Overview of local treatments for erectile dysfunction

This study reviewed evidence on local treatments for erectile dysfunction.

Researchers concluded that local treatment with alprostadil (Muse, Vitaros) is a safe and effective alternative treatment option for erectile dysfunction.

Drug therapy with phosphodiesterase-5 inhibitors (PDE5i), such as Viagra, is a well-recognized treatment for erectile dysfunction and believed to be very effective in achieving erection for sexual intercourse. However, some men do not tolerate, cannot use, or do not respond to PDE5 inhibitors.

Local treatments are believed to be a safe and suitable alternative. Alprostadil is a type of local treatment, which can be applied as an intraurethral suppository (small pellets inserted into the penile opening) or as a cream applied externally. Alprostadil assists in achieving erection by dilating local blood vessels. The aim of this review is to provide an overview of alprostadil as a treatment option for erectile dysfunction.

The intraurethral alprostadil suppository was demonstrated to increase penile blood flow and cause an erection within approximately 5 min (and typically lasting 30 to 60 min) from application. Overall, erectile function improvements were noted in 59 to 78% of men using this local treatment option, with 50 to 70% of men achieving an erection hard enough for vaginal penetration. Similar rates of treatment success have been noted among both users, and non-users, of PDE5 inhibitors.

Alprostadil cream was demonstrated to help achieve erection within 10 to 12 min of application (usually lasting just over 60 min). Results from high-quality studies indicate that 74 to 83% of men using alprostadil cream achieve an erection adequate for sexual intercourse. Studies included men with severe erectile dysfunction, as well as men with erectile dysfunction considered difficult to treat (such as after prostate surgery or due to other medical conditions).

Pain and a burning sensation were most commonly associated with alprostadil suppository (reported in 25 to 43% of patients). A burning sensation was also reported following application of alprostadil cream among 23% of patients. However, most reported side-effects were considered mild, usually resolved within 2 hours, and were limited to the site of application.

Researchers concluded that local treatment with alprostadil is a safe and effective treatment option for men with erectile dysfunction. Current local treatments are easy-to-use at home, therefore providing a suitable alternative for PDE5 inhibitors.