Erectile dysfunction (ED) is a common condition where a man has difficulty achieving or maintaining an erection firm enough for sexual activity. This can stem from various physical or psychological factors, or a combination of both. While several treatment options exist, topical treatments offer a non-invasive approach that can be a suitable alternative for many individuals for ED.
Understanding Topical ED Treatments
Topical ED treatments are formulations like creams or gels applied directly to the penis. The primary active ingredient in many of these treatments is alprostadil, a synthetic version of prostaglandin E1 (PGE1), a naturally occurring substance in the body. Alprostadil cream, such as Vitaros or Virirec, combines this active drug with a skin enhancer like dodecyl-2-N,N-dimethylamino propionate (DDAIP) HCl, which helps alprostadil penetrate the skin more effectively.
While alprostadil is the most well-known topical agent, research continues into other potential compounds. Topical alprostadil cream is not currently approved by the United States Food and Drug Administration (FDA), although it is available in other countries. An over-the-counter topical gel, Eroxon, has recently been authorized for marketing in the United States and works by stimulating nerve endings to increase blood flow.
How Topical Treatments Work
Topical ED treatments containing alprostadil work by directly influencing the smooth muscle in the penile arteries. Alprostadil binds to specific PGE1 receptors located on the surface of these muscle cells, initiating a cascade of events within the cells. This binding activates an enzyme called adenylate cyclase, which in turn increases the levels of cyclic adenosine monophosphate (cAMP) inside the cells.
Elevated cAMP levels lead to the relaxation of the smooth muscle tissue within the penis and dilation of the blood vessels. This vasodilation allows for an increased inflow of blood into the corpora cavernosa, which facilitates an erection. Unlike oral medications that require sexual stimulation to activate the nitric oxide pathway, alprostadil acts independently as a direct agonist to induce penile vascular smooth muscle relaxation.
Application and Expected Results
Applying topical ED treatments typically involves washing and drying the hands before use. For alprostadil cream, the entire contents of the applicator are usually applied to the opening at the tip of the penis, known as the urethral meatus. It is important to hold the penis upright and gently widen the opening to ensure the cream goes into the urethra, rather than just on the glans or surrounding skin. Any excess cream on the surrounding skin should be gently massaged into the urethral opening.
The onset of effect for alprostadil topical cream is generally rapid, with an erection developing within 5 to 30 minutes after application, and full rigidity often achieved in 10-12 minutes. The effect typically lasts 1 to 2 hours, varying among individuals. Clinical trials show successful penetration attempts within 5-30 minutes for most patients using 300 µg, with overall efficacy rates up to 83% in severe ED, showing significant improvement over placebo.
Side Effects and Safety
Topical ED treatments, while generally well-tolerated, can cause some side effects, mostly localized to the application site. Common side effects reported with alprostadil cream include local irritation, redness, mild pain, or a burning sensation in the penis, including meatal, glans, or urethral pain.
Less common but more serious side effects include priapism, which is a prolonged erection lasting more than four hours. While rare with topical forms (occurring in about 0.06-0.4% of men in trials), it requires immediate medical attention to prevent potential damage. Dizziness or fainting can also occur in a small percentage of users. Partners of men using topical treatments may experience vaginal burning or itching, reported in about 2.1% of cases. It is important to consult a healthcare provider to discuss any pre-existing conditions or other medications being taken, especially given that some products are not compatible with certain types of condoms.
Considering Topical Treatments
Topical treatments for erectile dysfunction offer an alternative for certain individuals. These solutions may be particularly suitable for those who cannot take oral medications due to contraindications or systemic side effects, such as individuals with certain heart conditions or those taking nitrates. They also present a less invasive option compared to penile injections or urethral suppositories.
For men who prefer a non-systemic approach or who have not responded well to oral phosphodiesterase type 5 (PDE5) inhibitors, topical creams can be a viable consideration. The choice of treatment for ED should always be made in consultation with a healthcare professional, who can assess individual health needs and determine the most appropriate and safest option.