Q: What are the pros and cons of the P-Shot?

Pros By improving blood flow to the penis, the treatment claims to deliver stronger erections, longer-lasting erections, and a more satisfying sex life. According to anecdotal reports, this no-downtime procedure may enhance the length and girth of the penis (more on this below). Initial results can be apparent within two days of treatment. For some patients, it can reduce scar tissue caused by Peyronie's disease, to alleviate curvature and erection pain (and related sexual dysfunction). This is a drug-free alternative to erectile dysfunction treatments like Viagra. Some providers claim it can enhance the effects of medications like Cialis or Trimix. PRP is derived from your own blood, so the risk of allergic reaction is very low. Cons The Priapus Shot is still considered experimental. Studies on whether it’s an effective treatment have so far been small, with mixed results (more on that below). Health insurance does not cover it. Even though your provider will apply a local anesthetic before injection, you may experience some discomfort. Some providers who offer the P-Shot lack training in the official protocol. During your consultation, ask if your provider is in the Priapus Shot provider network or subscribes to that standard of care.

Question 1

What is a P-Shot?

Accepted Answer

The P-Shot (short for Priapus Shot) is a nonsurgical regenerative treatment that involves injecting platelet-rich plasma (PRP) from your own blood into the penis, using a tiny needle.

Proponents claim this boosts blood flow through tissue regeneration, which improves sexual health and helps men achieve and maintain stronger, firmer erections. Some claim PRP can also increase girth and help treat urinary incontinence.

Blood contains white and red blood cells as well as platelets (also called thrombocytes), which contain the growth factors that are essential for healing and tissue growth. Isolating platelet-rich plasma and re-injecting it into targeted areas stimulates cell production, to repair tissues and even create new blood vessels.

Named for the Greek god of virility, the Priapus Shot procedure was developed by Dr. Charles Runels, a physician based in Fairhope, Alabama, who also invented the Vampire Facelift and the O-Shot for women’s sexual health. His controversial Priapus Shot protocol outlines optimum patient selection and education, as well as proper PRP extraction, anesthesia, and injection technique.

The official treatment plan also recommends daily use of a penis pump, aerobic exercise, and medication. Some providers combine the P-Shot with stem cells, in an effort to enhance results.

Question 2

What are the pros and cons of the P-Shot?

Accepted Answer

Pros

By improving blood flow to the penis, the treatment claims to deliver stronger erections, longer-lasting erections, and a more satisfying sex life.
According to anecdotal reports, this no-downtime procedure may enhance the length and girth of the penis (more on this below).
Initial results can be apparent within two days of treatment.
For some patients, it can reduce scar tissue caused by Peyronie's disease, to alleviate curvature and erection pain (and related sexual dysfunction).
This is a drug-free alternative to erectile dysfunction treatments like Viagra. Some providers claim it can enhance the effects of medications like Cialis or Trimix.
PRP is derived from your own blood, so the risk of allergic reaction is very low.

Cons

The Priapus Shot is still considered experimental. Studies on whether it’s an effective treatment have so far been small, with mixed results (more on that below).
Health insurance does not cover it.
Even though your provider will apply a local anesthetic before injection, you may experience some discomfort.
Some providers who offer the P-Shot lack training in the official protocol. During your consultation, ask if your provider is in the Priapus Shot provider network or subscribes to that standard of care.

Question 3

How much does the P-Shot cost?

Accepted Answer

Your price will depend on your provider's credentials and level of experience, their practice location, how many shots you need, and a few other key factors.

See our complete guide to P-Shot costs

Question 4

Who's a good candidate for the P-Shot?

Accepted Answer

Good candidates for the P-Shot are healthy men who may want:

improved erectile function and sexual performance
heightened sensitivity
greater stamina
increased girth and length
reduced curvature, if that’s a concern

The treatment is sometimes recommended for men with compromised sexual function or urinary incontinence due to medical conditions such as prostate cancer, diabetes, or an enlarged prostate.

Question 5

Does the P-Shot work?

Accepted Answer

There is no conclusive medical evidence yet that the P-Shot works, so the treatment is still considered experimental.

In 2022, French urologists conducted a small study to evaluate the safety and efficacy of PRP injections in men who hadn’t responded to oral medication for vascular erectile dysfunction.

They gave 15 patients three treatment sessions each, 15 days apart. Their protocol did not include use of a penis pump.
In their findings, they report that “20% of patients considered that the erection lasted long enough to have sexual intercourse before P-shot, versus 26.7% after the treatment.”
Given the small sample size, this means that 3 out of 15 patients were able to have sexual intercourse prior to the P-Shot, and 1 additional patient was able to maintain an erection post-treatment.

A 2023 study (co-authored by Dr. Runels) aimed to answer the hotly debated question: does the P-shot increase size?

Subjects were given a series of six monthly PRP injections.
Their treatment protocol also included “penile traction for lengthening, a vacuum erection device [aka penis pump] to increase girth, and nitric oxide precursor supplements, to augment penile vascular smooth muscle function.”
Six months following treatment, 16 healthy male subjects saw an average penis length increase of 0.85 inches and a girth increase of 0.47 inches.

Separate from the patented P-Shot procedure, a handful of studies explore platelet-rich plasma therapy for a variety of penile problems, with mixed results.

According to a prospective, double-blind, randomized, placebo-controlled clinical trial published in the Journal of Urology in 2023: “2 injections of intracavernosal platelet-rich plasma separated by 1 month in men with mild to moderate erectile dysfunction is safe,” but researchers saw no difference in efficacy between platelet-rich plasma and placebo.
A 2022 prospective study investigating PRP as a treatment for Peyronie’s disease reports promising results: a reduction in penile curvature coupled with less pain during sex.
A 2019 survey of peer-reviewed studies on PRP treatments for male sexual health concluded that "given the limited data on clinical efficacy and potential for harmful side effects, there is a need for a proper clinical trial to examine the role of PRP before it is accepted as standard of care in treatment for ED [erectile dysfunction]."
A 2017 study of men who used a penis pump after their P-Shot procedure showed an increase in penis length and girth—on a scale that could be attributed to the penis pump alone. Penis pumps are safe for most men, according to the Mayo Clinic.

The bottom line: While studies show the P-Shot Protocol works for some patients, more clinical trials on a larger number of patients are needed to show that penile injections can live up to all of the treatment's claims.

Question 6

What happens during a P-Shot treatment?

Accepted Answer

Here's what to expect during your hour-long appointment.

Every P-Shot treatment begins with extracting a small amount of your own blood from your arm.
The blood is placed in an FDA-cleared centrifuge, where it's rapidly spun to separate platelet-rich plasma from your red and white blood cells.
Your provider will apply a local anesthetic and numbing cream to the head and shaft of your penis.
Once your tissue is numb, your provider will use a small needle to inject the PRP into several areas, including the head and the nerve- and blood vessel-rich corpus cavernosum columns of erectile tissue.

Over the coming days and weeks, the PRP will stimulate new collagen production, spur tissue growth, and help new blood vessels form.

You’ll need at least one treatment to improve blood flow and sexual enhancement, though your treatment plan may include a series of up to six monthly treatments.

Question 7

Will you need any recovery time?

Accepted Answer

The P-Shot has minimal downtime, and no significant side effects have been reported. It's extremely unlikely that you'd have an allergic reaction to your own blood or develop scar tissue from the tiny needle, though according to one small 2018 study, you may have mild pain and bruising.

It’s also possible that you’ll have some swelling, pinpoint bleeding, and soreness around the injection site for a few days post-injection.

To encourage healing and minimize these side effects:

Avoid alcohol for three days before and after your PRP injection (to reduce bruising).
Stay well-hydrated on the day of your treatment and during the week after.
Wait for six hours after your injection before showering, since a temperature change could inhibit your body's response to the PRP.
Avoid vigorous exercise for three days post-treatment; after that, regular aerobic exercise is recommended.
Wait at least four hours after the procedure before having sex.
Talk to your provider about when you can safely take anti-inflammatories like ibuprofen or aspirin.

As mentioned above, the Priapus Shot's official protocol also includes daily use of a penis pump. Talk to your provider about how best to use it, to maximize your results.

They may also prescribe microdoses of a vasodilator drug like Cialis, to help increase blood flow.

Question 8

How long does the P-Shot last?

Accepted Answer

A single P-Shot treatment can purportedly improve blood flow to the penis for a year or more.

The aforementioned 2023 study (co-authored by Dr. Runels) showed that the modest increases in length and girth were apparent 6 months after treatment.

Question 9

How does P-Shot compare to GAINSWave?

Accepted Answer

GAINSWave treats erectile dysfunction with low-intensity acoustic wave therapy, sometimes called shockwave therapy. This needle-free treatment can also stimulate growth factors, create new blood vessels, and naturally increase blood flow to the penis. It’s primarily intended to improve erectile function and treat Peyronie’s disease, though it may also heighten sexual sensation.

A small 2023 study on the effectiveness of low-intensity shockwave therapy found it “improves erectile function in men with erectile dysfunction as compared with sham treatment, which persists even 6 months after treatment.”

GAINSWave requires a series of 6 to 12 sessions and costs about $500 per session, so depending on your recommended treatment plan, it may be more expensive than the P-Shot.

GAINSWave has very few reviews on RealSelf, while reviewers give the P-Shot a type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el Worth It Rating.

Consult with an experienced provider who offers a range of solutions and can recommend the best treatment option for you. They may even suggest combining the two therapies.

Question 10

Sources & studies

Accepted Answer

Masterson TA, Molina M, Ledesma B, Zucker I, Saltzman R, Ibrahim E, Han S, Reis IM, Ramasamy R. Platelet-rich Plasma for the Treatment of Erectile Dysfunction: A Prospective, Randomized, Double-blind, Placebo-controlled Clinical Trial. J Urol. 2023 Jul.

Kennady EH, Bryk DJ, Ali MM, Ratcliffe SJ, Mallawaarachchi IV, Ostad BJ, Beano HM, Ballantyne CC, Krzastek SC, Clements MB, Gray ML, Rapp DE, Ortiz NM, Smith RP. Low-intensity shockwave therapy improves baseline erectile function: a randomized sham-controlled crossover trial. Sex Med. 2023 Nov 11.

Schirmann A, Boutin E, Faix A, Yiou R. Pilot study of intra-cavernous injections of platelet-rich plasma (P-shot®) in the treatment of vascular erectile dysfunction. Prog Urol. 2022 Dec.

Achraf C, Abdelghani PA, Jihad PEA. Platelet-rich plasma in patients affected with Peyronie's disease. Arab J Urol. 2022 Oct 25.

Scott, Susan, Roberts, Matthew, Chung, Eric. “Platelet-Rich Plasma and Treatment of Erectile Dysfunction: Critical Review of Literature and Global Trends in Platelet-Rich Plasma Clinics.” Sexual Medicine Reviews, Apr. 2019.

“Shockwave or 'P-Shot' for Erectile Dysfunction? Don't Do It.” Hartford HealthCare Tallwood Men’s Health, Nov. 2018.

2Kumar C.S. “265 Combined Treatment of Injecting Platelet Rich Plasma With Vacuum Pump for Penile Enlargement.” The Journal of Sexual Medicine, Jan. 2017.

“Penis pump.” Tests and Procedures, Mayo Clinic, Dec. 2017.

P-SHOT

John Hettiarachchi, DO, FACS, FPMRS

Wendy Rose Gould

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John Hettiarachchi, DO, FACS, FPMRS

Wendy Rose Gould

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