Injections or Topical Treatments
Penile injections have now largely been replaced by PDE5 inhibitors such as sildenafil. Nevertheless, injection therapies employ various drugs that have properties that help achieve erection, even in many men who do not succeed with PDE5 inhibitors. The standard drugs used in injections include:
- Alprostadil
- Phentolamine
- Papaverine
Although any or all of these drugs are very effective, injections or other invasive methods of administration are awkward and uncomfortable.
Treatments Using Alprostadil
Alprostadil is derived from a natural substance, prostaglandin E1, and acts by opening blood vessels. It is an effective treatment for some men. It can be administered by:
- Injection into the erectile tissue of the penis (Caverject, Edex)
- Device that administers the drug through the urethra (MUSE system)
Candidates. Regardless of how it is administered, alprostadil works in many men with a wide range of medical disorders related to erectile dysfunction, including the following:
- Diabetes
- Prostate cancer treatments (early use of alprostadil injections after prostate cancer treatment, particularly when followed by a PDE5 inhibitor, may be helpful)
- Men who take nitrates
- Injury
Alprostadil is not an appropriate choice for the following individuals:
- Men with severe circulatory or nerve damage
- Men with bleeding abnormalities or men who are taking medications that thin the blood, such as heparin or warfarin
- Men with penile implants
Injected Alprostadil. Injected alprostadil (Caverject, Edex) employs a very small needle that the man injects into the erectile tissue of his penis. About 80% of men describe the pain of administering the injection as being very mild. Edex is a newer and less expensive form of injected alprostadil. In one 12-month study of 894 patients, Edex injections achieved erections in 95% of attempts.
The drug should not be injected more than 3 times a week or more than once within a 24-hour period.
MUSE System. The MUSE system delivers alprostadil through the urethra. It works in the following way:
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