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If Trimix injections have stopped working well for you, or you're tired of the needle, you have more choices than you might think. The main alternatives to Trimix are a urethral pellet called Muse, ED pills in some cases, a vacuum erection device, an external penis sleeve, and a penile implant. Surgery is one of those choices, but it isn't the only one left.
At RX Sleeve, we've been making penis sleeves since 2004, and we've spent more than 20 years helping men with ED keep intimacy in their lives. Because we make one of these options, we have a point of view. We also know the right choice depends on your health, on why injections aren't working for you, and on what feels right to you and your partner. Your doctor should guide any medical treatment. Knowing your options before your next appointment will help you get more out of it.
Many men stop using Trimix for practical and personal reasons, not only because the shots stop working. About a third of men who learn to use self-injections eventually stop. The most common reasons are the cost, discomfort with the idea of injecting (for the man, his partner, or both), not having a partner, and erections that come back on their own. Only about one in seven men who stop do so because the shots didn't work.
Other men stop because their erections aren't firm enough, the treatment costs too much, the penis feels sore, or they miss being spontaneous. Injections can also cause side effects, including bleeding where the needle goes in, a painful erection that lasts more than four hours (called priapism), and scar-like tissue inside the penis.
Your reason for stopping matters, because it points to the right next step. A man who can't stand the needle needs something different from a man whose erections are no longer firm enough.
Before you give up on injections, ask your doctor whether a different mix or a different dose could help. There are several injectable medicines for ED, including alprostadil on its own, two-drug mixes, and Trimix. Your doctor decides which one you use and how much. Only the doctor who prescribes your injections should make those changes.
Yes. Several options don't use a needle at all, and two of them, a vacuum device and an external sleeve, don't use any medicine.
Muse uses alprostadil, one of the three drugs in Trimix, without the needle. You use a small applicator to place a tiny medicated pellet into your urethra, the tube you urinate through. An erection usually starts within about 10 minutes and lasts 30 to 60 minutes. Some men feel pain or burning, and there can be minor bleeding in the urethra. Muse needs a prescription.
Many men who use Trimix tried pills like sildenafil (Viagra) or tadalafil (Cialis) first. It can still be worth asking your doctor about them again, especially if your health has changed. Pills aren't safe for everyone. They can be risky if you take nitrates for chest pain or alpha-blockers for an enlarged prostate. They also may not be appropriate after a recent heart attack or stroke; your doctor should determine whether they are safe for you. Pills and injections usually aren't used together, because they work in the same way. Only combine them if your doctor tells you to. Our guide to ED medication alternatives covers other options that don't involve pills.
A vacuum erection device is a hollow tube with a hand or battery pump. You place the tube over your penis, and the pump draws the air out, which pulls blood into the penis. Then you slide an elastic ring onto the base of the penis to hold the blood in, and take the tube off. The ring can stay on for up to 30 minutes. A pump uses no medicine and no needle, but some men find it bruises the penis, makes it feel cold, or blocks ejaculation. Your doctor can recommend a model that suits you.
A pump and a sleeve can also work together. Some men use the pump right before intimacy and then put the sleeve on while they're still engorged. That gives a snugger fit inside the sleeve and may help with sensation. We explain the differences between the two in our guide to penis sleeves vs. penis pumps.
A penis sleeve is a hollow silicone device you wear over your penis during intimacy. It gives you the firmness you need for sex, whether or not you can get or keep an erection. That means it doesn't depend on medicine or on blood flow to the penis. A sleeve involves no needles, no drugs, and no surgery. It doesn't treat ED. It's a way for you and your partner to stay close while you live with it.
Our sleeves are FDA-listed as Class II External Penile Rigidity Devices, and each one is handmade from certified skin-safe medical-grade* platinum silicone. With our firm material, the head stays soft for your partner's comfort and the rest stays rigid, even if you lose your erection or can't get one. Every sleeve comes with The Grip™, our patented harness, which holds the sleeve in place.
How much you feel while wearing a sleeve varies from man to man, depending on things like past surgery, treatments, and blood flow. Standard models cost $299 to $525, and a well-made sleeve can last for years with proper care. You can read more about how a penis sleeve helps with ED.
A penile implant is a surgical option. A surgeon places devices inside both sides of the penis. One type uses rods you can inflate when you want an erection, and the other uses firm rods that you can bend into position. Doctors usually recommend trying other methods first. Men who choose an implant after other treatments haven't worked tend to be very satisfied with it. Like any surgery, it carries risks such as infection, and if a part stops working, you'll likely need another operation. If you want to compare surgery with options you wear on the outside, our article on alternatives to a penile prosthesis may help.
Some clinics offer shockwave therapy as a drug-free treatment for ED. U.S. urology guidelines recommend it only as part of an approved clinical trial. If a clinic offers it to you as a replacement for injections, talk it over with your urologist first.
| Option | Uses needles? | Needs surgery? | Needs a prescription? | Relies on your own erection? | Main trade-off |
|---|---|---|---|---|---|
| Trimix injection | Yes | No | Yes | Yes | A shot before each use; can cause priapism or scar tissue |
| Urethral alprostadil (Muse) | No | No | Yes | Yes | Pain, burning, or minor bleeding in the urethra |
| ED pills | No | No | Yes | Yes | Not safe with nitrates; may not be appropriate after a recent heart attack or stroke, so your doctor should determine whether they are safe for you |
| Vacuum erection device | No | No | Not always | Yes | Ring can stay on only 30 minutes; bruising or a cold feeling |
| External penis sleeve | No | No | No | No | Sensation varies from man to man |
| Penile implant | No | Yes | Requires a surgeon | No | Permanent; infection risk; a failed part means more surgery |
Start with the reason injections aren't working for you, because that reason points to the options worth asking about.
Take your short list to your urologist. If stress, worry, or tension in your relationship is adding to the problem, a counselor or a certified sex therapist can help, and your partner can join those sessions. Some doctors and therapists already recommend our sleeves to their patients, and you can learn how we work with doctors and therapists.
Yes. Our sleeves don't interfere with medications, and you can put one on right after using a vacuum pump. Men with a penile implant, or who have had one removed, can wear a sleeve too. If you're using any prescription treatment, ask your doctor how a sleeve fits into your plan.
If you're thinking about a sleeve as your next step after Trimix, we're glad to help you figure out whether it's a good fit. You can email us at hello@rxsleeve.com or reach us through our contact page, and we'll answer your questions privately and without any pressure.
*In compliance with: In Vitro EpiDerm™ OECD TG 439 & EpiVaginal™ In Vitro Toxicity
