Hormone Therapy for Men

Erectile Dysfunction

Get a better erection and get it immediately.

What is Erectile Dysfunction?

Erectile dysfunction (ED) is the repeated inability to achieve or maintain an erection sufficient for satisfactory sexual performance1. It occurs in 15 to 30 million men in the United States. Incidence of ED increases with age but can be successfully treated.

Vacuum Erection Devices (VEDs)

VEDs, also known as vacuum constriction devices (VCDs), can be used to improve the rigidity of penile erections by patients with ED caused by many conditions, including

  • poor blood flow to the penis
  • diabetes
  • surgery for prostate or colon cancer
  • psychological issues such as anxiety or depression

Vacuum erection devices (VED), also known as vacuum constriction devices (VCD) have been used for improving the rigidity of penile erections for over a century.

Who Should Consider a VED?

Vacuum constriction devices are can be used by patients with ED caused by many conditions, including

  • poor blood flow to the penis
  • diabetes
  • surgery for prostate or colon cancer
  • psychological issues such as anxiety or depression

Combined use of sildenafil and VED therapy significantly enhances erectile function. It is well tolerated by diabetes mellitus patients not responding to first-line sildenafil alone.

VEDs are often used to manage erectile dysfunction (ED) following radical prostatectomy (RP). Penile rehabilitation programs are increasingly used to facilitate the return of natural postoperative erections; the VED is an ideal therapy given that it increases blood flow and oxygenation to the corpora to reverse the changes that result in ED after RP.

VEDs should be used with caution in men who

  • use blood-thinners or have a history of bleeding disorders
  • have sickle cell anemia or some forms of leukemia
  • have diminished penile sensation
  • have significant penile curvature
  • have a history of priapism (prolonged erection) or are at risk for its development
  • have reduced penile sensation, especially men with spinal cord injury

Selecting a VED

Be cautious when selecting a VED. All FDA approved cylinders have pop-off valves, which limit the amount of pressure held within the chamber. Non-prescription devices may not have this "quick release" feature, and there have been reports of penile injuries due to devices that did not release its vacuum on-demand or released it too slowly. The professionals at RxUnlimited recommend prescription VEDs with the quick release feature to avoid penile injury.

Using a Vacuum Erection Device

  • Place the pump, which can be pumped by hand or run on batteries, over the penis.
  • Pump the air out of the cylinder so that a vacuum is created. The vacuum draws blood into the shaft of the penis and causes it to swell and become erect.
  • Once the penis is erect, with the help of lubricant, slide the retaining band (constriction ring) down onto the lower end of the penis.
  • Remove the pump after releasing the vacuum.

Intercourse can be attempted with the constriction band in place to help maintain the erection. The band can be left on safely for up to 30 minutes to allow for successful intercourse.

Increasing Satisfaction

When using a VED, many men find that “double-pumping” increases the comfort level. This technique involves the generation of negative pressure and then letting some of the negative pressure off, waiting a while and then recommencing with the negative pressure build-up and repeating the process until a full erection is achieved.

Constriction rings come in a variety of shapes, sizes, and most importantly tension (tightness). Trial and error is used to define which ring size is most comfortable and efficient.

Studies suggest that about 50%-80% of men are satisfied with the results of VEDs. Battery-powered devices are especially helpful for men who do not have good hand strength or coordination or who have arthritis.

Side Effects of VED/VCDs

  • An erection obtained by the vacuum constriction device is not the same as an erection achieved naturally. The penis tends to be purplish in color and can be cooler than usual.
  • There may be a decrease in the force of ejaculation. The constriction band traps the ejaculate or semen at the time of orgasm. This is not dangerous and usually does not cause pain. The semen will usually dribble out once the constriction band is removed. Generally, this does not interfere with the pleasure of a climax or orgasm.

Does Insurance Cover Vacuum Constriction Devices?

Most insurance policies, including Medicare, cover at least part of the costs of a vacuum constriction device, especially if a medical cause for ED has been documented. Medicaid, however, does not cover the device except under extreme circumstances in certain states. Talk to the specialists at RxUnlimited regarding the options that are available to you.

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Intracavernosal Injection

An intracavernous injection, according to the American Urologic Association, is the most effective non-surgical treatment for ED. Injections into the penis, unlike oral medications, trigger an automatic erection. Injection can be done by the individual 5 minutes prior to sexual activity and should last for no more than 1 hour. Injection is considered second line to be used if oral therapy fails. Compounds that can be injected include alprostadil, papaverine, and phentolamine. Alprostadil and phentolamine are the most common agents used as monotherapy. However, combination therapies are used to increase efficacy and decrease side effects. Combination therapy includes Tri-Mix and Bi-Mix. Both products are not commercially available and must be compounded by specialty pharmacies and require a prescription from your doctor.

Self-Injection of Tri-Mix/Quad-Mix/Tri-Mix XL

Getting Started

  • Wash hands and keep the penis clean.
  • Have alcohol swab, syringe, and bottle of injectable solution ready.

The Syringe

  • Wipe the rubber top of the vial containing tri-mix with alcohol.
  • Remove the cap of the needle, fill the syringe with air by pulling back the plunger to the desired dosage.
  • Insert the needle into the rubber stop of the vial, inject the air, and then turn the vial upside down with the needle inside.
  • Slowly Pull back the syringe to the dosage required.
  • Tap the side of the syringe so the air bubbles float to the top and inject out the air bubbles before use.
  • Remove the needle from the bottle and recap.

Prepare The Site

  • Location of injection is between the base and mid portion of the penis at 9-11 and 1-3 o’clock. Avoid the midline because it can injure the urethra (where urine and sperm pass) and the penile arteries and nerves at 12 o’clock. Avoid any visible veins or arteries on the surface.
  • Pull the head of the penis towards to side of the leg and select a site for injection.
  • Clean the site with alcohol.


  • Steadily penetrate the skin with the needle at 90º. Push the needle to the end.
  • Inject Tri-Mix over a few seconds and withdraw the needle.
  • Apply compression at the injection site for 2 minutes. More time may be needed to prevent bleeding.
  • Dispose the needle and syringe in the proper container.
Erectile Dysfunction

General Rules For Injection

  • Use the smallest effective dose. Further dosage increases may result in more adverse effects.
  • Injections should be given at a maximum of three times per week or once every 2 days.
  • Seek medical attention if an erection lasts longer than 4 hours.
  • Sexual stimulation should occur after injection.

Common Causes of Inadequate Response

  • Injection into wrong location
  • Leakage of agent prior to injection
  • Premature Ejaculation during stimulation
  • Feelings of stress prior, during or after injection
  • Localized pain during and after the injection process
  • Inadequate Dose
Erectile Dysfunction

Steps To Correct Inadequate Response

  • Review injection technique
  • Evaluate timing of injection in relation to stimulation
  • Involve partner and inject in a comfortable environment
  • Try combination therapy with lower PGE-1 dose
  • Reassess dose with your physician and if approved by physician increase in 2-3 days or change to a more potent agent it at maximum doses