We instruct patients to keep some type of alpha adrenergic, such as Sudafed, on hand at home to counteract this side effect. Thus, the penis can remain hard, sometimes for hours and hours. When a sustained erection does occur, it is because the drug has dilated the blood vessels, allowing engorgement and an erection, but then after orgasm the vessels do not constrict as they would with a natural erection. This obviates the need for multiple and expensive recurrent office visits. Once the patient is checked out on the injection procedure, he is allowed to gradually increase the dose at home.

Sometimes that dose gives a satisfactory erection. He injects 0.1 cc (3 mg) on his initial monitored injection in the office. In the office setting, I let the patient do the very first injection under watchful supervision. Various studies have reported papaverine alone to result in a full erection in 35 to 60 percent of the males studied." Papaverine has a very high success rate, particularly in younger patients who have better erectile potential to begin with, and in patients whose erectile dysfunction is primarily psychological or nerve-related. In plain talk, papaverine stimulates the engorgement of the penis with blood, leading to a harder erection. Priapism risk is small, but can be further reduced by starting the patient with a very low dose of papaverine. Scarring can also be minimized by alternating the sides of the penis where the injection is given. In order to reduce that incidence, patients are instructed to inject no more than every third night and to suspend injections if they notice scarring in the erectile cylinders. Up to 20 percent incidence of corporal fibrosis has been reported. Fibrosis occurs as a result of the injection itself, from irritation of the cells when penetrated by the needle and as the fluid is injected, and occasionally by damage to the penile tissue as a result of priapism. The two major disadvantages are a rather variable incidence of priapism, where the penis stays erect for many hours, and corporal fibrosis (buildup of scar tissue).