Injection Therapy for Erectile Dysfunction

(Bimix and Trimix Injections)

For men who do not respond to pills like sildenafil (Viagra) or tadalafil (Cialis), intracavernosal injections can be a safe and effective treatment for erectile dysfunction (ED). These medications are self-injected into the side of the penis using a very small needle.

What Are Bimix and Trimix?

Bimix and Trimix are compounded medications designed to increase blood flow and trigger erections.
Bimix contains:
- Papaverine
- Phentolamine
Trimix adds a third component:
- Alprostadil (Prostaglandin E1)

Your provider will choose the right formulation and dose based on your medical history and treatment goals.

Where to Get the Medication

We use a reliable, licensed mail-order pharmacy:

Johnson Compounding Pharmacy
Waltham, MA
johnsoncompounding.com
Ships discreetly to your home
Store in the refrigerator upon arrival

How It Works

The medication is injected into one of the erectile chambers of the penis (corpora cavernosa).
Erections typically occur within 5–15 minutes and last 30–90 minutes.
The effect is localized and does not require sexual stimulation.

Injection Instructions

Where to Inject

Use the 10 o’clock or 2 o’clock positions on the side of the shaft. Avoid the top, bottom, or head of the penis.

Alternate sides with each use to avoid scar tissue.

How to Inject – Step-by-Step

Wash your hands thoroughly.
Clean the vial top with alcohol.
Draw up your prescribed dose using a small insulin syringe.
Hold the penis out and slightly stretched.
Insert the needle straight into the side of the shaft.
Inject the medication slowly.
Remove the needle and apply pressure for 1–2 minutes.

Activity Guidelines

Do	Don’t
Use no more than 3 times per week	Never use more than once in 24 hours
Rotate injection sites	Don’t inject into the same spot repeatedly
Refrigerate the medication	Don’t expose the vial to heat or sunlight

Side Effects & Safety Tips

Common, usually mild:

Mild discomfort or aching in the penis
Small bruise or bleeding at the injection site
Slight curvature with repeated use (can be minimized with site rotation)

Risks and Complications

While generally safe, intracavernosal injection therapy does carry some potential risks:

Risk	Description
Priapism	A prolonged erection lasting over 4 hours. This is a medical emergency.
Penile fibrosis	Scar tissue can develop if the same site is used repeatedly.
Penile curvature (Peyronie’s)	Irregular scarring may lead to curvature or deformity.
Painful erection	Alprostadil (in Trimix) can cause a burning sensation in some men.
Bleeding or bruising	Typically mild and resolves on its own.
Infection	Extremely rare; minimized with proper technique and hygiene.

If you experience a painful or prolonged erection (lasting more than 4 hours), call our office immediately or go to the ER.

Frequently Asked Questions

Q: Does the injection hurt?
A: Most men say it feels like a quick pinch. The needle is very small (29–31 gauge).

Q: Can I adjust my dose?
A: Only under the guidance of your provider. We start low and adjust based on your response.

Q: Will insurance cover this?
A: Often not. However, compounded medication from Johnson Pharmacy is affordable and predictable in cost.

Need Help or Want to Get Started?

We’ll walk you through your first injection in the office and provide full instructions.

207-518-6600
Request an appointment online