This protocol addresses men with erectile dysfunction in whom standard first-line management — including lifestyle intervention and oral phosphodiesterase type 5 inhibitor (PDE5I) therapy — has not produced an erection with rigidity sufficient for satisfactory intercourse. A structured next-line approach is indicated.
The preceding management line included phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) taken orally, combined with lifestyle modifications addressing cardiovascular risk factors. Alternative first-line options — including topical and intraurethral alprostadil, vacuum erection devices, and selected supplements — were also available within that line.
That line's defined target — erection with rigidity sufficient for satisfactory intercourse — was not achieved, establishing the indication for this next-line protocol.
This protocol uses intracavernous injection therapy — a well-established, evidence-based class of intervention for men in whom oral therapy has been insufficient. More than one vasoactive agent option exists within this class. An in-office training programme is required so patients can learn the administration technique before proceeding independently.
The clinical goal remains: achievement of a rigid erectile response sufficient for satisfactory intercourse. The complete protocol — including agent selection, all clinical parameters, and decision criteria — is available via the button below.