Later papaverine was used in combination with phen-tolamine (Regitine). The penile injection protocols that followed have been a major contribution to the treatment of male erectile dysfunction for almost two decades now. This was undoubtedly the first "hands on" demonstration in the U.S. for intracavernous injection therapy. He then walked out into the audience so those in attendance could have an up close and personal appreciation of the effects of his intracavernous injection.

At the national urology meeting in 1983 one urologist personally demonstrated the effects of an intracorporous injection by doing a self-injection a few minutes before his lecture. All of these actions promote smooth muscle relaxation in the penile arteries and sinusoids. Its molecular action is related to its inhibitory effect on phosphodiesterase, leading to increased levels of cAMP and cGMP in penile erectile tissue, its blockage of calcium channels, and a subsequent increase in calcium eflux from cells. Papaverine is derived from the opium poppy. Injection of 0.1 cc up to 1.0 cc of one of the drugs into either the right or left corpus cavernosum near the base of the penis, followed by a gentle squeezing of that area, circulates the drug to both erectile cylinders, resulting in an erection in 10 to 15 minutes. The process itself is quite simple. Literally millions of couples around the world have been able to experience satisfying sexual intercourse as a result of treatment with injection of these vasoactive drugs. While other medications have been utilized in clinical trials, these three preparations have received the most use and are now prescribed worldwide. More recently, over the last seven years, a combination of papaverine, phento-lamine, and PGE (Tri-Mix) has been utilized. Prostaglandin E, (PGEj) became available toward the end of the 1980s along with the synthetic form, alprostadil.