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Penile Neuromodulator Treatment

Firm-X™ — Penile Botox for Erectile Dysfunction & Enhanced Rigidity

A targeted penile neuromodulator treatment that improves erectile quality, enhances firmness, and increases flaccid hang — without daily medication. One treatment, results lasting 6–9 months.

Medically reviewed by Dr. Joel Pash · Updated February 2026

About the Treatment

What Is Penile Botox? How Firm-X™ Treats Erectile Dysfunction

Firm-X™ is a penile neuromodulator treatment — commonly called "penile Botox" — that improves erectile quality without daily medication. By injecting botulinum toxin (Botox, Xeomin, or Dysport) directly into the corpus cavernosum — the erectile tissue of the penis — Firm-X relaxes smooth muscle at the tissue level, allowing greater blood flow during arousal for firmer, fuller erections.

Unlike oral ED medications such as Viagra or Cialis that must be taken before each sexual encounter, Firm-X is a single in-office injection that provides ongoing benefits for 6–9 months. The 15–20 minute treatment requires no general anesthesia, no downtime, and no daily pills. Appointments are available at all 21+ Upsize™ clinic locations, and Firm-X can be performed on the same day as the Upsize™ penis filler procedure for patients seeking comprehensive enhancement.

At a Glance

Firm-X™ Penile Botox Quick Facts

15–20Minute Procedure
6–9 moResults Duration
100 UTypical Dosing
$1,890Per Treatment

The Process

How Penile Botox Treatment Works

1

Consultation

A confidential evaluation with your Urosculpt™ certified physician. Discuss your goals, medical history, current medications, and whether Firm-X is appropriate for your anatomy.

2

Treatment Plan

Your physician determines optimal dosing — typically 100 units of botulinum toxin — and injection placement based on your anatomy and goals.

3

Penile Botox Injection

The neuromodulator is precisely administered via intracavernosal injection in a brief 15–20 minute in-office session. Topical numbing applied beforehand.

4

Enjoy Results

Effects develop over 1–2 weeks as the neuromodulator takes full effect. Improved erectile rigidity, enhanced firmness, and increased flaccid hang. No recovery period.

Why Firm-X?

Benefits of Penile Neuromodulator Treatment

Enhanced Erectile Rigidity

Botulinum toxin relaxes smooth muscle in the erectile tissue, allowing increased blood flow for firmer, harder erections — even in men who don't fully respond to oral ED medication.

Increased Flaccid Hang

By relaxing targeted smooth muscle, Firm-X reduces retraction and increases flaccid length — giving a more confident appearance even when not aroused.

No Daily Pills

One treatment provides 6–9 months of improved erectile function. No more timing pills before intimacy. Firm-X works around the clock — spontaneity restored.

Clinically Proven

Supported by peer-reviewed clinical trials showing significant improvement in erection hardness, penile blood flow, and sexual function — with minimal side effects.

Pairs with Upsize™

20–30% of patients combine Firm-X with the Upsize™ filler procedure for both increased girth and improved erectile performance in the same visit.

Physician-Performed

Every Firm-X treatment is performed by a Urosculpt™ certified physician — never delegated to non-medical staff. 25+ certified doctors at 21+ locations.

Compare Treatments

Firm-X™ vs. Viagra, Cialis & Other ED Treatments

Firm-X™Viagra / CialisTrimix InjectionsPenile Implant
How It WorksSmooth muscle relaxation via neurotoxinPDE5 enzyme inhibitionDirect vasodilationSurgical prosthesis
AdministrationSingle in-office injectionOral pill (each time)Self-injection (each time)Surgery
Duration of Effect6–9 months4–36 hours per dose1–3 hours per injectionPermanent
Daily MedicationNoYes (on-demand or daily)Per-useNo
Procedure Time15–20 minutesN/AN/A1–2 hour surgery
DowntimeNoneNoneNone4–6 weeks
Improves Flaccid Hang
Reversible✓ (wears off naturally)N/AN/A
Typical Cost$1,890 (one-time)$30–$70/mo$100–$300/mo$15,000–$25,000
Can Combine with Filler
Schedule a Firm-X™ Consultation

Clinical Evidence

Is Penile Botox Supported by Research?

Yes — penile botulinum toxin for erectile dysfunction is supported by peer-reviewed clinical research. While still considered an emerging treatment, multiple studies have demonstrated safety and efficacy:

El-Shaer et al. (2021) — Randomized Controlled Trial

176 patients with vasculogenic ED. Intracavernosal botulinum toxin (50U and 100U) significantly improved erection hardness scores, penile blood flow (peak systolic velocity), and sexual function at 6-month follow-up. 100U showed the most durable results.

View on PubMed →
Giuliano et al. (2022) — Long-Term Retrospective Study

123 consecutive patients with ED insufficiently responsive to PDE5 inhibitors or prostaglandin injections. Botulinum toxin improved erectile function for at least 6 months in 41% of patients, with only 2 minor adverse events reported (mild penile discomfort). No systemic side effects.

View on PubMed →
Ghanem et al. (2021) — Safety & Efficacy Trial

70 patients with ED refractory to oral PDE5 inhibitors. Single intracavernosal injection of 100U botulinum toxin was safe and effective, with significant improvement in SHIM scores and erection hardness. Concluded that BoNT-A has "considerable long duration of action."

View on PubMed →

Note: Penile botulinum toxin is not FDA-approved for erectile dysfunction and is used off-label. All Firm-X™ treatments are performed by licensed physicians with Urosculpt™ procedural training.

Is It Right for You?

Who Is a Good Candidate for Penile Botox?

✓ Good Candidates

Men experiencing mild to moderate erectile dysfunction

Men who want to reduce dependence on Viagra, Cialis, or other ED pills

Men experiencing decreased firmness or rigidity during arousal

Men bothered by penile retraction or "shrinkage" when flaccid

Men seeking to combine with the Upsize™ filler procedure

✗ May Not Be Candidates

Men with severe vascular erectile dysfunction

Men currently on blood thinners (anticoagulants)

Men with neuromuscular disorders (e.g., myasthenia gravis)

Men with active infection at the treatment site

Men with known allergy to botulinum toxin products

Not sure if you're a candidate? Schedule a free phone consultation — your physician will evaluate your specific situation.

Questions?

Penile Botox & Neuromodulator FAQ

Firm-X™ is a penile neuromodulator treatment using botulinum toxin (Botox, Xeomin, or Dysport) injected directly into the corpus cavernosum — the erectile tissue of the penis. It relaxes smooth muscle to allow greater blood flow, improving erectile rigidity, firmness, and potentially increasing flaccid length. It is sometimes referred to as "penile Botox" or "Botox for ED."
The penis is in a contracted state by default. During arousal, smooth muscle must relax to allow blood to fill the erectile chambers and produce an erection. Botulinum toxin relaxes this smooth muscle directly, making it easier for blood to flow in. This is the same mechanism that oral ED medications target, but Firm-X works at the tissue level rather than through systemic enzymes — and lasts months instead of hours.
Viagra and Cialis are oral PDE5 inhibitors taken 30–60 minutes before sexual activity. They work temporarily and must be taken each time. Firm-X is a single injection that provides ongoing improvement for 6–9 months without taking a pill before each encounter. It works through a different mechanism — directly relaxing smooth muscle tissue via the neuromuscular junction rather than inhibiting enzymes. Many patients use Firm-X to reduce or eliminate dependence on daily or on-demand ED medication.
Yes. A 2021 randomized controlled trial published in Andrology (El-Shaer et al.) demonstrated that intracavernosal botulinum toxin significantly improved erection hardness scores, penile blood flow, and sexual function in men with erectile dysfunction that did not respond to oral medications. A 2022 study in the Journal of Sexual Medicine (Giuliano et al.) confirmed effectiveness lasting at least 6 months with minimal side effects.
Most patients report minimal discomfort. A topical numbing cream is applied before the procedure, and the injection itself takes only a few minutes. In clinical studies, only 1 out of 123 patients reported pain, and 1 reported mild discomfort lasting 3 days.
Yes — and many patients do. About 20–30% of Upsize™ patients add Firm-X during the same visit. The combination provides both increased girth (from filler) and improved erectile quality (from neuromodulator). Your physician will advise on optimal dosing when combining treatments.
Firm-X may be appropriate for men experiencing mild to moderate erectile dysfunction, decreased firmness or rigidity, penile retraction (shrinkage) in the flaccid state, or those who want to reduce dependence on oral ED medications. Men with severe vascular ED, those on blood thinners, or those with certain neuromuscular conditions may not be candidates. Your physician will evaluate during consultation.
Effects typically develop over 1–2 weeks as the neuromodulator takes full effect. Some patients notice improvement within the first week. Full results — improved rigidity, enhanced firmness, increased flaccid hang — are generally apparent by week 2–3.
Results typically last 6–9 months. Some clinical data suggests effects lasting up to 11 months. Firm-X is a one-time injection — ongoing daily use is not required, though some patients choose to repeat treatment to maintain benefits.
Side effects are generally mild and temporary. In published clinical trials, the most common were minor bruising at the injection site and brief penile discomfort. No systemic adverse events were reported across studies involving over 300 patients. Your physician will discuss all potential risks during consultation.
Firm-X is priced at $1,890 per treatment. Financing is available through CareCredit, Cherry, and United Credit. Visit our pricing page or financing page for details.
Firm-X is available at all Upsize™ clinic locations nationwide. Visit our clinic finder to locate your nearest office, or call for a free phone consultation.

Pricing

How Much Does Penile Botox Cost?

$1,890
Per Firm-X™ treatment · Financing available
CareCredit Cherry United Credit
Combine with Upsize™ for comprehensive enhancement — ask about package pricing.
Explore Financing Options

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Speak confidentially with a Urosculpt™ certified physician about how penile Botox can help you achieve your goals. Free consultation, no obligation.

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