In the previous entry we were discussing injection therapy for erectile dysfunction. It must be kept in mind that a man must have the cardiovascular health to endure sexual activity in general before using any aide. Often erectile dysfunction is the first noticeable sign of disease of the blood vessels throughout the rest of the body (heart, legs, etc.). The difficulty with erections may cause these issues to first be recognized.
Patients who are taking any form of blood thinner including aspirin, Plavix TM, warfarin/coumadin or any others on the market should not use injection therapy like Caverject, as this could lead to the complications of hematoma at the injection site. A hematoma is a collection of blood that occurs under the skin. When the body has normal clotting ability, the small amount of bleeding caused by the very small needle used to perform the injection clots off without a problem and with only minimal pressure applied. In a patient on these medications, the trauma caused by the needle to the deeper tissues may lead to the collection of blood under the skin or in the corporeal body (the structure responsible for the erection). This can cause the penis to have a large bump or irregularity on the shaft. There can also be a great deal of pain associated with the hematoma. Treatment for this is rarely surgical. Usually the hematoma (blood collection) will go away with rest (no further sexual or vigorous activity). Ice can also be used to relieve the pain. Full resolution may take a month or so (until it looks normal again).
Other side effects from the injections can be pain at the injection site. It is rare to injure one of the main nerves of the penis. More commonly, the pain is due to irritation of the skin. The patient is instructed to change the location of the injection site for each injection. This is done to “attempt” to prevent the formation of nodules or plaques from repeated injections. The word “attempt” is placed in quotations because the reality is that each injection will cause a small area of trauma, and, over time, scars can form. This scarring can lead to nodules on the penile shaft or something called a plaque. A plaque is a hardened area that will not allow the penis to expand normally and may give the penis a curve called Peyronnie’s disease. This can be treated by medication or surgery to correct. Keep in mind that these side effects are RARE, and that many, many people use these medications with great success throughout the world everyday.
One of the most problematic side effects is a problem called “priapism.” This is defined as a prolonged penile erection over four hours in duration. We will address the issue of priapism in greater detail in the next entry.