Penile Injection Therapy on Long Island
Trimix, Bimix & Quadmix — Reliable, On-Demand ED Treatment When Pills Haven’t Been Enough
What Is Penile Injection Therapy?
Penile injection therapy — also called intracavernosal injection (ICI) therapy — delivers medication directly into the erectile tissue of the penis, bypassing the need for nerve signals or adequate blood pressure responses. It is one of the most reliable and well-established treatments for ED, with a track record spanning decades.
Oral medications like Viagra and Cialis work by amplifying the body's natural response to arousal — which means they depend on intact nerve signals and sufficient arterial blood flow. When either of those is compromised (by surgery, diabetes, vascular disease, or other causes), pills often underdeliver. Injections sidestep that pathway entirely and act directly at the source.
Dr. Kashani provides the full in-office training session, personalizes your medication and dose, and follows up to make sure your results are exactly what you need.
Who uses injections? Men who find pills unreliable or ineffective, men recovering from prostate surgery, men with diabetes or vascular ED, and men who simply want a consistent, on-demand option with predictable results.
Sources: Shamloul & Ghanem, Lancet 2013; Burnett et al., AUA Guideline 2018.
Who Is a Good Candidate for Penile Injection Therapy?
Injections are appropriate for a wide range of men with ED. They are particularly valuable when pills have not provided adequate results, or when a reliable, predictable response is the priority.
ED Not Responding to Pills
Viagra, Cialis, and Levitra work for many men but not all. If oral medications have been inconsistent, weak, or ineffective, injections offer a higher and more reliable response rate.
Post-Prostatectomy ED
Men with ED following radical prostatectomy — whether nerve-sparing or not — often respond well to injections because the medication acts directly on the erectile tissue, independent of nerve function.
Diabetes or Vascular Disease
Both conditions can impair the blood vessel and nerve responses that oral medications depend on. Injections bypass these pathways and are one of the most effective options for this group of men.
Venous Leak
When blood drains from the penis too quickly, oral medications rarely provide lasting erections. Injections increase blood inflow forcefully enough to overcome the drainage, often producing results where pills fail entirely.
Younger Men Seeking Reliability
Some younger men with ED prefer injections because the response is consistent and does not depend on timing a pill, waiting for arousal, or worrying about whether it will work. The result is predictable every time.
Penile Rehabilitation After Surgery
Regular use of penile injections after prostatectomy helps maintain tissue oxygenation and may support the recovery of natural erections over time. Many urologists recommend this as part of a post-surgical plan.
Choosing Your Formula — Trimix, Bimix, Quadmix & Alprostadil
There are several medication options for penile injection therapy, and each is available in multiple concentrations that Dr. Kashani adjusts on a case-by-case basis. The right formula depends on your response, your medical history, and how your body reacts — it often takes one or two adjustments to dial in the optimal dose for you.
Trimix
The most commonly used compounded formula. Trimix combines three vasoactive agents that work through complementary mechanisms, making it highly effective across a wide range of ED causes. Because it is available in multiple concentrations, it can be precisely calibrated to produce exactly the response you need.
Components: alprostadil + papaverine + phentolamine
Compounded; requires refrigeration. Generally affordable through compounding pharmacies.
Bimix
A two-drug combination that omits alprostadil. Some men experience a mild burning or aching sensation with alprostadil-containing formulas — Bimix is a good alternative for those men. It can also be a useful starting point for men who are new to injections.
Components: papaverine + phentolamine
Compounded; refrigerated. Often preferred when Trimix causes discomfort.
Quadmix
A four-drug formula for men who have not achieved an adequate response with Trimix. The addition of atropine provides extra potency, making Quadmix the go-to option when standard formulas are not delivering sufficient results.
Components: alprostadil + papaverine + phentolamine + atropine
Compounded; refrigerated. Reserved for men who need more than Trimix provides.
Alprostadil (Caverject / Edex)
A single-agent, FDA-approved medication available at standard pharmacies. It is the most extensively studied option. Some men experience mild local discomfort with this formula, and it is used less frequently than compounded formulas in Dr. Kashani’s practice.
Component: alprostadil (prostaglandin E1)
Available at standard pharmacies without compounding. Not the first choice for most patients.
How It Works — From First Appointment to Home Use
Most men are apprehensive about the idea of self-injection before they try it, and pleasantly surprised after. Dr. Kashani takes you through a structured, unhurried process so that you leave each step feeling ready for the next.
Review Your History & Discuss Options
Dr. Kashani reviews your medical history, current medications, and ED history. You discuss the full range of injection formulas — Trimix, Bimix, Quadmix, and single-agent options — so you understand what is available and what makes sense for your situation. From there, he recommends a starting formula and explains the next steps.
Evaluate Penile Health & Try the Medicine
At a scheduled test appointment, Dr. Kashani administers your first injection and simultaneously performs a penile duplex ultrasound. The ultrasound evaluates the blood flow in your penile arteries and veins — essential information for choosing the right formula and dose. You also get your first experience of how the medication feels and how your body responds, which makes the next step much easier.
~45–60 min appointmentLearn to Self-Inject with Confidence
At a dedicated follow-up appointment, you perform the injection yourself with Dr. Kashani present. He walks you through the technique step by step, answers every question, and confirms your dose is right. Most men feel fully confident after a single teaching session — but if you want to come back for another, that is completely fine. You take nothing home until you are ready.
Most patients ready after 1 sessionUse It on Your Schedule
Once your dose is set, you inject at home as needed. The medication is kept refrigerated and has a shelf life of several months. Dr. Kashani provides written instructions, a safety protocol, and follow-up to adjust your dose or formula if anything changes over time.
About priapism (prolonged erection): If an erection lasts more than 4 hours, contact our office or go to an emergency room — this is straightforward to treat when addressed promptly. Dr. Kashani starts every patient on a conservative dose, provides a written protocol before anything goes home, and has reversal medication available in the office.
Frequently Asked Questions About Penile Injection Therapy
The questions men ask most often before their first appointment.
Does the injection hurt?
Most men are pleasantly surprised — the needle is very fine (similar to an insulin needle) and goes into the side of the shaft where there are fewer nerve endings. The most common sensation is a brief pinch. Any mild discomfort from the medication itself fades within a few minutes as the erection develops. The majority of men who try penile injections continue using them long-term.
Will I have to inject myself at home?
Yes — after your in-office training visit with Dr. Kashani, you will self-inject at home as needed. The technique is simple and most men feel comfortable after one or two practice sessions. Dr. Kashani provides detailed written instructions, and you can always call the office with questions.
What if the erection lasts too long?
An erection that persists beyond 4 hours is called priapism, and it is the main risk to be aware of. If this happens, contact the office or go to an emergency room — it is easily managed when addressed promptly. Dr. Kashani carefully calibrates your starting dose to minimize this risk and provides a written protocol before you take anything home.
What is the difference between Trimix, Bimix, Quadmix, and Alprostadil?
Bimix (papaverine + phentolamine) is a gentler two-drug formula. Trimix adds alprostadil and is the most commonly prescribed compounded option — it comes in multiple concentrations that can be fine-tuned to your response. Quadmix adds atropine as a fourth agent for men who need more potency than Trimix provides. Single-agent alprostadil (Caverject, Edex) is FDA-approved and available at standard pharmacies, though it is used less frequently in Dr. Kashani’s practice. The right formula depends on your history, your cause of ED, and how your body responds.
How quickly does it work and how long does it last?
Most men get an erection within 5 to 15 minutes of the injection, regardless of arousal. Duration depends on the medication and your dose — typically 30 to 60 minutes. The goal with dose calibration is a firm, reliable erection that lasts long enough for satisfying intercourse and then resolves on its own.
How often can I use penile injections?
Most men use injections one to three times per week as needed. Daily use is not recommended — spacing them out allows the tissue to recover and reduces the small risk of scar formation at the injection site over time. Dr. Kashani will give you specific guidance based on your dose and formulation.
Is penile injection therapy covered by insurance?
Compounded formulas — Trimix, Bimix, and Quadmix — are generally not covered by insurance, but they are typically affordable through compounding pharmacies. Dr. Kashani recommends the formula that is right for your medical needs; cost and coverage are part of the conversation, but they do not drive the clinical decision.
Can I use injection therapy after prostate surgery?
Yes — injection therapy is one of the most reliable ED treatments for men after radical prostatectomy, including cases where the nerves could not be fully spared. Unlike oral medications, injections work directly on the erectile tissue and do not require intact nerve signals. Many urologists also recommend penile rehabilitation with injections after surgery to support tissue health during recovery.
Are there side effects with long-term use?
Penile injection therapy has a strong long-term safety record. The most common side effect with regular use is a small amount of fibrosis (scar tissue) at the injection site, which is minimized by rotating injection sites and using the correct technique. Dr. Kashani monitors for this at follow-up visits and adjusts your protocol if needed. Systemic side effects are rare because the medication stays local.
How do I get started?
The process begins with a consultation with Dr. Kashani, during which he reviews your history and determines the right formula for you. He then schedules a training visit where he administers the first injection in the office so you can observe the technique and experience the result before taking anything home. Most men leave that visit feeling confident about the process.
Why Choose Dr. Kashani for Penile Injection Therapy?
Penile injection therapy sounds straightforward on paper, but outcomes depend heavily on proper training, the right starting formula, and careful dose calibration. Dr. Kashani completed a dedicated fellowship in Male Sexual Health at Lenox Hill Hospital in New York City, where intracavernosal injection therapy was a core part of clinical training.
He provides all formulation options — Trimix, Bimix, Quadmix, and single-agent alprostadil — performs the structured evaluation and training visits in-office, and follows up specifically to adjust your dose and formula until the treatment is actually working the way it should for you. He also offers the full spectrum of ED treatments so that if injections ever stop delivering adequate results, the next step is already planned.
- Fellowship-trained in Male Sexual Health & Intracavernosal Therapy
- All formulations available: Trimix, Bimix, Quadmix, and Alprostadil
- In-office training at both Rockville Centre and Carle Place
- Dedicated dose-calibration follow-up included
- Full ED spectrum: from injections to penile implants
- Private, discreet, judgment-free environment
See Whether Penile Injection Therapy Is Right for You
If pills haven’t given you the results you wanted, penile injection therapy may be the answer. Dr. Kashani will walk you through every option and help you decide what’s right for you.