PIO Tips & Tricks

PIO can be a pain in the butt… literally. But it doesn’t have to be. At least not as bad! Wondering how that is possible? Try my PIO tips & tricks for a pain-free shot.

There are lots of rumored ways to make a progesterone in oil (PIO for short) shot more manageable. The #1 culprit I see regularly bandied about is icing. Which, really? You think applying ice to a muscle immediately before stabbing it is going to help with pain in the long term? Sorry girls, but all you’re setting yourself up for is more pain in the rear down the line.

I recently went over to a friends house with Bill to walk her and her husband through their first PIO injection and figured now would be a great time to cover my tried and true, pain-free, tips and tricks. Keep in mind, when I say pain-free I am talking about the injection itself, not the muscle soreness you end up with due to repeatedly stabbing yourself in the ass with a needle.

Here’s what you need:

  • progesterone in oil (PIO)
  • 22g 1 1/2 inch needle
  • 18g 1 1/2 inch needle
  • 5ml syringe
  • 2 alcohol wipes
  • 1 2×2 gauze sponge
  • heating pad
  • rice heating pad

The first step is to heat up the rice heating pad in the microwave and plug in your heating pad and turn it on. Once the rice heating pad is hot, wrap the PIO bottle with it. Lay down with the other heating pad across your back. After 2-3 minutes, remove the PIO bottle, swab the top with an alcohol pad, and using the 18g needle tip, draw up your dosage of PIO (most frequently, this will be 1ml. I typically draw up to the next small line past the 1 ml, as there can be some spillage between bubbles and withdrawing the needle post injection).

Once you have your dose, flick the syringe with your finger while holding the syringe up to push any bubbles to the top, once they’re at the top, push the plunger gently to push out the bubbles until a small bit of the PIO bubbles at the tip of the needle. Then switch the needle to the 22g, and wrap the syringe in the rice heating pad. Continue to lay with the other heating pad across your back. I typically lay on the heating pad on my back for 10 minutes at this point. Once you feel ready, remove the needle from the rice heating pad. Check the temperature of the needle by placing the barrel of the syringe against your lips. You’re basically looking for it to be warm, close to body temperature or just slightly over before injecting. If too warm, let cool 1-2 minutes and check again.

Now, this is the point where Bill takes over for me. I typically give my own injections, but PIO, given the nature of it being intramuscular, I employ his help. At this point, I strip down to nothing and lay flat on my belly. I typically use a pillow to hold/prop my front up on while he is giving the injection. Using his hand to measure, Bill draws a line out from the top of my butt crack, out across the top of the butt cheek. He always injects a minimum of two fingers width away from the crack and generally tries to stay towards the upper center.

Once he has a spot picked, he takes the other alcohol pad and wipes the area. I’m not one for a countdown, so he just tells me when he is ready. If you want a countdown, feel free to do so! He then takes his index and middle finger from the hand opposite the one he uses to hold the needle and pushes down on the skin and spreads it taught. From there he pushes the needle all the way in in one swift motion. You will feel a slight pinch, but it shouldn’t necessarily hurt. Once all the way in, pull back slightly on the syringe to check for blood. If there is blood, you will have to remove the syringe and start over in a new spot, preferably with a new 22g needle tip. If you don’t see blood, you can now push down slowly and steadily to inject the PIO. Keep in mind that this is an oil, so injecting slowly works best. Once done, remove the syringe and cover the spot with the 2×2 gauze sponge and apply pressure to stop the bleeding.

At this point, we also massage the area. Making a fist, Bill will put pressure on the injection site and slowly rock his fist over the area, helping the oil to disperse into the muscle for 1-2 minutes. After he massages the area, I then spend another 5 minutes or so laying back on the heating pad. I have found this step helps immensely in preventing lumps across the injection sites, and even helps with next day soreness.

If you are concerned about pain for the injection site itself, feel free to ice for 30 seconds to numb the top layer of skin, or ask your doctor for a lidocaine cream. DO NOT ICE for long. Icing the muscle for too long will cause it to contract and tighten when you want it loose and relaxed for the injection.

That’s it! The injection itself isn’t bad honestly, the anticipation of it is actually the worst part. Well, maybe the soreness after several days of it. Just remember, it will hopefully be all worth it. And if not? Still worth the chance!

If you’d like to see a video, this video from the Sher Fertility Institute about PIO Injections is my favorite.

If you’re having to give yourself an injection, Keiko Zoll made a great guide to giving yourself injections in the butt.

Do you have any tips and tricks to add? Let me know!

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