ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Patient-Reported Pain with Initial Intracavernosal Injection


Jeffrey Albaugh, PhD (cand), APRN, CUCNS, Northwestern Memorial Wellness Institute, 150 E. Huron, Suite 1100, Chicago, IL 60611, USA. Tel: 312-926-4032; Fax: 312-926-1986; E-mail: jaalbaug@nmh.org


Introduction.  Despite the efficacy of intracavernosal injections, one of the greatest impediments to injection therapy is the negative reaction of men to the thought of a needle inserted into the penis.

Aim.  To determine the severity of pain associated with the initial intracavernosal self-injections for erectile dysfunction (both pain associated with the needle insertion and the medications).

Methods.  This is a descriptive study of self-reported pain associated with intracavernosal self-injections in 65 men with erectile dysfunction. Pain was assessed immediately after needle insertion and again approximately 10–20 minutes postinjection, utilizing a verbal 0–10 pain scale.

Main Outcome Measures.  A verbal 0–10 pain rating scale was used to assess pain both for injection pain and medication pain.

Results.  For needle insertion, the mean pain rating was 0.80 (standard deviation [SD] = 0.81), with 40% reporting no pain at all. Of the 39 patients who reported pain, the mean pain rating was 1.33 (SD = 0.61). For the medication itself, the mean pain rating was 0.92 (SD = 1.5), with more than half (64.6%) reporting no pain. For those experiencing pain from the medication (N = 23), the mean pain rating was 2.6 (SD = 1.27, range 0.5–5.0). Significantly more patients with radical prostatectomy experienced pain from the medication than other men (51.9% vs. 23.7%, P = 0.02).

Conclusion.  The majority of patients experienced little or no pain from either the needle insertion or the medication. Even for men who experienced pain, the severity was relatively low. This study provides information to help diminish fears about injection pain for patients considering penile injections. In addition, this study suggests that medication pain is more common in men postradical prostatectomy, so that it may be advisable to start with lower dosages of prostaglandin alone or in combination with other vasoactive medications for these patients. Albaugh J, and Ferrans CE. Patient-reported pain with initial intracavernosal injection. J Sex Med 2009;6:513–519.