Injection Mechanics

1. When filling the syringe, I have heard that the plunger should be pulled down to the 1.0 cc mark before pushing the needle through the rubber stopper and then pressing on the plunger, pushing the air into the ampoule before withdrawing the medication. Is there an advantage to this procedure?
2. Where in the penis do I want the medication to go? What structures am I aiming for and which do I want to avoid?
3. Besides the 3 and 9 o'clock positions, I've also been told that I can inject at 2, 4, 8 and 10 o'clock positions. Does it matter?
4. Are there any cues you can give me to tell when I'm in the right place? What should I feel when I inject? Will it hurt? Should I feel resistance? Can I feel if the needle is in too deep or too shallow?
5. Sometimes I feel more resistance to the plunger than others; when that happens, the injection usually fails. How come? What should I do?
6. f I don't get any response to an injection can I follow up with another injection maybe to a different side of the penis and perhaps using a smaller dose?
7. I'm bothered by the pain of the injection, are there topical anesthetics that I can use?
8. Are there thinner needles available that could be used to reduce discomfit?
9. What's an autoinjector and how might it help me?
10. Can I use 'needle-less' injections systems like are being used for diabetics?
11. At what angle should the needle enter the penis? Should it be 90 degrees or a shallower angle to stay away from the urethra?
12. Sometimes I see a tiny amount of blood from the injection site just when the needle is withdrawn and sometimes I don't. Why? Is it a problem either way?
13. What's the best way to hold the penis for the injections? Should the penis be pulled to maximum extension for example? Should I pull just the outer layer or the whole penis?
14. Is it important to apply pressure to the injection site for a full 5 minutes after injections? Aren???t a few minutes enough?
15. Should I vary the injection site? What is the best way to do that?
16. Is it important to get all the bubbles, even the littlest, out of the syringe before injection?

1. Q: When filling the syringe, I have heard that the plunger should be pulled down to the 1.0 cc mark before pushing the needle through the rubber stopper and then pressing on the plunger, pushing the air into the ampoule before withdrawing the medication. Is there an advantage to this procedure?

   A: It makes withdrawing easier.

2. Q: Where in the penis do I want the medication to go? What structures am I aiming for and which do I want to avoid?

   A: Alternate between injecting at the 3 and 9 o???clock positions. You will be injecting into the corpus cavernosum (erectile bodies). When choosing an injection site, avoid any area were a vein is clearly visible.

3. Q: Besides the 3 and 9 o'clock positions, I've also been told that I can inject at 2, 4, 8 and 10 o'clock positions. Does it matter?

   A: 2, 4, 8, and 10 are all OK, but 3 and 9 the best.

4. Q: Are there any cues you can give me to tell when I'm in the right place? What should I feel when I inject? Will it hurt? Should I feel resistance? Can I feel if the needle is in too deep or too shallow?

   A: As there are few nerve endings for pain in this area, there will probably be just slight momentary discomfort. Once through the skin (some resistance may be felt), push firmly until the needle is in the penis right up to the hub.

5. Q: Sometimes I feel more resistance to the plunger than others; when that happens, the injection usually fails. How come? What should I do?

   A: The needle may be in too far or not far enough. Pull the needle back a little or push it in further. If that does not work, the needle is probably in the wrong place.Do not inject if the resistance is strong. Withdraw the needle and reinsert in another suggested place. The plunger should press quite easily. Your doctor can demonstrate.

6. Q: f I don't get any response to an injection can I follow up with another injection maybe to a different side of the penis and perhaps using a smaller dose?

   A: Yes.

7. Q: I'm bothered by the pain of the injection, are there topical anesthetics that I can use?

   A: Yes, EMLA is the best.

8. Q: Are there thinner needles available that could be used to reduce discomfit?

   A: This is not recommended. Needle breakage has been reported with 30 gauge needles. But see following question on auto injectors.

9. Q: What's an autoinjector and how might it help me?

   A: An autoinjector is a spring-loaded device, which inserts the needle into the penis very quickly, minimizing any discomfort. You still push the plunger. Many men are happy using the autoinjector. Check with your local drug store to obtain one. Some of us have personal experience with the Becton Dickinson ???Inject-Ease??? automatic injector, but there are other brands out there as well. They are not very expensive.

10. Q: Can I use 'needle-less' injections systems like are being used for diabetics?

    A: No they only get into the skin. These will not work.

11. Q: At what angle should the needle enter the penis? Should it be 90 degrees or a shallower angle to stay away from the urethra?

    A: Angle of injection can be defined in two different mutually independent ways. One way is as seen from above and the other way is as seen in a ???front view???. Ninety degrees should be used in every view.

12. Q: Sometimes I see a tiny amount of blood from the injection site just when the needle is withdrawn and sometimes I don't. Why? Is it a problem either way?

    A: It depends on whether or not you hit a small blood vessel. It is not a problem.

13. Q: What's the best way to hold the penis for the injections? Should the penis be pulled to maximum extension for example? Should I pull just the outer layer or the whole penis?

    A: You should pull the whole penis. Some men find it best for them to lay the penis along one leg while injecting, without pulling.

14. Q: Is it important to apply pressure to the injection site for a full 5 minutes after injections? Aren???t a few minutes enough?

    A: Five minutes is best. On the needle site, using the alcohol pledget, immediately apply pressure to the penis with the thumb and index finger for 5 minutes, or longer if there is still bleeding.

15. Q: Should I vary the injection site? What is the best way to do that?

    A: The places for injection are limited by the anatomy of the penis and you must adhere to these. Changing injection sites from left to right and back again is O.K. and actually recommended.

16. Q: Is it important to get all the bubbles, even the littlest, out of the syringe before injection?

    A: The littlest are not necessary.