I need help/ suggestions for those who have gone through the gamut of trying different injection types to get an erection. I had my robotic prostatectomy 22 months ago and there has not been a glimmer of a natural erection returning, so I have been trying the alternatives. I am using the Vacurect pump which actual does a great job; I get a hard enough erection for penetration.... but the process is bizarre to say the least, and I can only use the erection for 30 minutes before risking tissue damage. My Urologist got me to try Alprostidil (caverject)..... .4ml / injection. The injection part is really nothing. The resulting erection "looks" nice and is something I can use to masturbate as long as I do not squeeze at all, as the blood will get forced out of my penis. Penetration, however, is impossible as it just does not get hard enough. And to top it all, it seems that I am in a small percentage group of guys who experience a general ache in their penis that lasts from beginning to well after the erection disappears. I don't want to try increasing the dose Alprostadil to try and get a harder erection, as I do not want to risk increasing the pain. To try and avoid the pain part, my urologist prescribed TRIMIX which has Alprostadil and 2 other meds. This is supposed to cause less pain. He told me to start with .3 ml and to increase .1-.2 until I was happy. I cannot say my erections were any better than with Alprostadil alone, and the general penile pain, tho a little less, was still there after the injection . I have read about BI-MIX which consists of those other 2 medication (aside from the Alprostadil) in the TRIMIX. Has anyone tried BI-MIX who had pain using the other injection combos? How much do you use? The whole experimentation process, and subsequent pain is making me want to give up on injections completely. I am open to suggestions and hearing what other guys out there have experienced.
Penis Injection options: advice needed - Prostate Cancer A...
Penis Injection options: advice needed
I'm using TRIMIX, while it's not particularly comfortable I don't think it's painful. The only thing I've had an issue with is the location of the injection site.
I’m a TriMix user. It mostly works for me when needed. I also use tadalafil 10mg, daily—suggested for good blood blow health, aside from sex. When I’m solo I think that helps.
Back to TriMix, on my syringe my dose is at 25. I first set the syringe at 50, to put that air in the medication vile before pulling the dose out. I was told to inject it at 2 fingers from the base alternating at 10 and 2 o’clock from one time to the next. Do this while standing, and maybe massage it thru your penis a but. Although there can be an immediate reaction I still need to be aroused/mental stimulation, and also try not to stress. 420 can help here…lol. Hope that info help.
Thanks for the info. I have used 30 and then 40. The result for me was just "ok".
I was originally prescribed papaverine alone. It works but it takes a full 1 mL dose. Plus the vials are single use so the cost with my new insurance co-pay per boner is ridiculous. I have my first bottle of Tri-Mix waiting for pickup next week. One suggestion for enhancing an erection is using a cockring. Even before surgery that was something I always used, but after surgery with the injections it definitely makes for a very rigid erection. There is a new ring I recently purchased which was developed with post-op men in mind. It’s called the Firmtech MaxPR.
Thanks for the reply. For me in Canada, a 300 unit (3ml) bottle of TriMix is $115 Canadian (About$85 USD) I'll probably get 5-6 doses out of that 1 bottle ($20 CND, or $15 USD) per injection.....so...not too bad. Alprostadil was costing me $40 per pre-measured 40 unit needle ($30USD).... which is CRAZY!!! Papaverine alone is probably even more expensive. So question..... are you wearing the cockring over your whole package? (cock and balls?) Do you put it on BEFORE injecting, or after you get hard? I was using a pump to get a little thicker before injecting. Haven't done it often enough to have a method down.
I usually wear a traditional ring that goes around the base of everything. I put it on after I inject, but before I’m fully hard. I tend to like a fixed ring so I have to maneuver myself into it so to speak. However, there are all sorts of options (leather with snaps, stretchier silicone) that can be put on once you’re hard. The Firmtech I mentioned is soft silicone and loops around your sack and around the base of your penis, as it’s intended to allow blood to enter the shaft but constrict the outflow. It’s a pretty nifty design.
Yeah my co-pay on 5 vials of papaverine (each vial contains 2 mL but they are intended for single use-I could probably save the unused half vial and use it the next day without too much risk) was a little over $200 USD so that’s like $40 a boner unless I get two injections from a single vial. I told my urologist that is ridiculous. The TriMix I’m getting is 10 mL and it’s $185 USD through my provider’s pharmacy network.
Thanks for this Color...... I have seen the Firmteck ring....nifty design. I'll try the silicone ring over my entire package next time I inject and see what it does. For now thought, the Trimix is still causing an "ache" which is quite off-putting. I have seen a video where they suggest ibuprofin and a warm washcloth after injecting to help fill the erection with blood and hold off the pain. ....ARGH!!!!!.... why does this have to be so difficult!!!
I think some guys are sensitive to alprostadil no matter the dose, so trying the BiMix is a good idea. I don’t think the discomfort you experience is something you have to just live with. Finding a practitioner with both the knowledge and the motivation to help you solve this is an important factor too.
Curious-was your surgery nerve sparing at all?
Tom
Thanks for this Tom. I agree.... I'll ask my urologist for the BiMix. After having spoken with several guys in my support groups, the consensus is that most Urologists, after getting you over prostate cancer, are not there for the rest of the ride in helping you regain your potency. Mine only prescribed Trimix at my insistence.
I had my surgery done robotically by a surgeon who had done over 4000 of them. He did do "nerve sparing" but from what I have read, it is a misnomer. There are so many tiny nerve branches that are attached to the prostate gland....removing the gland removes lots of nerves. I am thankful I can get hard with a pump and can still orgasm!
Same experience with my urologist. If I wasn’t advocating for myself it would be crickets from his end. I assume you are getting no response from full doses of tadalafil or sildenafil?
Have you heard of Melissa Hadley Barrett? She is a nurse practitioner in Australia who specializes in post op prostatectomy patients. She has an online penis rehab program but also does remote consults. She is someone who could be a resource for you in working through the right injection mix for you and your penis.
Someone once told me to think of urologists as plumbers....and we need an electrician! Honestly... a cop-out answer. They should be there to help with all thing penis-related.
You are correct, no meds are doing anything....zero erections, zero ANYTHING. I still take 5mg daily Cialis (forgot which of the 2 you mentioned is the generic name) just to help ... I am forever hopeful.
YES, I know of Melissa Hadley Barrett and am an avid listener of her podcast THE PENIS PROJECT.... filled with so much info the all men should know. I was unaware she did consultations. I will look into that. You should also look up Victoria Cullen (also Australian) who has a series of YOUTUBE videos call "A touchy Subject". Frank and informative.
Thanks Tom!
Shel
Yes I love that podcast. So informative and demystifying of this experience so many of us go through, yet the aftercare available can miss so much. And I discovered Victoria around the same time I discovered Melissa. It was right after the surgery when I was home recuperating and looking for ways to maximize my recovery.
Let me know if the ring suggestion helps firm things up.
I will. And thanks again!
Thank you for mentioning the work of Melissa and Victoria. I appreciate you and ejefowe's conversation here. Sending all the best for improved erections and great times---
Thank you for mentioning the work of Melissa and Victoria. I appreciate you and ColorandLight's conversation here. Sending all the best for improved erections and great times---Neil
Shel: I just picked up my first RX of TriMix and when I was looking at the compounding pharmacy website that made it up I saw this listed as an option:
Trimix without alprostadil – a mixture of phentolamine, papaverine and atropine. This combination can be prepared if one is sensitive or can not tolerate the pain associated with alprostadil.
Thought it might be worth asking your urologist about.
Tom
OMG….. Tom, you are amazing!!! I will look into this!! I am going to try a couple more injections with what I still have as I read that there MIGHT be a learning curve as my body (cock) adapts to the compound…. possibly tolerating the meds: no/less pain. TBD.
BUT PLEASE….. let me know what happens when you start injecting
Hi Tom. Today was the 3rd trial of using Trimix. My first 2 attempts using .3ml and then .4 ml were less than satisfactory erection-wise, and as I told you, moderately painful. Today I added another unit and injected .5ml. I had watched a Youtube video made by 2 Pharmacists who prepare Trimix and they had a few suggestions; one of which was that after injection, to wrap your cock in a warm/hot wet washcloth to open up the tissue thereby causing less pain. I actually think that it did something as this session was much less painful. I also took your suggestion and used a silicone ring after getting hard to maintain the erection. I have 2 rings that I tried and both worked pretty well. One was a squishy soft thin ring, medium diameter, that I got in a sex shop , and the other was a DUREX (from the pharmacy) ring. This one is pretty thick, a bit firmer, but also pretty squishy. I put one ring at a time around my whole package and each worked pretty well. I can't say with confidence that I could fuck anally, but would guess that I might be able to have vaginal sex and please us both! (did I mention I am bisexual?) End result: .5ml showed a definite improvement....but I think .6 will be the winner!
Great news! And so glad it wasn’t as uncomfortable as before. I had not heard of that warm washcloth suggestion. Melissa Hadley Barrett recommends circumferentially gripping the base for a minute after the injection to ensure the drug distributes and doesn’t just travel out of the penis. I think if you end up having to use 0.6 mL when you reorder they can adjust the concentration of the mix upward so you can use less volume and get the same dose. It just makes the whole thing more cost effective.
I have been "choking up" my penis as Melissa suggested.... and my erection lasts about 75 minutes...pretty good! I believe the pain associated with the injection is from the blood forcefully entering into the spongy tissue (corpus cavernosa) of the shaft without any nerves sending a signal for the tissue to relax..... nerves that, in my case, are no longer working. ......At least that's my theory. The warm cloth is relaxing and softening the tissue like a warm compress on tight muscles. I'll let you know if the .6ml works. I would love to go for the more cost effective route (at .6 ml / injection i'd get 5 doses from my 3ml vile @$115 CDN / vile)..... but the mixed compound only lasts 6 weeks in the fridge. I WISH I had sex 5 times in a 6-week period.... but such is NOT the case!..... and that is a story for another time!!! PLEASE PLEASE PLEASE let me know what happens when you finally get your Trimix script filled.
Tom, thanks so much for standing next to me on this journey. Neil, please feel free to reach out and ask questions. Gents.... we all have to be there for each other , cuz' no one else is going to be there for us.
Best wishes and good luck to us all!!!!
Thank you for the explanation and you are so correct that the support through sharing our individual experience is invaluable. I have my first TriMix prescription at home and ready to try it out. Maybe tomorrow I hope. It came in 4 2.5 mL vials. The instructions are to keep one vial in the fridge and the rest in the freezer. Their expiration is 90 days. It definitely seems like a lot of variation in how these are compounded.
Well what a (mis)adventure it turned out to be. The initial TriMix dose was 0.4 mL. Started to get hard within 15 minutes. I was using this solo so the intention was to pleasure myself. I used a cockring as I had in the past. Unlike papaverine alone, I got rock hard and after 45 minutes it was uncomfortable to the point I stopped all stimulation. Getting out of the cockring didn’t help. After 90 minutes I got to the local pharmacy to purchase pseudoephedrine, which is the rescue drug l
in this situation. I took a full dose 120 mg. No change. After another 30 mins I took 60 mg. No change. I reached out to my urology department and no one was able to get back to me. I was icing it and took another 60 mg and finally heard from the urology department and they said go to the emergency department. Off I went now approaching four hours of a rock hard erection. It was not pleasant. By the time they checked me in, and I saw the triage nurse, and they got into and exam room it was 4 1/2 hours. As I sat in the exam room lo and behold the extreme tumescence finally started to dissipate. I waited another half hour after the doc saw me to make sure the phoenix didn’t rise again and I finally went home with a $585 co-pay for the ER visit. The most expensive erection in history. Clearly I need to decrease my dose.
SHIT SHIT SHIT!!! What a nightmare! I am so sorry to hear this! My initial dose was .3 but yours at .4 is not much more. You'll have to talk this out with your urologist and see what he says. I hope you are not put off by the whole thing. Let some time pass and decide what to do going forward. A buddy of mine was STUPIDLY told by his Urologist (who had no experience with Trimix) to start off with 1 ml. He also ended up in emergency. ....... but uses it now with confidence at a lower dosage of .5ml. Tom, I am so sorry to hear this but I am glad to hear that the erection went away without having to have had to drain your penis of blood ....I would guess that would be pretty traumatic!
You WILL look back on this as a funny story you tell people.
Please keep me posted.... and I'll let you know how .6ml works for me.
Yes, one certainly needs to take these things with humor, right? Like the absurdity of me walking to the local pharmacy to pick up pseudoephedrine with a raging hard on, trying to hide it in my sweatpants!
Last night tried a lower dose as recommended by my urologist (0.2 mL) and unfortunately the same thing happened. A raging erection that was uncomfortable by 30 minutes and downright painful (even worse than the first time) at an hour. Took the rescue dose of pseudoephedrine at one hour and repeated it 30 minutes later. Sat up deep breathing through the pain. It finally started to dissipate at 2 1/2 hours and I was finally able go to bed 3 hours later. Ugh.
Just emailed my urologist. I reckon I need to try a completely different mix or try one more time with a micro dose (like 0.05mL).
Tom
WHAT....THE...FUCK.....!?!?!?!? This compound obviously does NOT agree with your biology! At least you knew the steps to take and you were not (totally) freaked out! Try the microdose and see what happens ..... and tell me. This morning I tried .6ml of Trimix. A nice-ish hard-on. Not sure about anal sex.....maybe with a lot of warming-up, stretching, loosening..... still a bit of "soreness" through the erection..... but able to easily "rub one out" as no one was around to share in the experience
I know right?
The one thing about the erection this mix has given me is it could probably penetrate steel. But who wants to penetrate anything when you’re hoping the freaking pain will let up.
I am going to see what my urologist says about trying a tiny dose or if he really thinks we need to start from scratch.
Just curious-what’s the concentration of each component in your mixture? Mine is Alprostadil 20 mcg, phentolamine 1 mg, and papaverine 30 mg per mL.
Same concentration in mine EXCEPT for the Papaverine.....mine is 15mg/ml. DO you think that is the culprit?
Nope. I have been using that by itself without issue. I can instill 1 ml of papaverine and the results are great. Decent erection (especially with a ring) that lasts a good length of time without any discomfort. It was the cost that made me want to look for alternatives.
Ah....i get it. Tom, can I ask, how old are you? And do you have any erectile function at all? And I'm guessing... you're a top? I'm just trying to weigh all the different factors. PLUS, of course, everyone's physiology is different. But I am curious.
60 (how did that happen???)
Not a top. Versatile bottom here actually.
66 here (WHAT THE f--k?!?!?) Don't look (or act) my age. Bi-versi top. Married...to a woman. Are you hooked up to any support groups? They are a god-send. This forum-based one is a great support tool as well. I have also joined FRANKTALK.org a forum for men with ED. Just getting into it, very slowly. You have been one of those god sends as well. Thanks Tom.
....and please keep me advised on what is happening with you and your progress
The latest: messaged my doctor about the second super erection. His first response was "you must be giving yourself too much-send me a picture of the syringe with the plunger set to how much you gave". I am like bro, I am a veterinarian. If I don't understand what 0.2 mL is on a syringe my license needs to be taken away. But I sent in a pic and was given an A+ on my volume measuring skills. Anyhoo, he said he is really surprised at how sensitive I am to it. Apparently my response is unusual. He suggested trying 0.1 mL. I countered that I want to try 0.05 mL and will go up if there is minimal response. I don't want to relive that dreadful super erection again.
I will look into that other forum you suggested. Thanks Shel!
I realize I never answered your earlier question about any erectile function. In terms of nocturnal erections, it seems like I am starting to get what I would call "chubs" in the early morning. Certainly not an erection, but the old fella definitely is full. This definitely is a change and one that I find promising. Melissa H-B says most men don't start seeing any return until a year, and I am just coming up on that anniversary end of this month, so it seems right on schedule.
Otherwise, I will sometimes masturbate after I do my daily penis pumping exercises. I use the Bath Mate most often (I also have the Vacurect) in the shower in the morning, and will slip on a silicone ring and do some penile massage afterward. If I stroke toward a finish, I will find what seems to be some engorgement the closer I get to orgasm, like right towards the end. It is definitely something compared to the nothing I have had since the surgery. I remember the first time I masturbated post-op after the catheter was removed. I knew what would happen (that nothing would happen) but there was a part of me that had some sort of magical thinking going on. It was strange that first time when stroking led to no response, something that had never happened before. I sort of sat there looking at the flaccid thing in a state of mild bewilderment and said to myself "Well, OK I guess its true."
Anyway, maybe these are some encouraging signs. I choose to take them in that way 
Sounds like you and "little Tom" are on your way in the right direction. That is great to hear and I am sure you are encouraged by it. Go slow with the injections... you've got nothing to prove to anyone. My first, and most important, hurdle to jump was when I first used my sex-shop pump post catheter and was able to have an orgasm. THANK GAWD!!!!! If I wasn't able to orgasm, I am not sure what I would have done! Keep up the good work!!! (pun intended)👍
I will! Appreciate your encouragement. Have you had any return of function at this point?
I have not. 22 months. Nada, zip, nuttin'. And I supposedly had NERVE SPARING surgery. I have been reading lots lately and it is a misnomer. Just because a surgeon has had success with that procedure, does not mean he will always have success repeating it. He just does his best, and I will just have to do the best with what I have. Thanks for asking
I’m sorry that nothing has returned yet, Shel. That certainly makes figuring out the right injection combo for you very important. I’ve thought about the idea of having to use injections moving forward if I don’t get any function back and ultimately that will be OK with me. When they work they are really good so far.
Last night I tried a much lower dose. My doctor had recommended 0.1 mL as I think I mentioned. I decided to go with 0.05mL although when I gave myself the injection I pulled up a bit more (7 units or 0.07 mL on an insulin syringe). Despite the tiny amount I was hard within 10 minutes and this time I didn’t have the painful super erection. Instead I had a very comfortable usable erection that allowed me a couple of hours of pleasant intense masturbation. It still lasted almost three hours but it wasn’t painful or extremely hard. Once I stopped the stimulation it softened up into a semi before finally dissipating. I am going to try just 5 units next time.
These are the results you want, and the news I wanted to hear! I am so happy for you Tom! For now, I am going to be happy with the results of using 60 units for sex with the wife. I'm going to try it with anal penetration with my fuckbuddy but I won't keep my hopes up.... or maybe I will be pleasantly surprised! Alternatively, my Vacurect pump gets me pretty rock-hard.... and he was happy with the results! Let's keep each other in the loop! Be well!
Hi Shoelee. Thanks so much for taking the time to respond to me. You actually sound like a counsellor or other professional. As I said, I have been using a Vacurect pump successfully to have sex, but was looking for other options and the pump has its drawbacks. The Trimix, as I said, seems to work. I patiently went through a slow but increasingly improving trial period with it and have the proper dosage for a decent erection. I was at my Urologist this week where we also discussed my concerns and he suggested that I have the lab that makes the compound add so Lidocane to the mix to help reduce the pain I am experiencing. I will try that and see how it works. But as you say, patience and trial is the best course to follow. All the best to you.
post-prostatectomy incontinence and ED
Rising PSA, biopsy, possible surgery, sex etc. The journey continues...
Prostectamy 
Prostate Cancer just about
Surgery was 1 year ago
