What Is Erectile Dysfunction?
Erectile dysfunction (ED) is defined as difficulty achieving or maintaining an erection sufficient for sexual intercourse. The condition increases with age and may affect over a third of men aged 40 and above.
What Causes Erectile Dysfunction?
Hormonal and Nonhormonal Causes
- Erectile dysfunction can be the result of one or more of the following: hormonal imbalances, conditions affecting blood flow and circulatory mechanisms, diseases impacting nerve signaling, or outside intervention.
- Hormonal
- As male patients age, testosterone levels typically decline and may negatively impact libido. Libido is a measure of a person’s interest in sexual intimacy. Studies show that fluctuations in desire for sex can be linked to testosterone levels. During andropause, hormonal support with testosterone therapy may help restore energy and improve sex drive.
- Nonhormonal
- Neurogenic – Disease states that interrupt nerve signaling can affect erection ability, such as diabetes mellitus and multiple sclerosis.
- Vasculogenic – Disease states that dysregulate blood flow can impact erections as well. High blood pressure, cardiovascular disease, high cholesterol, and benign prostatic hypertrophy are a few conditions that can have negative effect on erection quality.
- Iatrogenic – Certain medications and substances can put patients at higher risk for sexual dysfunction. For example, prescriptions used for mood may affect sexual health, as can alcohol.
Psychogenic Causes
- Interpersonal relationship conflict with partners can affect intimacy. Situational stressors may increase performance anxiety or limit interest in sexual connection.
- Psychological reasons such as depression or trauma should never be overlooked. These underlying issues are known to have a great impact on sexual function.
Why Choose an Injectable Medication for ED?
Sterile injectable medications for erectile dysfunction are given by intracavernosal route, meaning the active pharmaceutical ingredients are directly injected into the penis. Doing so allows the drugs to rapidly enter the site of interest and can encourage more immediate activity.
What Are the Compounded Injectable Prescription Options for Erectile Dysfunction?
- Alprostadil
- Alprostadil works to relax the smooth muscle of the penis, dilating local arteries to increase blood flow and promote an erection.
- Alprostadil may be a promising alternative for patients that do not succeed with oral PDE-5 inhibitors, like sildenafil citrate, tardenafil, or vardenafil.
- BiMix (Papaverine HCL /Phentolamine Mesylate)
- Papaverine is a smooth muscle spasmolytic that can lead to smooth muscle relaxation and vasodilation in the penis. Phentolamine can help promote an erection by blocking norepinephrine effects.
- These medications are used in combination only and can serve as an alternative to alprostadil monotherapy.
- TriMix (Alprostadil/Papaverine HCL/Phentolamine Mesylate)
- Many consider this drug trio the gold standard of injectable erectile dysfunction intervention. Combining all three therapeutic options offers multiple mechanisms of action simultaneously.
- This multimodal formulation may relieve the symptoms of erectile dysfunction at lower individual medication strengths, limiting the potential for side effects.
What Are the Benefits of Injectable Erectile Dysfunction Support?
- While oral PDE-5 inhibitors (sildenafil citrate, vardenafil, tadalafil) are considered first line therapy for erectile dysfunction, not all men see success with these agents. Absorption variation, onset delays, and side effects can contribute to challenges men face when seeking appropriate erectile dysfunction therapy.
- Compounded intracavernosal injections are an alternative option for patients who have not succeeded or are ineligible for oral therapy.
- When the moment strikes, waiting for medication to help isn’t always a reasonable request. Intracavernosal injections are thought to offer a more immediate onset of action for those unplanned intimate opportunities.
Who Should Avoid These Medications?
- Patients with an increased risk of priapism – erections lasting 4 hours or more – should seek medical advice before starting injectable medications for erectile dysfunction. Conditions like sickle cell disease, leukemia, and multiple myeloma can be predisposed to priapism and are encouraged to discuss appropriateness of therapy with a provider. Use is contraindicated for those with Peyronie’s disease, bleeding disorders, or recurrent priapism.
- Patients with higher likelihood for priapism should also discuss risk management, such as rescue medications, for emergent situations. Women’s International Pharmacy offers injectable phenylephrine, which can serve as a therapeutic option for these cases.
- There are other conditions that may affect your candidacy for compounded erectile dysfunction injectable medications. Please reach out to your medical provider for more clinical information and to discuss therapies appropriate for you.
Non-pharmacologic Options
- Lifestyle changes, such as improvements in diet and exercise and avoiding smoking, can make a big difference for sexual wellbeing. These interventions may decrease risk of developing conditions known to contribute to sexual dysfunction and prevent erectile dysfunction early signs from worsening.
