Overview of intracavernosal therapy

Intracavernosal vasodilator injections are an option for erectile dysfunction if PDE5 inhibitors are ineffective or contraindicated. Before starting treatment for erectile dysfunction, assess the patient for cardiac risk associated with sexual exertion; see Approach to managing erectile dysfunction.

Monotherapy with alprostadil (prostaglandin E₁) is the preferred intracavernosal vasodilator therapy. Other intracavernosal vasodilators (papaverine and phentolamine) have been used but have a higher risk of prolonged erections (priapism) and long-term cavernosal fibrosis than alprostadil and are not recommended for use as monotherapy. If monotherapy with maximal-dose alprostadil is ineffective, consider referral.

Intracavernosal therapy should be prescribed under the supervision of an experienced practitioner. Patients must be given written, clear, practical instructions on how to manage prolonged erections, including an after-hours contact number and information about appropriate 24-hour medical facilities. See Priapism after intracavernosal therapy for more information.