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Impotence and erectile dysfunction affect men of all ages, but there are many available treatments to help you have a satisfying sex life—even if you can’t get or maintain a strong erection on your own.
One such treatment option, alprostadil cream, is a topical cream effective at treating erectile dysfunction with a low risk of side effects. The only catch? It’s approved in the UK and other countries but is not yet available in the US. Luckily, alprostadil is available in the US in other forms. Read on to learn more about this topical cream for erectile dysfunction.
What is alprostadil?
Alprostadil is the name of a medication that can be used for erectile dysfunction (ED) in three forms: as a cream, as an injection at the base of the penis, and as a small pellet inserted into the penile opening (the urethra). It’s currently FDA-approved in the US for use as an injection and pellet, but not yet as a cream.
Alprostadil cream is approved and sold in other countries for ED; for example, it’s sold in the UK under the brand name Vitaros. Vitaros cream is a topical product that helps your penis harden and remain erect for more than an hour. You apply it with a dropper into the opening of the penis around 10 minutes before sex (Anaissie, 2016).
In the US, where the cream isn’t an option, alprostadil injections and pellets are often used as second-line treatments for ED; this means that it’s often used as an alternative to oral ED medications, which are often the first choice (Jain, 2022).
Alprostadil works for ED by helping to widen the blood vessels to allow more blood flow. It’s made of prostaglandins (which help the penis muscle relax and fill with blood) combined with a skin treatment that allows the skin to absorb it effectively (Cuzin, 2016).
Does erectile dysfunction cream work?
The erection cream Vitaros works well to improve erections. The majority of patients who use it have a fast and reliable erection within 12 minutes of applying it; their erections can last over an hour and allow for penetrative sexual intercourse (Cuzin, 2016).
Vitaros cream has a lot of advantages over oral ED medications. Since it’s applied locally, it won’t affect other parts of the body like an oral medication can. That means that it can have fewer side effects and also doesn’t interact with as many medications, which may make it a good option for those who can’t take oral ED drugs (Cuzin, 2016).
It also can afford more spontaneity in your sex life; it starts working quickly and can be used shortly before you want to have sex (Cuzin, 2016). It’s also less invasive than the injected or pelleted forms of alprostadil, making it an option many may prefer.
Alprostadil injections and pellets
If you live in the US, you still have access to effective alprostadil treatments for ED, in the form of penile injections or intraurethral pellets.
Penile injections are usually done with alprostadil or sometimes in combination with other injected ED medications like papaverine and phentolamine. You can administer these injections yourself in your own home, using tiny insulin needles. Injections are a common second choice for ED therapy if oral ED medications aren’t right for you (Sooriyamoorthy, 2022).
An obvious downside is the discomfort of the injection itself, but it does work for nearly everybody as long as the penis and blood vessels are healthy—94% of patients successfully attain firm erections lasting from 45–90 minutes (Sooriyamoorthy, 2022).
Alprostadil is also used in the form of a tiny intraurethral pellet the size of a grain of rice. You can administer it yourself—after urinating, you insert the pellet into the urethra with a thin insertion device.
It’s effective about two thirds of the time, but this can vary even for the same person, which might be due to differences in how far you insert the pellet each time. It’s less commonly used than injections because it’s more expensive, effectiveness can vary, and it requires more trips to the pharmacy (the pellets tend to be sold in sets of six) (Sooriyamoorthy, 2022).
Alprostadil side effects
Alprostadil cream has a few possible side effects, but nearly all users describe them as mild, local skin problems where they placed the cream, and report that they go away within an hour. These include:
- Pain or tenderness
Female partners may experience discomfort such as a vaginal burning sensation (2% of female partners reported experiencing this). This could be prevented by using a condom (Anaissie, 2016).
Overall—and especially compared with other ED medications—alprostadil cream has an excellent safety profile and low incidence of systemic side effects (Anaissie, 2016).
Other ED treatments
It may be disappointing that such a promising ED treatment as alprostadil cream isn’t available yet in the US. The good news is there are several approved erectile dysfunction pills and medications, as well as non-medical treatments available:
Oral ED medications
Oral ED medications are phosphodiesterase-5 (PDE-5) inhibitors, which improve erections by enhancing blood flow to the penis. There are several available PDE-5 inhibitors with different brand names (Sooriyamoorthy, 2022):
- Avanafil (Stendra)
- Sildenafil (Viagra; see Important Safety Information)
- Tadalafil (Cialis; see Important Safety Information)
- Vardenafil (Levitra or Staxyn)
You may not be able to take ED drugs if you have certain medical conditions or take medications for high blood pressure or high cholesterol. Your health provider can help determine if they’re safe for you to take.
Medical devices to treat erectile dysfunction
An external vacuum device, also called a penis pump, can be a good non-pharmaceutical option to help treat ED. It draws blood into the penis with gentle vacuum pressure, creating an erection that can last 30 minutes. It’s one of the least expensive ED treatment options (Sooriyamoorthy, 2022).
Penis implants, also called penile implants, are a surgical option to treat ED that offers improved erections for patients with medical conditions like Peyronie’s Disease. If you can’t take ED tablets and prefer something longer-term than an injection method, a penile implant might be right for you.
Lifestyle improvements that increase blood flow
ED is often a sign of underlying health and cardiovascular issues that affect blood circulation. Some simple lifestyle adjustments can help keep the blood vessels healthy in your penis and throughout your body, which may improve your erections. These strategies include (Sooriyamoorthy, 2022):
- Exercising regularly
- Reducing excess body fat
- Limiting smoking and drinking
- Eating a heart-healthy diet like a Mediterranean diet
If you’re interested in learning more about what ED treatments could be right for you, talk to a healthcare professional about your symptoms, other medicines you take, and what your needs and preferences are for ED treatment.
- Anaissie, J. & Hellstrom, W. J. (2016). Clinical use of alprostadil topical cream in patients with erectile dysfunction: a review. Research and Reports in Urology, 8, 123–131. doi:10.2147/RRU.S68560. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977016/
- Cuzin, B. (2016). Alprostadil cream in the treatment of erectile dysfunction: Clinical evidence and experience. Therapeutic Advances in Urology, 8(4), 249–256. doi:10.1177/1756287216644116. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5131739/
- Jain, A. & Iqbal, O. A. (2022). Alprostadil. StatPearls. Retrieved on May 25, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK542217/
- Sooriyamoorthy, T. & Leslie, S. W. (2022). Erectile dysfunction. StatPearls. Retrieved on May 25, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK562253/
Dr. Steve Silvestro is a board-certified pediatrician and Manager, Medical Content & Education at Ro.