Hi, my name is amy perlman and I am a urologist and men’s health specialist. The good news is, there are many ways that we can restore sexual function and one of those ways is with penile injection therapy or intracavernosaur injections. Now nobody is super excited about hearing about injecting their penis before sexual activity, but I think some people are surprised at how well they tolerate that therapy. There are a lot of different medications that we can inject into the penis. You can use one medication that you inject in there, but that medication tends to cause people like adult ache in the penis and some discomfort. My typical go-to, when it comes to penile injection therapy, is to combine three medications together and that therapy is called tri-mix. You can only get it from a compounding pharmacy. The mixture together is not available commercially as a compounded medication, so I use robbie at new care of pharmacy to provide that medication for most of my patients and he’s going to walk you through his consultation process. When you go to pick up the medication in person, if you are not local, he is happy to ship it to your house as well. Once you receive the medication, it will have driving ice in that package. So just make sure you leave the top open and then it will just subline and go in the air, and at that point you can just save the box or you can discard it, but with the medication you’ll receive your syringes and needles as well as alcohol swabs. Now the vial will look like this and it will be the medication frozen. You will want to store this in the freezer until you’re ready to use it once you’re ready to use it just set it outside of the freezer, let it thaw and then once you look at it and see that it is ready to drop the medication, then you’re ready to go if there’s any changes of color or it appears to be hazy at that point, you would not want to use the medicine and you would it’d be best for you to get a refill just because the product may no longer be sterile. So when you’re ready to use the device you want to sterilize the top of the vial. So you’ll take one of your alcohol, swabs and you’re going to wipe on the top and then let that dry before you drop the medication. So you’ll will want to look at the instructions and they will state starting at possibly 20 units or 30 units. Depending on what strength you’re on and what you’ve tried in the past, then you’ll get your insulin. Syringe carefully, remove the the top off here. So you don’t stick yourself and then on the side here there are markings here with units, so you want to pull back on to the 20 units and insert that amount of air into the vial before you drop the medicine so carefully insert that in the top of the vial there, you can push that air in and then turn it upside down to draw up the dose and then you’ll want to go to that 20 units and then you’re ready to go at this point be careful not to stick yourself. You can carefully put the tip on or the safety cap here. Otherwise, it’s easier if you sit on the ground and just scoop up with the needle to prevent sticking yourself and then just set it aside until you’re ready to use it once you’re ready, inject the medication you want to inject at 10 o’clock or 2 o’clock, apply the alcohol wipe just to sterilize that skin before injecting it you’ll then pull the cap off and you’re going to inject and then slowly push the medication in. It is best to wait to eight to ten seconds to make sure all the medication gets into that muscle prior to removing the needle. So you don’t lose any of the dose you’ll want to insert at the most one inch away from the base of the penis to make sure that the penis becomes fully erect and and then, after that, once you’ve injected the medication. You want to apply pressure on the injection site and stop any bleeding, and that may take up to five minutes and at that point, you’re done using the medication just make sure you put the medication back in the freezer when you’re done using it once you’re done using the the syringe needle you do not want to reuse. This make sure you have a sharp container and you’re properly throwing this away, so no one actually gets stuck with a needle, so it is recommended when you use the medication to use it no more than every other day, and this has helped to prevent scar tissue build up over time and also not to exceed three times per week. So, with this being in compounded preparation, there’s a beyond use date or expiration date assigned to the medication. So this sterile medication is good for 45 days prior to use once you inject and take a single dipole medication, it should be used within 28 days of the first injection. So when storing it, it is best to keep it in the freezer. This is a sterile product and the freezing also helps with the stability. It is important to know, though, as you’re using this over time. These the potency of the medication can go down so as you’re freezing and rethawing it may become less effective. So when you first start using the medicine you’re going to start off, let’s say 10 units and then you’re going to increase that dosing five to ten units per dose until you establish the appropriate dose for you, so once you’ve established your treatment dose once that is effective for you at that point, you don’t have to continue freezing rethawing, which, like I said it, can affect the bone scene medicine. So it is fine for you to drop all your doses, put them in the syringe and then you’ll have all these syringes that are pre-filled put those in the freezers. So when you’re ready to use it, you can take out the syringe and let it thought and that’s perfectly fine. I do recommend, though, when you get that next fill after your first fill for you to try the dose before you pre-fill. Those syringes just make sure that it’s appropriate dose for you.