The standard first-line treatment recommended by doctors for erectile dysfunction is a PDE-5 inhibitor (Viagra, Cialis, Levitra, or their generic equivalents). This is a good choice for most men, because the drugs are generally safe and allow men to achieve an erection.
But for about 1/3 of men with ED, these drugs don’t work, or they are contraindicated due to other medical conditions. For these men, there are few options available in the United States:
- Intracavernous Penile Injections – Intracavernous injections (penile injections) can be an effective alternative for men who do not respond well to oral ED medications like Viagra and Cialis. Some studies show a success rate of 75-80%. In order to achieve an erection, the user injects a vasodilator into the corpora cavernosa on the side of the penis. With the proper dosage, the man should achieve an erection in 20-30 minutes, and it should last 1-2 hours.
- Penile Implants – Inflatable implants allow a man to achieve an erection at any time, but using a small pump implanted in the scrotum to inflate the chambers in the penis. Implants have the highest rate of patient satisfaction of any form of ED treatment. In a study of men who have had implant procedures, the patient and partner satisfaction rates were 97% and 91%, respectively.
In much of the world, there is another option: a cream or ointment containing alprostadil, the primary drug used for injections. The cream is rubbed on the head of the penis, allow most men to achieve an erection in 10-15 minutes1 2 3.
The cream is sold under several brand names, including Vitaros® and Virirec®. However, it has not been approved by the FDA for sale in the United States. The FDA has already approved alprostadil, but the cream contains an additional ingredient, DDAIP.HCl, which allows the drug to be absorbed through the skin. This ingredient has raised safety concerns at the FDA, which contends that it has been linked to cancer.
Like penile injections, alprostadil creams carry a risk of priapism. Men are advised to seek immediate medical help for an erection lasting more than four hours.
- Cuzin, Béatrice. “Alprostadil cream in the treatment of erectile dysfunction: clinical evidence and experience.” Therapeutic Advances in Urology. August 2016; 8(4): 249–256.
- Anaissie, James; Hellstrom, Wayne JG. “Clinical use of alprostadil topical cream in patients with erectile dysfunction: a review.” Research and Reports in Urology. August 2016; 8: 123–131.
- Moncada, Ignacio; Cuzin, Béatrice. “Clinical Efficacy and Safety of Vitaros©/Virirec© (Alprostadil Cream) for the Treatment of Erectile Dysfunction.” Urologia Journal. March 2015.