A penile ultrasound is an ordinary gel-and-probe scan, but for erection problems it is usually done while you have an erection that the clinic brings on with a medicine. The scan itself is painless. What men tend to worry about is the small injection and how long the erection lasts afterwards.1Montreal Urologist | Steinberg Urology | Private Consultation Clinic. Penile Ultrasound Doppler | Steinberg Urology Doctors consider it the most reliable way to see why erections are failing, which is why it is often offered once pills haven’t worked.2PubMed. The penile duplex ultrasound: How and when to perform it?
Why Your Doctor Ordered This Scan
The scan is mainly used to check erectile dysfunction (ED) and Peyronie’s disease, where scar tissue called plaque causes a bend or lump.3PubMed. A Review on Penile Doppler and Ultrasonography for Erectile Dysfunction4PubMed. The penile duplex ultrasound: How and when to perform it? It can also give a clearer picture of blood vessel health, since erection problems can be an early sign of heart and artery disease.5PubMed. The penile duplex ultrasound: How and when to perform it?
Less often, it is used after a suspected penile fracture, where it can show the tear and bleeding to guide surgery. It can also help sort out which kind of lasting erection someone has. Those scans may not involve an injection at all.
The Doppler setting is the part that shows how fast blood moves through the arteries in the penis. With it, the doctor can tell whether too little blood flows in or too much leaks back out, which point to different types of ED.6PubMed. A Review on Penile Doppler and Ultrasonography for Erectile Dysfunction Blood flow can only be judged when the penis is erect, and that is why a medicine is used. The probe glides over the skin with warm or room-temperature gel, so it feels like light pressure, not pain.
A screen shows moving grayscale images and colored blood-flow signals. Depending on the clinic, the operator may turn it away or explain as they go, and you can ask what they’re looking at. The formal interpretation usually comes from the doctor who reads the images afterward.
Scar plaques show up as bright or dark patches, and the scan can note whether they contain calcium. It does not measure nerve function or hormone levels, so ED from those causes can look normal on ultrasound.
How to Prepare
Avoid sexual activity for 24 hours before the test.7NY Health. What to Expect During a Penile Ultrasound Don’t take Viagra, Cialis or Levitra the day before or the day of the scan, because combined with the injection they can cause a long, painful erection.8UW Medicine. What to Expect During a Penile Ultrasound You can keep taking your other prescribed medicines.9Guy’s and St Thomas’ NHS Foundation Trust. Penile Doppler ultrasound scan Bring a list of everything you take, since the clinic will ask.10NY Health. What to Expect During a Penile Ultrasound
Cialis stays in the body longer than the others, so ask whether the clinic wants a longer gap than one day. If you take pills daily for ED, ask exactly which dose to skip, and don’t stop other medicines such as blood pressure tablets unless the clinic tells you to.
On the day, you don’t need a full bladder.11Guy’s and St Thomas’ NHS Foundation Trust. Penile Doppler ultrasound scan Wear loose, comfortable clothing, which helps if the penis is still swollen or sore on the way home.12Guy’s and St Thomas’ NHS Foundation Trust. Penile Doppler ultrasound scan You will sign a consent form when you arrive.13NY Health. What to Expect During a Penile Ultrasound If you need an interpreter, transport or mobility help, ask the clinic ahead.14Guy’s and St Thomas’ NHS Foundation Trust. Penile Doppler ultrasound scan Staff do these scans routinely and you are covered except for the area being scanned.
A few questions are worth asking when you book:
- How long the whole visit lasts, since you’ll wait at least half an hour afterwards.
- Whether you should bring someone to drive if you might feel dizzy.
- Whether blood thinners need any special handling.
What Happens During the Scan
You lie on your back, gel is put on the penis and a probe is moved along it. While the penis is soft, the doctor first checks for plaques, calcium deposits, lumps or bruising and looks at the arteries.15PubMed Central. Ultrasound evaluation of the penis With Peyronie’s, the plaque is measured in three directions and checked for calcium, which helps track changes over time.16PubMed Central. US Imaging in Peyronie’s Disease This soft scan takes a few minutes.
Then comes the injection. A doctor or nurse cleans the skin on the side of the shaft, since the sides avoid the main nerves and vessels on top and the urine tube underneath. A very thin needle puts medicine, often alprostadil, into that side of the penis.17PubMed. A Review on Penile Doppler and Ultrasonography for Erectile Dysfunction They may gently stretch the penis to hold it steady and push the medicine in over a few seconds. Light pressure is held on the spot afterwards, and the penis may be rubbed or gently stroked to spread the medicine.
The medicine relaxes the muscle and widens the arteries so blood fills the penis.18PubMed. Intracavernous alprostadil. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential in erectile dysfunction A typical starting dose is 10 micrograms, and a second dose may be given after 10 to 15 minutes if the response is weak.19PubMed Central. Evaluation of the sensitivity of different doses of vasoactive drugs in diagnosing erectile dysfunction in impotent patients: a prospective case-control study Some clinics use a mixed medicine instead.20PubMed Central. Evaluation of the sensitivity of different doses of vasoactive drugs in diagnosing erectile dysfunction in impotent patients: a prospective case-control study Within a few minutes you may notice warmth or fullness as the erection begins, and the scanning resumes.
Blood speed is measured at intervals, often at 5, 10, 15 and 20 minutes after the injection.21PubMed Central. Differences in Penile Hemodynamic Profiles in Patients with Erectile Dysfunction and Anxiety Each round, the operator places the probe at the base of the penis, finds the main arteries and records how fast blood moves. You’ll be asked to lie still, since movement can blur the readings. If the blood speed is already clearly normal and the erection is full, the doctor may not need every time point.
Nervousness can slow the response, and anxious men may only reach normal flow by about 20 minutes.22PubMed Central. Differences in Penile Hemodynamic Profiles in Patients with Erectile Dysfunction and Anxiety A slow start in the room doesn’t mean your result will be poor. Some clinics may ask you to stimulate yourself privately to help, and extra doses can be given. A partial erection in the room is common and is taken into account.
Does the Injection Hurt
With the first injection, about 9% of men feel no pain, 61% mild pain, 19% moderate and 11% severe.23The Journal of Sexual Medicine. Injection Pain in Men Using Intracavernosal Injection During Penile Doppler Ultrasound On a 0 to 10 scale, the typical rating is about 2.24The Journal of Sexual Medicine. Injection Pain in Men Using Intracavernosal Injection During Penile Doppler Ultrasound
The needle is very fine and the prick is brief. Separately, about 1 in 10 men feel an ache from the medicine itself, not just the needle.25Montreal Urologist | Steinberg Urology | Private Consultation Clinic. Penile Ultrasound Doppler | Steinberg Urology With alprostadil it can come a minute or two later and then fades. Tell the doctor if the ache is strong. Some men also feel dizzy for a few minutes or get a small bruise where the needle went in.26Montreal Urologist | Steinberg Urology | Private Consultation Clinic. Penile Ultrasound Doppler | Steinberg Urology
A few things help. Breathe slowly and look away during the injection. If you’ve fainted with needles before, tell staff so you can stay lying down. Firm pressure on the spot afterwards limits bruising.
If the Erection Won’t Go Away
You’ll stay at least 30 minutes after the scan so staff can confirm the erection is going down.27Memorial Sloan Kettering Cancer Center. What to Expect During a Penile Ultrasound Some men who weren’t fully firm during the scan get a delayed erection in that window.28PubMed Central. EFFICIENT USE OF PENILE DOPPLER ULTRASOUND FOR INVESTIGATING MEN WITH ERECTILE DYSFUNCTION Most erections fade on their own within this time.
If the erection stays firm, another injection, often phenylephrine, is given to bring it down.29PubMed Central. EFFICIENT USE OF PENILE DOPPLER ULTRASOUND FOR INVESTIGATING MEN WITH ERECTILE DYSFUNCTION It tightens the blood vessels and muscle in the penis, pushing blood out. It goes in the same area as the first, so the discomfort is similar and short-lived. Doses can be repeated about every 10 minutes, with blood pressure checked, because the drug can raise it.30PubMed Central. EFFICIENT USE OF PENILE DOPPLER ULTRASOUND FOR INVESTIGATING MEN WITH ERECTILE DYSFUNCTION If three doses don’t work, blood is drained from the penis with a needle.31PubMed Central. EFFICIENT USE OF PENILE DOPPLER ULTRASOUND FOR INVESTIGATING MEN WITH ERECTILE DYSFUNCTION You aren’t sent home until the erection is too soft for sex.32PubMed Central. EFFICIENT USE OF PENILE DOPPLER ULTRASOUND FOR INVESTIGATING MEN WITH ERECTILE DYSFUNCTION
An erection lasting more than 4 hours needs emergency care.33New York Health. What to Expect During a Penile Ultrasound Blood trapped in the penis too long can damage it. If an erection returns at home, note the time it started. Call the clinic or go to emergency rather than waiting it out, and don’t take more ED pills that day.
Recovery Afterwards
You can go back to normal activities straight away.34New York Health. What to Expect During a Penile Ultrasound If you’re tender, avoid vigorous activity for a day or two.35New York Health. What to Expect During a Penile Ultrasound An ice pack for 15 to 20 minutes and acetaminophen can ease soreness or bruising.36New York Health. What to Expect During a Penile Ultrasound
The injection site may feel tender, like a small pinch bruise, for a day or two, especially when touched or when clothing rubs. A small purple or yellow mark can appear and is usually harmless, fading over days. Wrap the ice pack in a thin cloth first, because direct ice can irritate the skin. Check with the clinic before choosing a different pain reliever, especially if you take blood thinners.
Wait to have sex until tenderness settles. Driving is fine once any dizziness passes. Call the clinic if bruising spreads or swelling grows, or if pain worsens instead of easing over a day or two.
What the Results Mean
Blood speed into the penis above about 30 cm per second is generally seen as good inflow, though the reading is weighed alongside how full the erection was.37PubMed. Longer time to peak flow predicts better arterial flow parameters on penile Doppler ultrasound Little blood leaking out is also needed for a firm erection.38PubMed. Longer time to peak flow predicts better arterial flow parameters on penile Doppler ultrasound Low inflow points to artery narrowing, while good inflow with leaking points to a vein-type problem.
In many men with ED, though, the scan often doesn’t change treatment.39Travis Green, MD. Penile Doppler in Clear Lake, TX | Travis Green, MD40PubMed. The Efficacy of Penile Duplex Ultrasound in Erectile Dysfunction Management Decision-Making: A Systematic Review It is most useful in younger men or men with shape problems like Peyronie’s.41PubMed. The Efficacy of Penile Duplex Ultrasound in Erectile Dysfunction Management Decision-Making: A Systematic Review
The doctor who reads the images usually writes up the results, and you often hear them at a follow-up visit, not in the room that day. The report goes to the doctor who ordered the scan, who combines it with your history and symptoms. One low reading doesn’t prove permanent damage, and a slow early response can normalize by 20 minutes.
Poor inflow with artery narrowing may prompt a heart and circulation check, since the same disease can affect other vessels. Leaking veins can be harder to treat than artery problems, so the options discussed may differ.
At the results visit, consider asking:
- Was my erection full enough for the readings to be reliable?
- Did anxiety slow the results?
- Is this an artery or vein problem?
- Does this change my treatment or heart check-ups?