SELD ADMINISTERED PAPAVARINE INJECTION: SIMPLE WAY TO RESTORE INTIMACY

Erection is vascular phenomenon. During the tumescence the blood gushes into the organ.Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood.

It is a good option for men who fail on PDE-5 inhibitors and cannot undergo/ don't want to undergo penile implants.

The technique of injecting the vasoactive substance is taught to patient or patients spouse. In many cases patient is not comfortable with self injection. In such cases we teach patients wife( Four hand technique) the art of injecting the drug.

 

In the four hand technique; the patient holds the penis with one hand at the base of the penis and with the other hand he stretches the tip of the penis.Then the wife injects the drug with 29 G Insulin syringe in the cavernosa.

 

Drugs such as papaverine hydrochloride(15- 60 mg), phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including pain (36%) persistent erection (4%) and scarring. It gives a success rate of 70-90 % but these injections have a drop-out rate of 25-60% because of mainly pain or sometimes development of corporal fibrosis.

It is a good option for middle aged or old aged couple who perform sexual activity infrequently.

 

Methodology of giving papavarine/bimix:

 

Start with 29-30 G Insulin syringe for the injection therapy.

Papavarine:It can be started with 15 and given till 60 mg. Inject in any corpus.

Bimix: Add chlorpromazine ( 4 ml papavarine to 0.1 ml chlorpromazine combination) start with 0.1 to 0.2 ml and then gradually increased .Again the injection can be given in any one of the corpus.

 

RAMAYYA PRAMILA PROTOCOL:

We usually start patients with erectile dysfunction on sildenafil/tadalafil or udenafil after thorough sexual history and clinical evaluation. We have a psychosexual counselor for couple therapy.Counseling the couple is the most important part of the management of sexual dysfunction. While starting patients on sildenafil or equivalents we consider their fitness by assessing their metabolic equivalent for sexual activity. If they are fit to do sexual activity and if they don't have any obvious cardiac comorbidities ; we don't usually go for evaluation by a cardiologist in every case.

If the PDE-5 inhibitors fail to work then we do USG Doppler of the penis with papavarine injection to look for any arterial insufficiency or venous leak. If the erections  are fine with papavarine and the couple is elderly then we offer either Intracavernosal Injections or Vacuum erection Device.

In people who are more sexually active then we go for either MENTOR COLOPLAST or AMS penile Implants. The choice of the penile implant whether single/two piece or three piece rests with the patient.

In  patients who opt for self administered Bimix injection we give them prefilled Insulin syringes.So whenever the couple decides for sex they can use the injection before the sexual activity.