Erectile dysfunction (ED) is a common issue that affects many men, with an estimated 30 million men in the U.S. alone dealing with this condition. As men age, the likelihood of experiencing ED increases, but fortunately, it is a treatable condition. There are several treatment options available, ranging from oral medications like sildenafil (the active ingredient in Viagra®) to devices and injection therapies.

One treatment that has garnered attention is alprostadil, which is available in various forms, including an injectable solution, a urethral suppository, and a topical cream or gel. If you have ED and are looking for an alternative to oral medications, alprostadil cream may be a viable option.

In this article, we’ll explore what alprostadil cream is, how it functions as an ED treatment, potential side effects, and alternative treatments to consider if you’re one of the millions affected by ED.

What is Alprostadil?

Alprostadil is a medication used to manage and treat ED. It belongs to a class of drugs known as vasodilators, which work by relaxing blood vessels and enhancing blood flow throughout the body.

Alprostadil cream is not typically the first option a healthcare provider will prescribe for ED. Usually, ED is first treated with phosphodiesterase-5 inhibitors (PDE5 inhibitors), which are also taken before sexual activity. However, for men who have not had success with other ED treatments, alprostadil may serve as an alternative.

How Does Alprostadil Cream Work?

As a vasodilator, alprostadil cream relaxes the muscles around the blood vessels that supply the penis, allowing for improved blood flow and helping to maintain an erection long enough for sexual activity.

Healthy erections depend on consistent blood flow. During arousal, blood vessels dilate, enabling blood to flow into the corpora cavernosa—two cylindrical areas of erectile tissue within the penis. As blood pressure builds inside the penis, an erection forms that is firm enough for penetration.

Whether applied topically, injected, or inserted into the urethra, alprostadil’s effect is the same: it increases blood flow to the penis, aiding in the achievement of a better, longer-lasting erection.

Is Alprostadil Cream Effective?

Alprostadil cream is not a first-line treatment for ED, but how effective is it?

It’s important to note that alprostadil cream does not cure ED or enhance sexual desire. That said, there are benefits to this treatment.

According to multiple studies, including double-blind and placebo-controlled trials, alprostadil topical cream has been shown to be effective and well-tolerated by patients with varying degrees of ED severity.

One reason alprostadil creams and gels are not first-line treatments is that they lack approval from the Food and Drug Administration (FDA). However, other forms of alprostadil, such as injections (marketed as Caverject®) and suppositories (sold as MUSE®), are FDA-approved for ED treatment.

Some experts believe that, based on its effectiveness, topical alprostadil creams could become a preferred option for patients who do not respond well to or cannot tolerate PDE5 inhibitors. A 2016 review of Vitaros® topical cream for ED found it to be 83 percent effective at a 300-microgram dose in patients with severe ED, which was significantly better than the placebo group. Additionally, only three percent of the treated population reported systemic side effects.

Another 2016 review noted that clinical trials of alprostadil cream resulted in an increase in the erectile function score on the International Index of Erectile Function (IIEF) by 13 points from baseline.

What is Vitaros Cream?

Vitaros® is a popular brand of alprostadil cream. However, it is not available in the United States and is currently only sold in Europe. Vitaros cream is applied intraurethrally—into the opening at the tip of the penis—shortly before sexual activity. This application increases local blood flow, facilitating easier and longer-lasting erections.

In a survey of 152 ED patients, 53 percent who had tried at least two different ED treatments preferred topical cream over oral medications, injectables, or other intraurethral therapies.

Side Effects of Alprostadil Cream

As with all medications, there are potential side effects associated with alprostadil cream. These may include:

• A burning sensation at the application site
• Pain in the penis
• Prolonged erections (priapism)
• Painful erections (Peyronie’s disease)
• Vaginal burning or itching in female partners

A 2009 study involving 1,161 men with ED assessed the use of 200-mcg alprostadil cream up to two times per week for the first four weeks. Depending on their response, patients could adjust the dose for up to nine months. The findings included:

• 12 percent of patients stopped using the cream due to sensitivity issues.
• 16 percent withdrew from the study for various reasons.
• Fewer than 5 percent discontinued use due to adverse events.
• 73 percent used the 300-mcg dose.
• 74 percent saw an overall improvement in erectile function.

Regarding side effects:

• 12 percent experienced a burning sensation at the application site.
• 4 percent reported penis pain.
• About 1 percent experienced a prolonged or painful erection.
• Less than 1 percent had an erection lasting four or more hours.
• Approximately 2 percent of sexual partners reported vaginal burning or itching.

Alternatives to Alprostadil Cream

If alprostadil cream doesn’t seem like the right fit for you, there are several alternative treatments for ED. The most common first-line treatment involves oral medications, often combined with lifestyle changes and, if necessary, therapy.

Medication: PDE5 inhibitors are typically the go-to treatment for ED. Common options include:

• Sildenafil (generic for Viagra®)
• Tadalafil (generic for Cialis®)
• Avanafil (sold as Stendra®)
• Vardenafil (generic for Levitra®)

These medications work by relaxing arterial smooth muscles and increasing blood flow to the penis. Common side effects may include headaches, flushing, nasal congestion, indigestion, and, less commonly, visual disturbances.

If you’re not a fan of swallowing pills, chewable ED medications like hard mints are available. Additionally, certain foods and supplements might help increase penile blood flow.

Another alternative is injectable alprostadil, though some men may find this administration route less appealing.

Other Treatments

There are non-medication options as well, such as Eroxon, a non-prescription, non-medicated topical gel recently authorized by the FDA for ED. Vacuum erection devices and surgical implants are also viable options.

Counseling and Therapy

Mental health issues like anxiety and depression can contribute to ED. Psychological ED, where the cause is mental rather than physical, may be manageable with therapy or sexual counseling.

Lifestyle Changes

Addressing lifestyle factors can significantly impact sexual health. These include maintaining a healthy weight, exercising, eating a nutritious diet, avoiding smoking, limiting alcohol, and managing stress.

Should You Consider Alprostadil Cream?

If PDE5 inhibitors haven’t worked for you, or if you prefer not to take them, alprostadil cream may be a suitable alternative. Studies show that this topical ED treatment is effective in over 80 percent of patients.

Here are some key points to remember when exploring ED treatments:

• ED is common, affecting around 30 million men in the U.S.
• The first line of treatment typically involves PDE5 inhibitors like Viagra® and Cialis®.
• Alprostadil cream is a secondary option if you can’t or prefer not to use PDE5 inhibitors.
• Potential side effects of alprostadil cream include burning at the application site, penile pain, prolonged erections, and burning in your partner’s genital area.
• Lifestyle changes, such as maintaining a healthy weight, exercising, and reducing stress, can improve ED.

Always consult a healthcare provider before starting any new ED treatment. They can help you navigate side effects, potential drug interactions, and contraindications.

If you suspect that psychological factors might be contributing to your ED, consider speaking with a mental health professional.