I am doing something wrong HELP

[rahod1]

rahod1
You are taking Cialis generic daily and injecting? Tell have told me that was a big NO. I take Cialis generic 5 grams but not on days I inject. I am telling you as I didn't when i started this post this whole thing has been a nightmare for me.

You can take *daily Cialis 5mg* and inject..I take daily 10MG because it's generic. NO PROBLEMS with injecting!
Have you tried a constriction ring with injections? I use one. If not try one...make sure it can be removed when erect.

[Tybeeman]

Yes I have tried everything except I only take 5 grams of daily Cialis on the days i don't inject. I may try that. At this point I would love to have to go to the hospital after a 4 hour erection just so i know there is a this works. I have been shooting my self since August at less twice a week and only had intercourse 8 times. Those were not great because of the pain.

[cincinnatus1951]

Tybee: Attached is a paper I wrote about re-thinking when to decide on an implant. My recommendation is that you seriously consider one at this time. Cincinnatus
April 1, 2017

Guys: I’ve been doing a lot of thinking about the “right” time to decide on an implant. A lot of discussion about pumps and injections as well as pills indicates that a lot of men get some initial positive results, but, after time, the effectiveness declines. With injections, many report scarring and penile distortion. What’s not nearly as clear is what percentage of injection and pill users continue to have erection difficulties. Human nature teaches that the satisfied folks rarely complain. There are plenty of examples of marginal effectiveness of pills and injections, what I can’t tell is how large the percentage is.
In my own case, I went for about six months with pumps and pills with marginal results. My prostate surgeon recommended injections, which I used for about a year with inconsistent results. ( I had a Robotic assisted nerve sparing prostatectomy in July, 2013.) Sometimes, very little, sometimes too long, and never knowing how long the erection would last. I did have good firmness and longitudinal stability when it worked. At my two year surgical follow up visit, the surgeon suggested we consider an implant. My initial reaction was “They are not doing that to me!!!” We continued to bumble along. If the injection did not work (rarely) or did not last long enough, we would resort to toys and tongue. We were both able to climax; but, it was certainly not as satisfying as traditional penetrative sex. We were also getting tired of the hassle with injections. We visited one urologist (sexual medicine) specialist and he recommended “combination therapy” of pills and injections. He also recommended we consider an implant, showed us the prosthesis, gave us web sites where we could watch the surgery. We also learned of FrankTalk through a prostate cancer support group.
As we learned more about the surgery, risks, aftercare, healing, etc. the thought of surgery became less scary. My wife initially discouraged it saying we can do OK with toys and tongue, is it worth the risk? We agonized and went to see another sexual medicine specialist. He did not try to sell us on an implant, however, said none of the other therapies were working for us. At that stage 21/2 years out of prostate surgery, the likelihood of spontaneous erections returning were essentially nil. After one particularly frustrating love making session, I said to the wife, “Heck with it “I’m signing up for the implant. She agreed. I had the implant in January 2016. We had a text book recovery and we both wish we had not wrung our hands for so long. The implant removes all the hassle and uncertainty of the lesser methods.
That brings me to the point of this note. I have advised a goodly number of people both in public and private posts not to consider an implant unless nothing else works. While I still believe that to be the case. For the above reasons, I would recommend seriously thinking about an implant as soon as frustration begins to build. Essentially, once pills become less effective and you have tweaked your formulation and injection dosage without satisfactory results, I have come to believe that further avoidance of an implant is not helpful. In talking with my docs, they too, believe couples get frustrated and just give up on sex. My cardiologist even offered he would like to see way more men go for implants. He says many patients report that they have just given up.
Bottom line is I do not know how to accelerate the process to an implant. We believe we waited six to nine months too long. I also recall my almost complete rejection of the first implant recommendation. For guys who are say over age 55, are frustrated and have systemic ED regardless of the cause, I would say “Go for it”.
Sorry for the long post. Just food for thought. Cincinnatus

[rondad]

BTW, contrary what you might think, oral meds counteract injectables, so don't use them on the same day.
Ron

Why would they?

I must apologize - in interests of giving as much accurate information to the community as possible, I'd like to retract my reason above. My urologist DID tell me that Viagra counteracted the effects of my Bimix - that the way Viagra works. However, apparently the opposite is true - it can INCREASE the physical changes necessary for an erection:

1. Viagra Inhibits an enzyme called phosphodiesterase type 5 (PDE-5). According to drugs.com, there is a rather-complex interrelationship of actions:

With sexual stimulation, Nitric Oxide (NO) is released into the corpus cavernosum. A number of enzymes then interact (guanosine triphosphate (GTP) converts into quanosine monophosphate (cGMP). cGMP causes smooth muscle relaxation, which causes blood flow into the penis. PDE5 is responsible for converting cGMP into GMP, which causes the smooth muscle to "un-relax" which reduces the blood flow and causes your erection to subside. Viagra inhibits the PDE-5, which in turn limits the conversion of cGMP into GMP, so this allows the smooth muscle to relax and/or continue to be relaxed.

2. Papaverine works sort of in the same way as Viagra - while Viagra inhibits PDE-5, which in turn relaxes the smooth muscles, Papaverine, when injected, causes direct smooth muscle relaxation. So it makes sense to me that this, in combination with Viagra (which inhibits PDE-5), could potentially cause extended erection times.

3. Another component of trimix - PGE1 (Prostaglandin / Alprostadil) is a vasodilator - it works by widening (dilating) blood vessels to improve the flow of blood. But the smooth muscle must first relax to allow blood to fill the corpos cavernosum. So Viagra and/or Papaverine "opens the gate", and PGE1 "widens the pipe".

4. Another component of Trimix - Phentolamine - is also a vasodilator - works in a similar way to PGE1.

DISCLAIMER - This is NOT consistent with other posts in this forum which state that Phentolamine/PGE1 = duration, not rigidity. I will try to do more research and post my findings. Example: http://www.franktalk.org/phpBB3/viewtopic.php?f=5&t=7567&p=53453&hilit=duration#p53456

According to my research, Papaverine contributes to duration, while Phentolamine and PGE1 contribute to rigidness. HOWEVER, if you are very rigid, it stands to reason that it may last longer anyway.

Obviously, based on the number of posts on this topic, this is a complex matter, and not all doctors understand and/or agree.

So, my conclusion is that Viagra/Cialis/Levitra PLUS trimix MIGHT lead to prolonged erections and/or priaprism - not the other way around.

This, once again, supports the statements made by many of the members of the community - if things don't work, make adjustments - but to be safe, GO SLOW on the tweaks, e.g. if you want to try oral meds + injectables, start with low doses of both. I know we are all very eager to quickly find that "sweet spot", but just remember that NO trip to the ER is fun, especially one due to priapism.

Once again, I apologize if I made inaccurate or misleading statements. My goal has always been to help distribute accurate and/or helpful information.

Ron