together we will decide which approach – or combination of approaches – offers the best balance of effectiveness, safety and quality of life for you.