This page describes each treatment in clinical terms: what it does, how it is done, and what to expect afterwards.
What it treats
Platelet-rich plasma for erectile function
Blood is drawn, spun to concentrate the platelets, and the concentrate is injected into the erectile tissue of the penis under topical anesthetic and a local block. The proposed mechanism is the same one behind PRP elsewhere: growth factors prompting repair of tissue and small vessels.
A 2024 meta-analysis pooling 12 controlled trials and 991 patients found greater improvement in erectile function scores with PRP than with placebo, a moderate effect. The same analysis flagged high variability between studies, short follow-up, and too few trials to say which types of erectile dysfunction respond best. A double-blind placebo-controlled trial published in the Journal of Urology reached a similar conclusion, with a meaningful proportion of men reaching a minimum clinically important difference at six months.
It is a reasonable option, and it is not a cure. Erectile dysfunction also has causes that need identifying before anything is injected, since it is frequently the first sign of vascular disease, and it can be driven by medication, hormones, sleep apnea or depression. That assessment comes first here.
Botulinum toxin for the scrotum
The dartos is a layer of smooth muscle in the scrotal wall that contracts with cold, exertion and anxiety, drawing the scrotum tight and up against the body. Botulinum toxin relaxes it. The scrotum hangs lower, sits looser, and appears fuller and larger.
That appearance is the most common reason people ask for it. The others are comfort, where constant tightness is uncomfortable or causes chafing against the thigh, and sweating, since botulinum toxin blocks the signal to sweat glands as well as to muscle.
Onset is gradual over two to four weeks and the effect lasts about three to four months, in line with botulinum toxin elsewhere. It is not permanent, and holding the result means repeating it.
Botulinum toxin for the anal sphincter
Injection into the internal anal sphincter reduces resting pressure. It is an established treatment for chronic anal fissure, where the spasm keeps the fissure from healing. It is used as an alternative to surgical sphincterotomy, which carries a risk of permanent incontinence that this does not.
The same effect is what makes it useful for sphincter hypertonicity causing pain with receptive anal sex. The muscle relaxes, resting tone falls, and penetration is less painful. That indication has its own page, covering the causes worth excluding first and the continence question that comes before any injection: pain with receptive anal sex.
Pain in this area has several possible causes, including fissure, hemorrhoids, infection and inflammatory bowel disease, and some of them are not treated with botulinum toxin at all. Examination comes before treatment.
What a session is like
- Consultation first
- Always. Nothing is injected at a first visit without assessment.
- Numbing
- Topical anesthetic, and a local block for PRP.
- Session length
- 30 minutes for botulinum toxin. 60 for PRP, including the blood draw.
- PRP onset
- Change reported over 6 to 12 weeks, usually as a series of 3.
- Botulinum toxin onset
- 2 to 4 weeks, lasting 3 to 4 months.
- Downtime
- Swelling and bruising for a few days. No sex for a week after PRP.
- Performed by
- Dr. Mundluru.
- Privacy
- Scheduled so you are not waiting in a shared area.
You will be asked direct questions about erections, bowel habits, pain and sexual activity, because the answers change what is appropriate. There is no version of this consultation that works if you are guessing at what we want to hear.
Before, during and after
Open any of these to read it before booking, or again the week of your appointment.
Common questions
Does PRP for erectile function actually work?
The evidence supports a moderate improvement in erectile function scores compared with placebo. A 2024 meta-analysis of 12 controlled trials and 991 patients found that effect, while noting high variability between studies and short follow-up. It is a reasonable option, particularly for mild to moderate erectile dysfunction, and it is not a cure. What it will do for you specifically cannot be known in advance, which is why the assessment comes first.
Why do I need a workup before an injection?
Because erectile dysfunction is often the first sign of something else. It precedes cardiovascular disease by several years in many men, and it can be driven by medication, low testosterone, diabetes, sleep apnea, thyroid disease or depression. Injecting the penis without knowing which of those is in play means treating a symptom and missing the cause. The assessment includes history, examination and blood work.
How painful is it?
Less than people expect, and the anesthesia is not an afterthought. Topical numbing is used for all three, and a local block for PRP, which is the most involved of them. Most patients describe pressure rather than sharp pain during the injections. Soreness afterwards is usually mild and settles within a few days.
Will anal sphincter treatment affect my continence?
Temporary difficulty controlling gas is the most commonly reported effect, and it resolves as the botulinum toxin wears off. Temporary leakage of stool is less common. Both are described in the literature on fissure treatment, and the reason botulinum toxin is often preferred over surgical sphincterotomy is that surgery carries a risk of permanent incontinence while this does not. Dosing here is conservative for that reason.
Does it make the scrotum look bigger?
It looks fuller and hangs lower, which most people read as larger. Nothing is added and nothing grows. The dartos muscle that normally holds the scrotum tight and drawn up relaxes, so it sits at a lower, looser resting position rather than a contracted one. That is the appearance most people are asking for when they come in for this.
How long does scrotal treatment last?
Effects appear over two to four weeks and last about three to four months, which is the same profile as botulinum toxin anywhere else. It is not permanent, and holding the result means repeating it. Repeat treatment is scheduled once the effect has clearly worn off rather than on a fixed calendar.
How much evidence is behind each of these?
It differs a great deal between them, which is why they are set out separately on this page rather than presented as one offering. Platelet-rich plasma for erectile function has pooled controlled-trial data behind it. Botulinum toxin in the anal sphincter is an established treatment for chronic anal fissure and has been used and studied there for years. The scrotal and sexual-pain uses rest on smaller series and on clinical experience. Each one is discussed at consultation with the evidence it actually has rather than described as though they were all equally proven.
Do I have to explain why I want it?
You will be asked what you are hoping for, because it changes what is appropriate and it changes dosing. Wanting a treatment for appearance is a legitimate reason and gets the same straightforward answer as a medical one. Nothing you say here is a problem, and giving an incomplete history is the only thing that makes this harder to do well.
Can I have more than one of these in the same visit?
Sometimes. It depends on what is being done, what anesthesia is needed and how much recovery each involves. Combining is decided at consultation rather than requested in advance, and it is not always to your advantage.
This page is for general education and is not medical advice. It does not establish a physician-patient relationship, and it cannot account for your individual history, medications or skin. Suitability for treatment is decided at consultation following examination.