Viagra was the hottest thing to hit the prescription drug market in years. But it's not for everybody. Here are some other options for treating erectile dysfunction.

 

With about 30 million U.S. men affected by erectile dysfunction (ED), Viagra became wildly popular after hitting the market in 1998. 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.

Drug Substitutions

Viagra is not an option for everyone. Certain medications, including some high blood pressure medications, are thought to contribute to ED. When that is the case, alternative treatments (usually with drugs not known to have effects on sexual function) may offer a simple and effective alternative. But when lifestyle change fails, prescribed medications are not thought to be the cause, and Viagra is contraindicated or otherwise undesirable, then the treatments discussed below may become important.

Injection Therapy

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, but they 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.

Inserted Medication

MUSE is a pre-filled, single-use, plastic applicator containing a suppository of the drug alprostadil (also given by direct injection into the penis—see above). 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 MUSE.

Vacuum Devices

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.

Oral 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 can improve ED in carefully selected men. Testosterone is 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 (i.e., 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.

Penile Implants

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 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.

Surgery

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.

Drugs on the Horizon

Another drug, apomorphine hydrochloride, currently in clinical trials, is squirted into the nose by an inhaler. Since apomorphine works like Viagra, most people will probably not be able to use it safely as a substitute when Viagra is contraindicated.

A topical form of alprostadil, called Topiglan, has performed well in clinical trials. Another drug called vardenafil has been shown in clinical trials to help men with ED have erections. It is not yet available in the U.S.

Resources

Impotence.org
http://www.impotence.org

Sources:

Rajpurkar A, Dhabuwala CB. Comparison of satisfaction rates and erectile function in patients treated with sildenafil, intracavernous prostaglandin E1 and penile implant surgery for erectile dysfunction in urology practice. Journal of Urology. 2003;170:159-163.

Chen J, Mabjeesh NJ, Greenstein A. Sildenafil versus the vacuum erection device: patient preference. Journal of Urology. 2001;166:1779-1781.

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