Bocox-Can Botox treat ED?

It sounds counter-intuitive. An agent that relaxes muscle resulting in a harder erection? Yes, that is what it does! Botulinum toxin relaxes the arteries that feed blood to the penis, increasing the strength and speed of the erection for as long as the Botox lasts.

We have been treating Erectile Dysfunction with intracavernosal PRP injections (P-Shot®) for over a decade now, with excellent safety and efficacy. Now several studies have confirmed that injecting Botox® into the erectile tissue of the penis, much like we do with PRP in the P-Shot®, works much like Viagra and may have a synergistic, restorative effect when done along with the P-Shot®.

Unlike Viagra, Tri-mix injections and penile prostheses, restorative therapies like the P-Shot®, Bocox® and Shock Wave Therapy, improve erectile function by increasing blood flow to the penile tissues, enhancing oxygen delivery, increasing Nitric Oxide production and promoting new nerve and blood vessel growth. Adding the well known and trusted neurotoxin, Botox®, helps by relaxing the smooth muscles that control blood flow to the penis and increasing nitric oxide production, allowing for a more rapid and sustained erection. Another way it likely works is by enhancing the parasympathetic response in the penis which is essential for arousal, erection and orgasmic function in both men and women.

A recent double blind, placebo controlled trial, showed that 40% of men that were unresponsive to Viagra & Cialis, became able to maintain an erection, sufficient for penetrative vaginal intercourse after 100 Units of Botox® was injected into the erectile tissue of the penis without any adverse side effects. The effects last for at least 3 months and 6 months in some studies. It is postulated that over time, the results should have a longer duration of effect and an overall improvement in baseline erectile function due to the nature of regenerative modalities when applied to the penile tissue. To date there have been 7 well done studies showing both safety and efficacy of injecting Botox® and other neuromodulators in the penis to improve erectile function. More are currently underway.



Will I see an Increase in Penile Length or Girth?

Most men will see an increase in the length of their flaccid penis and a reduction in the typical retraction associated with "shrinkage". There does not seem to be any increase in girth with this procedure.

What Results Can I Expect?

For men without erectile dysfunction who want to make good better or want to do everything they can to prevent ED in the future, then they can expect a faster, harder erection within the first 2wks of the Bocox shot. The results seem to last anywhere from 3-6mos and longer in many.

In men with ED that is vasculogenic in nature, the results are dependent on the severity of their ED. In on recent study, men with severe ED that was unresponsive to medications like Viagra and Cialis as well as Tri-mix injections, were able to get 40% of participants to achieve erections that were adequate for penetrative intercourse. This was in men who's only option left was a penile implant. So it didn't work for all of these men, but 40% is pretty good when they were starting with nothing. The studies didn[t look at men with mild to moderate ED, however, in my office we see the majority of men who respond to oral PDE5I's or Tri-mix injections will also respond to injected neurotoxins in the penis.

Maintenance injections are required over time, but you may be able to reduce the dose or space them out over time as the erectile tissue regenerates and becomes more responsive to arousal stimulus.


Book an appointment

When you come in for your appointment we will evaluate you to determine if there are any other therapies that may be right for you. We treat erectile dysfunction in a holistic manner. We look at all factors that effect erectile dysfunction including diet and exercise, medication side effects, hormone levels, general medical status, previous treatments tried and may suggest further testing. If we feel that Botox® on the penis isn't right for you, we will cheerfully refund your deposit. If you aren't happy with what we do for you, we will also cheerfully give you a full refund. We have tried to take as much of the risk out of our therapies as possible, both medical and financial.


-A.C. Bocox/P Shot Patient*
"The Bocox procedure combined with the P Shot® have literally saved my marriage! I would reccomend every man have this procedure done! The team at The Scarlett Phoenix treated me with such dignity and respect. I am forever grateful!"

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-Jon Doe, Bocox Patient*
"I cannot say enough about Dr. Runnels and The Scarlett Phoenix! The Bocox procedure was a game changer for me! Every man needs to know about this!"

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Literature References

Botox for Improvement of Penis Health and Male Sexual Function

Giuliano F, Joussain C, Denys P. Safety and Efficacy of Intracavernosal Injections of AbobotulinumtoxinA (Dysport®) as Add on Therapy to Phosphosdiesterase Type 5 Inhibitors or Prostaglandin E1 for Erectile Dysfunction—Case Studies. Toxins. 2019;11(5):283. doi:10.3390/toxins11050283
Abdelrahman IFS, Raheem AA, Elkhiat Y, Aburahma AA, Abdel-Raheem T, Ghanem H. Safety and efficacy of botulinum neurotoxin in the treatment of erectile dysfunction refractory to phosphodiesterase inhibitors: Results of a randomized controlled trial. Andrology. 2022;10(2):254-261. doi:10.1111/andr.13104
El-Shaer W, Ghanem H, Diab T, Abo-Taleb A, Kandeel W. Intra-cavernous injection of BOTOX® (50 and 100 Units) for treatment of vasculogenic erectile dysfunction: Randomized controlled trial. Andrology. 2021;9(4):1166-1175. doi:10.1111/andr.13010
Emura F, Peura D. Interview with Barry J. Marshall. Winner of the Nobel Prize in Medicine for the Discovery of Helicobacter pylori. :8.
Giuliano F, Denys P, Joussain C. Effectiveness and Safety of Intracavernosal IncobotulinumtoxinA (Xeomin®) 100 U as an Add-on Therapy to Standard Pharmacological Treatment for Difficult-to-Treat Erectile Dysfunction: A Case Series. Toxins. 2022;14(4):286. doi:10.3390/toxins14040286
Habashy E, Köhler TS. Botox for Erectile Dysfunction. The Journal of Sexual Medicine. 2022;19(7):1061-1063. doi:10.1016/j.jsxm.2022.03.216

Safety of Botox

Naumann M, Jankovic J. Safety of botulinum toxin type A: a systematic review and meta-analysis. Current Medical Research and Opinion. 2004;20(7):981-990. doi:10.1185/030079904125003962
Stephens ML, Balls M. LD50 Testing of Botulinum Toxin for Use as a Cosmetic. 2005;(2):5.
Bhatia KP, Munchau A, Thompson PD, et al. Generalised muscular weakness after botulinum toxin injections for dystonia: a report of three cases. Journal of Neurology, Neurosurgery & Psychiatry. 1999;67(1):90-93. doi:10.1136/jnnp.67.1.90
Frevert J. Content of Botulinum Neurotoxin in Botox®/Vistabel®, Dysport®/Azzalure®, and Xeomin®/Bocouture®. Drugs R D. 2010;10(2):67-73. doi:10.2165/11584780-000000000-00000
Dhaked RK, Singh MK, Singh P, Gupta P. Botulinum toxin: Bioweapon & magic drug. Indian J Med Res. 2010;132(5):489-503. Accessed September 1, 2022.
Omprakash HM, Rajendran SC. Botulinum Toxin Deaths: What is the Fact? J Cutan Aesthet Surg. 2008;1(2):95-97. doi:10.4103/0974-2077.44169
Arnon SS, Schechter R, Inglesby TV, et al. Botulinum Toxin as a Biological WeaponMedical and Public Health Management. JAMA. 2001;285(8):1059-1070. doi:10.1001/jama.285.8.1059
Nigam PK, Nigam A. BOTULINUM TOXIN. Indian J Dermatol. 2010;55(1):8-14. doi:10.4103/0019-5154.60343
BOTOX 100 Units – Summary of Product Characteristics (SmPC) – (emc). Accessed September 1, 2022.

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