Potential side effects of the alprostadil suppository include mild dizziness, a burning sensation in the urethra, prolonged erection, and aching and pain in the penis and testicles. Minor urethral bleeding or spotting due to improper administration can occur. Sexual stimulation will enhance the effect of the drug.
Penile injections. Alprostadil can also be injected into the penis to treat erectile dysfunction. Penile injection therapy was introduced in 1995. Although it is a highly effective therapy, fear or reluctance to give an injection into the penis and the convenience of taking a pill have allowed the oral drugs to dominate the market. Men using penile injections have reported that this therapy gives good results and very natural looking erections (alprostadil, whether injected or used as a urethral suppository, often enables a man to achieve a firm head to his penis, while other therapies can result in a soft head). Unlike the other medicines listed before, penile injections require very little sexual stimulation to result in an erection.
The drug is injected with a syringe and needle (similar to insulin injections), causing blood vessels to dilate, which brings more blood into the penis. An erection occurs in about 5–20 minutes and can last up to an hour. This treatment requires practice to correctly administer the medicine. As with the alprostadil suppository, a man’s first dose is taken in the doctor’s office to ensure safety, learn proper technique, and find the proper dose. Penile injection therapy can be used three times per week, with at least 24 hours between each dose.
Potential side effects include pain, infection, and scarring. Too large of a dose can cause prolonged, painful erections, but education and careful dosing can prevent this problem.
Before there were drugs, mechanical devices were the main treatment for erectile dysfunction. Although drug companies have the financial muscle to advertise the latest medicines, these little-heralded devices are still useful and effective.
Constriction bands. Some men, especially men with diabetes, are able to get an erection but are unable to maintain it because of venous leakage. The blood flows out as fast as it comes in. With position changes or with penetration, men with leakage can lose their erections. This is where a constriction band can help. There are a number of bands on the market made in a variety of materials, sizes, and shapes. A man uses a band by placing it at the base of the penis after an erection is attained to prevent blood from leaving the penis. Some men use constriction bands in conjunction with alprostadil or the oral erectile dysfunction treatments.
To prevent tissues from becoming oxygen-starved, the constriction band should be left on for no more than 30 minutes, and there should be about an hour’s time between applications. In some cases, the band may also compress the urethra, blocking the emission of ejaculatory fluids (although a constriction band is not — and should not be used as — a contraceptive device). A man who has a reduced ability to sense pain in his penis should not use a constriction band because pain is a warning that the device needs to be removed.
Vacuum devices. An external vacuum device was once the only treatment available for men with erectile dysfunction. Today, it is a tried and true treatment used by many men. It is relatively inexpensive and does not require injections or medicines to be successful. These devices can be bought over the counter or with a prescription, and they are often covered by insurance plans, including Medicare.
The device consists of a plastic cylinder, a pump (either handheld or battery-operated), a set of constriction bands, and a water-soluble lubricant. The lubricant is applied to the base of the penis to help form an airtight seal. Then the cylinder is placed over the flaccid penis and held tight against the pelvis. The pump is activated to create a vacuum within the cylinder, drawing blood into the penis. Once the penis is engorged with blood, a constriction band is rolled off the cylinder to near the base of the penis. The cylinder is removed, and the penis is left erect. The constriction band must be removed within 30 minutes.