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Younger men’s erectile issues often have mental and emotional causes, says TT Baum, a San Francisco-based sex educator who does hands-on work with clients who struggle with sexual issues.

For those men, Hims’ promise of embarrassment-free treatment could seem particularly appealing: If you’re overwhelmed by the idea of talking about your anxiety-induced erectile dysfunction, a pill you order online can feel like an easy out. But that doesn’t address the underlying anxiety — and in some cases, pills may make it worse, making users feel their sexual fulfillment requires medication. A post on the Hims blog does note that erectile dysfunction can have psychological causes that aren’t readily resolved by popping a pill, but you have to search to find this information.

Its impact is somewhat lessened by the coupon code for Hims that appears at the top of the page. Also, sildenafil is a prescription medication — one that has side effects. Painful, hours-long erections occasionally land users in the hospital (and, in the worst cases, destroy their ability to ever get an erection again). But headaches, loss of vision, indigestion, and diarrhea are also fairly common; rarer side effects include facial swelling, renal problems, laryngitis, and, perversely, an inability to experience orgasm. Those are just the physical side effects; mental ones can occur, too. Using sildenafil regularly can cause a kind of disconnection, where the erection isn’t tied to the “emotional/psychological arousal state,” but is instead fueled by chemical assistance, Donaghue says.

That disconnection can drive an even bigger wedge between men and their emotions, and making users who crave an easy, automatic erection further dependent on medication.

Men who see good sex as being synonymous with the presence of an erection — any erection, no matter how emotionally disconnected from it they may be — are especially prone to developing a dependency on erectile dysfunction drugs, says Baum.

These medications can promote an attitude of “If I don’t have to do the work, why should I?” Baum says. While getting younger men hooked on sildenafil might make for a profitable business model, it’s not a great way to promote healthy attitudes toward sex, Baum notes. “It’s not about if you’re hard or not, it’s about ‘How does this feel?’” Instead of seeing a disappointing erection as a problem, Donaghue encourages clients to see it as an opportunity to expand their understanding of what sex and intimacy are truly about, moving away from a penis-centric, performance-based model that he sees as “really crappy sex.” Hims offers a solution to men who feel frustrated with their sexual performance, one that promises on-demand access to erections with none of the embarrassment of seeking help from a doctor. But truly getting in touch with your sexuality means confronting, not avoiding, all the embarrassments and anxieties of being human. Buying a pill online may feel like an easy alternative — but in the long run, it makes accessing authentic sexual pleasure much more difficult.

This information will help you learn to inject medication into your penis.

Penile injections can help you achieve an erection if you have erectile dysfunction (ED). ??? Read this resource carefully before starting injection therapy.

If you don’t follow the instructions in this resource, your doctor or APP may stop prescribing your penile injection medications and supplies.

The tissue that causes you to get an erection (erectile tissue) is a muscle. Going long periods of time without an erection is unhealthy for erectile tissue and may damage it.

We believe that having erections keeps erectile tissue healthy.

It works best if it’s given about 5 to 15 minutes before you want an erection.

Your advanced practice provider (APP) will review the instructions below with you.

Generally, the training for the injections takes 2 office visits. Please be aware that each visit may take up to 1 hour, so you should plan your schedule on the day of your appointment. Use this resource to help you the first few times you inject on your own.

Do not take the following medications within 18 hours of injecting (before or after): Sildenafil (Viagra®) - 20 mg to 100 mg Vardenafil (Levitra®) - 10 mg to 20 mg Avanafil (Stendra®) - 50 mg to 200 mg.

If you take tadalafil (Cialis ® ) 10 mg or 20 mg, do not inject within 72 hours (3 days) of taking the medication. If you are using tadalafil (Cialis) 5 mg daily, ask your APP how you should use this medication along with your injections. The 3 most commonly used medications for injection therapy are Trimix, Bimix, and Papaverine.

Most men begin injection therapy with Trimix, which is a mixture of 3 ingredients: alprostadil, phentolamine, and papaverine. These ingredients work by relaxing the smooth muscle and opening the blood vessels in your penis, causing an erection.

Your APP will decide whether Trimix or a different medication is best for you.

The alprostadil in Trimix can weaken over time, so Trimix should be stored in the refrigerator and away from light.

This can keep the medication good for a few additional months.

If you’re using Bimix or papaverine, you don’t need to keep the medication in your refrigerator because these medications don’t contain alprostadil. Don’t use the medication if: It has particles or is cloudy.

After your second training visit, your medication will be delivered directly to your home from the compounding pharmacy (specialized pharmacy).

Call the compounding pharmacy to make arrangements for billing and shipping.

Gather your supplies: 1 medication vial 1 syringe (one-time use only) 2 alcohol wipes Sharps container.

You can use an empty detergent or bleach bottle with a cap, or a metal coffee can with a plastic top.

If you’re using the medication

for

Next, push the plunger back up until the top of the plunger (the thin black line closest to the needle) is at the dose you were told to inject. Turn the syringe downward so the needle is facing the floor.

Hold the syringe in your hand like you hold a pen or dart. Hold the syringe close to the needle with your thumb, index (first) and middle (second) fingers. This will keep the needle from bending as you insert it into the rubber stopper. Holding the vial upright and the syringe downward, insert the needle through the circle in the center of the rubber stopper.

Push the plunger down to inject the air into the vial (see Figure 1).

You must replace the amount of medication you remove from the vial with air.

Turn the vial and syringe upside down (see Figure 2).

Hold the syringe with the hand you use to write with and the vial with your other hand. Make sure the tip of the needle is in the medication.

Rotate the syringe so you’re looking at the numbers and lines on the syringe. You must inject the medication into a specific area of your penis.

This is so you don’t inject into a nerve or blood vessel.

You will give the injection in the middle third of your penis at the 10 o’clock (left side) or the 2 o’clock (right side) position (see Figure 3). To prevent trauma generic viagra super active to your penile tissue, always change sides of your penis each time you inject the medication (right side, then left side). Don’t inject into any vein you can see or feel because it could cause a large bruise on your penis.

Don’t inject straight down on the top or the bottom of your penis.

This will allow your penis to be more fully stretched. It’s easiest to inject if your penis is pulled straight out in front of you.

If you aren’t circumcised, pull your foreskin back before grasping the head of your penis. This will prevent the needle from going between the skin and erectile tissue.

For your injection to work, the medication needs to go into the erectile tissue. Locate the area to be injected (the middle third of your penis). Let go of the head of your penis and pick up the syringe with 2 hands. Look at the syringe to make sure the dose is correct and you haven’t pushed any medication out by accident.

Hold the syringe between your thumb, index and middle fingers like a pen or a dart. Don’t place your index finger or thumb on the plunger.

Once again, grasp the head of your penis and pull it straight out. Keep pulling on your penis from the time the needle goes into your penis until it comes out.

Don’t twist your penis, since this could lead to injecting the wrong area. Touch the needle to your skin and quickly slide it into the shaft of your penis.

Make sure to insert the needle at a slight angle (either the 10 o’clock or 2 o’clock position, as shown in Figure 3).

Move your finger so that your index finger or thumb can push in the plunger. Quickly push down on the plunger to inject the medication into the shaft of your penis. Be careful not to pull the syringe out as you’re injecting the medication. Once you have injected all of the medication, quickly pull the needle out of your penis.

Don’t use a twisting or jerking motion, because this may cause bruising.

Apply pressure at the injection site for 2 to 3 minutes with your thumb on the injection site and your index finger on the opposite side of your penis.

If you’re taking a blood thinner or aspirin, hold the pressure for 5 minutes. This will help to decrease any bleeding or

bruising

If you’re adjusting your own medication dosing, the office will no longer be able to prescribe your medication. Please use the grading scale below to rate your level of hardness after injecting.

Call your APP and tell them your responses and whether you’re getting the results you want. Your APP will tell you which dose to try next based on your response.

Please make sure to include the information below in your injection reports.

For your first injection: inject ___________ units of ____________________________ while you’re at home. Use the erection scale above and record your response below. Call your APP after each injection to report your response. Keep calling your APP after each injection

until

Do not give yourself your next injection until you have reported the result of your last injection.

Don’t take more medication than the dose prescribed.

Don’t change the dose without speaking to your APP. Don’t give yourself another injection if the medication doesn’t work.

Speak with your APP if you aren’t getting the effects you want.

You can inject up to 3 times a week as long as there are 24 hours between each injection.

If you’re currently receiving chemotherapy for cancer, ask your oncologist (cancer doctor) when you can safely inject.

Don’t take any other medication for ED without speaking to your APP.

Do not take the following medications within 18 hours of an injection (before or after): Medication Dose Sildenafil (Viagra) 20 mg to 100 mg Vardenafil (Levitra) 10 mg to 20 mg Avanafil (Stendra) 50 mg to 200 mg. Your APP will order your supplies for you from a compounding pharmacy. Your supplies will include: 1 vial (500 units) of ______________________ medication 30 syringes (29 gauge, ? inch) 24 pseudoephedrine HCl (Sudafed ® ) 30 mg tablets.

You will also need to buy alcohol pads from your local pharmacy. Your injection medication can’t be ordered from your local retail pharmacy (such as CVS, Rite Aid, Duane Reade, or Costco).

They will be ordered from a specialty compounding pharmacy approved by MSK: MasterPharm www.masterpharm.com Telephone: 866-630-5600 Fax: 718-529-2780 Other: ______________________ ___________________________ ___________________________ ___________________________.

They will order more supplies for you and will let you know if refills are included.

If refills are included, you can contact the compounding pharmacy directly to set up your billing and shipping.

Pseudoephedrine HCl (Sudafed) Sometimes, penile injections can cause priapism (an erection that lasts too long).

If you have priapism, taking pseudoephedrine HCl can help.

Read the instructions in the “Treating Priapism (An Erection That Lasts Too Long)” section for more information.

If you want to buy the pseudoephedrine HCl at your local pharmacy, you don’t need a prescription, but the boxes are kept behind the pharmacy counter. Take the pseudoephedrine HCl card that’s hanging on the shelf to the pharmacist (see Figure 4).

You will have to show a photo ID before the pharmacist gives you the box to purchase.

Make sure to have pseudoephedrine HCl with you as long as you’re using the penile injections.

If you have problems with your heart, talk with your cardiologist about whether it’s safe for you to take pseudoephedrine HCl.

Treating Priapism (An Erection That Lasts Too Long) Priapism is an erection that lasts too long. Priapism can develop without sexual stimulation and doesn’t go away after orgasm.

There is a risk of having priapism after penile injection therapy. When you have a full erection, no fresh blood flows into your penis. This means that your penis isn’t getting oxygen, which can damage the tissue and lead to permanent ED. If you have an erection at penetration hardness (a 6 or higher on the erection hardness scale) that lasts 2 hours, take 4 (30 mg) tablets of pseudoephedrine HCl (Sudafed). Don’t take extended-release or long-acting tablets, such as Sudafed 12 hour.

Ask your pharmacist or APP if you have any questions. The pseudoephedrine HCl will be shipped by the compounding pharmacy along with the vial of medication and syringes, or you can buy it at your local pharmacy.

For more information, read the “Pseudoephedrine HCl (Sudafed)” section above.

If your erection becomes less than penetration hardness within an hour of taking pseudoephedrine HCl, call your doctor’s office the next day to speak with your APP. You shouldn’t continue to inject with the same dose if you took pseudoephedrine HCl for a prolonged erection. Your APP will make changes to your penile injection therapy medication dose. If you have an erection that lasts 3 hours (you still have an erection 1 hour after taking the pseudoephedrine HCl), call your APP and plan to go to MSK’s Urgent Care Center or your local emergency room.

Monday through Friday between 9:00 am and 5:00 pm , call your APP. Phone number: __________________________________________ Between 5:00 pm and 9:00 am , during the weekend, and on holidays, call 212-639-2000 and ask to speak to the urologist on call.

Go to MSK’s Urgent Care Center at Memorial Hospital (1275 York Avenue, between East 67 th and East 68 th Streets) if you’re less than 30 minutes away. Your APP will call the Urgent Care Center so they know to expect you.

Your APP will give you more instructions during your call.

Go to your local emergency room if you’re more than 30 minutes away from MSK’s Urgent Care Center. Your APP will give you viagra 50mg tablet online shopping more instructions during your call. If you have an erection that lasts 4 hours and you haven’t talked to your APP, this is a medical emergency.

You should treat it with the same urgency as a heart attack. Erections lasting longer than 4 hours can cause permanent damage to your erection tissue. Go to MSK’s Urgent Care Center if you’re less than 30 minutes away. Ask the guard at the entrance to the hospital how to get there. Go to your local emergency room if you’re more than 30 minutes away from MSK’s Urgent Care Center.

Tell the staff at the Urgent Care Center or emergency room that you’ve had an erection for 4 hours.

If you aren’t treated quickly, it’s possible that you will end up with permanent ED. Give the doctor or nurse the priapism card that was given to you to carry in your wallet.

You can also have the doctor or nurse call us at the numbers listed above. After Pelvic Surgery for Prostate or Bladder Cancer.

If you have had pelvic surgery for prostate or bladder cancer within the past year, your doctor may have told you to take a low dose of sildenafil (Viagra), vardenafil (Levitra), avanafil (Stendra), or tadalafil (Cialis) every night, except on days or nights you plan to inject. This improves the chance that your erectile function will return.

Do not take the following medications within 18 hours of an injection (before or after): Medication Dose Sildenafil (Viagra) 20 mg to 100 mg Vardenafil (Levitra) 10 mg to 20 mg Avanafil (Stendra) 50 mg to 200 mg.

Your response to oral ED medications may improve over the first 18 to 24 months after surgery.

A full dose is one of the following: 100 mg of sildenafil (

Viagra

200 mg of avanafil (Stendra) taken with or without food. 20 mg of tadalafil (Cialis) taken with or without food.

To achieve the best response, you must be: Relaxed Sexually aroused, either from contact with a partner or from self-stimulation Not tired Back to top.

Speak with your APP about how to travel with your injection medication. They can give you a letter explaining your treatment, if needed.

If you need a letter, be sure to ask for it before your travel dates.

For information about storing and disposing of your home medical sharps, read our resource How to Store and Dispose of Your Home Medical Sharps. How is Cialis different from the currently approved products for erectile dysfunction (ED)?

As with any drug product, there may be side effects. The most commonly reported side effects in patients treated with Cialis during the testing of the product were: headache indigestion back pain muscle pain flushing stuffy nose. Patients who get back pain and muscle aches usually get them 12 to 24 hours after taking Cialis and these usually go away by themselves within 48 hours.

A small number of patients taking Cialis also reported abnormal vision. What important information should you know about Cialis?

CIALIS can cause your blood pressure to drop suddenly to an unsafe level if it is taken with any nitrate medication.

You could get dizzy, faint or have a heart attack or stroke.

Tell your healthcare provider that you take Cialis . If you need emergency medical care for a heart problem, it will be important for your health care provider to know when you last took Cialis. After taking a single tablet, some of the active ingredient of Cialis remains in your body for more than 2 days. The active ingredient can remain longer if you have problems with your kidneys or liver, or you are taking certain other medications. Physicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha-blockers and antihypertensive medications.

What should I talk to my doctor about when considering if Cialis is right for me? Can Cialis be used with other treatments for impotence?

Will Cialis be prescription or OTC (over-the-counter)? How can I report a serious side effect with Cialis to FDA? FDA encourages anyone aware of a serious side effect, including consumers or patients, to make a MedWatch report. You can report an adverse event either online, by regular mail or by fax, using the contact information at the bottom of this page. Viagra is now being used to treat not only erectile dysfunction (ED) but also pulmonary hypertension.

And the drug may have potential for treating several other conditions, according to a recent report. The three ED medications currently on the market—Viagra, Levitra, and Cialis—all work by the same means, and they have similar side effects. The most common are headaches and facial flushing, which occur in 15% of men. Other reactions include nasal congestion, indigestion, and back pain.

The most important worry about ED pills is their ability to widen arteries enough to lower blood pressure.

And men who are taking nitrates should never use any of the ED pills.