Welcome to our health education library. The information shared below is provided to you as an educational and informational source only and is not intended to replace a medical examination or consultation, or medical advice given to you by a physician or medical professional.
The penis is made up of spongy tissue that holds blood. When the penis is flaccid (soft), blood flows in and out of the tissue. During sexual excitement, extra blood flows into the tissue. The extra blood makes the tissue swell so the penis becomes erect (rigid) and firm enough for intercourse.
When There’s a Problem
Physical or psychological problems can keep the penile tissue from filling with extra blood or from holding the extra blood in. When this happens, the penis remains soft or gets hard but won’t stay hard. This is known as erectile dysfunction.
Self-injection is a good option for many men with erectile dysfunction (ED). A tiny needle is used to inject medication into the penis. This helps your penis get hard and stay that way long enough for sex. And sex and orgasm will feel as good as always. You may be nervous about doing self-injection at first. But with practice, it will get easier. Your healthcare provider will show you how to do self-injection the first time. The simple steps are outlined on this sheet.
Preparing for Injection
Injecting the Medication
Gaining an Erection
Call Your Doctor If You Have:
Penile self-injection is a simple technique that may improve your sex life. Some men even find that self-injection leads to an increase in natural erections. If you have questions or concerns about self-injection or erectile dysfunction (ED), talk to your healthcare provider. The information on this sheet will help you get the best results.
Notes About Penile Self-Injection
Work with Your Doctor
Ask how often you can safely repeat injections, as well as any other questions you have. You and your healthcare provider will talk about follow-up exams and how to get supplies. If the medication doesn’t work or stops working over time, tell your healthcare provider.
Call Your Doctor If You Have:
The steps below show how to gain and maintain an erection with a vacuum erection therapy system.
Gaining an Erection
Using the Tension Ring
When to Call Your Doctor
Note: The tension ring may block ejaculation during orgasm. This is harmless, but will NOT prevent pregnancy.
If you have trouble getting or keeping an erection, you have lots of company. Erectile dysfunction (ED) is a problem getting an erection firm enough or keeping it long enough for intercourse. The problem can happen to any man at any age. But health problems that can lead to ED become more common as a man ages. Up to half of men over age 40 experience ED at some point.
Causes of ED
ED can have many causes. Most are physical. Some are emotional issues. Often, a combination of causes is involved. Causes of ED may include:
ED Can Be Treated
Prescription medications for ED are now available. They help many men who try them. Depending upon the cause of the ED, though, medications may not be enough. In these cases, other treatment options are available. These include erectile aids and surgery. Your healthcare provider can tell you more about the treatment that is right for you. And new treatments for ED are being studied. No matter what the treatment you decide on, stay in touch with your doctor. If your symptoms persist, he or she may be able to adjust your current treatment or try something new.
An erection requires a healthy mind-body “team effort” led by the brain. Upon receiving signals from the brain, the blood vessels, nerves, and hormones work together to cause and maintain an erection.
1.) The Soft (Flaccid) Penis
If nothing is causing a man to become aroused, then his body’s erection “team” of brain, nerves, blood vessels, and hormones won’t begin working to cause an erection. The amount of blood flowing into the penis’s spongy chambers (corpora cavernosa and corpus spongiosum) equals the amount flowing out. His penis remains soft.
2.) The Swollen (Tumescent) Penis
A man becomes aroused through his senses (such as sight or touch) or his thoughts (such as memories or fantasies). During arousal, messages brought by nerves cause the blood vessels and spongy chambers to dilate (open up). More blood flows into his penis than flows out. His penis starts to swell.
3.) The Erect (Rigid) Penis
As arousal continues, nerves keep carrying messages of arousal between the penis and brain. Blood keeps moving into the man’s penis. Blood-swollen tissues press against the veins. Some of the blood is kept from flowing back out. Filled with blood, his penis becomes rigid. The man is able to have intercourse.
Many men feel embarrassed to talk to a doctor about ED. This common problem can be treated, but only if your doctor knows about it. Your doctor will likely ask you questions about your ED. Whether you’re asked or not, tell your doctor anything that might help your doctor understand the problem. Your doctor may do an exam and may run some tests to help find the cause of your ED.
A Simple Exam
A medical exam may help your doctor understand what is causing your problem. ED is sometimes the first sign of some other health problem, so your doctor may check your overall health. He or she may also examine your penis, scrotum, and testicles. Tell your doctor about all of the medications you take, including prescribed and over-the-counter medications, as well as any herbs or supplements.
You May Have Some Tests
Your doctor may recommend some or all of these tests:
Your Treatment Plan
Based on what you say and what any exam shows, your doctor will recommend a treatment plan. The first step may be to try ED medications, since they help most men. If they don’t help you, your doctor can suggest other kinds of treatment. You and your partner may also want to discuss which options would work best in your relationship. Treatment may include addressing the cause of health problems, such as lowering your cholesterol. And counseling may be recommended to talk about underlying emotional issues.
Prescription oral medications are often very successful in treating ED. But men with certain health problems or who are taking certain other medications should not use them. And all medications may cause side effects. Talk with your doctor about whether oral ED medication is right for you, and the risks and benefits of the medication.
Types of Oral ED Medications
There are three types of prescription oral ED medications on the market. Each increase blood flow to the penis. When the penis is stimulated, the result is an erection. The three medications are:
What Oral ED Medications Don’t Do
Taking Oral ED Medications Safely
Possible Side Effects of Oral ED Medications
Risks of Oral ED Medications
If you have erectile dysfunction (ED), treatment can help. Certain treatments work directly on the penis. Talk to your doctor about the pros and cons of each. And be sure to learn the correct technique.
A tension ring is usually used along with another type of treatment. Once enough blood has flowed into the penis to cause an erection, the tension ring will keep the blood from flowing out again. This maintains the erection. The ring must not stay on for more than 30 minutes. A tension ring is also called a constriction ring or venous flow controller.
Risks and complications may include pinched, bruised, or irritated skin. If you have an allergic reaction to latex rings, try a silicone ring.
You inject a special drug into the penis. The drug relaxes blood vessels so they can fill with blood. Within about 10 minutes, the penis can become rigid enough for sexual intercourse. A tension ring is not needed to maintain the erection. Your doctor can explain the injection process to you.
Risks and complications may include pain, bleeding, bruising, or scarring. Get medical help right away if you have an erection that lasts for longer than 4 hours.
Surgery for erectile dysfunction is not common, but it may be the best treatment in some cases. During surgery, an implant (also called prosthesis) is placed inside the spongy chambers of the penis. Then, the implant can be used to provide an erection.
This type of implant is easy to use. Bendable rods can make the penis appear erect. When not in use, the rods can be bent downward. Some implants have joints that lock into position.
This is the most complex type of implant. It allows the penis to look and feel either erect or flaccid. You pump fluid from a storage bulb to make the penis erect. A release valve makes the penis flaccid again. Using the device properly takes some skill and practice.
Risks and Complications
Being intimate means being close as a couple, with sex as just one part of intimacy. A hug, a kind remark, or a gift can be very romantic, even if sex doesn’t follow. So renew your intimacy along with your sex life. Learn to talk with, and listen to, your partner. And remember that your value as a man goes beyond what you do in bed.
Tips for Intimacy
As you and your partner become closer to each other, you might find that you can enjoy sex more.
Tips for Talking
It’s okay to be shy when you talk about sex with your partner. But talking gets easier with practice. Use these tips when you talk with each other.