The potential upside is significant
The ideal treatment for erectile dysfunction (ED) would be nonsurgical and permanent but no such treatment is yet in existence. However, a relatively new technique that temporarily improves ED and helps men get and maintain excellent erections, is to inject Botox directly into the sides of the penis.
With this safe, in-office procedure, Botox is injected only once but the benefits last up to 11 months.
Although Botox is an FDA-approved medication for many different purposes, it is not yet approved for the management of ED. However, studies have shown its efficacy and lack of side effects.
When a man is getting an erection, the smooth muscle in his penis relaxes, dilating up the arteries and letting more blood flow in more quickly, while simultaneously activating the trapping mechanism, which keeps the blood from escaping. More blood in and less blood out is what gives a man an erection.
Botox causes the smooth muscle in the penis, which is chronically contracted, to relax by paralyzing it. When a man is excited, he sends signals to cause additional smooth muscle relaxation. The combination of the chronic smooth muscle relaxation from the Botox and the immediate smooth relaxation from the man’s sexual excitement give him a good erection.
How Does Botox Work To Improve Erections?
In order to understand how an injection of Botox into the penis can help a man get an erection, it is important to understand how men get erections in the first place.
Nature has designed men to not have erections at all times; otherwise, men would probably have a bone there. Thus men are constantly sending a signal to the penis to inhibit an erection. This is why, in a non-excited state, men are not erect.
When a man is excited physically, psychologically, or both, he sends a signal to the penis to initiate an erection. This signal causes the smooth muscle in the penis to relax and stretch. Smooth muscle lines the arteries that bring the blood into the penis. Thus when it stretches, the arteries dilate and more blood can enter. Smooth muscle also lines the chambers that hold onto the blood when the man is erect. When these muscles relax and stretch, more blood can be stored in the penis resulting in an erection. When these chambers are full, they compress the veins draining the blood from the penis, trapping it there. Anything that increases smooth muscle stretching and relaxation will help a man get an erection.
A man’s ability to get an erection will depend on two main factors:
- The first is mechanical; how good is the penis at getting blood into it and holding onto it. This can be affected by a variety of factors including age, hypertension, diabetes, and hypercholesterolemia.
- The second factor is what is the balance between the neurological signals that promote an erection (those causing smooth muscle to relax) and the neurological signals that work against an erection (those causing smooth muscle to contract.) These signals can be both physical and psychological.
Botox acts by paralyzing nerves. When injected into the penis, it paralyzes the baseline signals to the nerves that prevent a man from getting an erection continuously. This makes it easier for a man to get an erection when excited. It is changing the balance towards the signals that promote an erection and against the signals that prevent an erection.
Is Penile Botox Injection Supported By Research?
The treatment of ED with Penile Botox Injections is relatively new. There is currently one study with 123 patients, which does show a significant efficacy.
Though a good study, it does not meet the highest standard of being a double blind placebo controlled randomized trial. Hopefully, more and better research will be forthcoming.
However, we have felt comfortable offering this procedure to our patients because:
Intuitively the procedure makes sense
Increasing smooth muscle relaxation is the basic mechanism for men to get an erection (see above), and of course that is what Botox has been proven to do in many areas of the human body.
The procedure is not dangerous and has no known side effects.
The potential upside for our patients is significant.
For men with mild ED, they may be able to get and maintain spontaneous erections, even without oral medications. Many men don’t like the side effects of the medications, or do not like the decreased spontaneity of sex that comes with them.
For men with moderate ED, they may be able to avoid the use of penile injections, and respond to the oral medications, or even be able to get spontaneous erections.
For men with severe ED, they may be able to avoid the use of penile injections, or be able to respond to penile injections, thus avoiding the need for a penile prosthesis.
How Does Penile Botox Injection Compare To Other Treatments For ED?
Though there is overlap, the treatment of erectile dysfunction can be broken down into two main groupings.
Management of ED- Erection by Erection
Most of our treatments are actually management tools. They give a man a better erection at the time of planned intercourse. These would include, of course, the oral medications (the PDE 5 inhibitors), vacuum erection devices, and injections.
Improving Baseline Erectile Function- Improving Your Penis
Recently there have been more innovative ways of trying to improve the baseline ability of the penis to get erections. Included in this grouping would be Shockwave Therapy, Regenerative Cell Therapy (PRP injections), testosterone replacement therapy (TRT), and now penile Botox injections.
So far, none of these therapies permanently improve the anatomy of the penis and its ability to get and maintain blood and thus an erection. However, the temporary improvement is worthwhile for many men while the treatment is working.
Who Is A Candidate For Penile Botox Injection?
Penile Botox injection can theoretically improve the erectile functioning of any man.
In severe ED it may help men who are not responding to the maximum dosage of intracavernosal penile injections or are unwilling to try penile injections. These men would otherwise need a penile prosthesis.
In moderate ED it may help men who are not adequately responding to oral medications respond to them better, avoiding the use of other techniques, like penile injections.
In mild ED it may help men get better erections without any other intervention other than natural sexual excitement.
How Effective are Penile Botox Injections?
Clinical Response Rates:
Penile Botox injections are a relatively new treatment. In the largest study to date, which included 123 men, the clinically significant response rate depended on how severe the man’s ED was prior to receiving the treatment.
In men with mild ED, 90% had clinically significant improvement at around one month.
In men with moderate ED, 50% had clinically significant improvement at around one month.
In men with severe ED, 33.3% had clinically significant improvement at around one month.
How many treatments would I need?
There are a total of twelve treatments, spread out over nine weeks. Each treatment lasts for approximately 10-15 minutes.
We follow the published protocol which consists of two treatments per week, for three weeks (for a total of six treatments.) This is followed by a break of three weeks. It is then followed by another set of six treatments over three weeks.
Is Penile Botox Injection Safe?
Fortunately, the Penile Botox Injections are extremely safe. The theoretical concerns would be of effects to the penis itself (for example chronic erections) or systemically (to the rest of the body).
In the largest study to date, of the 123 patients who participated, none had negative effects to the penis and none had systemic side effects at all.
Do The Treatments Hurt?
The penile Botox injections feel the same as the penile injections men give themselves regularly before sex.
We use an autoinjector and men receiving injections this way often describe it as if the penis was being flicked with a rubber band, or less.
Only one patient in the largest study to date, out of 123 patients, described the injection giving pain. One patient described discomfort for 3 days.
How Many Treatments Would I Need?
Only one treatment is all that is needed.
However, Botox does not permanently paralyze the smooth muscle in the penis. It is likely that particularly for men with moderate or severe erectile dysfunction, additional treatments may be needed to maintain efficacy.
What are my next steps?
Penile Botox injections are safe and relatively painless.
They work for a reasonably high percentage of men, but not everyone.
In theory, they are a temporary “fix”, as Botox wears off. However, it is possible that better erections can cause physiological and psychological changes that make the effects last even after the Botox wears off.
Contact us to learn more about the Penile Botox Injection, to schedule a free phone consult or to schedule an appointment. If you’re missing spontaneity in your sex life or just tired of relying on pills or injections every time you want to have sex, the Penile Botox Injection may be a good choice for you.
IN A PATIENT'S OWN WORDS
I felt like I was 20 years old again.
When I first came to Dr. Werner, I was having trouble with erections and used Viagra which worked poorly. I would get an erection, but the erection would not last very long. I then used Levitra, but the same thing happened and some psychological stuff was going on too, where I would think about it, whether I was going to get an erection or think about how long I was going to stay erect, and that had an effect on how long I could keep an erection. The more concentration it took, the less I was able to perform without just enjoying it.
The treatment has been successful for me, and Dr. Werner’s manner made it easier to seek help than I thought it would be.
– L, NY, 50 –
Last updated: January 2024