I enjoy being on the cutting edge of sexual medicine and the first to offer new treatments to men with sexual dysfunctions. The idea of using Botulism Neurotoxin to treat ED was intriguing, so I reviewed the data on the use of Botulism Toxin A for treating erectile dysfunction that has not responded to traditional therapies.
A group in Egypt published a study on 200 men divided into three groups: Placebo, 50 Units, and 100 Units injected into the penis. In this group of men with moderate to severe ED, there was a significant improvement in penile blood flow measured by ultrasound and the SHIM questionnaire. The improvement in erectile function lasted between 3 and 6 months, which is typical for Botox. There were no adverse effects of the injection of Botox. In addition to boosting erectile function, Botox increases the size of the non-erect penis.
You may be asking yourself: how does Botox help improve erectile function? When the penis is flaccid, the vascular smooth muscle in the penis is in a contracted state. When a man is stimulated, the vascular smooth muscle relaxes, allowing blood to flow more quickly in the penis. The effect of Botox is to relax the vascular smooth muscles in the penis so that the penis fills more easily with blood. The lower penile blood vessel resistance increases blood flow velocity to the erectile bodies, providing a better and longer-lasting erection.
Botox® for Men Protocol was created so that men could improve their sexual health without penile injection therapy or implant surgery, which often result in dangerous side effects and unwanted results. Botox for ED is an off-label use for BOTOX not approved by the FDA — as are other typical “off-label” applications of BOTOX. As with any new procedure, more studies are required before the medical establishment fully accepts it.
IS BOTOX SAFE? Thankfully, we have two decades of use of Botox for many indications and millions of doses per year with an extremely high safety profile. The toxic, lethal dose for injecting cosmetic Botox intravenously for a 180-pound man is estimated to be around 150 to 200 Bottles of Botox (or approximately 15,000 to 20,000 units); we only inject a total of 100 units of Botox (one bottle) into the corpus carvernosum when we perform the procedure.
PENILE BOTOX PROTOCOL: The initial thought behind using Botulism Neurotoxin in the treatment of erectile dysfunction was that cavernosal smooth muscle relaxation is an integral part of the development of an erection, and Botulism Neurotoxin is a potent inducer of smooth muscle relaxation. A study by researchers at Banha University in Egypt in 2021 explored intracavernosal injections of Botox (botulism neurotoxin) in treating vasculogenic erectile dysfunction. Two hundred men were randomized to receive either a placebo, 50 units, or 100 units of Botox. The injections were administered at four different sites, one inch proximal and one inch distal to the corona and base of the penis, at the right and left cavernosa. Following the injection, a rubber band was placed at the base of the penis for 20 minutes.
BOTULISM NEUROTOXIN AND ERECTILE DYSFUNCTION RESULTS: The results of the study showed that Botox injection improved flaccid penile length by reducing the baseline contraction of the smooth muscle in the penile erectile bodies. Additionally, men who received the injection could go from a flaccid state to an erect state more quickly because the baseline vascular resistance was reduced. The study also found that the 50-unit dose increased the SHIM Score (a measure of erectile dysfunction) by 13 points at three months, which returned to baseline at six months. The 100-unit dose increased the SHIM Score by 6 points at three months, which remained elevated at six months. The erectile hardness score also increased, and the peak systolic velocity increased from 20 to 37.5 with the 100-unit dose and from 22 to 29 with the 50-unit dose, with no change observed in the placebo group. The use of Botulism Neurotoxin in treating erectile dysfunction is a promising area of research. The study conducted by researchers at Banha University in Egypt showed that intracavernosal injections of Botox can improve flaccid penile length and increase the SHIM Score and erectile hardness score. Further research is needed to determine the long-term safety and effectiveness of this treatment.
CONCLUSION Using Botox for ED is an off-label use for BOTOX not approved by the FDA—as are other common “off-label” uses of BOTOX. Some experts do not think Botox should be used for ED. Thankfully, we have two decades of use of Botox, with millions of doses per year, for many indications with an extremely high safety profile. I have had success using Botulism Neurotoxin in helping my patients with ED. It is one more tool that sexual medicine specialists can use to help men have a better and more satisfying sex life.
To learn more about Dr. Judson Brandeis and his clinical research projects, please visit https://p-long.com/about-dr-brandeis