With about 30 million US men affected by
erectile dysfunction
(ED), Viagra became wildly popular after hitting the market in 1998. Cialis and Levitra, drugs in the same family, followed soon after. But, like all prescription medications, it can cause some undesirable side effects and isn't appropriate for everyone.
Fortunately, there are some other options for treating ED.
Viagra and its relatives, Cialis and Levitra, are not an option for everyone. Certain medications, including some
high blood pressure
medications, are thought to contribute to ED. When that is the case, a change in medication treatments (usually with drugs not known to have effects on sexual function) may offer a simple and effective alternative. When lifestyle change fails, prescribed medications are not the cause, and Viagra-like drugs are contraindicated or otherwise undesirable, then the treatments discussed below may become important.
Some medical treatments, like injection therapy, which existed when Viagra was released, are still being used.
"Once men get used to injections at the base of the penis, they love it," says Steven Lamm, MD, assistant professor of medicine at New York University and author of
The Virility Solution
. "It's felt as a tiny bee sting because the shot is put into a relatively insensitive part of the organ with a very fine needle."
The medication injected into the penis is alprostadil, which increases penile blood flow. It's known by the trade names Caverject and Edex. These injections can be used by most men who can't take Viagra-like drugs, but treatment cannot be used safely by men who use blood thinners.
On the medical horizon in the United States is Invicorp, another intracavernous injection that treats moderate to severe ED and has been approved for use in some European countries.
MUSE is a pre-filled, single-use, plastic applicator containing a suppository of the drug alprostadil, which is also given by direct injection into the penis. You insert the medication into the urethra opening at the end of the penis and let it dissolve. A topical cream containing the same medication is in development.
MUSE is effective in men with
diabetes
, but because it opens blood vessels, it does not work well in those with severely compromised circulation to the penis. Men with significant nerve damage also do not respond well to this medication.
There is also a vacuum pump that draws blood into the penis and engorges it. A band is placed at the base of the penis to prevent blood from flowing out again. These devices are cumbersome but can be effective. They are best tolerated by people with a moderate degree of ED, in comparison to mild or severe dysfunction. At least one study suggests that a sizeable proportion of men who get comparable benefit from vacuum devices and Viagra prefer to continue with the devices rather than the medication.
Many men over the age of 60 have relatively low testosterone levels. While hormone replacement therapy for such men remains controversial because the risk/benefit balance has not been adequately defined, testosterone might improve ED in some men. Testosterone is thought to be primarily effective in improving sexual desire or libido, but it may also have other beneficial effects on ED. The combination of testosterone and Viagra may be more effective than Viagra alone under some clinical circumstances. For now, men should probably receive testosterone replacement only under the care of an endocrinologist.
Other drugs may have some positive effect on ED as well. When giving smokers the drug bupropion hydrochloride (Wellbutrin) to help them quit, researchers found that the smokers experienced enhanced libido. So some men who have other reasons to take bupropion (ie, smoking cessation, depression) may choose to take that drug in the hopes of improving libido and possibly erectile dysfunction as well. There is as yet no solid medical evidence establishing the effectiveness of bupropion in treating ED.
For more serious cases of ED, surgical implants are available. Some of these devices add permanent stiffness to the penis, while others have an inflatable balloon, which allows men to produce an erection mechanically.
While the promotion of Viagra has perhaps led to decreased interest in surgical implant procedures, at least one study suggests that, in relatively long term follow-up, the results from surgery are better than those from drugs (including Viagra). These results should, however, be interpreted with caution because they have not been widely confirmed. Also, men should be warned that once they have the devices implanted, they might never again be able to independently have an erection because the implants can damage the erectile tissue.
For men with damaged blood vessels, surgery can be performed to bypass blocked arteries to the penis, or tie off leaky veins that allow blood to escape from the penis during an erection.
Another drug, apomorphine hydrochloride, currently in clinical trials, is squirted into the nose by an inhaler. It does not seem to be as effective as drugs in the Viagra family, but it works in a different way and may be useful when Viagra is contraindicated. However, it presents its own set of risks which may make it unsafe to use.
A topical form of alprostadil, called Topiglan, has performed well in clinical trials.
