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What Does Science Say about Botulinum Toxin Injection and ED?

Since at least 2016 researchers have been exploring the effects of botulinum toxin on erectile tissue. The men in the studies frequently suffered from erectile dysfunction that was resistant or not responsive to oral and injectable ED meds. They did well with botulinum toxin injection!


Botulinum Toxin Penile Injection is a simple in office procedure that takes less than 30 minutes

Safe and effective

Studies to date have shown very good benefit for most, and no systemic side effects.

Long Lasting

Typical patients enjoy improved erectile function for about 6 months.

Introducing: Botulinum Toxin Penile Injection

Botulinum toxin has a new "off label" use for the enhancement of erectile function

Botulinum toxin injections have been used for many decades for a wide variety of aesthetic and clinical applications. From the early days of the treatment of eyelid spasm, to the aesthetic uses for fine lines and wrinkles, to the treatment of a growing list of medical conditions where muscle spasm is a key pathology, it has shown an excellent safety profile and high patient satisfaction. This procedure has also been called "Priapus Toxin"

Botulinum Toxin worked even when other ED meds failed

A prospective randomized double-blind placebo-controlled trial was conducted between July 2016 and February 2019.
A total of 176 patients, who were non-responders to oral and injectable ED medications, were randomly assigned (1:1:1) to one of three groups: Botox 100 U (62 patients), Botox 50 U (59 patients), or placebo group (55 patients).
All patients were followed up for 6 months.
Results: Significant improvement in all parameters, that is, SHIM score & Erection Hardness Score (EHS), Sexual Encounter Profile (SEP), Global Assessment Score (GAS), and Doppler parameters (p < 0.001) was observed in patients of BTX-100 and BTX-50 groups with maximum improvement at 3rd month of treatment.
Around 40% of these previously non-responding patients were responders and were able to engage in sexual intercourse. Patients in placebo group did not experience significant improvement.

Botulinum Toxin Penile Injection Has Numerous Beneficial Effects:

Increases Blood Flow

Botulinum toxin injection into the penile tissue affects certain neurotransmitter pathways in a way which promotes vasodilatation (relaxation of blood vessels) and thus increased blood flow. A decrease in cavernosal (penile shaft) smooth muscle tone results in the penis having more blood flow in the flaccid state.

Improves Firmness of Erection

It’s also easier to achieve an erection because parasympathetic nerve activity is simultaneously increased. An increase in penile length may also be noted. When the smooth muscle in the arterioles (blood vessels) of the penis are more relaxed there is increased blood flow during erection as well, resulting in improved firmness of erection.

Long Lasting

Overall, a 100 unit dose appeared to produce benefit for about 6 month in most patients. Importantly, there were no systemic side effects!

We've Got You Covered!

Sustain Injection for Men is a procedure which uses one of several FDA approved neuromodulators for the treatment of erectile dysfunction in men. This is considered an “Off Label” use, meaning that the FDA has not yet evaluated the use of the medication for this indication. Physicians are permitted to use medications in Off Label applications when there is good evidence for benefit, regardless of the status of FDA evaluation. This is quite commonplace in medicine in general. Botulinum toxin in particular is a medication with a history of many decades of Off Label use for a wide variety of indications. 

There have been no reports of unwanted systemic side effects from the use of botulinum toxin injection for the treatment of erectile dysfunction.

Multiple formulations of botulinum toxin have been evaluated in this way. They all appear to work well. There are no head-to-head comparisons between brands for this particular indication. 

For the formulations that have been tested, 100 units appears to produce longer lasting results versus 50 units.

The penile shaft of the human penis comprises three columns of tissue: two corpora cavernosa, one on either side of the corpus spongiosum. The urethra runs through the center of the corpus spongiosum and is the main passage for urine and semen.  The corpora cavernosa is considered erectile tissue, as it plays a major role in achieving erection.  When flaccid, the penis is actually in a “contracted state” with respect to blood flow. When the smooth muscle in the penis relaxes, blood flow increases and the penis becomes engorged. The botulinum toxin allows this to happen with greater ease and to a greater extent.

After topical numbing, a soft penis ring is placed at the base of the penis. The prepared dose of the medication is then injected into the shaft of the penis at specific sites and the ring is left in place for 15 minutes. The needle used is very small and thin. The procedure should be painless.

Botulinum toxin effects generally develop over the course of a couple of weeks.

A typical ‘standard’ dose is $1200

Yes, the botulinum toxin penile injection procedure can be performed in conjunction with other ED procedures such as the P Shot (PRP Injection) and Gainswave (Low Intensity Shcokwave Therapy).

Yes, erectile dysfunction is not a requirement in order to try this procedure. Studies to date have focused on treating men with ED. 

This procedure would be performed by Dr. Vuich or by an RN under her direct order. 

No, there are no activity restrictions after this procedure.

We cannot predict changes in penis size for any individual patient. 

It is not possible for us to guarantee a result or specific outcome. In studies evaluating men who had failed other interventions, approximately 40% were able to have sexual intercourse after receiving this type of procedure. The success rate is higher (approximately 80%) for men who do still  respond to Viagra-type medications but are looking for further improvement in function. 

This procedure to the best of our knowledge is not covered by insurance. We do not bill insurance and cannot submit any prior authorization paperwork. 

Yes, in most instances we have no difficulty processing payments via HSA/FSA cards. We are able to submit documentation of the appropriate medical use of the funds as needed.


Disclaimer: Individual results will vary by person and are based upon patient variables (such as genetics, age and lifestyle), the severity of the condition before the procedure, the procedure(s) chosen, and other comorbidities. No one can guarantee an exact outcome for any medical procedure.

The content of this website is intended to be general information - it should not be used to diagnose or treat a medical condition, and is in no way meant to be a substitute for seeking appropriate medical care.