An awakening injection for an erection

Dear Dr. G,

I have lived with Type I Diabetes since my teenage years, and as I approach my 50s, I have been doing well with my glucose control and daily insulin injections.

I visit my doctors regularly and have my kidneys and heart checked. However, during an annual check-up, a doctor asked me about my sex life.

To be honest, I have been avoiding this subject for several years now as my erection has been compromised since my early forties.

I started taking the blue pills, which worked for several years but even the blue diamonds are not so effective these days.

I went to see the urologist, who reckons my erectile dysfunction stems from diabetes; I was told that despite stringent glucose control, vessels and nerves have continued to deteriorate.

The doctor recommended that I take penile injections instead and it seems like I need both the insulin and penis injections to function now.

I am interested in putting Dr. G on the spot for some clarification on the treatment.

First, can you explain why diabetic patients often end up with ED?

Why are the blue pills not so effective for me after several years?

What exactly is ICI (Intracavernosal-Injection) and how does it work?

I also heard the injection is quite dangerous and that a person can end up with priapism?

What exactly is priapism? And what causes priapism and what is the treatment?

Yours truly,

Injection Ian

Type I diabetes, once known as juvenile diabetes or insulin dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin. With the treatment of the hormone, type I diabetic patients can expect to live a normal healthy life.

In some diabetic patients, despite the stringent sugar control, the destruction of the nerves and vasculature in various parts of the body will continue, resulting in nephropathy (destruction of the kidneys), retinopathy (destruction of the eyes), neuropathy and vasculopathy.

The intricate function of the penis to achieve full rigidity is dependent on the state of the blood vessels and nerves, allowing perfusion following sexual stimulation. For diabetic patients, the hardening of the blood supply can be temporarily reversed with the help of the blue pills. Medical therapy has benefited patients with diabetic erectile dysfunction, with an efficacy that can be as high as 80%.

However, success of the pills will dwindle with time, due to continuing diabetic neuropathy and vasculopathy. The next line of treatment for erection restoration is ICI or Intracavernosal-Injection.

ICI was initially discovered by a French surgeon claiming to have accidentally injected a patient’s penis with a vasodilator in the 1980’s. Although the mystery of how a doctor can accidentally inject medication into a patient’s penis was never revealed, medications such as Alprostadil and Papaverine have been approved by FDA as a treatment option for ED.

That said, ICI is no longer a first-line treatment since the introduction of the blue pills in 1998; however it is still recommended for men who have complicated ED and failed the initial medical intervention.

That said, one of the most feared side effects of ICI is priapism or a persistently erect penis. In medical terms, priapism is a persistently erect penis that does not return to its flaccid state even though there is no physical or psychological stimulation.

Although many may think such rigidity is a blessing, on the contrary, priapism is considered a medical emergency. The persistent erection will require treatment within four to six hours, as the trapped blood in the penis can result in organ ischemia and long-term damage.

Various factors can result in priapism, including blood sickle cell anemia, blood clots, trauma and spinal cord injury. The venom of certain scorpions and black widow spiders can also induce priapism. Alcohol and illegal drugs such as marijuana or cocaine are also well-known causes of priapism.

Medications that are associated with such complications are PDE5-I, such as the blue pills, antidepressants, antipsychotics and even common medications such as warfarin, widely used as a blood-thinning agent.

The treatment of priapism is the recognition of the condition and prompt reversal of the ischemia. Most priapism is self-limiting, but some may require the aspiration of ischemic blood from the corpus cavernosum. Failure to reverse the ischemia may lead to a gangrenous penis. Another long-term consequence of repeated injections into the penis is scarring of the erectile tissues. This can lead to Peyronie’s Disease, causing permanent bending.

The utilization of the blue pills for more than two decades has certainly transformed the treatment of ED from the dark days of ICI. Despite medical advancement, the curse of diabetes can still result in the failure of the magical blue diamond, resulting in the second- or third-line treatments of ICI and the penile vacuum pump.

Many men facing fear of direct injection into the penis for the awakening of the erection, often put Dr. G on the spot for his assurance. His view is that the weaker the blue becomes, the stronger it calls towards injections and awareness of the complications is the key to ensure that priapism never happens.