Table of Contents

Chapter 3: Maximizing Quality of Life After Initial Treatment

ii. Injections, Mechanical Devices and More

If the oral medications don’t work, or if you can’t take them because you have other health issues, there are a number of alternative treatments that might be helpful. Because they require a bit more work than taking an oral medication, they’re not typically seen as the first option. But if you do need to use one of these treatments, remember for all of the years before 1998, these were the only options available, so you’re not alone.

As we noted above, the basic concept behind the oral medications is to allow blood flow into the penis so it can become rigid. This same approach is used by two other treatments as well.

MUSE is a medicated pellet about half the size of a grain of rice that is inserted into the urethra through the opening at the tip of the penis using a disposable plastic applicator. Unlike the oral medications, there is no need for sexual stimulation in order for it to work, but some manual stimulation and massage is required to help achieve rigidity. An erection typically occurs within 10 minutes after insertion of the pellet, and can last for 30 to 60 minutes. About 40% of men have reported successfully achieving erections after using this drug, but the results are often inconsistent. Some local reactions, particularly a burning sensation, are frequently seen, and many men discontinue use after a short time.

Caverject uses the same drug that is in the MUSE pellets, but delivers it via an injection directly into the penis. It, too, takes about 10 minutes to work and lasts for about 30 minutes. Although nearly 90% of men using Caverject reported erections about six months after therapy, as you can imagine, most men are not willing to inject themselves regularly, so the treatment is not often used for long periods of time.

The drug in both of these systems works in a similar fashion to the one in the oral medications, but the short-lived action and the local insertion or injection of the drug make it far less likely to affect the action of other medications. Nevertheless, it’s always a good idea to make sure that each member of your care team has your complete medical history and a full listing of all medications that you might be taking.

For those unwilling or unable to use any form of medication to help improve erectile function, there are still a number of choices. The most commonly used option is the vacuum constriction device, or vacuum pump. Remember, in order to achieve erection, you must have a rush of blood into the penis and no flow back out. The vacuum device accomplishes the same thing, only in a mechanical fashion. The penis is inserted into a plastic tube that is sealed at one end. The air is pumped out of the tube, causing blood to flow in and for the penis to become erect. However, because this is a mechanically driven erection, the blood starts to flow back out once the vacuum seal is broken. Therefore, a rubber ring is rolled onto the base of the penis, constricting it sufficiently so that the blood does not escape.

About 80% of men find this device successful, but it, too, has a high drop-out rate—partly because it’s somewhat cumbersome to use, but mostly because the erections tend to feel somewhat unnatural. The constriction ring at the base of the penis is effectively cutting off fresh circulation. Because of this effect, it is crucial that the ring be removed immediately after intercourse, or the tissue can be damaged due to lack of flowing oxygen.

The final option for treating erectile dysfunction is the surgically inserted penile implant. There are a few different types of implants, but the one that provides the most natural feeling when erect and when non-erect is the three-piece prosthesis. A narrow flexible plastic tube is inserted along the length of the penis, a small balloon-like structure filled with fluid is attached to the abdominal wall, and a release button is inserted into the testicle. The penis remains flaccid until an erection is desired, at which point the release button is pressed and fluid from the balloon rushes into the plastic tube. As the tube straightens from being filled with the fluid, it pulls the penis up with it, creating an erection.

The surgical procedure is done under general anesthesia, so this option is not available to men who are not considered good candidates for surgery because of other health reasons. In addition, in a small percentage of cases, the device can malfunction, requiring a second surgery to repair it. Finally, because the penile tissue itself remains unchanged, the erection can seem somewhat unnatural. Nevertheless, assuming the mechanics are working correctly, it is, by definition, 100% effective, and about 70% of men remain satisfied with their implants even after 10 years.